Peripheral Intravenous Catheters (PIVCs) play an important role in the treatment of hospitalized patients, especially those who are critically ill. Among these patients, PIVCs are important tools to administer liquid treatment, blood products, parenteral feeding, and infusion of various medicines. Conversely, this practice makes patients vulnerable with increase morbidity, mortality, hospital cost and length of stay. According to the Centers for Disease Control and Prevention (CDC), approximately 4 million PIVCs are used per year, and the estimated mortality rate associated with Catheters Related Blood Stream Infections (CRBSIs) is 22.9 percent, with an average rise in hospital length of stay of 6 to 22 days and an estimated cost of $27321 per case (8).
Phlebitis is a medical condition in which a vein becomes inflamed, and this happens most often in the leg. The existence of bacteraemia originating from intravenous catheters is characterized as Catheter-Related Bloodstream Infections (CRBSIs). These infections are preventable and several healthcare administrations took this prospect to implement Evidence Based Practices (EBP) in order to reduce or eliminate them. Adhering to the intervention and utilizing a multidisciplinary approach with staff education can greatly reduce or prevent these infections (Andersen 540).
Several researches on the risk factors for infusion phlebitis have recently been published, and according to the findings, the length of catheterization is one of the risk factor for infusion phlebitis. The studies assume that extending the time a PIVC is in place raises the risk of CRBSIs and Phlebitis, but many hospitals have seen positive results following staff education and training. It’s critical to assess the need for education among home care staff and their families (Li, et al. 38). However, according to many research studies, the effect of educational programs on extending the indwelling time of PIVCs to 96 hours among hospitalized patients has been positive. However, the key cause of CRBSIs and phlebitis may be eliminated by following infection management procedures, conducting standardized audits, and providing nurse and patient education.
Nurses should always avoid risk factors including inappropriate skin preparation at the untended insertion site, poor hand hygiene, CVAD positioning in the femoral region, improper use or lack of Munchausen Syndrome by Proxy (MSBP) and contamination during insertion, and failure to follow the insertion checklist and procedure. Central Venous Access Devices (CVADs) are devices that are inserted into the body via a vein which allow fluids, blood products, and medicine to be administered into the bloodstream. Munchausen Syndrome by Proxy (MSBP) is a mental health condition in which a caregiver induces an illness or injury in an individual in their care. In order words, it is associated with a caregiver or guardian that cares for the child and inflicts harm to achieve attention.
According to Andersen, CRBSI preventive guidelines can only be effectively implemented in any facility if members of an interdisciplinary team are ready and able to participate. If this can be achieved, it will result in fewer illnesses, shorter hospital stays, improved health outcomes, and lower patient hospital bill burdens (423). According to Paşalolu and Kaya, the highest rate of phlebitis occur in catheters inserted for less than 48 hours, with a lower rate in catheters inserted for 49–96 hours and the lowest rate in catheters inserted for 97–120 hours (4). The requirement that a catheter be removed only for clinical indications is an unresolved problem for adult patients, according to the guidelines. Several hospitals have procedures that require IV catheters to be replaced every 72 to 96 hours, regardless of the clinical indication.
According to Oh et al., to avoid phlebitis, peripheral intravenous catheters should be replaced every 72 to 96 hours in hospitalized patients, and this is based on the lack of a demonstrable difference in the risk of phlebitis when catheters are left in place for 72 hours versus 96 hours (278). Paşalolu and Kaya indicated in their study that an indwelling time of more than 72 hours raises the risk of staphylococcus aureus bacteremia, phlebitis, and induced 9.5 percent of catheter-related infections compared to 23.7 percent in patients with central venous catheters in non-intensive care unit settings (4).
In the study of Andersen, Catheters made of Teflon, or polyurethane have less bacterial complications than those made of polyvinyl chloride or polyethylene (González López, et al. 119). There is no need to change peripheral catheters more often than every 72 to 96 hours to prevent infection and phlebitis, but it should be removed if a patient develops signs and symptoms of phlebitis, along with infections, or if a catheter starts malfunctioning (Andersen 540). If an instructional program is implemented, extending the indwelling time of Peripheral Intravenous Catheters (PIVCs) to 96 hours for hospitalized patients does not raise the risk of catheter-related bloodstream infections or phlebitis………………..