Registered nurses' adherence to clinical guidelines regarding peripheral venous catheters: a structured observational study.

ABSTRACT

BACKGROUND: Peripheral catheterization is a common procedure, which affects numerous patients in health care today. Having peripheral venous catheters in situ might lead to complications such as thrombophlebitis and sepsis, and clinical guidelines have been developed to assist nurses in their decision-making. Several reasons are given for clinicians not always adhering to clinical guidelines, although such adherence might lead to fewer complications. AIMS: This paper aims to describe registered nurses' adherence to national and local guidelines on peripheral venous catheters by focusing on time in situ, site, size, and documentation at the dressing. An additional aim is to describe the thrombophlebitis frequency associated with peripheral venous catheters in situ. METHODS: Structured observational study of patients with peripheral venous catheters in situ, conducted from December 2004 to June 2005. Data of 343 peripheral venous catheters were analyzed. RESULTS: Nurses partly adhered to national and local guidelines concerning size and site. Guideline adherence concerning documentation at the dressing was low. The results showed that non-adherence pertaining to time in situ varied between 5% and 26.3%. Differences between adherence to national or local guidelines were shown for size, site, and documentation at the dressing. Mild thrombophlebitis (Grades 1 and 2) was observed in 7.0%. CONCLUSIONS: Nurses partly adhered to clinical guidelines. Differences in guideline adherence were observed for wards with local or national guidelines, as well as for wards with different specialities. In accordance with clinical guidelines, the nurses seemed to replace or remove peripheral venous catheters before any severe complications arose. IMPLICATIONS FOR PRACTICE, RESEARCH, AND MANAGEMENT Adherence to clinical guidelines has an impact for preventing patient complications and thus it is essential that nurses are aware of their existence. Feedback and discussions of guideline adherence or of complication rates might influence nurses' clinical decision-making.