Improving Peripheral Intravenous Catheter Care for Children with Cancer Receiving Chemotherapy in Malawi

Purpose: To change pediatric oncology nursing management of peripheral intravenous catheter (PIVC) insertion and care based on current best evidence.

Design and methods: Practice change strategies were developed, and nurses completed education on proper PIVC insertion, dressing placement, and ongoing PIVC assessment with emphasis on preventing chemotherapy extravasation. Nurses also completed a chemotherapy course as part of their orientation program. The plan for PIVC practice change was based on evidence from published research and established PIVC care guidelines. Pre-assessment data revealed numerous PIVC attempts and a high incidence of extravasation (42%) in children with cancer receiving treatment in Malawi.

Results: Post-assessment data nine months later resulted in a reduced extravasation rate from 42% to 4% using point prevalence assessments. PIVC insertion attempts reduced following education and guideline implementation; 81% of children required more than 3 PIVC insertion attempts before the practice change. Only 1% of PIVC insertions required more than 3 attempts after education and practice change implementation. Nurses completed a 32-item written examination before the chemotherapy course; the mean score was 50/100. Upon completion of the chemotherapy course, nurses obtained a mean score of 97/100 on the written examination.

Conclusions: Using an organized approach to nursing practice change improved PIVC care in children with cancer.

Practice implications: This project provides evidence that nursing practice change strategies can be used in any setting including countries like Malawi with limited resources.