Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-8-2020

Graduate Advisor

Dr. Laura Kuensting

Co-Advisor

Dr. Elizabeth Mantych

Committee

Dr. Laura Kuensting

Dr. Elizabeth Mantych

Sharon Holtmeyer

Abstract

Problem Hospitalized adult patients require more than one short peripheral catheter (SPC) to complete the prescribed intravenous (IV) therapy due to catheter failure and the practice of resiting. The purpose of this quality improvement initiative was to increase the rate of SPCs remaining in situ for the entire duration of the IV therapy for hospitalized adult patients.

Methods Application of an engineered securement device (ESD), an educational program pertaining to modifiable risk factors, and changing the practice to removal upon clinical indication were methods utilized to reduce the number of SPC insertions and catheter failures. This study was conducted at a rural, Midwestern hospital using a convenience sample (N=405) and an observational, descriptive, cohort design in six phases between September 2019 and March 2020.

Results Following the practice changes, there was a reduction of SPC replacement (24%), catheter failures (24% to 13%), SPCs per patient (M=2.9 to 2.2 p=.045), SPC insertions (4,000 per year), and zero SPC-related CRBSIs (0.26 per 1000 catheter days to 0.0) and a significant increase of SPCs remaining in situ (M=2.6 to 3.8 days; p=p=.007) and upper arm (p=.026) and significantly reduced when inserted in the forearm (p=0.39).

Implications for Practice Study findings suggest the use of an ESD, promoting insertion in the forearm, avoidance of the wrist and upper arm, and the practice change to removal when clinically indicated.

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