Implementation of a Phlebitis Prevention Bundle on a Neurotrauma Critical Care Unit

Abstract

Problem: Peripheral intravenous catheter (PIVC) associated phlebitis is a significant cause of morbidity leading to increased healthcare costs, prolonged lengths of stay, additional medical treatments, and increased mortality. Phlebitis, an inflammation of the vein, presents as redness, pain, warmth, streak formation, or a palpable cord. Annually, 80,000 patients with catheter-related blood stream infections are admitted to intensive care units; a large portion of these are attributed to PIVC phlebitis. The Society of Infusion Nurses supports the removal of emergently placed PIVCs and early detection of phlebitis. A neurotrauma critical care (NTCC) unit identified 68 cases of phlebitis over a 17-month period (M=4). PIVCs that are emergently placed or used for vesicant medication infusions are critical risk factors. Purpose: The purpose of this quality improvement (QI) project was to implement a Phlebitis Prevention Bundle (PPB) in a 13-bed NTCC unit of a major academic urban trauma center, determine adherence to the practice change, and monitor the incidence of phlebitis following vesicant-prone medications. Methods: This project was implemented over 15-weeks following education and training of the project champions and Registered Nurse (RN) staff (N=40). The PPB consisted of two practice changes, specifically the removal of emergently placed PIVCs, within 24 hours of admission to the unit and education pertaining to assessment of phlebitis, knowledge of common vesicants and documentation. Registered nurses completing the PPB training were recognized with a pin and certificate. Results: Registered nurses (n=40) completed education and training. Following educational sessions, adherence to the PPB reached 100% by Week 4 and was sustained for the last 9 weeks at 100%. During implementation, 25 (62.5%) PIVC were removed for early phlebitis, despite an increase in the mean incidence (M=13). Conclusions: Implementation of the PPB has the potential to increase quality of care for trauma patients and decrease the incidence of late phlebitis and its associated complications. Nursing assessment of phlebitis and its related complications has improved RN awareness prompting earlier removal of phlebitis PIVCs. Weekly display of PPB data using run charts helped to communicate practice change efforts, improve RN adherence, which in turn promoted acceptance and sustainability of the practice change.