Addressing the Silence: a Need for Peripheral Intravenous Education in North America

Abstract

Background: Greater than 90% of hospitalized patients receive some form of peripheral intravenous therapy for the delivery of fluids, medication, or parenteral nutrition. Nurses are the largest group of clinicians responsible for the placement and management of peripheral intravenous therapies. The literature suggests that many graduate nurses lack the confidence, knowledge, and ability to not only place peripheral intravenous catheters, but also adequately maintain peripheral intravenous sites. This fact, combined with the increasing acuity of hospitalized patients with multiple comorbidities, makes peripheral intravenous placement and management even more challenging. This drove a team of researchers to explore the current state of peripheral intravenous education in health care institutions and examine potential gaps in ongoing professional development and competency assessment. Methods: A convenience sample of United States and Canadian health care institution representatives were recruited to participate in a 12-item web-based questionnaire regarding peripheral intravenous education and staff competency. Participants were recruited via the Association for Vascular Access listserv, newsletter, and annual meeting. Members were also asked to forward the recruitment e-mail to other health care institutions to ensure a representative sample. Results: A total of 611 health care institution representatives participated in the study. The large majority (80%) worked in a health care institution with more than 150 beds. Over half (67%) indicated that they provide peripheral intravenous education to their staff using varying modalities to deliver the education. The majority (54%) of health care institutions reported spending between 1 and 5 hours on peripheral intravenous education while, alarmingly, 38% reported spending less than 1 hour on peripheral intravenous education for their staff. Despite these numbers, over half of the participants (58%) believe peripheral intravenous education is a shared responsibility between pre-licensure nursing schools and health care institutions. Discussion: The study highlights the varying level of peripheral intravenous education and competency evaluation of staff working in health care institutions. The results suggest the need for an evidence-based, standardized peripheral intravenous curriculum that could be used in both health care institutions and nursing education programs. Conclusion: Currently, there are inconsistencies in the peripheral intravenous education and competency programs used in health care institutions. The authors will use the results of this study to design and examine the effects of a standardized, evidence-based peripheral intravenous curriculum to assist health care professionals responsible for peripheral intravenous education and competency assessment. Given the risk for complications from peripheral intravenous therapy, it is hoped that improved peripheral intravenous education will reduce potential complications and improve patient outcomes.

Nurses' knowledge on routine care and maintenance of adult vascular access devices: A scoping review

“…Moreover, our review underscores that there is room for improvement in the educational preparation of nurses with respect to VAD care. While the education of nurses regarding the care and maintenance of VADs should be a responsibility shared by the educational institutions and the healthcare employers (Hunter et al., 2018; Marchionni, Gauthier, Aube, & Lavoie‐Tremblay, 2018; Vizcarra et al., 2014), there are several mechanisms by which this can be accomplished. For example, journal clubs have been shown to improve evidence‐based practice skills of allied health professionals and this is one method to disseminate research findings (Lizarondo, Grimmer‐Somers, Kumar, & Crockett, 2012).…”

“…Both PIVs and CVADs require significant nursing knowledge, skill and clinical judgement to ensure positive patient outcomes (Hunter, Vandenhouten, Raynak, Owens, & Thompson, 2018; Raynak, Paquet, Ruck, & Wood, 2018). Literature published globally, in addition to anecdotal evidence, has identified gaps in nurses’ knowledge regarding the care and maintenance of VADs.…”

Using “Knowing That” and “Knowing How” to Inform Learning of Peripheral Vein Cannulation in Nursing Education

“…Competence in peripheral vein cannulation (PVC) in nursing is emphasized as important to ensure effective treatment and patient safety (Hunter, Vandenhouten, Raynak, Owens, & Thompson, 2018;Marshburn, Engelke, & Swanson, 2009). Learning PVC is a key component in nursing education, in both academic and clinical settings (Alexandrou et al, 2012;Ewertsson, Bagga-Gupta, Allvin, & Blomberg, 2017;McWilliams & Malecha, 2017;National Curriculum Regulations for Nursing Programs, 2008).…”

“…Learning PVC is a key component in nursing education, in both academic and clinical settings (Alexandrou et al, 2012;Ewertsson, Bagga-Gupta, Allvin, & Blomberg, 2017;McWilliams & Malecha, 2017;National Curriculum Regulations for Nursing Programs, 2008). However, many newly qualified nurses lack competence in PVC (Hunter et al, 2018;Marshburn et al, 2009), and consequently fail and make mistakes in many of their attempts at PVC. In the nursing literature, the practical skill of PVC is identified as one of the most difficult invasive skills to learn and perform (Ewertsson et al, 2017;Hunter et al, 2018;Marshburn et al, 2009;McWilliams & Malecha, 2017).…”

“…However, many newly qualified nurses lack competence in PVC (Hunter et al, 2018;Marshburn et al, 2009), and consequently fail and make mistakes in many of their attempts at PVC. In the nursing literature, the practical skill of PVC is identified as one of the most difficult invasive skills to learn and perform (Ewertsson et al, 2017;Hunter et al, 2018;Marshburn et al, 2009;McWilliams & Malecha, 2017). Given the risk of patient harm associated with a lack of competence in PVC, e. g. phlebitis and bloodstream infection (Carr et al, 2016;Hadaway, 2012), the effectiveness of much PVC teaching has to be questioned.…”