Changing Intravenous Cannulas - Term Paper Example

Clinical Evidence Based Practice on Changing IVCs Name Institution Clinical Evidence Based Practice on Changing IVCs Introduction The implementation of evidence-based practice within the nursing profession has been long recognized as an important issue that facilitates the needed practice. The main aim of evidence-based practice (EBP) is to assist the nursing practitioners based their actions on the current evidence. Currently, the educated nurses understand the valuable role played by the nursing research since it challenges and tests the effectiveness of the care practices offered to the patients. Nevertheless, the nursing practice is still rooted within the myths (Canterbury District Health Board, 2010). To overcome such challenges, the practitioners need to recognize the significant role played by the evidence based care and improvement in the nursing care practice. Healthcare institutions need to create an environment that allows research-based care systems, which in turn influence the processes of the healthcare delivery systems. Development of research in practice should not surprise the nursing practitioners since it has long had interest in the identification of clear theoretical basis for the practice and considerable work examined in the link between practice, research, and theory. Recommended Timeframe for Changing Intravenous Cannulas (IVCs) It is important to follow the outlined healthcare policy since they are meant to reduce the vulnerability of people to various diseases. Research indicate that infections associated with intravascular cannulas remain a major problem within the healthcare and significantly relates with additional cost, morbidity, and mortality. Through the formation of the microbial biofilms, the infections become complicated with microbial cells detaching from the biofilm that causes infections. Moreover, most microorganisms are very resistant to the antimicrobial factors; so, frequent changing on the IVCs is important for successful treatment. This is a concept that Olivia failed to understand by accepting the views of a fellow nurse without adequate research. As a result, Olivia placed the patients at risk. Even though there are many strategies of reducing the risks associated with IVCs, antibiotic coated methods, improving the aseptic insertion care practices, impregnated methods, and implantation methods, institutional policies vary. Nonetheless, despite advancement in these methods, healthcare instructions have not been able to eradicate completely such infections. Access to quality healthcare is the right of every person globally; as a result, most healthcare institutions have developed practices in line with such rights and require all the practitioners to adhere to. Nurses deal with lives of people, which make health sector one of the most critical areas. The practice does not require theoretical applications or irrational decisions based on perceptions or the views of others (Fang, 2012). Olivia did not consider these factors. With increased scope of practicing IVCs, there comes increased professional accountability through demonstration of great knowledge while responding to cannulation, passion of the needed interpersonal skills that ensure accurate treatment and assessment, and acquiring and maintaining a high level of competence within the technical skills important to perform the IVC. Duration of the IVCs Cannulation of the IV presents various health risks for infections to the patients. The common patients that are vulnerable to the infections are those above 60 years of age, those that have experienced IV phlebitis site infection, emaciated, and immune-compromised. The commonly witnessed form of disease is the purulent release; however, it might not be the evidence unless there is removal of the device. To prevent such infections, there is need to undertake frequent check on the cannula site while administering the drug or saline flush that needs to be done in every 8 hours using Normal Saline. According to the Centers for Disease Control and Prevention (CDC), it is crucial to change the peripheral IV cannula after every 72 hours in a bid to prevent the infections and phlebitis. Based on the experience of Charlotte, Olivia’s friend, changing the IVC on a frequent basis is a waste time and resources (Zhang & Rickard, 2013). Patients’ safety and welfare is the objective of healthcare institutions; as a result, the manner in which Charlotte practices nursing raise questions on her knowledge on clinical evidence based practice. In the event the nurses are asked to change the cannula because of the suspected phlebitis, it is of great significance to recognize the symptoms and signs and having great understanding of phlebitis. There are many interventions established with an aim reducing the incidences associated phlebitis. Some of the commonly used methodologies are new IVCs materials, innovative techniques to secure the IVCs, and heparinized IVCs. The extensively practiced method is the routine replacement of the device. The CDC advocated for the replacement of devices in every 72-96 hours to limit the infection; however, such recommendations are based on scant evidence (Schultz, 2005). Most recent research, especially those on observational studies, indicates that the devices may be left in place for longer days. This is the theory that Charlotte’s healthcare facility used; however, Olivia should have noticed differences in institutional policy. To some extent, it might be argued that the two healthcare institutions use different types of devices. Despite the research holding such stand, some evidence reveal that phlebitis is more likely to take place two days after insertion. Accordingly, removal of a functional device and re-sitting it