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 not actually used. Australian studies report that this is even higher in 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 up to almost 70% of the time, including:
- blockage and dislodgment,
- redness and swelling of the vein
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.
Development of a Clinical Care Standard
Experts in the insertion and management of PIVCs, healthcare managers, infection control clinicians and consumers met on 6 March 2019 at a roundtable meeting to discuss the development of a clinical care standard to improve the use of PIVCs. The membership of the clinical care standard working group was drawn from attendees at the roundtable.
All roundtable attendees and working group participants are required to disclose financial, personal and professional interests that could, or could be perceived to, influence a decision made, or advice given to the Commission. Disclosures are managed in line with the Commission’s Policy on Disclosure of Interests.
To further inform development, the Commission engaged the Queensland University of Technology(QUT), and KP Health to carry out two literature reviews to better understand the:
The reviews address the following research questions:
- What relevant guidelines, policies and procedures, health programs or strategy documents are available in Australia or in the absence of an Australian guideline, high quality guidelines from an equivalent healthcare system (e.g. UK, USA, and Canada)?
- What do current guidelines specifically recommend?
- What evidence is there regarding current clinical practice in Australia?
- What contributes to variations in techniques used/infection rates associated with peripheral venous access? What are the evidence gaps?
- What is the literature on interventions to reduce complications/infections associated with PIVCs? What is the effectiveness of those interventions? What are the evidence gaps?
- What is the rationale for a clinical care standard (or of standardised interventions to improve care)?
Public consultation on the draft clinical care standard, evidence sources document, consumer and clinician fact sheets was undertaken from 5 August 2019 until 15 September 2019. Following public consultation, the Commission will review all comments and use this analysis to finalise the draft clinical care standard.