Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines

Abstract

Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. Aim To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. Methods We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/

What Fuels Suboptimal Care of Peripheral Intravenous Catheter-related Infections in Hospitals? – a Qualitative Study of Decision-making Among Spanish Nurses

“…However, participants acknowledged that they did not engage in patient education, arguably the initial requirement for patient implication in care. The consequences of such lack of engagement are not surprising, as seen in other studies reported by our group where we identi ed that 50% of patients did not know anything about the catheter they carried [19]. These ndings are concerning in themselves, but also highlight the missed opportunities to embed patient education about multiple related safety areas such as infection prevention and control, hand hygiene, and vascular catheter care, where patients could have a crucial role [34].…”

“…However, implementing and adopting recommendations within CPGs can be protracted [21] due to clinician perceptions [22], the volume and quality of the evidence [23], and even di culties to integrate the mandates of different CPGs [17]. Speci cally, previous ndings from our group suggest that the decisionmaking of nurses was suboptimal regarding the adoption of CPG recommendations for preventing infectious complications and failure related to PIVC, highlighting behavioural and organisational differences between hospital environments and services [19]. Further exploring individual motivations, barriers and facilitators within organisations would contribute towards understanding the contextual elements that underpin decision-making around PIVC care [24,25].…”

“…However, these studies did not provide insights into any institutional mechanisms likely in place to assure patient safety and quality in PIVC care [14]. The determinants of optimal catheter use can exert an in uence at different levels: individual (i.e., often reported gaps in knowledge and skills among nurses [15]), social (i.e., collective perceptions shaping the relative importance apportioned to PIVCs and, by extension, their adverse events [16]) and, nally, organisational (i.e., unclear guidelines [17] or as our group has reported, lack of patient involvement in their self-care [18,19]).…”

Occupational Safety and Health Training for Undergraduates Nursing Students: A Spanish Pilot

“…), and airborne pathogens, such as tuberculosis, being highly presented in the daily day of healthcare workers [3,4]. These workers are at risk of being exposed to diverse pathogens, from mortal (i.e., Ebola) to highly contagious viruses (i.e., Sars-covid-19) via material or surfaces and corporal fluids [5,6]. This threat among healthcare workers continues to be presented and has economical and health repercussions in the healthcare systems and the workers' physical and mental health [5,6].…”

“…These workers are at risk of being exposed to diverse pathogens, from mortal (i.e., Ebola) to highly contagious viruses (i.e., Sars-covid-19) via material or surfaces and corporal fluids [5,6]. This threat among healthcare workers continues to be presented and has economical and health repercussions in the healthcare systems and the workers' physical and mental health [5,6]. In order to decrease this hazard, serval educational programs have been created and implemented to raise awareness among healthcare workers regarding risk and prevention, including hand washing or disposal in specific resistant containers [7].…”