might expose the patients to various health complications. Despite the increased use of the devices and their universal acceptance for the need of ensuring routine replacement, the practices have for many years experience little evaluation. In responding to the health complications associated with the device, the hospital developed a strict policy that would ensure the removal of IVCs on a daily basis. There is no addition time for extension of removal. Furthermore, the hospital included the replacement time, which Olivia was aware of and had to act depending on the hospital’s schedule (The Royal Children's Hospital Melbourne, 2015). Failing to comply with the policy was a complete violation of the practice. In this case, it seems that the healthcare facility undertook some steps to prevent the infections. Replacement of the devices seems to be simple, inexpensive, and evidence based practice considered important for prevention of the risks associated with the device in the future. IVCS and Evidence Based Practice Despite many practices used in preventing healthcare risks associated with the device, there one thing that stands: the optimal frequency of changing the IVCs. As highlighted in the research, there is lack of strong evidence supporting the routinely changing of the devices after every 72 hours as projected with most studies. It is evident that longer day, more than 48 hours, IVCs dwelling time is risk factor for the occurrence of phlebitis. Some research undertaken reveal that most of the cases of phlebitis are associated with culture-negative which suggests that local inflammation are not caused the infection and extension of the scheduled IVCs for replacement at the interval of 48-72 hours and 72-96 hours do not significantly increase the risk of microbiologically proven infections. Recent research revealed that there is no conclusive evidence of the benefits associated with changing the device every 72-96 hours compared with the clinically indicated with reference to the IVCs related complications. A longer replacement schedule has significant benefits in ensuring the comfort of the patients and cost savings, which should be weight against the potential harm of the increased health risks of the device like bacteremia (Brown & Rowland, 2013). Therefore, there is need for properly trained healthcare practitioners who are not driven by their emotions or theoretical concepts. In absence of properly trained IVCs practitioners, the replacement needs to be undertaken when the clinically indicated carries the risk associated with delaying of the infection by the inexperienced staff until the recognition of the infection. Among the adult patients, replacement of the device at interval of 72-96 hours is more comfortable and less expensive compared to the routine 48-72 hours exchanges without significant increment in the infection risks (Shlamovitz, 2017). The healthcare facility in which Olivia works attributed such adverse event to non-adherence to the required standards of operating procedure while strictly enforcing the replacement of the device in every 72-96 hours, which is considered consistent with recommendations of the CDC. Even though that is a straightforward and a commendable solution to lacks adequate capacity to prevent the future occurrence. Therefore, it is important to direct the efforts towards improving the expertise among the nurses and healthcare practitioners on insertion and maintenance of the device instead of focusing on the replacement schedule (Queensland Department of Health, 2015). For the healthcare sector and facilities to ensure the best practices, then it is important that they consider hiring qualified healthcare personnel trained on the IVCs which reflects the most effective method of reducing various health complications associated with the device. In most cases, the replacement occurs after every three to four days in a bid to prevent irritation of the vein or infection of the blood. Nonetheless, such practices are likely to cause discomfort among the patients, and it is costly practice. Generally, the management of skills is important and necessary especially with the integration of evidence-based practices in a bid to facilitate quality of the care system. References Brown, D., & Rowland, K. (2013). Optimal timing for peripheral IV replacement? J Fam Pract, 64(2), 200–202. Canterbury District Health Board. (2010). Peripheral Intravenous Cannulation Self Learning Package. Retrieved April 24, 2017, from https://www.cdhb.health.nz/Hospitals-Services/Health-Professionals/Education-and-Development/Study-Days-and-Workshops/Documents/SELF%20LEARNING%20Cannulation%20Package%20011013.pdf Fang, C. T. (2012). Peripheral IV in Too Long. Retrieved April 24, 2017, from https://psnet.ahrq.gov/webmm/case/278/peripheral-iv-in-too-long Queensland Department of Health. (2015). Peripheral intravenous catheter (PIVC). Retrieved April 24, 2017, from https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf The Royal Children's Hospital Melbourne. (2015). Clinical Guidelines (Nursing) : Peripheral intravenous (IV) device management. Retrieved April 24, 2017, from http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intravenous_IV_Device_Management/ Schultz, A. A. (2005). Evidence-based quality improvement project for determining appropriate discontinuation of peripheral intravenous cannulas. Evidence-Based Nursing, 8(1), 8-8. Shlamovitz, G. Z. (2017). Intravenous Cannulation: Background, Indications, Contraindications. Retrieved April 24, 2017, from http://emedicine.medscape.com/article/1998177-overview#a1 Zhang, L., Keogh, & Rickard. (2013). Reducing the risk of infection associated with vascular access devices through nanotechnology: a perspective. International Journal of Nanomedicine, 8(2), 4453–4466. Read More