Implementing Best Practices to Reduce Pediatric IV Infiltrations

Over 90% of hospitalized patients require peripheral intravenous (PIV) catheters for the delivery of fluids, nutrition, or medication.  PIV catheter site complications such as infiltration account for the greatest risk to most patients receiving IV therapy.  Infiltration, the unintentional infusion of non-vesicant fluid or medication in the extravascular space, can lead to range of symptoms from minor discomfort to necrosis and amputation.  These complications may result in substantial acute or chronic injury, which may be further exacerbated if the affected individual is a child.  Nursing leaders face an increasing concern for healthcare-acquired conditions, including IV infiltration. These complications have been noted to increase hospital length of stay and result in monies lost to litigation settlements. The Iowa Model of Evidence-Based Practice to Promote Quality Care is utilized to guide inquiry into this problem and implement a practice change.  Evidence suggests the implementation of a care bundle comprised of staff nurse training and more frequent assessment will reduce the risk for IV site complications.  An evidence-based practice change project was implemented on a pediatric, medical-surgical unit in a free-standing children’s hospital.  Pre-test/post-test measures revealed an statistically significant increase in participant knowledge following an education sessions on the best practice guidelines in preventing PIV infiltrations.  An increase in the frequency of assessment resulted in downward trending in reported PIV infiltration events. Implications for nursing practice include an expanded implementation of policy change throughout the organization with monitoring to evaluate outcomes.