The preliminary approach to bundle insertion and maintenance in preventing peripheral intravenous catheter-related complications

Nội dung text: The preliminary approach to bundle insertion and maintenance in preventing peripheral intravenous catheter-related complications

1. RESEARCH ARTICLE THE PRELIMINARY APPROACH TO BUNDLE INSERTION AND MAINTENANCE IN PREVENTING PERIPHERAL INTRAVENOUS CATHETER-RELATED COMPLICATIONS Ngo Thanh Hai1, Tran Thuy Khanh Linh2, Lise Husby Høvik3 1Representative Office, Becton Dickinson Asia Company, Ho Chi Minh City, 2University of Medicine and Pharmacy, Ho Chi Minh City, 3Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU) ABSTRACT Introduction: In Viet Nam, there are English back translation version and the currently no studies on using of a Bundle in checklist were evaluated by the experts for the care of peripheral intravenous catheters the content validity compared to the original for both adults and children, as well as version and formed a complete scale in research on developing a tool for monitoring VietNamese. Results: The preliminary quality of care of peripheral intravenous results indicated that the survey tool had catheters. Objective: To evaluate the been considered by experts to be suitable content value of a bundle insertion, for application in practice. Bundle and maintainance of peripheral intravenous checklist in VietNamese version had similar catheter and tool for monitoring quality of content with the original English version. care. Method: Study subjetcs were Bundle Bundle and checklist were feasible to use insertion and maintenance of peripheral in the patients with a peripheral intravenous intravenous catheters and quality of care catheterization. Conclusion: Bundle and checklist. The study was implemented from checklist in VietNamese version had similar January to May 2020. The research was content to the original English version, conducted according to the design of cross- suitable for practice. cultural adaption of research instrument Keywords: Care bundle, peripheral which adjusted research tools to the local intravenous catheters culture. The Bundle’s VietNamese version, 1. INTRODUCTION Complications involving the peripheral (PLABSI). There were various studies intravenous catheter (PIVC) range from on central line–associated bloodstream local complications such as displacement, infection (CLABSI), while clinical and drainage, chemical drainage or phlebitis to epidemiological data on PLABSI was still potentially severe systemic complications incomplete [1]. One retrospective study leading to the critical condition of peripheral reported a PLABSI rate of 0.5 / 1000 days line– associated bloodstream infection hospital stay was lower than the CLABSI rate of 2.7 / 1000 days hospital stay; however, the total time of PIVC insertion Cor. author: Ngo Thanh Hai and retention was 15 times higher than Email: ngothanhhai1989@gmail.com that of the central line device, therefore, Received: Feb 08, 2021 the number of PLABSI patients with PIVC Revised: Feb 15, 2021 complications is high and significant Accepted: Mar 05, 2021 considerations [2]. 66 Journal of Nursing Science - Vol. 04 - No. 01
2. RESEARCH ARTICLE One of the interventions that helped use to access each care of PIVC. For reduce the incidence of complications the reason, the researchers would like to related to intravenous lines was the conduct a study to translate the peripheral application of the care bundle [3]. The care intravenous Bundle and care Bundle of bundle is an evidence-based three- to five- the Society for Infection Prevention and step intervention group, when combined Control incorporated the British National together may be shown to be effective and Health Authority in English into VietNamese improve the quality of care. There were and Quality assessment tool for peripheral some applications of the care bundles intravenous line care. which, the bundle prevented ventilator- 2. RESEARCH METHOD related pneumonia, Bundle for prevention Research period: From January to May of infection related to urinary tract, 2020 Bundle for prevention of central venous catheter infection [4]. As for the peripheral Research design: The design of cross- intravenous line, there had been several cultural adaption of research instrument: health care agencies that had developed adapting research tools to the local culture Bundles during daily placement and care for [9] patients with PIVC. The research indicated Study subjects: Bundle placement that the application of the Care Bundle may and care of PIVC; PIVC quality of care reduce the rate of phlebitis, septicemia [3]. assessment checklist. In addition, the development of a tool for Bundle placement and care of PIVC systematic assessment of all the important developed by the Society for Infection factors related to PIVC is essential to help Prevention and Control incorporated with nurses detect and promptly manage them. the