Improving Peripheral Venous Catheter Insertion and Maintenance in the Emergency Department Using a Quality Improvement Bundle

Background: Peripheral venous catheter insertion and maintenance is a common procedure undertaken by various healthcare workers using variable techniques. Much research has been published on peripheral venous catheter insertion, maintenance, and strategies to limit complications and disparities. Despite existing evidence, not all healthcare systems or healthcare workers identify or use a standard insertion, maintenance, or documentation approach. A peripheral venous catheter insertion and maintenance bundle has been identified as a technique that could reduce the disparity between best practice and common practice for most patient populations. A bundle is a collection of minor interventions implemented as a group. Methods: A quality improvement project was developed to standardize peripheral venous catheter insertion, maintenance, and documentation at an urban emergency department. A chart review was conducted to determine baseline peripheral venous catheter insertion, maintenance, and documentation practices. A pretest and posttest were developed for emergency department staff to evaluate a change in knowledge of peripheral venous catheter best practices. An educational video was designed to describe the peripheral venous catheter bundle. Printed posters outlining the bundle and an additional tool for barrier reduction were also created. Post- education and post-implementation surveys were sent to staff members to evaluate the effectiveness of the education and bundle tool. Results: The data demonstrated that documentation was more complete following the intervention. Undocumented insertions fell from 24.6% (n=13) to just 6.0% (n=3). Data analysis found statistically significant improvements in the documentation of orientation, location, insertion attempts, patient tolerance, site assessment, and line status. Pretest and posttest data showed that ED staff knowledge improved significantly in several categories, most notably in using the appropriate gauge, identifying barriers to success, acknowledging correct procedure, and recognizing preferred anatomical sites. Most participants, 81.0% (n=30), reported the bundle was very easy to understand, and 89.19% (n=33) found the video component helpful to practice. All respondents (n=37) were either very satisfied or somewhat satisfied with bundle components and education. An increase of peripheral catheters placed in the antecubital site was reported post-intervention. Conclusions: The educational presentation and bundle tool appear to be valuable resources to help standardize peripheral venous catheter insertion and improve documentation, leading to safer care. Replication of this quality improvement project is needed to assess impact on other clinical outcomes such as complication rates, patient satisfaction and hospital costs. Future studies should incorporate increased sample sizes and variety of clinical settings.