A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to the clinical practice guideline
(CPG) of clinically indicated replacement.
Guided by Lean principles, a clinical nurse leader
(CNL) led a quality improvement small test of change on a 38-bed medical unit. The impact of the CPG was evaluated using quality, safety, and workflow measures.
Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P
< .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis
= .41) or catheter-related bloodstream infections. Nurses attributed the improvements in workflow (P
= .01) and the quality of patient care (94%) to the updated PIVC guideline.
Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, improved efficiency, and is being implemented hospital-wide. This project highlights and advances the CNL role in transforming healthcare.