Australian College of Nursing
Recommendations from the Australian College of Nursing on peripheral IV catheters, blood glucose self-monitoring, antipyretics, urinary catheters & x-rays for ankle trauma. The Australian College of Nursing (ACN) is the national professional organisation for nurses in health and aged care settings. ACN provides nursing expertise to government and key stakeholders, and seeks to enhance the expertise of nurses when providing leadership and contribution to policy, practice and delivery of health care.
Don’t replace peripheral intravenous catheter unless clinically indicated.
Peripheral intravenous catheters (IV) are routinely used for vascular access. The unnecessary removal and replacement of a functional IV catheter breaches skin integrity, posing an increased risk of healthcare-associated infection and trauma to patients. This in turn, frequently results in increased length of stay, less than optimal health care outcomes and unnecessary use of health resources.
Evidence suggests there is no significant difference in cases of phlebitis if peripheral IV catheters are replaced only when clinically indicated. Common clinical indications for replacement include phlebitis, infiltration and blockage.
Catheter related trauma and infection may also be minimised by vigilant monitoring of the insertion site by health care staff and removal of catheters as soon as it is no longer required.
- National Clinical Guideline Centre (UK). Infection: prevention and control of healthcare-associated infections in primary and community care: Partial update of NICE clinical guideline 2. London: Royal College of Physicians (UK) 2012.
- Morrison K, Holt K. The effectiveness of clinically indicated replacement of peripheral intravenous catheters: an evidence review with implications for clinical practice. World Views on Evidence Nursing 2015;12:(4)187-98.
- Webster J, Clarke S, Paterson D, Hutton A, van Dyk S, Gale C, Hopkins T. Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trail. BMJ 2008;337:a339
- Darvill J, Gardner A, Milbourne K, Gardner G. Routine replacement of short peripheral intravenous cannulae in children: evidence of an unnecessary practice. Australian Infection Control 2004;9:(4)138-41.
- Brown D, Rowland K. Optimal timing for peripheral IV replacement? BMC Medicine 2010;8:53.
- Webster J, Osborne S, Richard CM, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systemic Reviews 2015, Issue 8.
The Australian College of Nursing (ACN) as nursing lead, established a collaborative working party incorporating a diverse range of nursing expertise. Professional nursing bodies involved in initial collaboration included: Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM); CRANAplus; Australian Primary Health Care Nurses Association (APNA); Australian College of Mental Health Nurses (ACMHN).
ACN’s membership was consulted via publications, web site and ACN’s National Nursing Forum. This consultation provided a broad view from our members regarding planning and delivery of nursing care across Australia. An interactive session invited delegates to actively participate in identifying those nursing practices, interventions, or tests that evidence shows provide no benefit or may even lead to harm. This informative stimulating session examined a range of nursing practices and their effects on healthcare consumers.
At this point specialist nursing groups were approached for comment on our recommendations. This group included: Australasian College for Infection Prevention and Control (ACIPC); Australian Diabetes Educators Association (ADEA); Continence Nurses Society Australia (CNSA); Australian and New Zealand Urological Nurses Society (ANZUNS); Medical Imaging Nurses Association (MINA); and the Australian and New Zealand Orthopaedic Nurses Association (ANZONA). Final consultation with ACN Members and Fellows prior to submission ensured a collaborative result.
- 1 Don’t replace peripheral intravenous catheter unless clinically indicated.
- 2 Don’t restrict the ability of people with diabetes to self-manage blood glucose monitoring unless there is a clinical indication to do so.
- 3 Don’t routinely administer antipyretics with the sole aim of reducing body temperature in un-distressed children.
- 4 Don’t use urinary catheters to manage urinary incontinence unless all other appropriate options have proved to be ineffective or to prevent wound infection or skin breakdown.
- 5 Don’t initiate plain X-ray for foot and ankle trauma unless criteria of the Ottawa Ankle Rules are met.