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J Nurs Care Qual. 2019 Jul 8. doi: 10.1097/NCQ.0000000000000429. [Epub ahead of print]

Implementing Clinical Practice Guidelines for Replacing Peripheral Intravenous Catheters.

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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).



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 (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.


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.

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