Choosing the appropriate insertion site for peripheral intravenous catheters (PIVCs) is important for patient outcomes and safety, preventing care delays, and increasing patient satisfaction, according to a presentation at the 47th Annual Oncology Nursing Society (ONS) Congress.
Oncology teams at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH) collaborate to care for adults with cancer. The collaboration allows patients to meet with different specialists at each center in a single visit. For example, patients can undergo restaging scans at BWH prior to a same-day appointment for chemotherapy infusion at DFCI.
The initial peripheral intravenous catheter (PIVC) is placed in the antecubital fossa (ACF) at BWH for contrast injection. However, DFCI policy specifies the ACF is never the appropriate position for PIVC for chemotherapy due to it being an area of flexion with increased risk of extravasation and infiltration. These patients need to undergo another venipuncture at DCFI for chemotherapy.
PIVC insertion is an invasive procedure that may increase patients’ discomfort and anxiety. Most patients tolerate a single venipuncture attempt, but repeated attempts result in increased pain. Multiple unsuccessful attempts cause delays in diagnosis and treatment. Delays of 15 to 120 minutes can occur in patients with poor peripheral access.
Incident reports at DFCI revealed 44 instances in which an initial PIVC was placed in the ACF by the imaging technicians in a 10 month span. Therefore, a team at DFCI sought to develop strategies that would reduce incidents of the initial PIVC being placed in the ACF.
Interviews with the imaging team revealed that technicians did not check patients’ appointment schedule to identify those with a same-day chemotherapy infusion. A checklist was developed to help technicians identify these patients and shared with the imaging staff.
Monthly reviews of incident reports showed a decrease to 9 submissions over 3 months. However, due to time limitation, data was insufficient to determine the change effect, explained Phuong Vo, BSN, RN, OCN®, MEDSURG-BC, a staff infusion nurse at DFCI, during her presentation.
Follow-up interviews with the imaging technicians revealed inconsistent use of the checklist. As this remains an ongoing project, explained Vo, the DFCI team is exploring other options for promptly identifying patients with same-day chemotherapy when the PIVC is inserted at the other facility.
In conclusion, Vo explained that staff and patients understand the importance of appropriate IV site for chemotherapy infusion. With the interdisciplinary nature of oncology care, the checklist helps assist in care transitions between departments, but staff noncompliance can be a barrier.
A future project will evaluate the use of a colored card during patient check-in to assist with quick identification of DFCI patients and prevention of PIVC insertion in the ACF, she added.
Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.
Vo P, DelSignore N, Austin M, Cloud J, Wright D. Improving patient safety through utilizing appropriate intravenous site. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.