"Phase 1; Exploration of paramedic protocol for field IV insertion" and "Field IVs: To Replace or Not"
Submitted by Caitlin Wright, En-Dien Liao, and Dr. Deborah Behan
HURCA Abstract
Caitlin Wright, Senior II Nursing
Faculty Advisor: Dr. Deborah Behan, PhD, RN-BC
Phase 1; Exploration of paramedic protocol for field IV insertion
Current protocol at a south central hospital in the U.S. requires nurses to change field IVs within 24-48 hours. Changing IVs in-hospital result in patient duress and nurse time loss. This article reports data from the IV Insertion Protocol Survey and the Paramedic Educator Survey. These surveys attempt to identify paramedic protocol and practice related to IV insertion and aseptic technique. Further, the surveys explore paramedic education regarding IV insertion. Surveys were hand-delivered, participants were invited to participate in the anonymous survey, and data were then analyzed using RemarkOffice.
The results suggest paramedics are educated on the use of aseptic technique and that paramedics clean the IV site unless circumstances such as limited space or patient acuity prevent proper cleansing. Eighty-eight percent of participants report following a protocol, 64% almost never/never use hand sanitizer, and 83% of educators said that paramedics are not instructed to use hand sanitizer. In summary, paramedics use aseptic technique, which suggests that field IVs should not need to be replaced within 24-48 hours after a patient’s hospital admission.
Purpose Statement
The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol.
PHASE 1; EXPLORATION OF PARAMEDIC PROTOCOL
FOR FIELD IV INSERTION
OUTLINE
Introduction
• Background
o Some studies indicate that IV insertions are periodically performed without maintenance of aseptic technique.
• Problem and Purpose
o Current protocol at a South Central hospital in the United States requires nurses to change all field IVs within 24-48 hours after a patient’s admission.
o If paramedics are complying with a protocol requiring site cleansing before IV insertion, changing the IV in-hospital may not be necessary.
o The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol.
Materials and Methods
• IV Insertion Protocol Survey and the Paramedic Educator Survey were created for the study.
• The survey is a 10 item survey using a likert scale to determine paramedic practice and adherence to IV insertion protocol.
• A pre-written script was read before each survey.
• The survey was given to each paramedic, paramedic educator, and paramedic supervisor who chose to participate.
Results
• Eighty-eight percent said they follow a protocol for IV insertion.
• Eighty-nine percent of participants reported to always use aseptic technique and the remaining 11% reported almost always.
• Nine percent of participants always use hand sanitizer before inserting IVs in the field, and 64% almost never/never use hand sanitizer.
• Certain circumstances in the field may not allow for aseptic technique to be used.
• The Paramedic Educator Survey results showed that 100% of the educators teach cleaning of the skin before IV insertion.
Discussion
• The EMS providers that we surveyed do not have a protocol that is equivalent to hospital IV insertion protocols; they follow algorhythms.
• The results from the Paramedic Educator Survey suggest that paramedics are taught to use aseptic technique when inserting a peripheral IV
• The group felt that it was impractical to use hand sanitizer before applying gloves.
• Educators did not express the desire to begin teaching about the use of hand sanitizer.
• There is no form or official process of communicating whether or not the IV was placed with proper aseptic technique
• Future study recommendations: hand-off report between paramedic and receiving personnel, follow IVs in-hospital to see if there is a need for replacement
Conclusion
• EMS providers in this South Central region of the United States have been well educated on aseptic technique and IV insertion.
• Change of protocol could better manage nurse time, as well as provide substantial health benefits for the patient.
ABSTRACT
FIELD IVS: TO REPLACE OR NOT
En-Dien Liao, B.S. in Nursing
The University of Texas at Arlington, 2014
Faculty Mentor: Deborah Behan, Ph.D., RN-BC
Patients admitted to the emergency room via Emergency Medical Services with a field-established peripheral intravenous catheter (IV) were observed for 96 hours while in the hospital. Currently, many nurses restart the IV upon admission because they feel an IV started by a paramedic while in the field needs to be changed within 48 hours of hospital admission. The purpose of the study was to determine if field IVs started by paramedics could be utilized after patient admission to the hospital. Each day, observations of the IV site were recorded for signs of redness, swelling, and pain or tenderness, which would indicate the IV needed to be restarted. Results suggest that IVs started in the field by a paramedic in the ambulance may last up to 96 hours before they need to be changed.
PURPOSE STATEMENT
The purpose of this study was to determine if the field EMS IVs can last up to 96 hours without being changed by the nurse in the acute care setting. This study is aimed at identifying the aftereffects of IVs inserted in the field and determining whether or not pre-hospital IVs need to be replaced in the acute hospital setting within 24-48 hours of patient arrival.
OUTLINE
Introduction
Purpose
• The purpose of this study was to determine if the Emergency Medical Service (EMS) peripheral intravenous catheters (IVs) can last up to 96 hours.
Background/Literature Review
• Lawrence and Lauro (1988)- field-started IVs are 2.88 times more likely than hospital-started IVs to develop complications within 24 hours of insertion.
• Lee et al. (2009)- In the hospital setting, IV catheter replacement time can be extended from 48 up to 96 hours.
• Wright (2011)- evaluation of aseptic technique used by EMS personnel.
• 88% of EMS follows a protocol for IV insertion
• 100% always or almost always use aseptic technique when inserting field IVs
• All paramedic educators were found to teach cleaning of the skin with alcohol prior to IV insertion
Method
- On random days, the researcher went to the emergency room (ER) and identified patients who arrived by EMS with an EMS established IV.
- After admission orders, the patient was followed to room.
- Verbal consent obtained, and patients were followed for the next four days
- Data were collected each day on the following criteria: Site, redness, swelling, and pain/tenderness.
Result
• Total participants: 62 (134 measurements across 4 days)
• One participant withdrew, and another participant passed away
IV Location: Within the 134 measurements, 37 of the measurements were for an IV located in the right arm (33.9%). Seventy-two of the measurements were for an IV located in the left arm (66.1%).
IV Redness: Out of 134 measurements, 12 measurements had redness (9%) and 110 measurements did not have redness (82.1%).
IV Pain: Out of the 134 measurements, seven measurements were reported as pain or tenderness (5.2%) and 114 reported no pain or tenderness (85.1%).
IV Swelling: Out of the 134 measurements, seven had signs of swelling (5.2%) and 110 measurements did not (85.8%).
Discontinued Reasons ranked from highest to lowest: 36 due to discharge (64.3%), 6 to leaking (10.7%), 5 to policy removal (8.9%), 5 to pulled-out (8.9%), 2 to infiltration (3.6%), 1 to bruising (1.8%), and 1 to poor location (1.8%).
Conclusion
- EMS IVs may remain longer than 24 hours and up to 96 hours before they need to be changed.
- Potential benefits :
- Better quality of care for patients
- More time saved for nurses from restarting IVs
- Decreased cost to hospitals from reduced length of stays in hospitals.
- Majority of patients were left handed
- Inconsistency between system policy and actual bedside practice. Further education from nurse educators may be needed on the hospital’s IV policies.
- Future Research: correlation between IV needle size and IV leakiness.
- Wright (2011) found 82% of paramedics to use 18 gauge needles
- Leaking was found to be the 2nd highest cause for IV discontinued