British National Health Authority. The In Viet Nam, there are currently no tool was part of a set of practice standards studies on the application of a Bundle in “High impact practical interventions” as part PIVC care for both adults and children, of the project “Saving Lives” first published as well as research to build a tool to in 2005. Since then, the tool had been assess systematically the quality of care updated continuously in 2007 and 2010. The of peripheral intravenous catheter. In the latest update was 2017. In the latest version established peripheral intravenous Bundle of this set of the practice standards, there and care Bundle, the Society for Infection are seven groups of Bundles updated and Prevention and Control incorporated the added. Bundle for prevention of infections British National Health Authority to develop involving peripheral intravenous equipment. the tool. This is a visual, convenient tool The tool consisted of 2 elements of the for compliance monitoring, effective in care process for 1 patient with a catheter preventing catheter-related infections [5- device used to connect the peripheral 8]. About tools to evaluate the quality of intravenous line including a Bundle for the peripheral line care; Lise Husby Hovik et period of PIVC insertion and the Bundle for al. calibrated and built upon a literature PIVC care. The PIVC bundle consisted of review a convenient tool with a full range 5 steps: using aseptic technique, assessing of factors including phlebitis related signs the vein before insertion, preparing the and symptoms, catheter tape and other patient’s skin, applying a permanent tape connection, documentation and usage and recording medical records. The PIVC indications. The tool had the reliability care bundle consisted of 6 steps: hand and level of convenience for nurses to hygiene, use of appropriate personal Journal of Nursing Science - Vol. 04 - No. 01 67
3. RESEARCH ARTICLE protective equipment, assess clinical of Bundle insertion and care of peripheral indications and continuous venous status intravenous catheters were used without before each intervention, disinfect of PIVC authorization for training purposes, ports before each intervention; change the application in the healthcare field. The infusion set, connect line according to the PIVC quality of care assessment tool was regulations and change the tape according Permitted by Lise to be used in the study. to the prescribed procedure. Translation phase from English to PIVC Quality of Care Assessment VietNamese were conducted by an Checklist: Proposed by Lise Husby Høvik independent translator was a Master of et al. [10] based on a study evaluating 63 Nursing, C certificate in English (as the health workers while providing care to 177 author of this study). The researcher patients with 205 placement times of PIVC; translated the tool from English (original Each PIVC is supervised by 2 independent language) into VietNamese. assessors, a total of 410 PIVCs are The back translation phase from monitored. This tool was developed into a VietNamese to English was conducted by checklist called PIVC-miniQ which includes an independent translator, who is a Nursing 16 elements systematically into 4 groups of PhD student, certified in IELT 5.0. She has factors related to undesired catheter care never known through research tools. The quality outcome problems. The first group tool was translated back from VietNamese of factors was related to the signs and to English. symptoms of phlebitis at the site of PIVC (9 factors include pain or pain while the Examination of content after translation touch, redness, swelling, heat, discharge was sent to two American Doctors of / hard-to-touch caps and veins); in which Nursing to assess the consensus on content signs were assessed by the researcher between the back translation English (redness, swelling, ...) and symptoms were version and the original version. The both expressed through the patient’s perceptions American Doctors of Nursing had confirmed (pain, pain while the touch, ..). The second the consent of the two versions, then the group of factors reflects problems related VietNamese translation was met content to PIVC tapes and line connections related reliability while translated into VietNamese. to possible damage to the functionality of 1 Once a complete VietNamese version PIVC (5 elements include dirty tape, loose was available, the tool were sent to nursing tape, or peeling, blood in the infusion line / specialists for professional content validity extension cord and no date recorded on the evaluation. After sending letters to 5 tape). The third group of factors is related to experts, the researcher received feedback the lack of nursing documentation on PIVC from 4 experts. Researcher sent four in the medical records (1 factor). The fourth documents of a VietNamese translated group of factors involved in assessing the version, an English back translation that needs of the placement and maintenance had been content appraised by 2 American of PIVC (indicative placement of PIVC); Nursing Doctors, the original version of the This factor evaluated the placement and research tool and an assessment form of retention of a PIVC without a clinical the VietNamese version tool to experts. The indication (1 factor). assessment form consisted of 5 questions Research process designed based on the assessment form of The researcher got permission from a scientific research topic with 5 rating levels the author to use the tool. The materials from 1 to 5 (Likert scale with 1 was very 68 Journal of Nursing Science - Vol. 04 - No. 01
