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Abstract
Peripheral Venous Catheter (PVC) is a widely used device in the hospital setting and is often associated with significant adverse events that may impair treatment administration and patient health. The aim of the present study is to define the incremental benefits related to the implementation and the standardized and simultaneous use of three disposable devices for skin antisepsis, infusion, and cleaning, assuming the hospital's point of view, from an effectiveness, efficiency, and organizational perspective. For the achievement of the above objective, real-life data were collected by means of an observational prospective study, involving two hospitals in the Liguria Region (Northern Italy). Consecutive cases were enrolled and placed into two different scenarios: 1) use of all the three disposable devices, thus representing the scenario related to the implementation of a standardized optimal procedure (Scenario 1); 2) use of only one or two disposable devices, representing the scenario related to not being in a standardized optimal procedure (Scenario 2). For the definition of effectiveness indicators, the reason for PVC removal and the PVC-related adverse events occurrence were collected for each patient enrolled. In addition, an activity-based costing analysis grounded on a process-mapping technique was conducted to define the overall economic absorption sustained by hospitals when taking in charge patients requiring a PVC. Among the 380 patients enrolled in the study, 18% were treated with the standardized optimal procedure (Scenario 1). The two Scenarios differed in terms of number of patients for whom the PCV was removed due to the end of therapy (86.8% versus 39.40%, p-value = 0.000), with a consequent decrease in the adverse events occurrence rate. The economic evaluation demonstrated the sustainability and feasibility of implementing the standardized optimal procedure specifically related to the need for lower economic resources for the hospital management of adverse events occurred (€19.60 versus €21.71, p-value = 0.0019). An organizational advantage also emerged concerning an overall lower time to execute all the PVC-related activities (4.39 versus 5.72 minutes, p-value = 0.00). Results demonstrate the feasibility in the adoption of the standardized optimal procedure for PVC management, with significant advantages not only from a clinical point of view, but also from an organizational and economic perspective, thus being able to increase the overall operational efficiency of the hospitals.
Highlights
The Peripheral Venous Catheter (PVC) is a wisely used device in the hospital setting [1], representing an essential element of modern medicine, used for the administration of fluids, nutrients, drugs, and blood products, as well as in the collection of blood for examinations [2–4]
The present study aims at analyzing the management of the PVC process in clinical practice in term of the outcomes measures achieved in the implementation of a standardized optimal procedure for PVC implant and management
Focusing on the patients for whom the PVC removal was due to the development of adverse events (Table 3), it emerged that the implementation of the standardized optimal procedure guaranteed the lower level of occurrence for complications, considering, in particular, conditions of occlusion and phlebitis (p-value = 0.000)
Summary
The Peripheral Venous Catheter (PVC) is a wisely used device in the hospital setting [1], representing an essential element of modern medicine, used for the administration of fluids, nutrients, drugs, and blood products, as well as in the collection of blood for examinations [2–4]. Up to 70% of patients require a PVC during their hospital stay, and conservative estimates suggest that PVC days account for 15%-20% of total patient days in acute care hospitals [5]. Such devices are frequently used and often considered to present a low risk for the patient, PVCs are associated with significant adverse events that may impair treatment administration and patient health [6–8]. The short dwell time, which approaches the recommendation of the US Centers for Disease Control and Prevention (CDC) for catheter replacement, is usually the result of short operating times and short hospital stay [10, 12]. The development of any of the above complications would lead to the PVC’s removal before the end of its intended dwell time [14, 15]
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