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Implementing Clinical Practice Guidelines for Replacing Peripheral Intravenous Catheters

Oh, Jong Hee MS, RN, CNL, CRNI, VA-BC; Shelly, Mark MD; Nersinger, Sharon MS, RN, NEA-BC; Cai, Xueya PhD; Olsan, Tobie PhD, RN, NEA-BC, CNL, FNAP

doi: 10.1097/NCQ.0000000000000429
Original Article: PDF Only

Background: A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to the clinical practice guideline (CPG) of clinically indicated replacement.

Methods: 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.

Results: 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 (P = .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.

Conclusions: 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.

Highland Hospital, UR Medicine, Rochester, New York (Mss Oh and Nersinger); Geisinger Medical Center, Danville, Pennsylvania (Dr Shelly); Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York (Dr Cai); and School of Nursing, University of Rochester, Rochester, New York (Dr Olsan).

Correspondence: Jong Hee Oh, MS, RN, CNL, CRNI, VA-BC, Highland Hospital, UR Medicine, 1000 South Ave, Rochester, NY 14620 (

The authors thank Professors Bonnie Walden, MS, CNL, RN-BC, RNC-OB, and Madeline H. Schmitt, PhD, RN, FAAN, FNAP

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: June 7, 2019

Published ahead of print: July 8, 2019

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