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Implementation of a paediatric peripheral intravenous catheter care bundle: A quality improvement initiative
Tricia M Kleidon1,2, Paula Cattanach1, Gabor Mihala3,4
1Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
Insights
Implementing a care bundle improved paediatric peripheral intravenous catheter (PIVC) insertion success and dwell time. However, PIVC failure rates remained a significant concern despite interventions.
Area of Science:
- Pediatric critical care
- Vascular access devices
- Patient safety and quality improvement
Background:
- Peripheral intravenous catheters (PIVCs) are crucial for pediatric patient care.
- Suboptimal PIVC insertion and maintenance can lead to complications and increased healthcare costs.
- Existing practices for PIVC care require enhancement to improve patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive care bundle for improving pediatric PIVC insertion and maintenance.
- To enhance PIVC insertion success rates and promote optimal catheter function.
- To support best practices in PIVC management within a tertiary pediatric hospital setting.
Main Methods:
- A pre-post study design utilizing mixed methods, including clinical audits, staff surveys, and parent interviews.
- Development and implementation of the SUCCESS PIVCS mnemonic care bundle.
- Data collection on PIVC first-attempt insertion success, failure rates, dwell time, and escalation procedures.
Main Results:
- Pre-implementation data revealed high PIVC failure rates (49%) and challenges with equipment and insertion pressure.
- Post-implementation, first-attempt PIVC insertion success significantly improved (45% vs. 62%).
- Escalation to senior clinicians decreased (junior doctor 72% vs. 41%), and median PIVC dwell time increased (40 vs. 52 hours).
Conclusions:
- The multi-level care bundle intervention demonstrated significant improvements in pediatric PIVC insertion and management.
- Despite improvements, high rates of PIVC failure persist, indicating a need for further targeted interventions.
- The study highlights the importance of structured care bundles in optimizing vascular access device care for children.
Aim:
To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles.
Methods:
A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured.
Results:
Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved.
Conclusion:
This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high.
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