RESEARCH RECAP

The One Million Global Catheters PIVC worldwide prevalence study Evan Alexandrou

Evan Alexandrou is Lecturer, School of Nursing & Midwifery, University of Western Sydney, Australia; Clinical Nurse Specialist, Central Venous Access & Intensive Care, Liverpool Hospital, New South Wales Australia; and Adjunct Senior Research Fellow, Alliance for Vascular Access Teaching & Research Group, Griffith University Queensland, Australia Accepted for publication: April 2014

Such valuable information can potentially save millions of unnecessary PIVC reinsertions and reduce healthcare costs substantially, particularly in developing nations. The study will also provide valuable information on whether hospitals adopt best-practice guidelines for care and management of such devices. Overall, the evidence gained from this research will be easily translatable into clinical practice and healthcare policy and will help improve patient outcomes related to PIVCs The OMG PIVC study is a worldwide, multicentre observational investigation, where hospitalised patients (both adults and paediatrics) will be reviewed for evidence of a PIVC in place. Using a validated datacollection tool, patients with PIVCs will be reviewed. All data to be collected will be de-identified and no physical interventions will be planned within the study.

What would hospitals need to do? Every participating organisation will be asked to complete an OMG Study Site Information Form, which will include questions such as: ■■ Who is responsible for inserting IVs at your organisation? ■■ Which, if any, guidelines/policy does your organisation follow for PIVC insertion and care? ■■ What are the PIVC brands in use at your organisation? ■■ What are the PIVC dressings in use at your organisation? ■■ What are the cleaning solutions in use for PIVC insertion and dressing changes at your organisation? The study will be conducted on a given day in 2014 or 2015. Hospitals will have the choice to choose the day to undertake the audit (it is best however if a group of hospitals from the same region are in the study that they undertake the audit on the same day). On the chosen day, participating organisations will be asked to conduct an audit of patients with a PIVC. This audit will involve the completion of an OMG Study Data Collection Form for each patient with a PIVC. The organisations will assess the patient’s IV site in order to do complete the form. The patient information to be collected includes:

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■■ Age

and gender of patient of health condition: Medical/surgical/ oncology/critical care ■■ Date and time of PIVC insertion ■■ Cannula type/brand (if known) ■■ Who inserted the PIVC (if known) ■■ Where was the PIVC inserted (if known) ■■ Site/position of PIVC insertion ■■ Cannula gauge/size ■■ IV connectors in use ■■ PIVC site assessment ■■ IV securement method ■■ IV dressing type ■■ IV dressing assessment ■■ IV orders today ■■ IV fluids today ■■ IV medications today. All the data collected will be de-identified, and there are no physical interventions planned within the study. However, patients who show signs of intravascular phlebitis or infection will have the treating team notified regarding the patient’s condition. ■■ Type

OMG study aims This study has several aims: ■■ To identify and compare the prevalence of PIVCs in hospital populations worldwide ■■ To evaluate the prevalence of PIVC complications (extravasation, phlebitis, occlusion, thrombosis) in patients with PIVCs worldwide ■■ To benchmark international use of PIVCs, including cannula characteristics such as type and size and anatomical placement, along with types of intravenous fluids and medications infused ■■ To identify the risk factors associated with PIVC failure ■■ To identify the prevalence of redundant (unused or unneeded) catheters in situ ■■ To identify the current practice in PIVC dressing use and management ■■ To identify the current practices in PIVC securement ■■ To compare local hospital policies on PIVC insertion and management with international guidelines ■■ To encourage future international collaborative research among vascular access nurses and physicians.

British Journal of Nursing, 2014 (IV Therapy Supplement), Vol 23, No 8

British Journal of Nursing 2014.23:S16-S17.

© 2014 MA Healthcare Ltd

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t is estimated that approximately half the number of all patients admitted to hospital require the insertion of an intravenous cannula into a peripheral vein, for the administration of intravenous fluids, medications and blood products. It is the most common invasive clinical procedure performed in hospitals worldwide (Webster et al, 2008; Ahlqvist et  al, 2010). The annual use of peripheral intravenous cannulas (PIVCs) in North America has been reported to be as many as 150–200 million units. However, the estimated number of PIVCs used across greater Europe or other regions of the world is largely unknown (Maki et al, 2006; Zingg and Pittet, 2009). As a common device used widely in hospitalised patients, government authorities and professional organisations have developed standards of practice to assist clinicians in managing these devices. In spite of these evidence-based guidelines, PIVCs are associated with both local and systemic infection that can contribute to increased morbidity, increased mortality and prolonged hospitalisation (Kagel,  2004). Localised complications include phlebitis, infiltration and extravasation, occlusion, and thrombosis, all of which can lead to device failure. Failures of PIVCs are responsible for adverse therapy outcomes, such as patient-reported pain, interruptions in intravenous therapy and missed medication doses, resulting in increased healthcare costs associated with increased length of hospital stay (Kagel and Rayan, 2004). This study is the first prevalence investigation to audit the care and management of PIVCs across many hospitals in many nations. It will provide previously inaccessible data on the use of PIVCs including average dwell and risk factors contributing to PIVC failure along with characteristics of device and consumables used.

