Peripheral venous catheters : quality of care assessment

Abstract

About half of the patients admitted to hospitals receive intravenous therapy through peripheral venous catheters (PVCs). Unfortunately, the use of PVCs is associated with the risk of complications that may lead to increased morbidity and prolonged hospitalisation. Because of the frequent use of PVCs and the risk of PVC-related complications, there are good reasons to assess quality of care.

The overall aim of this study was to attain increased knowledge about PVC documentation in the patient s medical record and to develop methods for assessment of inserted PVCs.

Patients were recruited on medical and surgical wards at two emergency hospitals (Study I) and at one university hospital (Study I, II). A convenient sample of 933 adult inpatients with PVCs inserted into a vein on their upper extremity was included in study I. A study-specific data collection form was used for bedside registration of PVC insertion site, hand side, lumen size, patient s age and gender. The post-insertion documentation of the same PVCs was checked in patient medical record and recorded. The data were descriptively analysed via frequency distribution and factors associated with PVC documentation were examined using univariate and multivariate logistic regression analysis. Results showed that 10 descriptions could be used to explain PVC insertion site. Any kind of PVC documentation was found in 72% of the patients medical records. Notes that included information on insertion site, hand side and lumen size were identified in 46%. Documentation, including the latter three variables, was significantly associated with medical wards at general hospitals and smaller lumen size.

A PVC assessment tool (PVC ASSESS) was developed through confirmation of content validity, evaluation of face validity, inter-rater and test-retest reliability (Study II). The tool consists of three sections: PVC management, signs and symptoms of PVC-related thrombophlebitis and PVC documentation. To test the reliability two groups of registered nurses (RNs) (Study II) and nursing students (NSs) (Thesis) used the tool to perform PVC assessments on 67 PVCs on actual patients at bedside (inter-rater reliability). Two other groups of RNs and NSs assessed 67 PVC photographs taken concurrently with the bedside assessments (test-retest reliability). The tool s reliability was evaluated by calculation of proportion of agreement and Cohen s unweighted kappa coefficient (κ) among the RNs and NSs. The inter-rater reliability (κ) ranged from moderate to almost perfect in 93% and 81% of the tested items among RNs and NSs, respectively. Test-retest reliability (κ) ranged between moderate and almost perfect in 95-100% of the items tested among RNs and in 90-95% among NSs.

In conclusion, the findings imply the need for education of RNs in PVC documentation and development of terms for documentation of PVC insertion site. The reliability of the PVC ASSESS instrument is considered satisfactory and of relevance for use in research and clinical audits.