Peripheral Venous Access Clinical Care Standard

Introduction

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. About 30 million are used in Australia each year, 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 needed, placing the patient unnecessarily at risk of infection.

Despite frequency in PIVC use, complications are reported to be as high as 70%. They can be prone to blockage and dislodgment, cause inflammation of the vein and infection. Nearly half of all first insertion attempts also 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

A roundtable comprised of individuals with expertise in the insertion and management of peripheral intravenous access devices, and experience in the Australian health care system as well as consumer representation met on Wednesday 6 March 2019 to provide input to this work. From this, a small working group of attendees has been convened to assist with refining the clinical care standard.

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.

Literature Reviews

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:

  1. 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)?
  2. What do current guidelines specifically recommend?
  3. What evidence is there regarding current clinical practice in Australia?
  4. What contributes to variations in techniques used/infection rates associated with peripheral venous access? What are the evidence gaps?
  5. 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?
  6. What is the rationale for a clinical care standard (or of standardised interventions to improve care)?

Next steps

The Commission will continue to develop the Peripheral Venous Access Clinical Care Standard based on the outcomes of the roundtable, and assistance from the working group that was convened from the roundtable. Public consultation on the draft clinical care standard and supporting documents is expected to take place mid-2019 for a four-week period.

If you wish to be informed when the consultation period commences, please email ccs@safetyandquality.gov.au