What's the recommendation for flushing practice to keep a PIVC patent?
The purpose of intermittent flushing is similar to slow continuous infusion to keep vein open (KVO). Intermittently rinsing the peripheral intravenous catheter (PIVC) (with 0.9% sodium chloride) is thought to maintain catheter patency by preventing internal luminal (inner surface) occlusion. This theoretically reduces the formation of blood clots, bacterial biofilm, drug precipitate (interactions between incompatible fluids/medicines), and reduces the risk of occlusion.1
Recent trial research2 revealed that a multifaceted intervention bundle combining clinical education, reinforcement of PIVC flushing guidelines, and complementary product use (prefilled saline syringes) reduced the proportion and risk of PIVC failure, improved cost effectiveness of PIVC maintenance, and was rated favourably by clinicians.
The concept of bundling key steps from lengthy practice guidelines into a set of point-of-care reminders to improve staff compliance is not new. There is evidence that a combination approach to interventions or the processes of care delivery is an advantageous approach that consistently yields improved outcomes compared to single interventions.3,4
Researchers of this new study demonstrated that raising awareness about the importance of maintenance of vascular access and the techniques to do, coupled with products that facilitate adherence with practice recommendations, minimised variation in practice.
Take home message
There is currently no specific guiding principle for choosing between intermittent flush and KVO Infusion. From research to date, it seems that excessively low and high shearing forces contribute to platelet and/or endothelial activation.
It may be that a combination of steady KVO infusion and gentle intermittent flushing is the best way to safely keep PIVCs working.
References:
1. Infusion Nurses Society. Infusion Nursing Standards of Practice. Journal of Infusion Nursing, 2016;39:Suppl.
2. Keogh S, Shelverton C, Flynn J, Mihala G, Mathew S, Davies KM, Marsh N, & Rickard CM. Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial. BMC Med, 2020;18(1):252. doi: 10.1186/s12916-020-01728-1.
3. Lavallee JF, Gray TA, Dumville J, Russell W, & Cullum N. The effects of care bundles on patient outcomes: a systematic review and meta-analysis. Implement Sci 2017;12(1):142. doi: 10.1186/s13012-017-0670-0.
4. Ray-Barruel, G, Xu H, Marsh N, Cooke M, & Rickard. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Infect Dis Health 2019;24(3):152-168. doi: 10.1016/j.idh.2019.03.001.
