An observational study of nurses’ intravenous flush and medication practice in the clinical setting

Introduction: Research has quantified the unacceptably high failure rate of peripheral intravenous catheters (PIVCs) prior to completion of prescribed treatment. Surveys and audits have highlighted inconsistencies in reported practice and guidelines. Aim: The aim of this study was to gain a 'real world' overview of nurses' intravenous (IV) flushing and medication practice, and compare this to current practice recommendations. Method: This was a single-centre, prospective observational study of IV flush and medication administration by nurses over a range of times on surgical and medical wards of a tertiary metropolitan hospital. Results: Eighty-two nurses were observed in the study, yielding 82 sets of observations. Most observations were for PIVCs (n = 77; 93%) with modes of delivery divided between IV bolus (n = 28; 34%), IV medication in a bag (n = 36; 44%), and IV burette (n = 18; 22%). Pre and post drug administration flushes were delivered in all cases of bolus delivery; however, flushing practice was less consistent with other delivery modes. The majority (n = 56/61; 91%) of flushes used 10 mL syringes with 0.9% sodium chloride. Nearly a third of nurses were not fully compliant with hand hygiene (n = 36/82; 32%) or of aseptic non-touch technique (ANTT) (n = 27/82; 33%) in the preparation phase. However, needleless decontamination was conducted in 99% of cases. Conclusion: Mixed forms of drug delivery were observed, with use of single bags predominating. This has implications for healthcare costs and infection control. Flushing practice was consistent for bolus delivery but inconsistent for bag and burette delivery. Adherence to hand hygiene and ANTT was also sub optimal. The limited studies on flushing practices to date are inhibiting recognition of this important patient quality and safety issue. Practice and guidelines need to be consistent with current best practice recommendations. Future studies need to minimise practice variation in trial protocol and/or acknowledge and account for varied practice with analysis