PERIPHERAL INTRAVENOUS CATHETERS

Care And Maintenance Of Peripheral Intravenous Catheters

Care And Maintenance Of Peripheral Intravenous Catheters

Introduction

Infection prevention and control measures have been recognised as effective in minimising the risk of infection from peripheral intravenous cannulas. However, this relies on health professionals' compliance with guidelines for the care of patients with intravenous catheters and at times it may be that practice is inconsistent with guidelines. This article uses a reflective approach to a practice incident and examines the main issues relating to the care of cannulas, specifically discussing the evidence relating to the amount of time that peripheral cannula should remain in place.

Rationale

The prevention of healthcare-associated infections (HAIs) is one of the major challenges facing the NHS (Department of Health, 2001). The DH (2005) has called for all health professionals and other NHS staff to help reduce the risk of infection in everyday practice and numerous policy documents, including Getting Ahead of the Curve (DH, 2002) and A Matron's Charter (DH, 2004), have raised the profile of infection control. Winning Ways: Working Together to Reduce Healthcare Associated Infection inEngland (DH, 2003) identified the challenges facing health professionals in their attempts to bring and maintain infection control measures into mainstream service improvement. The implication is that it is now 'everybody's business' to be actively involved in reducing HAIs, while having effective infrastructures provided by management and clinical leaders to support staff (Vaughan and Randle, 2005).

Literature Review

In order to ensure best-practice in infection prevention and control, based on the systematic review of research and other evidence, guidelines should be easily accessible to staff (DH, 2001). This is part of the framework for clinical governance where NHS staff are striving to continually improve the quality of service provision and promote high standards of care (DH, 2001). Furthermore, from a professional perspective, the Code of Professional Conduct (NMC, 2004) states that individual nurses have a responsibility to deliver evidence-based care. This means patients have the right to receive a uniformly high standard of care, regardless of who they are and where they are treated (DH, 2000).

A way of ensuring all patients benefit from safe and appropriate care is by the production, implementation, auditing and regular updating of clinical standards, which reflect current research findings (RCN, 2002). Using audit to monitor clinical effectiveness is in the professional competencies for infection-control nurses (Infection Control Nurses Association, 2000). King (2005) stated that these are considered as standards to work towards in order to achieve consistency in the infection prevention and control specialty.

Clinical scenario

As part of the local clinical governance strategy, we audited a clinical area in a large teaching hospital in England. A component of this audit was the insertion and maintenance of peripheral intravenous catheters/cannulas (PICs). In order to critically examine current practice and compare it with the evidence base relating to PIC care, a reflective framework based on Gibbs' work (1988) was used (Box 1). Reflective practice is considered a route to articulate knowledge locked in practice and resolves the theory-practice gap (Freshwater, ...