Painful, Pointless and Potentially Infectious Improving Perioperative IV catheter management Philippa Ratcliffe RN M.A. CNS, PACU

The Problem IV cannula inserted in the holding area were taped without using a Statlock® securement device requiring redressing in PACU In PACU the tape was then removed, IV exposed to potential microbe infections, and redressed with Statlock® and Tegaderm ®

Problems Painful to patients Risk of decannulation in the immediate post anesthetic period Potential for infection

Reasons for habit-based technique Common belief in the perioperative area that the existing Statlock® tubing was unable to deliver bolus fluids and medication

Good reason for a change Introduction of evidence-based peripheral I.V. securement device with wide-bore Statlock® extension set No financial implication to hospital JCAHO and OSHA recommended hospital-wide

Benefits IV cannula are secured from holding to PACU to final admission, reducing potential unscheduled IV restarts by up to 80% Reduces the rates of potential phlebitis and overall complications by 67% Frey, Anne Marie RN, BSN, CRNI(R); Schears, Gregory J. MD. Why Are We Stuck on Tape and Suture?: A Review of Catheter Securement Devices. Journal of Infusion Nursing. 29(1):34-38, January/February 2006.

Benefits Improvement in staff safety by limiting exposure to blood and accidental needle stick injury Increased patient satisfaction and reduction in patient stress Reduction in time that cannula are open to airborne microbes

How we conducted change Product extensively tested by David P Maguire, MD. Collaboration and cooperation from the anesthesiology department Teaching sessions made available for CRNA’s, Residents and Attending Anesthesiologists in all affected OR areas Posters in work area Additional sessions for PACU staff to remain vigilant for missed Statlocks®

One year later… 80 - 90% patients have an IV Statlock® in place on arrival to PACU – the remainder have had new IV’s started in the OR Reduction in catheter and tape manipulation Successful long term change of practice Reduction in staff risk

Next Steps Aim for all Arterial lines to have arterial Statlock® device placed at point of insertion Aim for all new IV’s inserted in the OR to have Statlock® Continuation of education by ensuring new residents and staff are aware of practice and hospital policy