Infection Control Today

MAY 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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" Dislodgement typically results in a delay in the administration of necessary treatment, a time-consuming IV restart and a potentially more invasive procedure that can lead to greater stress and anxiety for the patient. 19 May 2019 ICT Shifting the Standard of Care in IV Dislodgement Prevention A ccidental dislodgement of IV catheters is a widespread but often unrecognized issue in vascular access device (VAD) care. Approximately 70 percent to 90 percent of hospitalized patients in the U.S. receive IV therapy at some point during their stay, and current literature estimates overall catheter failure rates as high as 50 percent. 1 Of the factors contributing to catheter failure, dislodgement is the most common. One reliable study lists dislodgement as the reason for restarts in the majority of catheter failures. 2 Given the prevalence of both IV therapy and catheter failure as a result of dislodgement, this issue has huge implications for both patient safety and healthcare costs. Dislodgement typically results in a delay in the administration of necessary treatment, a time-consuming IV restart and a potentially more invasive procedure that can lead to greater stress and anxiety for the patient. Vessel health and issues of preservation are also impacted, as dislodgement can damage veins and cause loss of peripheral IV site integrity, along with increasing the risk of complications like phlebitis, infi ltration and infection. The most serious risks of IV dislodgement include hemorrhage, air embolism and bloodstream infection that may result in more serious illness for the patient and even death. Dislodgement also contributes to rising healthcare costs. Accidental dislodgement events are estimated to affect more than 75 million catheters per year. 1,3-4 That translates to an annual estimated cost of more than $1.8 billion. Signifi cant healthcare savings can be realized if even a small percentage of dislodgement is reduced. Hiding in Plain Sight According to a recent clinical survey, led by this author, dislodgement is seen in virtually every setting, in every device, and by every type of provider. The survey, sponsored by Linear Health Sciences and published in the Journal of the Association for Vascular Access (JAVA), was conducted to assess clinical perceptions of the incidence and risks of IV dislodgement. Of the 1,561 nurses and vascular access specialists surveyed, 68 percent reported that accidental dislodgement occurs "often," "daily," or "multiple times daily" in their institutions. Almost all respondents (>95 percent) considered IV dislodgement a patient safety risk. 4 Awareness of this issue seems to vary among clinicians. Moreover, a lack of auditing and documentation procedures to track accidental dislodgement makes it diffi cult to identify the true incidence and solutions to improve outcomes. For the vascular access community to effectively address IV dislodgement, we fi rst need to bring transparency to this "accepted but unacceptable" issue — which includes highlighting the prevalence and causes of dislodgement — as well the clinical and economic consequences. 1 Once this problem and its associated complications are more widely acknowledged, solutions can be applied to reduce the incidence of accidental dislodgement. Step 1: Focus on Securement Multiple factors contribute to IV dislodgement. Respondents in the clinical survey identifi ed the top three causes as: confused patient (80 percent), patient physically removes catheter (74 percent), and loose IV catheter tape or securement (65 percent). 4 Taking steps to secure catheters with consistent practices is the fi rst way clinicians can address this issue. Without proper catheter securement or stabilization, perspiration, hair growth and skin oils can easily cause a dressing to lose its adhesive qualities. This is especially true for peripheral IV (PIV) catheters, which are placed in the hands or arms. These areas see a lot of movement from normal patient activity, thereby increasing the chances for dislodgement. According to the clinical survey, PIV catheters are the most commonly dislodged device. 4 Securement techniques and dressings are used in order to stabilize the device and hold the catheter in place, whether it's a PIV or central venous catheter (CVC). The most basic securement methods are either sterile tape and a transparent dressing placed on top of the IV to stabilize the catheter and protect the insertion site. A standard transparent dressing is a fl at fi lm dressing that is applied over the catheter insertion site. Other dressings have a built-in securement method that can provide more stability than a normal transparent dressing. However, these methods are sometimes not strong enough to secure the catheter and can frequently result in dislodgement, particularly if done incorrectly or inconsistently. Research shows that engineered stabilization devices, as well as subcutaneous securement (primarily for CVCs), provide better securement and stabilization. 5-9 These devices may also afford better control of the catheter and connected tubing than tape or transparent dressings. These engineered technologies include adhesive-based anchoring devices, as well as devices that allow the catheter and/ or tubing to be positioned and held in place either by a molded technology or a Velcro-type surface. In fact, the By Nancy Moureau, RN, PhD, CRNI, CPUI, VA-BC feature

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