Do policy and practice for PIVCs actually match Australia’s Clinical Care Standard?

Study Overview

This multi-site point prevalence study checked how well Queensland public hospitals follow the Australian Management of Peripheral Intravenous Catheters Clinical Care Standard (2021). Data were collected across 134 acute wards in 21 hospitals (8 health services). Among 2,247 screened patients, 1,117 had a PIVC; 788 consented for detailed assessment. The team mapped 10 Quality Statements (QSs) using the Standard’s 13 structural (policy) and process (bedside practice) indicators, plus additional measures.

Key Findings

Policies lag behind the Standard: Structural (policy) adherence for QS3-7 was 19-43%. Policies for insertion/securement (QS6) existed everywhere, but many gaps remained for competency, device/site choice, first-attempt success, and documentation.

Practice is mixed at the bedside:

• PIVC used therapeutically since insertion 91%; used in last 24 h 81%.
• Patients could identify the reason for their PIVC 86%.
• First-attempt success 70%; indication documented 80%; ongoing need assessed in last 24 h 61%.
• Clean, dry, secure dressing 81%; inspection documented ?8-hourly 42%.
• 53% of PIVCs were placed in an area of flexion (e.g., cubital fossa, wrist, ankle).

Bottom line: Only 2 of 10 QSs (20%) met overall binary adherence (all indicators satisfied).

Why it matters

Despite a clear national Standard, unwarranted variation persists across policies and practice—creating avoidable patient-safety risks and inconsistent care.

Actionable Takeaways

• Fix the policy baseline: Provide/statewide policy templates aligned to each QS (competency, device/site selection algorithms like MAGIC/MiniMAGIC, escalation and attempt limits, documentation requirements).
• Measure implementation, not just outcomes: Track fidelity/adoption/sustainability alongside CLABSI and dressing metrics; add service/cost indicators to enable resourcing and scale-up.
• Close the documentation loop: Standardise indication, 8-hourly inspection timestamps, and daily need review—embed prompts in electronic records.
• Target high-risk practices: Reduce area-of-flexion cannulation; escalate difficult access earlier; use ultrasound/experienced inserters per policy.
• Support behaviour change: Combine education + local champions + audits/feedback and consider validated tools (e.g., I-DECIDED®) to lift documentation and reduce idle PIVCs.
• System-level alignment: Coordinate local, jurisdictional and national strategies so rural/regional sites aren’t left behind.

Read more: https://www.idhjournal.com.au/article/S2468-0451(25)00058-6/fulltext 

Authors: Josephine Lovegrovea, Sally Havers, Jessica Schults, Gillian Ray-Barruel, Alice Bhasale, Samantha Keogh, Sarah Smith, Jemima Fritts, Amanda J. Ullman, Hui (Grace) Xu, Claire M. Rickard