Developing a Clinical Referral Pathway for the Management of Difficult Venous Access for Ward Nurses at North Shore Hospital

Eappen, Seena
Britnell, Sally
Item type
Practice Project
Degree name
Master of Health Practice
Journal Title
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Auckland University of Technology

Peripheral Intravenous (IV) access is a commonly performed clinical procedure in hospitals, used to obtain blood samples or administer medications and fluids by the IV route. Various circumstances such as patients with difficult veins, staffing issues, staff experience, and workload demands contribute to a difficult venous access situation (DVA). Delays in obtaining IV access can be detrimental to patient care and treatment, threatening the patient’s health and increasing morbidity and mortality risks. Specifically, early adequate IV access in unwell patients is vital for life-saving therapies. Despite nurses being trained in IV cannulation techniques at North Shore Hospital , many factors intervene to affect the success of cannulation. Examples of factors are patients with poor venous access, very unwell or dehydrated patients with peripheral venous shutdown or those with physical impediments that prevent easy access to veins. Add to this the experience and confidence levels of nurses undertaking the IV cannulation and the process can be very challenging, particularly when IV access is required for critical treatments. Doctors and other expert clinicians are available during business hours if nurses cannot establish IV access. However, there is reduced support for nurses outside business hours (after hours). A clinical support team is available after hours and they can be contacted through the SmartPage© (Alcidion, 2021; Gill et al., 2013a) system. Furthermore, if the clinical support team fail to gain IV access, the anaesthetic team can be contacted to perform ultrasound-guided insertion. There is no clinical policy or pathway regarding this, many nurses are unaware of whom to contact in such a situation and what pathway to follow. Navigating these multiple levels of support can cause delays in administering medications and multiple failed attempts to obtain IV access, resulting in undesirable patient outcomes. A more efficient process is needed for nurses to access rapid support for IV cannulation when patients urgently need it. This practice project aims to streamline a clinical referral pathway for DVA. A review of the current literature is conducted to provide the background information to support this practice project and research topic. The project is then developed using John Hopkins Nursing Evidence-Based Practice (JHNEBP) model. A six-month sample of SmartPage© referral data is collected to identify the trends and situation of the referral process. The data is then analysed using descriptive statistics and thematic analysis. The four key themes identified during the data analysis were ‘patient clinical condition’, ‘difficult access’, ‘staff education and training’, and ‘urgency for treatment.’ These themes, plus the descriptive statistic results, inform improvements to the SmartPage© referral system by streamlining a referral flow chart. The significance of this practice project is that a streamlined clinical referral pathway (flow chart) will lead to a more efficient approach to managing difficult IV access after hours, thereby minimising delays in patient care and treatment and avoiding further complications.

Intravenous access , Difficult IV lines , Venous access , Difficult venous access , Intravenous therapy , Referrals management , Clinical pathway , Clinical policy development , Patient experience
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