4. RESEARCH ARTICLE inappropriate to 5 was very appropriate). For the 2nd Nurse Doctor, the contents The mean score for each response greater that need clarification include “Red line than or equal to 3.41 was considered along vein” or “Red line from the insertion appropriate [11]. site running along the vein”; “Tape soiled 3. RESULTS with blood or fluids” or “Tape or dressing soiled with blood or fluids”; “Unknown for Results of the translation into PIVC indication” or “Unknown indication VietNamese, back translation into for PIVC”. After receiving feedback, the English and assessment of the content researcher had translated the content of similar to the original version the VietNamese version, send it to another During the study period from January independent translator to translate into the to April 2020, the researcher carried out a second English reverse translation version translation from English to VietNamese for to send to the two American Nursing the Bundle PIVC and care and PIVC quality Doctors for re-evaluation. In the evaluation of care assessment tool. stage, the two American Nursing Doctors In the first translation, the English back assessed that the English back translation translation toolkit had been commented by version had similar content to the original 2 American Nursing Doctors. There were version. some points unclear need to be clarified Compared to the original version, the in terms of content. For the First American English back translation version had a Doctor of Nursing, words to reconsider number of different words with the same like “every day” or “every time”; “Infusion” contents. The contents of the toolkit was or “transfusion”, “Palpable hard vein” or presented as follows. “Palpable hard vein away from the PIVC”. Bundle for prevention of PIVC-related infections [12] PIVC insertion stage 1. Sterile technique • Place PIVC using sterile technique includes hand hygiene 2. Assessment of intravenous • Perform an intravenous assessment of the patient before insertion of a PIVC 3. Prepare the skin • The patient’s skin is prepared with 2% Chlorhexidine gluconate in 70% alcohol and allows to dry completely. (If patient was sensitive to Chlorhexinde, povidine- iodine was applied) 4. Dressing changes • A sterile, semi-permeable, transparent tape is applied to the PIVC allows the catheter site to be monitored. 5. Documentation • Documentation included date, time and reason for the placement of PIVC. Assessment of intravenous strength, indicating the preparation of the placement. The type and size of the PIVC device should be recorded Journal of Nursing Science - Vol. 04 - No. 01 69
5. RESEARCH ARTICLE Period of continuous care every day 1. Hand hygiene • Hands are disinfected immediately before and after each contact with an infected person using correct hand hygiene techniques 2. Personal protective equipment • Wear appropriate protective equipment when contacted patients according to hospital regulations 3. Assessment of clinical indications and continuous venous status • Indications of continuity of need and venous status should be recorded at least once per shift, PIVC is removed when a clinical indication is no longer indicated or if there are signs of phlebitis / bacterial infection • The placement should be observed at least during each shift on duty, in the case of PIVC, the VIP phlebitis score should be used. 4. Connect PIVC • Connection port and catheter shaft are disinfected with Chlorhexidine gluconate 2% in 70% alcohol and allow to dry completely. (If patient is sensitive, use povidine- iodine in 70% alcohol) 5. Replace the infusion set • Continuous infusion set should be changed at least every 96 hours • The infusion set uses continuously for blood transfusions and blood products should be changed every 12 hours, or when the infusion is finished. Platelets should be transfused through a new set of blood transfusion lines • The infusion set are labeled with the date and time to ensure they are replaced on time 6. Change the tape • Transparent, sterile tape should be changed at least every 7 days or earlier if the integrity of the tape is not present. • Site cleaning is performed with 2% Chlorhexidine in 70% alcohol and allow to dry completely (If patient is sensitive, use povidine-iodine in 70% alcohol) before each dressing change. • Change the tape to ensure that it uses appropriate sterile techniques according to current regulations of the medical facility The PIVC-miniQ survey table monitors the quality of care for patients with intravenous connection equipment [13] - Pain or pain when touching PIVCs - Redness> 1 cm from the placement site - Swelling> 1 cm from the placement site - Warm in the placement site - Pus - Red line from the placement site along the vein 70 Journal of Nursing Science - Vol. 04 - No. 01
