PROCESS OF INSERTION, MAINTENANCE AND REMOVAL OF PERIPHERAL INTRAVENOUS CATHETERS: PREVENTIVE RISK ANALYSIS

to demonstrate the applicability of the Healthcare Failure Mode and Effect Analysis tool to analyze, preventively, the risks related to the process of insertion, maintenance, and removal of peripheral intravenous catheters.

Method:

theoretical study, conducted from August to November 2022, in São Paulo-SP, Brazil, whose process was mapped in stages/activities, detailing the failure modes, using the tool. The Risk Priority Number was calculated, the severity and probability matrix was elaborated, adapted to health by DeRosier and collaborators, and actions were proposed to reduce failure modes.

Results:

The major risks identified were: “perform antisepsis of the area to be punctured with an alcohol swab” and “disinfect the connector with an alcohol swab”, and were recommended training and use of kit materials as the main mitigation strategies.

Conclusion:

knowing the risks associated with peripheral intravenous catheters is the basis for the implementation of preventive strategies, minimizing the occurrence of damage and the associated healthcare costs.

DESCRIPTORS:
Catheterization, Peripheral; Administration, Intravenous; Nursing Care; Hospital Units; Risk Management

Activity	Hazard	Probability	Severity	Risk
1. Check indication for peripheral venous puncture	Unnecessary punching, wrong choice of device	4	1	4
2. Separate materials for puncture	Separate incorrect material, forget material, inappropriate device	4	1	4
3. Enter the patient’s room and explain the reason for the puncture	Refusal to puncture, delay in therapy, change of route to administer medication	3	1	3
4. Clean the hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
5. Put a tourniquet on the arm and analyze the venous net to choose the puncture site and the size of the access	Not considering the best access option, puncturing arm with restriction, tourniquet too long, not positioning the tourniquet above the site	2	1	2
6. Release the tourniquet	Forget to release the tourniquet	2	1	2
7. Open materials	Contamination of material, dropping material on the floor, damaging material, waste	1	1	1
8. Sanitize hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
9. Perform antisepsis of the area to be punctured with alcohol swap for 3 times or until it comes out clean	Contamination	3	3	9
10. Put on the procedure gloves	Not putting on gloves	3	1	3
11. Put the arm back in tourniquet	Too much garrote for too long, or forget to garrote	2	1	2
12. Perform the puncture with an angle of 15 to 45 degrees	Use inadequate angle	2	1	2
13. Observe venous return	Do not observe venous return	2	1	2
14. In the case of puncture with an intravenous catheter, introduce the external part of the device (silicone part)	Transfix vein, not silicone progression	2	1	2
15. Remove the tourniquet	Forget to release the tourniquet	2	1	2
16. Press with your thumb on the skin where the device is pointed and remove the mandrel	Loss of access, work accident with sharp	2	1	2
17. Connect the micro-claves	Forget to connect, contaminate the clave	2	3	6
18. Aspirate the venous return	Not aspirating and salinizing may lead to infiltration, loss of access	2	1	2
19. Proceed with the salinization of 20ml of SF 0.9%	Use less than 20ml, catheter obstruction, loss of access, vessel rupture due to capillary fragility	2	1	2
20. Fix the access by placing the appropriate cover	Use non-standardized cover, inadequate fixation	2	1	2
21. Dispose of the perforating-cutting material in appropriate garbage	Accident at work with sharp objects	2	1	2
22. Remove gloves and sanitize hands	Professional contamination with biological material, contamination	2	1	2
23. Dispose of the rest of the materials	Inadequate disposal of regular garbage, environmental contamination	2	1	2
24. Make nursing notes.	Not documenting materials involved, or puncture failures	4	1	4

Activity	Hazard	Probability	Severity	Risk
25. Separate materials for salinization	Not separating material properly, forgetting some material	3	1	3
26. Sanitize hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
27. Enter the patient’s room and explain the reason for salinization	Not explaining properly, the importance of salinization	3	1	3
28. Sanitize the hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
29. Inspect insertion site for signs of inflammation	Not checking for signs of inflammation	2	2	4
30. Disinfect connector with alcohol swap	Carry out disinfection without vigor, for inadequate time, forget to perform disinfection procedure	3	3	9
31. Connect the syringe to the connector	Contaminate connector during connection, no salinization	3	2	6
32. Infuse serum content and check for resistance, swelling, pain complaint, note any changes in access insertion	Do not check for signs of inflammation when infusing	2	2	4
33. Dispose of material in the trash	Improperly disposing of in common garbage, environmental contamination	2	1	2
34. Sanitize hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
35. Write down procedure	Not documenting materials involved, or puncture failures	4	1	4
36. Separate materials for removal from access	Not separating material properly, forgetting some material	3	1	3
37. Sanitize hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
38. Enter the patient’s room and explain the reason for removing the access	Failure to properly explain the reason for removal	2	1	2
39. Wash hands	Incorrect technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
40. Remove the film from the patient’s skin	Removing film, causing pain to the patient	2	1	2
41. Remove access and press the insertion site with cotton	Bleeding, hematoma	2	1	2
42. Place bloodstop	Bleeding, hematoma	2	1	2
43. Dispose of material in the trash	Improper disposal of common garbage, environmental contamination	2	1	2
44. Sanitize hands	Improper technique, inadequate hygiene due to poor choice of solution, forgetfulness	2	3	6
45. Write down procedure	Not documenting materials involved, or punching failures	4	1	4

Risk Priority Number - RPN
Preventive Action	1	2	3	4	6	9	Total
Carrying out periodic training on PIC	1	28	3	8	6	18	64
Carrying out periodic training on hand hygiene		2			48		50
Carrying out an audit of the procedure		2			48		50
Establishment of a materials kit		12	6	4	6	18	46
Implantation and implementation of a Bundle			6	16			22
Periodic awareness-raising about the importance of proper nursing notes				12			12
Adoption of saline syringe for the maintenance of the AVP		2			6		8
Total	1	46	15	40	108	36	252

Universidade Federal do Paraná Av. Prefeito Lothário Meissner, 632, Cep: 80210-170, Brasil - Paraná / Curitiba, Tel: +55 (41) 3361-3755 - Curitiba - PR - Brazil
E-mail: cogitare@ufpr.br

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[1] Corresponding author: Maryana da Silva Furlan Escola de Enfermagem da Universidade de São Paulo Rua Peixoto Gomide, número 379 - Apartamento 608. Jardim Paulista. CEP: 01409-001 E-mail: maryanafurlan@usp.br