Closed/ Open IV Systems

PIV Dwell Times:​ Closed vs open Catheter Systems

Claire Law​Mackenzie Genatone​ Martha Morrill​ Melanie Helms​ Melanie Robbins

INDEXI. Introduction and BackgroundA. Who needs an IV? B. Traditional IV facts C. Closed-system IV facts D. What is dwell time? E. Risks vs. benefits F. Goals of EBP ProjectII. PICO and Clinical QuestionIII. Framework Model IV. Literature Review V. Ethical ConcernsA. Gaps in literature B. Areas for future researchVI. RecommendationsVII. Conclusion VIII. References

Introduction

The IV. A small device, but a crucial and intrinsic part of healthcare. The IV is a pathway to the vasculature of the body and more importantly a pathway to the life source of the body…the heart.

Who needs an IV?

“Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients” (Ray-Barruel & Alexander, 2023). “As the most commonly performed invasive procedure in all of healthcare, approximately 90% of hospitalized patients receive a PIVC at some point during their stay, and the majority receive more than one” (Steere, 2020). A patient might require an IV if they:

• Are receiving IV therapy: maintenance fluids, medications, inability to tolerate oral medications, etc.
• Are receiving a blood transfusion or may require one
• Are having surgery

“About one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, “just in case” they might be needed” (Ray-Barruel & Alexander, 2023).

Traditional IV Insertion

Traditional IV Facts

What are they?

“Peripheral intravenous (IV) lines, catheters or cannulas are indwelling single-lumen plastic conduits that allow fluids, medications and other therapies such as blood products to be introduced directly into a peripheral vein” (Beecham, 2022).

Disadvantages

“Open cannulae are associated with an increased risk of blood spillage from the cannula hub because blood leakage can only be controlled by complete vessel occlusion following removal of the stylet” (Shaw, 2017).

Closed-System IV Insertion

Closed-System IV Facts

• “Closed cannulae have the potential to: increase patient comfort; reduce the risk of complications associated with a peripheral IV cannula; reduce the risk of blood leakage and spillage; and reduce the risk of blood exposure for the practitioner and environment” (Shaw, 2017).
• “Closed integrated catheters are better regardless of similar cost because of much lower need for reinsertion” (Tamura et al., 2014.)
• One study reports reduced exposure to blood in 98% during peripheral venipuncture, reducing the potential for contamination of the professionals handling this catheter. The same study noted catheter displacement reduced by 84% because of its stabilizing platform, minimizing risks of local complications that lead to catheter removal and new punctures, consequently reducing costs of health facilities. Another international clinical trial included in this review showed statistically significant reduction risk of phlebitis in 29% and the relative risk for catheter-related infection in 20% (Danski et al., 2016).

What is dwell time and what affects it?

Dwell Time

• Dwell time or rate is the length of time that an intravenous device is left in place after being inserted into the patient
• Dwell times are dependent on a multitude of factors aside from the cannulation device which we have chosen to focus our study on. Other clinical indicators must be considered, including:
• vascular access training
• IV maintenance including flushing of the IV routinely
• assessment for complications
• need for continued use- IV should not be changed based on arbitrary times, but on clinical signs (infiltration, phlebitis, leaks, etc.)
• type of securement/ dressing used
• type of cleaning agent used to cleanse the skin before venipuncture
• technique/ skill of the person inserting cannula
• type of fluids being used (vesicants)
• site chosen for venipuncture
• setting (emergency)

This is a significant issue because....

An IV device that has a longer dwell time results in less venipuncture (IV insertion)

• This results in less cost, as well as reducing the amount of anxiety, pain, and fear for the patient
• “Most young children undergoing venipuncture experienced high preprocedural anxiety. Children with high preprocedural anxiety had increased odds of moderate to severe pain at venipuncture" (Lunoe et al., 2021).

Complications that can result from an IV...

Extravasation

Phlebitis/ Thrombophlebitis

Infiltration

Hematoma

Catheter associated bloodstream infection (CABSI)

Sepsis

Non-thrombus occlusion

Thrombus occlusion

Goals of EBP Project

Inform and educate on the clear benefits of the use of closed-system intravenous catheters.

• Despite higher initial cost per unit, use of closed-system intravenous catheters led to:
• Better patient outcomes
• Increased safety for medical personnel (less blood exposure)
• Longer dwell times
• Lower risk of complications such as phlebitis
• Increased cost-effectiveness in the long term

Clinical statement

In adult and pediatric patient populations in the acute care setting with a PIV, how does using closed catheter IV systems affect the dwell time of peripheral IVs vs. traditional angiocath systems?

PICO

Comparison

Population

Intervention

Outcome

Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model

The five-step approach of the ARCC model involves:

• Asking the clinical question (PICO format)
• Searching for the best evidence (ROL)
• Critically appraising the evidence (critique and analysis)
• Addressing the sufficiency of the evidence (Is there enough evidence to implement the change?)
• Evaluating the outcome of evidence implementation (evaluation of the desired outcome).

Literature Review

Potential ethical issues:

BENEFICENCE

• Utilizing current EBP and closed-system PIVCs ultimately results in cost savings for patients and hospitals.
• Some hospitals may be averse to switching to a new system which requires an initial investment in educating and training staff despite the benefits to patients.

NON-MALEFICENCE

• The longer dwell times reduce the number of needlesticks that patients are subjected to
• Venipuncture attempts can cause distress, pain, and anxiety for patients and also increase their risk for infections and other adverse outcomes
• Venipuncture can cause lasting damage (scarring) to veins which can lead to further complications in the future
• Closed-system IVs can reduce the blood exposure that healthcare workers are exposed to
• While this is an inherent occupational hazard, mitigating risks and increasing workplace safety is vital.

Gaps in literature

Areas for future research:

• Ongoing research is necessary to quantify the benefits of one system over the other and determine generalizability. (<5 years old)
• With more hospitals utilizing closed system PIVCs, more evidence should be compiled to advance EBP
• Different styles of closed system PIVCs could be compared to each other to determine most effective features

Studies are not comparing the same brands of units; there are many styles and types of both open and closed system PIVCs

Studies are specific to pediatrics or adults

According to Platt and Osenkarski (2018)

“While closed catheters are more costly than conventional catheters, reports suggest that they minimize the risk of accidental displacement, contamination, cross-contamination, and HCW exposure to hazardous bloodborne pathogens, such as the hepatitis C virus and human immunodeficiency virus. They also reduce the incidence of phlebitis and infection in patients with catheters, while increasing dwell times.”

Recommendations

Conclusion

There are many factors that affect the dwell time of peripheral intravenous catheters. A few of these are how often they are flushed, the type of medications being infused, placement of the catheter, the skill of the person placing it, and the type of cleaning agent used. Utilizing closed system catheters along with these other practices will elongate the dwell time of the PIV. This leads to better patient outcomes and is safer as it reduces the likelihood of complications and injuries.