Pediatric IV Infiltrates: Using the Guidelines and Benchmarks to get to Zero

Purpose:
Intravenous (IV) needle placement in hospitalized children is a common procedure. Patient safety issues related to maintaining IV sites are an important part of nursing practice.

Significance:
Not only are there inherent risks of IV infiltration and medication extravasation affecting patient safety, but parents and children exhibit a great amount of anxiety related to the IV placement and stability during the child's stay.

Strategy and Implementation:
Utilizing the Infusion Nurses Society (INS) evidence-based guidelines and standards our organization has had two consecutive years of zero IV infiltrate prevalence according to NDNQI data definitions. The guidelines that are strictly adhered to by our nursing staff include: topical anesthetic use every time an IV is started to ensure proper placement and minimize trauma, use of the smallest-sized and shortest-length catheter possible, sites are taped and secured using opsite dressing on insertion site to allow for ease in visibility and assessment, all sites are checked hourly and prn by the RN and documentation is completed, sites are flushed with 1-3cc of NS prior to starting any meds to ensure patency, and parents are educated on admission on what symptoms regarding the IV site would warrant immediate attention by the nursing staff.

Evaluation:
By utilizing the benchmarking data supplied by NDNQI, we are able to demonstrate our excellent patient outcomes to our staff, patients, and parents and assure them they are receiving the best evidence-based care and highest standards available.

Implications for Practice:
Importance of using evidence based guidelines and benchmarking to demonstrate success.