Coordination of intravenous site selection for same-day imaging and chemotherapy

Choosing the Proper Insertion Site for Peripheral Intravenous Catheters (PIVC) Is Important for Patient Outcomes and Safety, Preventing Delays in Care, and Increasing Patient Satisfaction, According to a Presentation at the 47th Annual Meeting of the Oncology Nursing Society (ONS).

Oncology teams at the Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH) work together to care for adults with cancer. The collaboration allows patients to meet different specialists in each center in a single visit. For example, patients may undergo restaging exams at BWH prior to a same-day appointment for chemotherapy infusion at DFCI.

The initial peripheral intravenous catheter (PIVC) is placed in the antecubital fossa (ACF) at the BWH for contrast injection. However, DFCI policy specifies that the ACF is never the appropriate position for the PIVC for chemotherapy because it is a flexing area with an increased risk of extravasation and infiltration. These patients should undergo another DCFI venipuncture for chemotherapy.


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PIVC insertion is an invasive procedure that can increase patient discomfort and anxiety. Most patients tolerate a single attempt at venipuncture, but repeated attempts lead to increased pain. Multiple failed attempts lead to delays in diagnosis and treatment. Delays of 15 to 120 minutes may occur in patients with poor peripheral access.

Incident reports to DFCI revealed 44 cases in which an initial PIVC was placed in the ACF by imaging technicians over a 10-month period. Therefore, a DFCI team sought to develop strategies that would reduce incidents related to initial PIVC placement in the ACF.

Interviews with the imaging team revealed that technicians did not check patients’ appointment schedules to identify those who had received a chemotherapy infusion the same day. A checklist has been developed to help technicians identify these patients and shared with imaging staff.

Monthly reviews of incident reports showed a decrease to 9 submissions over 3 months. However, due to lack of time, there was insufficient data to determine the effect of the change, Phuong Vo, BSN, RN, OCN®, MEDSURG-BC, DFCI infusion nurse, explained during his presentation.

Follow-up interviews with imaging technicians revealed inconsistent use of the checklist. As this remains an ongoing project, Vo explained, the DFCI team is exploring other options to quickly identify patients with chemotherapy the same day when the PIVC is inserted at the other facility.

In conclusion, Vo explained that staff and patients understand the importance of an appropriate IV site for chemotherapy infusion. Given the interdisciplinary nature of oncology care, the checklist helps facilitate care transitions between departments, but staff non-compliance can be a barrier.

A future project will assess the use of a colored card during patient check-in to aid in the rapid identification of DFCI patients and the prevention of PIVC insertion into the ACF, she added. .

Read more from Oncology Nurse Advisorof coverage of the ONS 47th Annual Conference by visiting the conference page.

Reference

Vo P, DelSignore N, Austin M, Cloud J, Wright D. Improving patient safety through the use of an appropriate intravenous site. Oral presentation at: 47th ONS Annual Conference; April 27-May 1, 2022; Anaheim, California.

Martin E. Berry