It Depends

Abstract

Short peripheral catheters (SPCs) are frequently idle when they are not being used for clinical indications. Focus group interviews were performed with multidisciplinary clinicians at a large tertiary hospital to explore SPC practice related to inserting or maintaining idle SPCs. Findings indicated that decision-making regarding insertion and removal of peripheral intravenous catheters depends on internal and external influences, such as the clinicians' knowledge and skills, emotional responses, expectations of others, organizational policies and practices, and the patient. In today's complex health care environment, the need for an SPC may constantly change, yet decision-making about SPC insertion and removal must remain patient-centered and evidence-based.

CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management

“…For many years, every patient admitted to the hospital automatically had a short PIVC inserted “just in case” they might need it. It was believed that having a PIVC in situ was best for the patient, in preparation for any event, any scenario, any crisis 1. Furthermore, when inserting a PIVC, a blood sample could be obtained at the same time as cannulation was performed.…”

“…Health care professionals have given many reasons for not removing idle catheters. “Just in case” they might be needed is often top of the list,1, 14 but other reasons include concerns over inadequate staff skills if a patient requires urgent cannulation1; the expectations of others and fear of criticism from coworkers1; staff convenience and workload efficiency1, 14-16; avoiding patient discomfort with potential future recannulation1; organizational policies or practices1; and fear of legal repercussions in the case of delays in laboratory testing or PIVC insertion 1…”

“…By Gillian Ray-Barruel, PhD, RN, MACN, and Mary Alexander, MA, RN staff skills if a patient requires urgent cannulation 1 ; the expectations of others and fear of criticism from coworkers 1 ; staff convenience and workload efficiency 1,[14][15][16] ; avoiding patient discomfort with potential future recannulation 1 ; organizational policies or practices 1 ; and fear of legal repercussions in the case of delays in laboratory testing or PIVC insertion. 1 Sometimes PIVCs remain idle because of "fragmentation of responsibility"-that is, there is confusion or uncertainty about who's responsible for in case" they might need it. It was believed that having a PIVC in situ was best for the patient, in preparation for any event, any scenario, any crisis.…”

“…It was believed that having a PIVC in situ was best for the patient, in preparation for any event, any scenario, any crisis. 1 Furthermore, when inserting a PIVC, a blood sample could be obtained at the same time as cannulation was performed. No need for two needlesticks!…”

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

“…Many devices are not promptly removed when no longer needed, with reports that up to 50% of PIVCs (Becerra et al, 2016), 32% of CVADs (Kara et al, 2016), and between 31%-45% of IUCs (Corral-Gudino et al, 2019;Kuriyama et al, 2019;Laan et al, 2020) are left in place without medical indication, increasing risk of infection. Reasons for leaving devices in situ unnecessarily include inaccurate documentation; perceptions of patient comfort; lack of priority for device removal; lack of agreement on indications for removal; and confusion regarding staff authority to remove unneeded devices (Bourgault et al, 2021;Castro-Sanchez et al, 2014;Quinn et al, 2020). The clinical need for a device should be reassessed daily, and it should be removed when no longer required (Canadian Vascular Access Association, 2019; Gorski et al, 2021;Gould et al, 2010;O'Grady et al, 2011).…”