Impact of an Innovative Securement Dressing and Tourniquet in Peripheral Intravenous Catheter-Related Complications and Contamination: An Interventional Study

Abstract

Reusable tourniquets and conventional securement dressings are considered risk factors for the occurrence of reported complications and catheter-related bloodstream infections. This study’s purpose is to assess the impact of single-use disposable tourniquets and advanced occlusive polyurethane dressings with reinforced cloth borders on peripheral intravenous catheter (PIVC)-related complications and contamination. A pre- and post-interventional prospective observational study was conducted in a cardiology ward of a tertiary hospital between April 2018 and February 2019. Overall, demographic and clinical data from 156 patients and PIVC-related outcomes were collected (n = 296) as well as PIVC tips for microbiological analysis (n = 90). In the pre-intervention phase (n = 118), complication rates of 62.1% were reported, while 44.1% of the PIVCs were contaminated (n = 34). In the post-intervention phase (n = 178), complication rates decreased to 57.3%, while contamination rates significantly decreased to 17.9% (p = 0.014; n = 56). Through a logistic regression, it was found that the use of innovative technologies reduces the chance of PIVC contamination by 79% (odds ratio (OR): 0.21; 95% confidence interval (CI): 0.05–0.98; p = 0.046). Meanwhile, PIVC-related complications and fluid therapy emerged as predictors for PIVC contamination. Findings suggest that the adoption of these innovative devices in nurses’ practice contributes to the significant reduction of PIVC contamination.

Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective

“…It is not necessary to wear sterile gloves if the previously disinfected area is not touched again during the technique [4]. Using disposable tourniquets can help reduce PVC contamination rates [49].…”

“…Changing dressings at least every 7 days, except in pediatric patients, where the risk of moving the catheter is greater than the advantages derived from changing the dressing [7]. Routine dressing change is not recommended, as it increases the risk of colonization at the puncture site [49].…”

Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients

“…Nevertheless, the A-DM can be considered a reliable and valid contribution to clinical practice in Portugal by standardizing the initial assessment of the patient’s peripheral venous network and reporting it with a common method [ 10 ]. Early assessment of difficult peripheral intravenous access can likely decrease known high rates of the first-attempt failure and need for consequent attempts [ 17 , 18 ], reducing the incidence of PIVC-related complications and premature removal [ 30 ]. Although nurses are the health professionals primarily responsible for PIVC insertion and management in Portugal [ 31 ], we believe that the A-DM scale can assist any health professional with competences in vascular access by improving early assessment of the patient’s peripheral venous network and identification of difficult peripheral intravenous access, enhancing PIVC-related care quality, continuity, and record keeping [ 12 , 14 ].…”

“…To the best of the authors’ knowledge, there are no known validated tools used in the early assessment of patients’ peripheral intravenous access in Portugal. This may potentially explain why current studies conducted in Portugal report between two to eight puncture attempts before a successful PIVC insertion in almost a quarter of the study population [ 16 , 17 , 18 ]. In fact, if considering the entire period of hospital admission, one study highlighted that an average of five puncture attempts are performed before a successful PIVC insertion, ranging between 1 and 20 puncture attempts [ 16 ].…”

Reduced bacterial contamination rates detected on silicone tourniquets compared to conventional tourniquets in clinical routine

“…Improved infection control measures of tourniquets should not only improve infection control of blood sampling but moreover any peripheral venous access especially the process of placing peripheral intravenous catheters where the catheter is left in place for several days. One recent study described indeed a correlation between disposable tourniquets combined with other dressings and peripheral intravenous catheter-related contaminations [20], but further studies are needed to define the specific impact of tourniquet contamination in this context. While our study does not investigate this effect, it clearly provides information regarding contamination level and processing of different types of tourniquets.…”