Vascular access is the most common invasive procedure performed in health care. In the United States alone, patients undergo more than 380 million peripheral intravenous catheter (PIVC) placements every year.1 Nearly everyone will undergo this procedure at some point in their lifetime. For patients with cancer, PIVCs are an all-too-frequent part of diagnosis and treatment.
Unfortunately, PIVC insertion also is one of the top 3 skills that graduate nurses feel uncomfortable performing.2 Why? Most reasons point back to training issues. For example, up to 57% of new graduate nurses never have an opportunity to insert a PIVC prior to licensure.2,3 Moreover, a little more than 10% of new graduates learn the skill through the age-old see-one- do-one-teach-one scenario.2
Today, this critical skill is taught in an inconsistent manner. If 3 nurses from 3 different universities start on a med-surg floor on the same day, the variability in their preparedness for PIVC insertion, care, and maintenance is palpable. Some students get outstanding education and hands-on proctoring from amazing preceptors who teach current best practices. Others are taught by preceptors who really care, but who pass down outdated techniques. Still others have preceptors who merely demonstrate how to do the task exactly the same way they learned.
Given this inconsistency, perhaps it should not be surprising that 33% to 69% of PIVCs fail before treatment completion,4 and that more than half of adults describe PIVC insertion as “moderately painful” or worse.4
However, healthcare professionals can elevate the standard of care by first acknowledging that there is a problem, and then taking meaningful steps to correct it. Across nursing schools and facilities, we can do a better job at teaching the importance and risks of the most common invasive procedure in healthcare.
The Missing Link in Current Education
Many nurses and patients simply accept that multiple PIVCs may be needed over the course of treatment. Changing that mindset starts by improving nurses’ knowledge of this vital procedure, including information on the most common causes of PIVC failure:
- Insertion site Areas of flexion cannot continue to be nurses’ “go-to” insertion sites. Although they may offer easy access, they are not the best for patients. Data prove that using these areas contribute to shorter dwell times, as well as more infections and mechanical phlebitis.5 In addition, patients experience increased discomfort and dissatisfaction with PIVCs in the hand, wrist, or antecubital (AC) area. 6
- Infusate characteristics Nurses need to understand how various infusates affect their patients’ vasculature. Extremes in osmolarity and pH, vesicants, and other irritants can have insulting effects on the intima of the vessels being accessed. For that reason, for example, caustic solutions should not be introduced into very-low flow areas where the blood return is unable to dilute the harsh endothelial interaction.
- Clinical attitudes Healthcare culture tends to take PIVC devices for granted, overlooking them as if inconsequential. As a result, they may not be adequately cared for or maintained per policy.
Increased healthcare costs and length of treatment can result from neglecting these factors.4 Therefore, PIVC placement is much more than putting a needle and tube in an arm. Sliding a catheter over a needle into a vein is a task. Teaching critical thinking and the procedure of venous access is the missing link in PIVC education.
PIVC insertion is an intentional process. Various factors must be taken into consideration to determine where and how to place the best device for the least amount of patient discomfort and the greatest likelihood of lasting throughout the duration of therapy. These factors include the patient’s age, medical history, current diagnosis, and planned therapy. Is the patient undergoing outpatient surgery, for example, or do they have osteomyelitis? The insertion site chosen should reflect a multitude of patient and clinical needs.
For oncology nurses in particular, comprehensive training on PIVC insertion, care, and maintenance is paramount for patient safety. PIVCs are a huge source of infection for all patients, but the risk for patients with cancer is exponentially higher due to chemotherapy-induced neutropenia.7 Every nurse on the oncology floor should know that the risk of infection and thrombosis from PIVCs is higher for these patients than almost any other group. 7
Still, healthcare professionals will only begin to view PIVCs as consequential to patient care if PIVC use becomes a consistent part of medical education. A more organized and comprehensive training approach is necessary.