Practice Variation In Evidence-Based Infusion Therapy And Peripheral Intravenous Cannulation Among Nurses In A Tertiary Care Teaching Hospital: An Exploratory Cross-Sectional Study

Abstract

Background: Peripheral intravenous catheters (PIVCs) are among the most frequently used vascular access devices in hospitalized patients and are essential for administering intravenous fluids, medications, blood products, and vasoactive agents. Despite the availability of international evidence-based recommendations, variation in infusion therapy and vascular access practices persists across healthcare settings. In India, the absence of a nationally standardized vascular access framework may contribute to inconsistencies in medication administration, catheter maintenance, flushing practices, and the management of difficult intravenous access.

Objectives: To evaluate variation in evidence-informed infusion therapy and peripheral intravenous catheter practices among nurses and to examine professional and workplace factors associated with adherence to selected evidence-based infusion practices.

Methods: An exploratory cross-sectional questionnaire-based study was conducted among 186 registered nurses working in inpatient wards, intensive care units (ICUs), operating theatres (OTs), and emergency medical services (EMS) at a tertiary care teaching hospital in South India between August and November 2024. A structured 24-item questionnaire assessed vascular access assessment, medication administration safety, catheter maintenance, flushing practices, patient education, and professional confidence and stress perception. An exploratory Evidence-Based Infusion Practice Adherence Indicator (EBIPAI; range 0–10) was developed to summarize adherence to selected evidence-informed infusion practices. Descriptive statistics, chi-square tests, and multivariable logistic regression were used for analysis.

Results: The mean EBIPAI score was 7.05 ± 1.31. Most participants (58.6%) demonstrated moderate adherence, while 39.2% demonstrated good adherence to evidence-informed infusion practices. Considerable variation was observed in the safety of medication administration and in catheter maintenance practices. Only 47.8% correctly identified recommended Piperacillin–Tazobactam dilution practices, 55.9% recognized complications associated with prolonged peripheral administration of dextrose-containing solutions, and 19.4% reported using recommended flush volumes. Although 90.3% reported flushing after medication administration, substantial variability was observed in flushing frequency and volume. Clinical experience of more than 5 years was independently associated with good adherence to evidence-informed infusion practices (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.11–3.82; p = 0.023).

Conclusion: Substantial variation exists in infusion therapy and peripheral intravenous catheter practices among nurses, particularly in medication administration safety, flushing behaviours, and catheter maintenance. The findings highlight important evidence–practice gaps and support the need for standardized institutional protocols, competency-based education, audit-feedback mechanisms, and development of a national vascular access framework to improve infusion safety and practice consistency.