University of California
Type of paper: Thesis/Dissertation Chapter
Evidence Based Practice Aseptic Technique for Peripheral IV Insertion
The significance of asepsis in the intravenous IV therapy is integral in the modern patient care because of the increased patients number requiring IV therapy due to changes in patterns of prescription and the today’s illnesses which has acute nature (Bofah et al, 2012). Peripheral Intravenous Cannulation according to Bofah et al (2012), is a procedure in which patent’s skin is punctured with a needle allowing a device to be temporarily inserted into the hand or forearm veins in administering intravenous medications or fluids, although other body sites can be used. It is vital to use intravenous drugs in the management of the patients who are hospitalized. The infections linked to the intravenous therapy may affect the blood stream or the skin around the insertion site of the catheter (Bofah et al, 2012). For this reason, Bofah et al (2012) suggested that general infection control and universal precautions measures need to be taken into considerations when undertaking a clinical procedure. However, specific measures need to be taken into consideration when administering intravenous therapy especially those in the home setting and the vulnerable patients.
Kampf et al (2013) conducted an observational intervention study on “Improving Patient Safety during the Insertion of Peripheral Venous Catheters. The aim of the study was to determine the application of specific steps for peripheral venous catheters insertion in clinical practice and implementation of a multimodal intervention with an aim of improving both optimum order and compliance with the steps. Results indicated that 202 insertions were observed during the intervention period and 207 in the control period (Kampf et al, 2013). Compliance significantly improved for 4 to 5 steps that are 11.6% – 57.9% for disinfection of hand before contact with the patient (Kampf et al, 2013). Skin antisepsis of the site of puncture compliance was high after and before intervention (99% after and 99.5% before). Specific steps performance in the correct order also improved, which is from 7.7% – 68.6% when 3-5 steps were done. From the description of the intervention by participants, 46.8% said it was helpful, 46.8% as neutral and 6.4% as disruption (Kampf et al, 2013). This indicated that a multimodal strategy, of improving compliance with peripheral venous safety steps of insertion of catheter and optimum procedure performance, was effective and regarded as helpful by the health professionals.
Bofah et al (2012) conducted a study, “Peripheral Intravenous Therapy: Focus on Asepsis Systematic Literature Review.” The aim of the study was to describe the principles that are involved in the preparation, management and administration of peripheral IV in the clinical setting. Systematic literature review was conducted on the published studies describing asepsis principles involved in the preparation, management and administration of peripheral IV in the clinical setting from the year 2005 to 2012 January (Bofah et al, 2012). The findings from the 1135 publications suggested that the healthcare professionals should consider the patients always as being susceptible. Additionally, practices of standardizations will help in a reduction of infection risk. Lastly, all healthcare professionals must be educated to ensure procedures and practices are consistent and are adhered to with the day-to-day practices (Bofah et al, 2012).
O’Grady et al (2011) developed guidelines for healthcare workers who insert the intravascular catheters and also for the people responsible for control and surveillance of infections in outpatient, hospital and healthcare hoe settings. The report was compiled by members of professional organizations that represent the disciplines of infectious diseases, critical care medicine, surgery, healthcare infection control, interventional radiology, anesthesiology, pediatric medicine, pulmonary medicine and nursing (O’Grady et al, 2011). The guidelines are to provide recommendations that are evidenced based for preventing infections related to intravascular catheter. The major areas of emphasis by the guidelines include (1) training and educating healthcare workers who maintain or insert catheters;(2)using sterile barrier precautions maximally during central insertion of venous catheter; (3) using alcohol with >0.5% chlorhexidine skin preparation for antisepsis; (4) avoiding the routine central venous catheters replacements as a strategy of preventing infection;(5)using sponge dressing that are impregnated by chlorhexidine and short-term central venous catheters that are impregnated by antibiotic/antiseptic if the infection rate is not reducing despite adherence to strategy 1 to 4 (O’Grady et al, 2011).
The strengths of the current research of Kampf et al (2013)was that the methodology of observations applied provided direct access to the variables under consideration rather than relying on some form of self-report like asking questions in questionnaires and interviews. The strength of Bofah et al (2012) was that it used 1135 publications that were a good sample size. The guidelines recommended by O’Grady et al (2011) had a strength of the input from different professional bodies and expert hence reliable.
The weaknesses of Kampf et al (2013) research is that might be having observer bias hence undermined its validity and reliability. The weakness of Bofah et al (2012) was that systemic review was not done under a set of guideline and standards hence could be unreliable. The weakness of O’Grady et al (2011) is that with the presence of many professionals, coming to a common ground in scenarios of disagreements affects the validity of the recommendations and guidelines.
Future research should address pediatric infections and resistant organisms in Aseptic Technique for peripheral IV insertion. There are much evidence supporting current nursing practice on different techniques of IV insertion including aseptic technique. Moreover, guidelines have been provided by a collection of all relevant heath professional and organizations. In addition, the current nursing practice is the best since it is widely used, it is supported by many different researches, and it is standardized. Meaning all healthcare professionals have a standard procedure of practicing as elaborated in the guidelines agreed by all professionals and healthcare bodies.
In conclusion, the essay discussed the evidenced based Aseptic Technique for peripheral IV insertion. The essay defined Peripheral Intravenous Cannulation before detailing what the paper will analyze. Three studies has been analyzed, and their strengths and weakness discussed. The paper then provided an area for future research before elaborating that there is enough evidence supporting current nursing practice. Lastly, the paper elaborated why the current practice is the best practice.
Bofah, Metropolia Ammattikorkeakoulu, Josephine Adu-tutu, & Lay, Albert Alexander. (2012). Peripheral intravenous therapy : focus on asepsis : Systematic literature review. Metropolia Ammattikorkeakoulu. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0CD8QFjAE&url=https%3A%2F%2Fwww.theseus.fi%2Fbitstream%2Fhandle%2F10024%2F42656%2FBofah_Josephine.pdf%3Fsequence%3D1&ei=hJ_AVKnGHaTV7QagyoCwBA&usg=AFQjCNHQcdW7lEuoXASBbH-A3ZNVZ7-nvQ&sig2=hCJEBzRL69lu8TtTSNFDHQ&bvm=bv.83829542,d.ZGUKampf, G., Reise, G., James, C., Gittelbauer, K., Gosch, J., & Alpers, B. (January 01, 2013). Improving patient safety during insertion of peripheral venous catheters: an observational intervention study. Gms Hygiene and Infection Control, 8, 2.). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850230/O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., … Healthcare Infection Control Practices Advisory Committee (HICPAC) (Appendix 1). (January 01, 2011). Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 52, 9, 1087-99. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106267/