Page 134 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F3.1 Clinical Safety and Quality Service I 14:30 Room 421

Measures for the Successful Implementation of Peripheral Venous Cannula Care Bundle
Ng HL1, Chow M 2, Wan SL 3, Chan EHY4, Tse A 3, Chow YY 3, Que TL1, Wong TY4
1Department of Clinical Pathology, New Territories West Cluster, Hospital Authority, 2Infection Control Team, New Territories
West Cluster, Hospital Authority, 3Department of Orthopaedics and Traumatology, New Territories West Cluster, Hospital
Authority, 4Infectious Disease Control Training Centre, Hospital Authority Head Office/Infection Control Branch, Centre for

Health Protection, The Government of the Hong Kong Special Administrative Region

Introduction

Peripheral venous cannulation (PVC) is a common procedure that can have undesirable effects, the most common one is
phlebitis. Moreover, up to 6.2 % of hospital-acquired bacteremia may be directly attributable to peripheral IV cannulation.
Many adverse events related to the use of peripheral venous cannula are preventable by the use of multifaceted interventions.
Overseas study had shown that regular “plan, do, study, act” (PDSA) cycles can help to improve the compliance of the
implementation of “care bundle” of these interventions.

Tuesday, 3 May Objectives

(1) To standardise the peripheral venous cannula care practice; (2) to promote “care bundle” approach; and (3) to reduce
peripheral venous cannula related phlebitis in the participating wards (total of four wards) of the Department of Orthopaedics
and Traumatology of Tuen Mun Hospital over a study period of six months.

Methodology

The components of the care bundle included insertion, ongoing care and documentation. Insertion: proper aseptic technique
and hand hygiene, skin preparation using 2% chlorhexidine gluconate in 70% isopropyl alcohol, application of sterile and
transparent dressing. Ongoing care: proper hand hygiene, daily site inspection and evaluation of indication for continuation,
decontaminate cannula access port by 2% chlorhexidine gluconate in 70% isopropyl alcohol, scheduled cannula replacement
at 72 hours unless in patients with limited venous access, prompt removal of cannula with Visual Infusion Phlebitis (VIP) score
greater than or equal to 2/not in use for >24 hours, timely administration set replacement. Documentation of insertion and
ongoing care was done by the healthcare workers using the peripheral venous cannula assessment record form. Monthly
PDSA cycles was conducted on sampled forms throughout the study period from April to October 2014.

Results

At the end of study, 3,525 assessment forms (by ward staff) were collected. The average compliance rate of proper
documentation by ward staff was 90% (Range: 79.6% to 95.8%) from the sampled forms. Percentage of peripheral vein
phlebitis assessed by Infection Control Team was significantly decreased from 10.7% before the study to 4.7% over the
study period (p-value=0.003). PVC-related Staphylococcus aureus bloodstream infection (BSI) rate per 1,000 catheter days
remained as 0 before and over the study period. The implementation of PVC care bundle has successfully aroused awareness
among the staff in participating wards to preventing PVC related complications. The reduction in PVC related phlebitis is
encouraging. It is recommended to extend the implementation of the PVC care bundle to all clinical departments in New
Territories West Cluster as well as other hospitals.

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