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Aim: To explore the barriers and facilitators influencing emergency department clinicians' adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard, using the Behaviour Change Wheel (BCW)., Background: Suboptimal PIVC practices are frequently linked to a range of patient-important adverse outcomes. The first Australian Peripheral Intravenous Catheter Clinical Care Standard was introduced in 2021, aiming to standardize practice. However, a recent national survey revealed a lack of adherence to the Standard among emergency department clinicians., Design: A qualitative descriptive study., Method: The study was conducted across two Australian emergency departments in 2023. Utilizing purposive sampling, semi-structured interviews were conducted. The analysis incorporated both deductive and inductive approaches, mapping the findings to the BCW., Findings: Interviews with 25 nurses and doctors revealed nine key subthemes. The main barriers were the stressful environment, insufficient education and training, and the absence of a feedback mechanism. The main facilitators were recognition of suboptimal practice, belief in the importance of patient engagement, and the desire to improve practice., Conclusion: Multiple complex factors have an impact on clinicians' adherence to the Standard. The identified interventions will serve as a guide for future implementation of the Standard., Implications for the Profession and Patient Care: The findings inform healthcare organizations of the significance of implementing strategies to enhance clinicians' acceptance of the Standard. Clinicians should consider incorporating the multifaceted interventions developed in accordance with the BCW for future implementation projects., Impact: Promoting adherence to standards opens avenues to challenge suboptimal practice and has the potential to instigate a culture shift in the fundamental skills of frontline clinicians., Reporting Method: The study is designed and reported according to the Consolidated Criteria for Reporting Qualitative Research checklist., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Paediatric patients with complex or acute conditions may require a central venous access device, however, almost one-third of these devices have associated complications (e.g. infections). Implementation of evidence-based practices regarding central venous access devices can reduce and potentially prevent complications., Aims: This scoping review aimed to explore recent interventional research in CVAD management through an implementation lens., Design: This scoping review used the Arksey and O'Malley framework. Studies were included if they were written in English, published in 2012 to July 2023, involved children and were relevant to the study aims. Risk of bias was appraised by the Mixed Methods Appraisal Tool., Data Sources: Searches were undertaken in EMBASE, CINAHL (Ebsco), PubMed, Web of Science and Cochrane Library (CENTRAL)., Results: Of the 1769 studies identified in a systematic search, 46 studies were included. Studies mostly focused on health professionals and central venous access device maintenance and had quantitative pre-post study designs. Adherence to implementation frameworks was lacking, with many studies employing quality improvement approaches. Implementation strategies were typically multipronged, using health-professional education, bundles and working groups. Bundle compliance and reductions in central line-associated bloodstream infections were the most featured outcomes, with most studies primarily focusing on effectiveness outcomes., Conclusion: Translation of evidence-based practices to the clinical setting is difficult and current adoption of implementation frameworks (apart from 'quality improvement') is limited. Implementation strategies are diverse and dependent on the local context, and study outcomes typically focus on the effectiveness of the physical intervention, rather than measuring the implementation effort itself., Implications for Patients: Future intervention research requires a more uniform and deliberate application of implementation frameworks and strategies., Impact: Greater exploration of relationships between frameworks and strategies and implementation and service outcomes is required to increase understanding of their role in maximizing resources to improve health care. Adhered to best reporting guidelines as per PRISMA-ScR (Tricco et al., 2018)., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose., Aim: In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long-term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport., Design: Multi-site, parallel, multi-method, prospective cohort study., Methods: A multi-site, multi-method study was carried out in 2020-2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months., Results: Overall, utility rates were acceptable, with 78.3% (N = 36) using the IV Passport over the follow-up period, with high rates of planned future use for those still active in the project (N = 21; 73%), especially in the child/family cohort (N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5-10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality., Conclusion: Several recommendations were made to improve the end-user experience including 'how to' instructions; and scheduling functionality for routine care., Implications for the Profession And/or Patient Care: The IV Passport can be safely and appropriately integrated into healthcare, to support consumers., Impact: Patient-/parent-reported feedback suggests the Intravenous Passport is a useful tool for record-keeping, and positive communication between patients/parents, and clinicians., Reporting Method: Not applicable., Patient Contribution: Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital., Methods: This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies., Results: The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk., Conclusion: HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations., Implications for the Profession and Patient Care: This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies., Impact: The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care., Reporting Method: STROBE guidelines., No Patient or Public Contribution: There was no patient or public contribution to the conduct of this study., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI., Design: A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023., Methods: Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach., Results: Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence., Conclusion: These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings., Impact: Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs., Patient or Public Contribution: No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice., Background: Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice., Design: Qualitative description., Methods: A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi-structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis., Results: There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress-before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre-determined