Optimal timing for intravascular administration set replacement

Ullman, Amanda; Cooke, Marie; Gillies, Donna; Marsh, Nicole; Daud, Azlina; McGrail, Matthew Richard; O'Riordan, Elizabeth; Rickard, Claire M

doi:10.1002/14651858.cd003588.pub3

Cited by 28 publications

(33 citation statements)

References 42 publications

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“…The variability in recommendations has implications for hospital policy developers and may create confusion and uncertainty for nurses. The most recent Cochrane review (Ullman et al, ) found no evidence of a difference in catheter‐related or infusate‐related bacteraemia or fungaemia between different frequencies of administration set replacement (24, 48, 72 or >96 hr).…”

Section: Introductionmentioning

confidence: 99%

Nurses' decision‐making about intravenous administration set replacement: A qualitative study

Ray‐Barruel

Woods

Larsen

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To explore nurses' decision‐making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. Background Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter‐related bloodstream infection; however, emerging evidence is challenging traditional hang‐time durations. Nurses' perceptions and contextual factors affecting decision‐making for administration set replacement have not been assessed previously. Design Qualitative study using focus groups with contextualism methodology and inductive analysis. Method During November–December 2016, eight semi‐structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio‐recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7‐step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. Results Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. Conclusions Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Relevance to clinical practice Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.

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Section: Introductionmentioning

confidence: 99%

Nurses' decision‐making about intravenous administration set replacement: A qualitative study

Ray‐Barruel

Woods

Larsen

et al. 2019

Journal of Clinical Nursing

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“…The child’s case study, in agreement with previous literature,2 3 has demonstrated that the harm associated with CVADs frequently occurs during the later stages of CVAD dwell, not on the early days after insertion. Paediatric CVAD maintenance procedures such as flushing,20 dressing,21 administration set changes,22 and hub decontamination23 are not well supported by evidence, likely perpetuating these preventable complications for patients.…”

Section: Discussionmentioning

confidence: 99%

Substantial harm associated with failure of chronic paediatric central venous access devices

et al. 2017

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Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.Over 2½ years, a child requiring parenteral nutrition and associated vascular access dependency due to 'short gut syndrome' (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs.

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“…In fact, several studies indicate that the routine replacement of PIVCs (using predetermined time frames, e.g. 72-96 h) does not show advantages when compared to clinically indicated replacements [44][45][46]. Previous to the administration of the intravenous medication, vein permeability will be assessed and the pulsatile (push-pause) delivery action will be used to optimize flush outcomes and minimize damage to the vein [31,33,36].…”

Section: Interventionsmentioning

confidence: 99%

Double-chamber syringe versus classic syringes for peripheral intravenous drug administration and catheter flushing: a study protocol for a randomised controlled trial

Parreira

Sousa

Marques

et al. 2020

Trials

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Background: The prevention of catheter-related complications is nowadays an important topic of research. Flushing catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing should be carried out both pre-and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, and also increasing the need for manipulation of the venous catheter). Methods/design: A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration drugs with flushing procedures, with a double-chamber syringe (arm A) or with classic syringes (arm B). The outcomes assessment will be performed on a daily basis by an unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day. Discussion: The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of this medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate nurses' adoption of good clinical practices in intravenous procedures, reducing catheter manipulations. Trial registration: ClinicalTrials.gov, NCT04046770. Registered 13 August 2019.

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Optimal timing for intravascular administration set replacement

Abstract: Issue 9. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

Cited by 28 publications

References 42 publications

Nurses' decision‐making about intravenous administration set replacement: A qualitative study

Nurses' decision‐making about intravenous administration set replacement: A qualitative study

Substantial harm associated with failure of chronic paediatric central venous access devices

Double-chamber syringe versus classic syringes for peripheral intravenous drug administration and catheter flushing: a study protocol for a randomised controlled trial

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