How to Improve PIVC Education
Improving the standard of care will not happen immediately. But gradual improvement can result from a standardized training program that changes the way PIVC placement is taught and regarded.
Whether training is in-person or virtual, it should involve current, evidence-based education created and delivered by subject matter experts. A layered learning approach to the curriculum can keep students from being overwhelmed, as well as offer multiple opportunities to embed information in students’ minds so it is there for clinical practice, not just exam success.
Since many chemotherapeutics can be given safely peripherally, this is essential additional training for nurses who will be administering chemotherapeutics. Even before they get their chemo card, they should understand safe practices regarding the administration of vesicants, and the pitfalls of peripheral insertion errors as related to these infusions.
True shifts in practice and knowledge may take years, but change can happen by making an evidence-based curriculum on the fundamentals of peripheral IV access available at all nursing schools. If such a curriculum is used to teach nurses coming into the field, and simultaneously is used for annual competencies within hospital systems, then change may happen in an accelerated time frame.
Ideally, PIVC training should be introduced in Fundamentals, and then in each subsequent semester until the curriculum is completed. A model curriculum in the prelicensure program might look like this:
- First course Students get foundational knowledge, including how to assess a PIVC that already has been placed, infection prevention principles, legal aspects, and complications stemming from care and maintenance.
- Second course This should be the first course in which students learn how to safely insert a PIVC. At this time, they also learn about infusates, as well as the various complications that can arise from insertion of a PIVC.
- Final course Students are introduced to advanced topics, special populations, data collection, and research.
A condensed course can then be given each year as an annual competency in the licensed cohort.
This kind of layered learning is important because the insertion of a PIVC represents only a fraction of its life. How to assess, care for, and maintain these devices needs to be taught equally carefully. Adult learners need to know not just the “what” but the “why.”
For example: “Why do we need to make sure we let the skin disinfectant dry completely before the needle breeches the skin?” Simply telling nurses, “Wait 10 or 15 seconds before insertion,” is not good enough. If they know the reason for waiting is because bacteria die as the disinfectant solution dries, then the added time makes sense.
Another example: “Why can’t I put the PIVC in the AC? It’s so easy.” Nurses need to understand that the potential for a PIVC to piston in and out when placed in the AC area contributes to mechanical phlebitis and infection, as well as shorter dwell times. Plus, patients hate it when their pump alarms.
Such questions demonstrate why nurses should be taught to think through the PIVC procedure critically. They must consider the type of solution that will be introduced through the PIVC, as well as what else could potentially be introduced into the bloodstream through the PIVC and travel throughout the body. As nurses, we have seen hundreds of patients lying in bed with a dual lumen PICC and a PIVC in their arms. We’ve also witnessed a Staphylococcus aureus infection seed the PIVC, traverse the vessel to the PICC, and cause infective thrombophlebitis.
Perhaps most of all, new nurses need to gain the confidence to say, “I’m not ready for this patient” or “Is a PIVC the right device?” or “Let’s call the vascular access team because this patient is complex.” They need the courage to remind us all that a PIVC is not “just” a PIVC.
Data show us that PIVC placement is a skill in which nurse graduates lack confidence.2 But knowledge is power, and the long-term positive impacts of better PIVC placement training start with improved nurse confidence.
Enhancing nurses’ confidence undoubtedly translates into a better patient experience, too. Patients don’t want a PIVC in their hand, wrist, or AC area causing complications and getting in the way of eating, drinking, sleeping, and other daily activities. Fewer needle sticks, fewer infections, and easier activities of daily living can result in a more satisfying patient experience.
For oncology patients, fewer PIVCs also offer a proactive way to preserve as much vasculature as possible. Consider the damage done each time a vein is used. Especially in young cancer patients, the opportunity exists to minimize long-term negative effects.
For all patients, one of the greatest benefits of best-practice PIVC training stems from the potential to lower rates of infection. In addition to other health hazards, treatment is disrupted whenever patients acquire a catheter-related blood stream infection (BSI) or a central line-associated blood stream infection (CLABSI). Yet “several preliminary studies suggest that nearly as many BSIs are linked to PIVCs as to central lines.”8
One final benefit from better PIVC training is potentially lower healthcare costs. Complications such as those mentioned in this review are costly. Understanding best practices in PIVC placement and embodying these tenets are tantamount to preventive medicine. It is always less expensive to prevent a complication than to treat one.
Time to Raise the Standard of Care
Current PIVC education is conducted haphazardly.2,3 Some students receive stellar education, while others learn outdated or even substandard methods. Inherently, this does not work for patient safety, especially as oncology patients are some of the most vulnerable for which we care.
Conversely, meaningful improvements in patient care can result when the education of the student nurse mirrors that of the practicing nurse. A standardized, evidence-based curriculum that is developed by experts in the specialty of vascular access can arm nurses with both the “how” and the “why” of best practices. State-of-the-art PIVC education using a layered approach offers nurses an opportunity to raise the standard of oncology care.
Judy Thompson is director of Clinical Education at the Association for Vascular Access.
- iData Research. US Market Report Suite for Vascular Access Devices and Accessories. iData Research; 2020.
- Hunter MR, Vandenhouten C, Raynak A, Owens AK, Thompson J. Addressing the silence: a need for peripheral intravenous education in North America. J Vasc Access. 2018;23(3):157-165. doi:10.1016/j.java.2018.06.001
- Vandenhouten CL, Owens AK, Hunter MR, Raynak A. Peripheral intravenous education in North American nursing schools: a call to action. J Nurs Educ. 2020;59(9):493-500. doi:10.3928/0148434-20200817-03
- Cooke M, Ullman AJ, Ray-Barruel G, Wallis M, Corley A, Rickard CM. Not “just” an intravenous line: consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS One. Published online February 28, 2018. doi:10.1371/journal.pone.0193436
- Kaur P, Rickard C, Domer GS, Glover KR. Dangers of peripheral intravenous catheterization: the forgotten tourniquet and other patient safety considerations. In: Stawicki SP, Firstenberg MS, eds. Vignettes in Patient Safety – Volume 4. InTech Open; September 18, 2019. doi:10.5772/intechopen.83854
- Larsen E, Keogh S, Marsh N, Rickard C. Experiences of peripheral IV insertion in hospital: a qualitative study. Br J Nurs. 2017;26(19): S18-S25. doi:10.12968/bjon.2017.26.19.S18
- American Cancer Society. Low white blood cell counts (neutropenia). Last revised February 1, 2020. Accessed June 21, 2021. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/neutropenia.html
- Devries M, Valentine MJ. Bloodstream infections from peripheral lines: an underrated risk. Am Nurse. Published online January 13, 2016. https://www.myamericannurse.com/piv/