Pvc maintenance-bundle

Peripheral Vascular Catheter Care Bundle

Version 2008-2

Don’t put them in; Get them out; Look after them properly

The Bundle
1. Checking the PVCs in situ are still required
2. Removing PVCs where there is extravasation or inflammation
3. Checking PVC dressings are intact
4. Considering removal of PVCs in situ longer than 72 hours
5. Performing hand hygiene before and after all PVC procedures

Improving process to improve outcome


This example of a Standard Operating Procedure illustrates one way to deploy the PVC
Bundle. You can use it as somewhere to start, but it is anticipated that locally the
bundle will be used in many different ways, for example, local decisions include: when
it is done, how often it is done, who does it and how the data are collected. Successful
implementation of this bundle can be achieved using the SPSP rapid cycle testing
methodology.

As long as the bundle criteria data are collected, and reported back then the bundle is
being done. Therefore please use this procedure as a starting point but do not consider
it to be prescriptive. To confirm the bundle criteria are fixed, how you execute the
procedure to complete the bundle criteria reliably is up to you and your team locally.

HPS would be delighted to assist in the sharing of good practice, please let us know of
anything you have identified that could help someone else do it better quicker. Email:
HPSinfectioncontrol@hps.scot.nhs.uk

Other tools that may help you with this bundle are found at
http://www.hps.scot.nhs.uk/haiic/ic/index.aspx


Example of a Peripheral Vascular Catheter (PVC) Care Bundle – Standard Operating Procedure
Statement PVCs cause phlebitis and insertion site sepsis; PVCs are the third leading cause of device-related blood stream infections. Complications arise directly
from their use and in particular if the care is sub optimal. We have a duty to our patients to optimise PVC care and to ensure that our PVC care does not
cause the patients harm. Monitoring our PVC care will assist us to optimise procedures and reduce the risk to patients.
Objectives Objectives:
1. To optimise Peripheral Vascular Catheter (PVC) care in OUR ward and reduce as far as possible any infectious complications.
2. To be able to demonstrate quality PVC care in OUR ward
Requirements Before the PVC Bundle Procedure can be Considered
Signed commitment from the clinical team: consultants; junior doctors, ward manager and nurse team to optimising PVC care.
Signed agreement from all consultants that named individuals on a weekly/named basis will undertake a PVC bundle, including agreement from the
clinical team for the actions within the bundle.
Named individuals competent in performing the bundle as written.
Prior to starting the PVC Bundle Procedure
Small clean trolley containing: Alcohol hand gel; Cotton wool balls;
Orange or Yellow waste bag; Small sharps container
Personal Protective Equipment (PPE): Disposable Gloves – non-sterile; disposable plastic apron
Procedure 1. Perform hand hygiene.
2. Collect a bundle sheet and complete the top boxes: name, location, etc.
3. Proceed to the first patient.
4. Introduce yourself to the patient and explain that you are checking all catheters to see if any need removed.
5. If it is not obvious ask ‘Do you have any of these needles, catheters or cannulae?’ If the answer is ‘no’ thank the patient, move on to the next patient
and go back to step 4. If the answer is ‘yes’ proceed to number 6.
6. If it is obvious they do have a catheter, or they have said they do, perform hand hygiene


7. Maintaining the patient’s privacy, ask to see the catheter insertion site – complete the bundle questions. Ask ‘buddy nurse’* to confirm hand hygiene
procedures and alcohol hub procedures have been optimal. NB Extra-vasiation may still be detected even if there is a sterile gauze dressing over the
insertion site, however, NEVER, remove a dressing just to view an insertion site. If the dressing does not facilitate observation of the insertion site
then score on extra-vasiation alone.
8. If deemed necessary, remove the catheter aseptically [wearing appropriate PPE]. If you are unsure as to whether to remove the catheter – confirm with
a member of the medical team the appropriateness of removing the catheter remaining in situ.
9. Perform hand hygiene.
10. Record actions/findings on the bundle sheet. If necessary record in the patient’s notes.
11. Go back and repeat steps 4-9 until all patients in the ward have been visited.
After care Complete form.
Give it to:
Discuss and display the data when it has been returned.
Keep Bundle forms for XX time

*A buddy nurse can be used to verify optimal care and to act as a reminder to the nurse in charge of an individual patient.
Each buddy nurse must be prepared to observe their colleague’s care, comment on it and in turn have their own practices scrutinised


Ward: Name of person performing the bundle
Date

Observation The PVC is still in use; Absence of inflammation The PVC dressing is The PVC has been Hand Hygiene before & What was
number and or extra-vasation intact inserted for <72 hrs. after all PVC procedures done
Continue Continue Continue Continue Continue PVC left in
Sample Yes bundle Yes bundle Yes bundle Yes bundle Yes bundle situ
Remove Remove Remove Request Request
No catheter No catheter No catheter No removal No removal PVC Removed
Yes bundle Yes bundle Yes bundle Yes bundle Yes bundle situ

1 Remove Remove Remove Remove Request
No catheter No catheter No catheter No catheter No removal PVC Removed


situ


Observation The PVC is still in use; Absence of inflammation The PVC dressing is The PVC has been Hand Hygiene before & What was
number and or extra-vasation intact inserted for <72 hrs. after all PVC procedures done

4 Yes bundle Yes bundle Yes bundle Yes bundle Yes bundle
Remove Remove Remove Remove Request PVC Removed
No catheter No catheter No catheter No catheter No removal






Summary Table of PVC Bundle Findings Comment (if required)
Total number of PVCs in situ at start of PVC Bundle
Total number of PVCs removed because they were not being used or were no longer required.
Total number of PVCs removed because of extravasation or insertion site inflammation
Total number of PVCs removed because the dressing was not intact or was inappropriate
Total number of PVCs in situ longer than 72 hours.
Total number of PVCs where hand hygiene has been performed before and after all PVC procedures*
All or None Table – Was PVC Care Today Optimal Tick if achieved
100% of PVCs in situ are required
0% (Zero) PVCs had extravasation or insertion site inflammation
100% of PVCs had appropriate and intact dressings
0% (Zero) PVCs removed as a consequence of the bundle round
0% (Zero) of PVCs were in situ >72 hours.
100% of PVCs were visible and well positioned
If all the above were achieved the PVC care was optimal
* Use a buddy HCW to demonstrate that hand hygiene has been done.
Signature of person completing the PVC bundle:
Date bundle completed

Pvc maintenance-bundle

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