theme, (4) Recommendations for good clinical practice is also described., Conclusions: Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims: The aim of this study was to critically evaluate implementation frameworks, strategies and/or outcomes used to optimise peripheral intravenous catheter (PIVC) care and/or promote guideline adherence., Background: Although a considerable volume of research has investigated the effectiveness of PIVC interventions and treatments to promote performance and prevent harm, how to best implement this evidence into dynamic clinical settings and populations is not well understood. Implementation science is central to translating evidence-based knowledge to the bedside; however, there is a gap in identifying the best implementation framework, strategies and/or outcomes to optimise PIVC care and/or guideline adherence., Design: A systematic review., Method: The review was conducted using innovative automation tools. Five databases and clinical trial registries were searched on 14 October 2021. Qualitative and quantitative PIVC intervention studies reporting implementation strategies were included in the review. Data were extracted independently by experienced researchers in pairs. The Mixed Method Appraisal tool was used to assess the quality of individual studies. Narrative synthesis was used to present the findings. The systematic review was reported following the PRISMA checklist., Results: Of 2189 references identified, 27 studies were included in the review. Implementation frameworks were used in 30% (n = 8) of studies, with most used during the preparation (n = 7, 26%) and delivery phase (n = 7, 26%) and then evaluation phase (n = 4, 15%). Multifaceted strategies were commonly adopted (n = 24, 89%) to promote PIVC care or study interventions which were clinician (n = 25, 93%) and patient-targeted (n = 15, 56%). The most commonly reported implementation outcomes were fidelity (n = 13, 48%) and adoption (n = 6, 22%). Most studies were scored as low quality (n = 18, 67%)., Conclusion: We call for researchers and clinicians to work together and use implementation science frameworks to guide study design, implementation and evaluation in future PIVC studies, to improve evidence translation and thereby improve patient outcomes., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aim: To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure., Design: Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement., Data Sources: The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000-21 September 2020., Review Methods: Studies enrolling hospitalised participants >16 years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists., Results: Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence., Conclusion: Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications; multiproduct dressing and securement bundles were prevalent; and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Paediatric peripheral intravenous catheter (PIVC) insertion using traditional landmark insertion technique can be difficult., Aim: To systematically review the evidence comparing landmark to ultrasound guidance for PIVC insertion in general paediatric patients., Study Design: Cochrane methodology to systematically search for randomised controlled trials comparing landmark to ultrasound-guided PIVC insertion., Data Sources: Cochrane Central Register of Controlled Trials, US National Library of Medicine, Cumulative Index to Nursing and Allied Health, Embase., Data Extraction: English-language, paediatric trials published after 2000, reporting first-attempt insertion success, overall PIVC insertion success, and/or time to insert were included. Central venous, non-venous and trials including only difficult intravenous access were excluded. Data were independently extracted and critiqued for quality using GRADE by three authors, and analysed using random effects, with results expressed as risk ratios (RR), mean differences (MD) and 95% confidence intervals (CI). Registration (CRD42020175314)., Results: Of 70 titles identified, 5 studies (995 patients; 949 PIVCs) were included. There was no evidence of an effect of ultrasound guidance, compared to landmark, for first-attempt insertion success (RR 1.27; 95% CI 0.90-1.78; I 2  = 88%; moderate quality evidence), overall insertion success (RR 1.14; 95% CI 0.90-1.44; I 2  = 82%; low quality evidence), or time to insertion (mean difference -3.03 min; 95% CI -12.73 to 6.67; I 2  = 92%; low quality evidence)., Limitations: Small sample sizes, inconsistent outcomes and definitions in primary studies precluded definitive conclusions., Conclusions: Large clinical trials are needed to explore the effectiveness of ultrasound guidance for PIVC insertion in paediatrics. Specifically, children with difficult intravenous access might benefit most from this technology., (© 2022 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: Central venous access devices (CVADs) are vital medical devices to support the treatment of paediatric cancer; however, device occlusion is common, which disrupts treatment. This study aimed to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic, clinical and device characteristics associated with increased risk for CVAD occlusion., Methods: A pre-post-implementation study was conducted at a metropolitan paediatric oncology facility in Australia, using the Theoretical Domains Framework. Patients with a CVAD for anti-cancer therapy were prospectively followed for occlusive events pre- and post- the implementation of clinical resources to support the identification and management of CVAD occlusive events. CVAD occlusion and management data were collected and compared pre- and post-implementation. Risk factors for CVAD occlusion were described by mixed-effects Poisson regression and incident rate ratios (IRR)., Results: A total of 133 CVADs were inserted into 131 patients for a total of 6784 catheter days. The incidence of CVAD-related occlusion pre-implementation was 59.7 (95% confidence interval (CI) 51.4-69.0, per 1000 catheter days); compared to 31.6 (95% CI 26.4-37.6); P < 0.01) post-implementation of clinical resources. In multivariate models, other than post-implementation phases (IRR 0.51 (95% CI 0.32-0.81)), only neutropaenia significantly increased the risk of CVAD occlusion (IRR 2.14 (95% CI 1.15-3.97))., Conclusion: CVAD occlusions in paediatric oncology are common. The development and implementation of CVAD occlusion resources to guide the identification and management of occlusive episodes led to a significant decrease in occlusive events., (© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aims: The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications., Design: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies., Data Sources: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019., Review Methods: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models., Results: Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies., Conclusion: Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced., Impact: Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters., (© 2020 John Wiley & Sons Ltd.)

