Purpose for the Program
There is currently no consistent protocol described in the literature for documentation of the nursing assessment of neonatal peripheral intravenous sites. Most authors concur that hourly assessments are the minimum frequency and indicate what the assessment parameters should be; however, they do not discuss a protocol for documentation of the assessments. Multiple authors and professional nursing groups have identified that problems exist in the care of peripheral intravenous sites in neonates. This project attempted to determine if nurses in a neonatal intensive care unit (NICU) could conduct and document an hourly evidence-based focused assessment of neonatal peripheral intravenous sites.
An additional purpose of the project was to obtain input from direct care nurses before initiating a change in practice. Critical care nurses perform multiple hourly assessments and care interventions on each patient. Additional documentation of five measurement parameters may not be realistic to add to the workload of the direct care nurse. By having the nurses who participated in data collection provide feedback regarding the complexity or simplicity of the instrument, they were able to evaluate the potential value of the process and the instrument to their care.
Many NICUs use a system of charting by exception for assessment of peripheral intravenous sites in neonates. This project introduced a documentation form that includes the five evidence-based parameters to indicate the status of the peripheral intravenous sites. It attempted to determine if an instrument on which to document the assessment was relevant to the practice of the NICU nurses providing care. The project also determined the time needed to perform and document the peripheral intravenous site assessment and if that time was considered reasonable by the NICU nurses providing care.
Implementation, Outcomes, and Evaluation
The documentation form was piloted in a large suburban NICU. The short-term goal of this pilot project was to determine if the instrument on which to document the assessment and the time to perform and document it was deemed reasonable by the nurses providing care. The nurses are still participating in the pilot project. Early data suggest that the tool may be helpful but nurses are unsure if all of the parameters are necessary for an adequate assessment.
Implications for Nursing Practice
It is hoped that this project will stimulate further study of the individual assessment parameters to determine if any or all of them in a tool format are valid and reliable in predicting infiltrations and extravasations, which would be useful in improving patient outcomes.