Examining the Effectiveness of Two Solutions Used to Flush Capped Pediatric Peripheral IV Lines at Children's Hospital of Michigan

White, Mary L., Jaime Crawley, Linda A. Lewandowski, Hossein N. Yarandi, Munirah Curtis, Natalie Fisher, Elizabeth A. Rennie, Mary Kosek, Heather Schaewe, Bethany A. Page, Robin L. Ferguson, and Mark Riederer

Purpose:

This study was constructed to provide the evidence needed to assess “Best Practice” related to maintenance of capped peripheral intravenous (IV) lines in children. The purpose is to examine the relative effectiveness of two solutions, heparin and normal saline, used to flush capped pediatric peripheral IV lines at the Children's Hospital of Michigan (CHM).

Background:

Current research supports using saline rather than heparin in capped pediatric peripheral IV lines. Reasons cited include decreased self-reported pain; decreased nursing time in flushing the lines; fewer side effects; and lower cost. An international phone, e-mail, and web-based survey of 36 hospitals found that 28 hospitals use saline (77.7%) in capped peripheral pediatric IV lines. Registered nurses at the Children’s Hospital of Michigan currently use heparin but would like to switch to normal saline.

Methods:

This random, quasi-experimental study will be implemented in March of 2007. A quasi-experimental 4 X 3 X 2 factorial design (4 units at CHM, times 3 needle gauges, times 2 solutions) is planned, which consists of a combination of 6 main and interaction effects. The capped peripheral IV line will be assessed 3 times per day while the capped peripheral IV line remains patent or until it is discontinued based on physician’s order. A data collection sheet will be used to record redness; swelling; clotting; bruising; leakage; and patient complaint or reaction to pain (i.e., FLACC scale or FACES scale) of the capped peripheral pediatric IV line. IRB approval, HIPPA, informed consent, informed assent and oral assent will be obtained.

Sample/Setting:

A convenience sample of 96 pediatric patients will be enrolled from 1 of 4 pediatric hospital units and randomly assigned to either heparin or saline IV flush groups. The inclusion criteria are: children between the ages of 4 weeks and 17 years that have a capped pediatric peripheral IV or an IV that has the potential to be converted to a capped pediatric peripheral IV.

Results:

Data collection is underway. Descriptive statistics will be used to analyze the frequencies and means of variables. To compare differences of means, analysis of variance (ANOVA) and post hoc analysis will be utilized. For all tests, significance will be set at alpha ≤ .05.