6. RESEARCH ARTICLE - The tissue around the site of the PIVC - Do not know the indication of PIVC is tight and stiff - Missing PIVC notes in documentations - Vein from PIVC site is prominent on the Results of the evaluation phase by skin, can touch and spread far away the content experts toolkit - Partially / completely deviated Research tool after translation was - Adhesive tapes, tapes dirty with blood, sent to 4 specialists in Nursing (2 Doctor fluid of Nursing, 1 Master of Nursing, 1 Nursing - The tape edge is loose, folded up Specialist I). - Only fixed with adhesive tape The average score to comment on the feasibility when applying to the clinical - Blood in the infusion set practice of the research tool was presented - Do not note the date of placing PIVC in graph 1. on the tape 5 4 5 5 4.75 Relevant level of the instrument 4 3 5 5 4.25 Relevant level of instrument translation 5 5 5 5 5 Practical significance of the instrument 4 5 5 5 4.75 The scientific significance of the instrument 5 5 4 5 4.75 the importance of the instrument 0 5 10 15 20 25 30 Expert 1 Expert 2 Expert 3 Expert 4 Mean Figure 1. The feasibility of the instrument in applying into clinical practice Research results show that factors surveyed by experts had an average score of greater than or equal to 4.24 for each factor (the lowest was 3 and the highest was 5); 4. DISCUSSION The preminilary results indicated that the opinion that it was necessary to further survey tool had been considered by experts assess reliability and validity by one study on to be applicable in practice. However, a group of patients with catheter and though The experts provided comments the a group of nurses used the VietNamese appropriateness factor of the research tool version of the tool to apply in practice. translation method. They had a common Then, it was possible to have accurate Journal of Nursing Science - Vol. 04 - No. 01 71
7. RESEARCH ARTICLE conclusions about the effectiveness of the apply to clinical trials, there will be another VietNamese version tool. More specifically, step, with the author of the original checklist, about the care bundle, the expert feedback to build a library of images with descriptions that Bundle prevention of infections of complications in the checklist to ensure related to intravenous equipment was very consistency of practice and reliability of meaningful and practical if it was applied using checklists. clinically. The translation method at this In addition, because the translation stage was quite reasonable, the translation from English to VietNamese and from was suitable when it was satisfactory in VietNamese to English required that in terms of similarities between translation addition to ensuring the similarity between - back translation. However, with the the original version and English back quality of care assessment checklist tool, translation, the VietNamese version needs an additional comment was noted that it to be translated for the users who are the was necessary to clearly describe how nurses providing care for patients with the assessment was done, and there was an intravenous connection device. The a table explaining each term or evidence nurses should understand correctly and pictures of the complications. This was conveniently while using this tool in clinical a very positive expert response, as each practice. Therefore, after synthesizing the checklist complication needed to have corrections and suggestions from experts, an evaluation criterion or a picture that the VietNamese version of the research specifically describes the sign or symptom tool was completed for the final complete of that complication. To overcome this version: shortcoming, in the next research phase to Bundle for prevention of PIVC-related infections PIVC insertion stage 1. Sterile technique • Use sterile technique (including hand hygiene) when placing peripheral intravenous catheters 2. Asessment of the condition of the intravenous • Assess the patient’s intravenous prior to peripheral intravenous catheter insertion 3. Prepare skin • The patient’s skin is prepared with 2% Chlorhexidine gluconate in 70% alcohol and allows to dry completely. (If patient was sensitive to Chlorhexinde, povidine-iodine was applied) 4. Dressing changes • A sterile, semi-permeable, transparent tape is applied to the PIVC allows the catheter site to be monitored. 5. Documentation • Documentation included date, time and reason for the placement of PIVC. Assessment of intravenous strength, indicating the preparation of the placement. The type and size of the PIVC device should be recorded 72 Journal of Nursing Science - Vol. 04 - No. 01
