Management of Peripheral Intravenous Catheters Clinical Care Standard
This clinical care standard describes best practice care for using peripheral intravenous catheters (PIVCs) - also known as 'cannulas'. It describes how to use PIVCs wisely to preserve vessel health and improve patient outcomes and experience for one of the most common procedures in Australia.
Overview
Inserting a peripheral intravenous catheter (PIVC) – or cannula – is one of the most common procedures performed in hospitals, with approximately 7.7 million Australians undergoing the procedure each year.
The Management of Peripheral Intravenous Catheters Clinical Care Standard contains 10 quality statements and 13 indicators to guide quality care for the management of cannulas, and is accompanied by supporting resources.
Despite this, PIVCs are associated with a range of problems including unnecessary cannulation, multiple insertion attempts and significant complications such as infection, including Staphylococcus aureus bacteraemia.
Contents of the standard and resources
The Management of Peripheral Intravenous Catheters Clinical Care Standard is made up of ten quality statements and a set of indicators for safe and appropriate care.
- For consumers, the standard describes the care you should expect to receive if you have a cannula or 'drip'. Find out more about what the standard means for consumers and the information available.
- For clinicians, the standard provides guidance on the ten evidence-based quality statements from the clinical care standard. Find out more about what the standard means for clinicians, as well as helpful resources including the IV-WISE discussion tool.
- For health service organisations, the standard describes key components of care that health services can use to guide practice and monitor improvements in care. Find out information about the clinical care standard, the NSQHS Standards and resources to support implementation.
National launch and live webcast
The Management of Peripheral Intravenous Catheters Clinical Care Standard was launched via webcast on Wednesday, 26 May 2021.
The recording from the event is below.
Hosted by Associate Professor Amanda Walker, Clinical Director at the Australian Commission on Safety and Quality in Health Care, the panellists included:
- Professor Michael Kidd AM – Deputy Chief Medical Officer and Principal Medical Advisor, Australian Government Department of Health
- Dr Jennifer Stevens – Anaesthetist and Pain Medicine Specialist, St Vincent's Hospitals
- Dr Evan Alexandrou – Senior Lecturer Western Sydney University, Clinical Nurse Consultant Liverpool Hospital NSW, Adjunct Associate Professor Griffith University
- Professor Peter Collignon AM – Infectious Diseases Physician and Microbiologist, Canberra Hospital, Australian National University.
The launch is relevant to all involved in cannula insertion and management including nurses, infection prevention and control practitioners, venous access experts, doctors, junior medical officers, as well as health service managers and quality and safety managers in hospitals.
The slides from the event are available below.
Background
A peripheral intravenous catheter (PIVC) is a small flexible tube that is inserted through the skin into a peripheral vein. This allows for the administration of a range of therapies such as medicines and fluids directly into the bloodstream, which otherwise cannot be given, or are less effective if given by other ways such as by mouth.
The insertion of a PIVC is one of the most common clinical procedures performed, with up to 70% of hospitalised patients requiring a PIVC at some point during their hospital stay. However, studies estimate that 4% to 28% of PIVCs inserted are never used. This is even higher in Australian emergency departments, where about 50% of PIVCs inserted are not used, placing patients unnecessarily at risk of infection.
Despite their frequency of use, PIVCs are reportedly associated with complications almost 70% of the time, including:
- blockage and dislodgement
- redness and swelling of the vein
- infection.
Unfortunately, not all attempts to insert PIVCs are successful. Nearly half of all first insertion attempts fail, causing undue pain and anxiety for patients as a result of multiple failed attempts.
To reduce rates of complications associated with PIVC use, best practice guidelines recommend a range of strategies. Despite this, data from Australia and internationally suggest that a significant proportion of patients do not receive care as recommended to optimise use of PIVCs.
Consultation and endorsement
The standard was developed following consultation with a roundtable meeting of healthcare managers, infection control clinicians and consumers, with further advice from a small topic working group drawn from the roundtable meeting. Feedback was also obtained during public consultation and incorporated into the final version. The standard has been endorsed by a number of key organisations.
Evidence base
To inform development of the standard, the Commission engaged the Queensland University of Technology (QUT) and KP Health to carry out two literature reviews:
The evidence or guidelines supporting the quality statements is described in the evidence sources below: