The Appropriate Use and Care of Peripheral Intravenous Cannulas: A Quality Improvement Project.

Abstract

Background Peripheral intravenous cannula (PIVC) insertion is a universal intervention for hospital inpatients. Previous studies have demonstrated that more than a third of inserted PIVCs remain unused in the emergency department and that there is inadequate documentation regarding the insertion and use of PIVCs. Additionally, the use of PIVC is associated with cannula-related complications. Using the PIVC care bundle attached to the guideline should help prevent cannula-related complications. As part of a quality improvement project, we aimed to perform an initial audit (1^st cycle), implement interventions for improvements, and then perform a re-audit (2^nd cycle) of our adherence with the use and completion of the care bundle for PIVC. Methodology An initial audit (1^st cycle), followed by implementation of interventions, and then a re-audit (2^nd cycle) of our adherence with the use and completion of the PIVC care bundle was performed. The standards/criteria used for both the 1^st cycle and 2^nd cycle of the project were obtained from our PIVC care bundle and comprised of documented evidence of the date of cannula insertion, site of cannula insertion, indication for cannula insertion, whether the cannula was inserted in a non-common site (e.g., lower limbs), cannula assessment at least every 24 hours, cannula-related complications, and whether the cannula care bundle was completed for the patient. A score of less than 75% was considered not adherent, 75-90% was partially adherent, 90-100% was adherent, and a score of 100% was considered fully adherent. The target adherence score for each standard/criterion was set a priori to 90-100%, and the results were compared between both cycles. An increase in the adherence score in the 2^nd cycle over the 1^st cycle was taken to indicate improvement, while a negative difference indicated challenges. Results There were 28 patients in the 1^st cycle and 40 patients in the 2^nd cycle of this project. The commonest initial indications for PIVC insertion were intravenous fluids and intravenous antibiotic administration. The hand and forearm were the commonly used sites of insertion, and none of the patients had a cannula-related complication. Compared to the 1^st cycle, the results of the 2^nd cycle demonstrated improvements in the adherence scores for all the standards/criteria, with the scores for documenting the site of insertion and using a commonly used/acceptable site indicating full adherence (100%). The score for documenting the indication for insertion indicated adherence (90-100%). The score for ensuring that the cannula was being assessed at least every 24 hours and the score for completing the care bundle both indicated partial adherence (75-90%). The score for documenting the date of cannula insertion indicated non-adherence (<75%). Conclusions This project has demonstrated improvement in adherence with the use and completion of the care bundle for PIVC insertion after implementing interventions for improvement. National guidance is required to produce a standard audit tool for general use. The importance of continued education, complete cannula care, and accurate documentation in enhancing adherence to consensus guidelines cannot be overemphasized.