Implementation and evaluation of peripheral intravascular catheter flushing guidelines: A stepped wedge cluster randomised trial (Flush SWRCT)
This study was funded by a competitive Australian State Government (Qld) Health Innovation, Investment and Research Office grant to address the observed inconsistent peripheral intravenous catheter (PIVC) flushing practice and rate of PIVC failures. Peripheral intravenous catheters are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing.
The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on PIVC maintenance had on patient outcomes. The study used the innovative stepped wedge trial design to facilitate both implementation and evaluation of an educational intervention that reinforced flushing guidelines and the use of manufacturer prepared prefilled flush syringes.
We hypothesised that raising awareness about the importance of the maintenance of vascular access and the techniques to do this, coupled with products that facilitate adherence with guidelines, would minimise variation in practice and improve patient outcomes.
Results demonstrated that a multifaceted intervention combining clinical education, reinforcement of PIVC flushing guidelines, and use with manufacturer prepared prefilled flush syringes reduced both the proportion and risk of PIVC failure. Further, health economics analysis revealed that costs were significantly lower in the intervention group, and process evaluation showed that staff rated the educational intervention and product use highly. Evidence-based education, surveillance and products for post insertion PIVC management are vital to improve patient outcomes.