Improvement Program of Peripheral Venous Cannulation (PVC) Care Practices in Hospital

Abstract Description

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Authors (including presenting author) :

Ng PY(1), Ng MT(1), Wong PY(2), Cheng WM(2), Leung AFY(1), Lee WM(2), Ching HC(2), Fung YL(1), Lau EKF(1)

Affiliation :

(1) Infection Control Unit, Caritas Medical Centre (2) Infection Control Team, Princess Margret Hospital

Introduction :

CMC had high prevalence of MRSA bacteremia since 2015. PVC phlebitis was identified as a significant cause which phlebitis related MRSA bacteremia increased from lowest 1.82% in 2015 to 10.53% in 2017. By revision of international recommendations, a PVC improvement program was initiated jointly by CMC and PMH ICNs. It took reference to the experience of PVC program of PMH held in 2014 with successful achievement. It piloted in surgical department of CMC since July 2018.

Objectives :

1.To educate nurses the knowledge on early detection of phlebitis by introducing a standardized assessment tool 2.To enhance nurses’ knowledge on PVC care by educational talks

Methodology :

1.International guidelines review on PVC care was done and 7 key elements were chosen for PVC bundle of care: -Hand hygiene -Proper aseptic technique -Use an upper extremity for catheter insertion -Skin preparation using 2% CHG in 70% alcohol -Application of sterile, semi-permeable and transparent dressing -At least daily review of line necessity -Proper documentation with VIP score 2. A visual poster was designed for the recommended peripheral venous cannulation care practices. 3. The Visual Infusion Phlebitis (VIP) score was introduced to CMC as standard assessment tool for PVC site monitoring because of its content validity, inter-rater reliability, and is clinically feasible. 4. FOUR identical educational sessions were held for nurses. Total 5 audits were done by CMC and PMH ICNs, including a pre-intervention audit. 5.Pre- and post-test on knowledge of PVC care; phlebitis and use of VIP score were done by nurses before and after the program.

Result & Outcome :

Total 221 PVC sites were observed: 1.“No phlebitis (VIP=0) in patient” was improved from 63% to 100% 2.VIP score was charted correctly by nurses. Resulted from 82% to 100% 3.Compliance of using VIP scores to monitor the condition of PVC sites increased from 85.7% to 100% 4.Knowledge in PVC care, phlebitis and VIP score was improved as shown by pre- and post-test comparison With this successful interim result in educational phase, the PVC bundle of care will be rolled out to all patient-care areas in CMC. A tentative elevation will be done later to review phlebitis related MRSA bacteremia rate in CMC.