Impacte de uma intervenção multimodal nas práticas de cateterização periférica por enfermeiros

Abstract

Background: Obtaining vascular access emerges as one of the most notable advances in modern healthcare. Across international settings, among the established vascular access techniques, none is more recurrent than peripheral intravenous catheterizations, with nurses being responsible for care delivery. However, a significant number of catheterizations fail prematurely, resulting from practices not properly informed by recent scientific evidence, posing a risk to people’s health and well-being. This reality is particularly challenging for people with cancer, who experience an increased risk of peripheral venous system depletion. In the literature, although incipient, some authors emphasize the potential of multimodal interventions in promoting efficient, safe, and sustainable nursing care for the person in need of peripheral intravenous catheterization. Aim: To assess the impact of a multimodal intervention (MI) on nurses’ peripheral intravenous catheterization practices in people with cancer. Material and methods: This is an action research study, developed in collaboration with a nursing team from a surgical service of an oncology hospital in Portugal. The study was developed based on six main activities: i) prospective observational study in the study setting, to assess the impact of nursing practices and technologies used on care-sensitive outcomes; ii) translation, adaptation, and validation for the Portuguese adult population of two peripheral intravenous system assessment scales; iii) development of a peripheral intravenous catheterization pack; iv) development of a clinical bundle informed by recent scientific evidence and the opinion of international experts in vascular access; v) conduction of discussion panels with the nursing team; and vi) prospective observational study, to assess the impact of the MI in the standardization and alignment of nurses’ peripheral intravenous catheterization practices, as well as in the prevention of associated complications. Results: Concluded the first activity, we found that peripheral intravenous catheterization practices were not consistent among the nursing team, occasionally differing from the existing recommendations in international guidelines, which may explain the low first- attempt success rates (67%), the high number of consecutive punctures attempts (M = 1.6; SD = 1.1, 1-8), and the significant premature failure rates (26%) observed. The implementation of the MI resulted in the delivery of nursing care to the person in need of peripheral intravenous catheterization informed by recent scientific evidence, especially when focusing on the involvement and assessment of the person's peripheral venous system, preservation of the aseptic no-touch technique, secure fixation of the peripheral venous catheter, post-insertion person education and surveillance by the team. The observed changes resulted in superior nursing care quality indicators in this field, with an increase in first-attempt success rates (86%; χ2(1) = 10.04; p = 0.002), a decrease in the number of consecutive puncture attempts (t(154) = 7.6, p = 0.007, d = 0.39) and in the premature failure rates observed (10%; χ2(1) = 8.7; p < 0.003). Conclusions: The MI (co)developed with the nursing team emerges as a structured response, sensitive to structural and process challenges, which enhanced the delivery of evidence-informed nursing care to the person in need of peripheral intravenous catheterization, with a significant impact in its quality and the person’s care experience.

Date of Award	13 Nov 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Sponsors	Fundação para a Ciência e a Tecnologia
Supervisor	Margarida Maria Vieira (Supervisor) & João Manuel Garcia do Nascimento Graveto (Co-Supervisor)