8. RESEARCH ARTICLE Period of continuous care every day 1. Hand hygiene • Hands are disinfected immediately before and after each contact with an infected person using correct hand hygiene techniques 2. Personal protective equipment • Wear appropriate protective equipment when contacted patients according to hospital regulations 3. Assessment of clinical indications and continuous venous status • Indications of continuity of need and venous status should be recorded at least once per shift, PIVC is removed when a clinical indication is no longer indicated or if there are signs of phlebitis / bacterial infection • The placement should be observed at least during each shift on duty, in the case of PIVC, the VIP phlebitis score should be used 4. Connect PIVC • Connection port and catheter shaft are disinfected with Chlorhexidine gluconate 2% in 70% alcohol and allow to dry completely. (If patient is sensitive, use povidine- iodine in 70% alcohol) 5. Replace the infusion set • Continuous infusion set should be changed at least every 96 hours • The infusion set uses continuously for blood transfusions and blood products should be changed every 12 hours, or when the infusion is finished. Platelets should be transfused through a new set of blood transfusion lines • The infusion set are labeled with the date and time to ensure they are replaced on time. 6. Change the tape • Transparent, sterile tape should be changed at least every 7 days or earlier if the integrity of the tape is not present. • Site cleaning is performed with 2% Chlorhexidine in 70% alcohol and allow to dry completely (If patient is sensitive, use povidine-iodine in 70% alcohol) before each dressing change. • Change the tape to ensure that it uses appropriate sterile techniques according to current regulations of the medical facility Journal of Nursing Science - Vol. 04 - No. 01 73
9. RESEARCH ARTICLE The PIVC-miniQ survey table and sending to experts to assess the monitors the quality of care for patients applicability of research tools were not with intravenous connection equipment completely consistent with the guidelines of scientific research. - Pain or pain when touching PIVCs 5. CONCLUSION - Redness> 1 cm from the placement site Bundle placement and maintainance of peripheral intravenous catheters and patient - Swelling> 1 cm from the placement site care quality assessment checklist with a - Warm in the placement site VietNamese version was content similar to the original version. The contents of the - Pus VietNamese version of the Bundle and the initial feedback checklist can be applied to - Red line from the placement site along practice, it is necessary to have research on the vein a group of subjects to assess reliability and - The tissue around the site of the PIVC validity. With comments by experts, Bundle is tight and stiff and checklist were premilinary applied in clinical practice. Health care facilities may - Vein from PIVC site is prominent on the consider incorporating Bundle and checklist skin, can touch and spread far away into patient care practices with peripheral venous catheters to prevent complications - Partially / completely deviated associated with peripheral intra venous - Adhesive tapes, tapes dirty with blood, catheters, especially complications of fluid catheter-related sepsis. The further study should be conducted to apply the Bundle - The tape edge is loose, folded up and checklist on a specific group of patients to assess the reliability and validity of the - Only fixed with adhesive tape Bundle and checklist. - Blood in the infusion set REFERENCES - Do not note the date of placing PIVC 1. Akihiro Sato, et al., Peripheral on the tape venous catheter-related bloodstream infection is associated with severe - Do not know the indication of PIVC complications and potential death: a - Missing PIVC notes in documentations retrospective observational study. BMC Infect Dis, 2017. 17: p. 434. LIMITATIONS 2. G.Maki, D., D. M.Kluger, and C. The study evaluated the accuracy of J.Crnich, The Risk of Bloodstream Infection the content when translating the tool from in Adults With Different Intravascular English to VietNamese. The study has not Devices: A Systematic Review of 200 yet applied a pilot study to a specific group Published Prospective Studies. Mayo Clinic of research subjects, therefore, the results Proceedings, 2006. 81(9): p. 1159-1171. did not present validity and reliability of the research tool. 3. GillianRay-Barruel, H., NicoleMarsh, MarieCooke, Claire The research process of translation M.Rickarda, Effectiveness of insertion 74 Journal of Nursing Science - Vol. 04 - No. 01
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