RESEARCH RECAP Expected benefits

Data storage

This study is expected to provide extensive information about the standards of PIVC management in many countries. More than 250  hospitals have registered their interest in participating across the world. A list of registered countries can be seen in Table 1. This study will have international significance in documenting the prevalence of PIVC use and its complications, such as phlebitis, worldwide. The information gained from this study will be invaluable in directing future policy and budget initiatives in the healthcare sector and will provide clinicians, administrators and manufacturers the vital evidence that can be translated into practice. The collaborative nature of the study will also assist in building networking opportunities and research capacity among healthcare workers in diverse environments, which will facilitate the beneficial development of further research opportunities in the future. The information can be used by hospitals to benchmark results with other hospitals in their local area or country; compare performance; and identify areas for further education, patient safety initiatives, quality control issues, use of consumables (i.e. dressings, IV cannulas), number of redundant cannulas, and so on. The study is designed to discover what is actually happening with PIVCs in clinical practice. Are we using research findings to improve health care? Are we doing the best we can for our patients? We believe the study will help clinicians to evaluate their own practice, compare it with the research, benchmark it against other hospitals, and discover ways to improve patient safety and health care.

Stringent processes will be employed to ensure that the data collected by the partipating organisations will be kept confidential. The details about PIVC sites will be entered in LimeSurvey, a secure survey database. Those participating sites that do not have access to the website will be asked to record the data on paper and email/fax/post the data collection forms to the researchers.

Are there any risks? There are no foreseeable risks with this research study. The PIVC site will be assessed as per the usual standard IV practice. No interventions are planned as part of this research. Moreover, each hospital participating in the study will be de-identified and be assigned a unique identifier. The data will not be shared with other organisations, and the results will be published by country and not by hospital, ensuring the confidentiality of the results. The information collected by each hospital will remain the property of the hospital.

© 2014 MA Healthcare Ltd

Data confidentiality Each organisation will be given a unique identification code. No patient’s personal, demographic or medical condition details will be collected as part of this research. Moreover, it will not be possible to track back any data to a particular patient.

Table 1. Registered countries ■■ Argentina

■■ Kenya

■■ Australia

■■ Malaysia

■■ Brazil

■■ Malta

■■ Canada

■■ Namibia

■■ Chile

■■ New

■■ China

■■ Papua

■■ France ■■ Germany ■■ Greece ■■ India

Reporting of results The results of this prevalence study will be published in peer-reviewed journals and presented at national and international conferences. No data identifying participating organisations will be disclosed. All contributors will be acknowledged either in the publication or as an appendix to the publication.

Ethical approvals Human research ethics approval has been gained from the National Health and Medical Research Council of Australia. The ethics applications were lodged through The Griffith University Health Research Ethics Committee and a Local Health District in New South Wales, Australia. A copy of this approval will be sent to all participating organisations.

Conclusion This prevalence study will be the first of its kind to be undertaken to compare PIVC use and practices from hospitals across the world. It will provide previously unavailable data on the prevalence of PIVC use internationally and what proportion of healthcare facilities utilise bestpractice guidelines for the care and management of these devices. This study will also provide critical, easily translatable data into clinical practice on factors that contribute to PIVC failure. This can potentially help save millions of unnecessary PIVC resiting across the globe, thus reducing healthcare costs substantially while improving patient outcomes in both developed BJN and developing nations. 

■■ Ireland ■■ Iran ■■ Italy ■■ Israel

Zealand New Guinea ■■ Romania ■■ Saudi Arabia ■■ South Africa ■■ Spain ■■ Sweden ■■ Tanzania ■■ UK ■■ USA

Conflict of interest: none. This is a recap of a study that is scheduled to take place between 2014 and 2015. Are you interested in joining the study? Register at: www.omgpivc.org or email [email protected] OMG  Team Investigators: Evan Alexandrou, Gillian Ray-Barruel, Peter Carr, Steve Frost, Sheila Inwood, Niall Higgins, Francis Lin, Leonard Mermel and Claire Rickard. Ahlqvist M, Berglund B, Nordstrom G, Klang B, Wirén M, Johansson E (2010) A new reliable tool (PVC assess) for assessment of peripheral venous catheters. J Eval Clin Pract 16(6):1108-15. doi: 10.1111/j.13652753.2009.01278.x Kagel EM, Rayan GM (2004) Intravenous catheter complications in the hand and forearm. J Trauma 56(1):123-7. doi: 10.1097/01.TA.0000058126.72962.74 Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81(9): 1159-71. http://bit.ly/R9JTjG Webster J, Clarke S, Paterson D et al (2008) Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ 337: a339. doi: http://dx.doi.org/10.1136/bmj.a339 Zingg W, Pittet D (2009) Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 34(Suppl 4): S38-42. doi: 10.1016/S09248579(09)70565-5

KEY POINTS n There is minimal published data on the prevalence of PIVC use between the developing and developed world n Despite evidence-based guidelines that are published to assist clinicians on the care of PIVCs, reported complication rates remain high n The objective of this study is to evaluate and compare the current state of PIVC use and practices from hospitals across the world n The study will be the largest clinical audit to be undertaken on PIVCs across the globe n The study will provide previously unavailable data that can be easily translated into improving clinical practice

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British Journal of Nursing, 2014 (IV Therapy Supplement), Vol 23, No 8 

British Journal of Nursing 2014.23:S16-S17.

The One Million Global Catheters PIVC worldwide prevalence study.

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