Aim: To describe practice evolution, complications and risk factors for multiple insertion attempts and device failure in paediatric central venous access devices (CVADs)., Methods: A paediatric retrospective cohort study using prospectively collected data from CVAD database 2012-2014. Data included were patient (i.e. age, condition), insertion (i.e. indication, device, technique) and removal (complications, dwell). Descriptive statistics and incidence rates were calculated per calendar year and compared. Risk factors for multiple insertion attempts and failure were explored with logistic regression and cox regression, respectively., Results: A total of 1308 CVADs were observed over 273 467 catheter-days in 863 patients. Multiple insertion attempts remained static (14%) and significantly associated with non-haematological oncology (odds ratio 2.19; 95% confidence interval (CI) 1.08-4.43), respiratory (3.71; 1.10-12.5), gastroenterology (4.18; 1.66-10.5) and other (difficult intravenous access) (2.74; 1.27-5.92). CVAD failure decreased from 35% (2012) to 25% (2014), incidence rate from 1.50 (95% CI 1.25-1.80) to 1.28 (1.06-1.54) per 1000 catheter-days. Peripherally inserted CVAD failure was significantly associated with lower body weight (per kilogram decrease, hazard ratio (HR) 1.02; 95% CI 1.00-1.03), cephalic vein (1.62; 1.05-2.62), difficult access (1.92; 1.02-3.73), sub-optimal tip placement (1.69; 1.06-2.69) and gastroenterology diagnosis (2.27; 1.05-4.90). Centrally placed CVAD failure was significantly associated with younger age (per year, HR 1.04; 95% CI 1.00-1.07), tunnelled device (3.38; 2.41-4.73) and gastroenterology diagnosis (1.70; 1.06-2.73)., Conclusions: While advancement in CVAD practices improved overall CVAD insertion and failure outcomes, further improvements and innovation are necessary to ensure improved vessel health and preservation for children requiring CVAD., (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery., Methods: A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7-14 days post-surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016., Results: The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra-operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32-45% at 4-20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post-discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post-operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re-admitted., Conclusions: There was variety in perioperative and post-discharge care. Pain scores were infrequently documented post-tonsillectomy, and parents are generally dissatisfied with the management of post-operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery., (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aims and Objectives: To explore nurses' decision-making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings., Background: Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter-related bloodstream infection; however, emerging evidence is challenging traditional hang-time durations. Nurses' perceptions and contextual factors affecting decision-making for administration set replacement have not been assessed previously., Design: Qualitative study using focus groups with contextualism methodology and inductive analysis., Method: During November-December 2016, eight semi-structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio-recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7-step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation., Results: Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions., Conclusions: Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice., Relevance to Clinical Practice: Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands., (© 2019 John Wiley & Sons Ltd.)

Aim: To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles., Methods: A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured., Results: Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved., Conclusion: This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high., (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions., Methods: A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools., Results: Across the six sites, 1027 patients were screened with CVADs prevalent in 26.1% (n = 268), and 261 CVADs in 248 patients available for audit. Variations in management were evident with dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs (n = 35), and non-sterile dressings used to reinforce 26.4% of CVADs (n = 69). Almost half of CVADs (49.4%; n = 132) had no documentation regarding site assessment in the previous 4 h, and 13.4% had no planned use in the next 24 h (35 CVAD). CVAD-associated complications within the previous 7 days were evident in 9.5% of CVADs (n = 27), most commonly catheter blockage (5.7% CVAD, n = 15), and bloodstream infection (1.9% CVAD, n = 5). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; P = 0.04), and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; P = 0.04), had significantly higher proportions of CVAD-associated complications in the previous 7 days. Variation between the sites' guidelines was evident across many practices., Conclusions: CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity., (© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)