Evaluating Difficult Intravenous Access: A Program to Decrease Harm in Outpatient Oncology

Abstract

Nurse’s play a critical role in the safe administration of intravenous (IV) anti-cancer therapy but are not always part of the interprofessional team in choosing the appropriate type of IV access. Venous evaluation and appropriate vascular access device selection prior to the initiation of anti-cancer therapy are recommended as a method to reduce IV failure and extravasation. The goal of this project was to reduce extravasation, IV failures, and patient harm through implementing a collaborative approach to venous evaluation, including a determination of risk factors for IV failure and to secure the appropriate IV access prior to beginning anti-cancer therapy. Three pilot cancer disease groups with the highest extravasation rates were identified and engaged for participation. The pilot groups were responsible for requesting in-clinic referrals for IV evaluation in patients when central venous access was not planned. Expert infusion nurses volunteered to be part of a venous evaluation team (VET) and were trained to use a validated venous evaluation tool when performing these assessments. The total number of venous access attempts decreased by 10% and extravasation events were reduced by 60%. One highly engaged pilot group saw a 53% reduction in the number IV access attempts. The two other pilot groups saw increases in venous access attempts, which were not statistically significant. With this project, there was a reduction in patient harm through fewer IV access attempts, extravasation events, and interprofessional collaboration.