Improving Peripheral Intravenous Access Assessment to Prevent and Reduce PIV Infiltrations in a Pediatric Acute Care Setting: A Guideline for Success

Abstract

PURPOSE: Peripheral intravenous catheters (PIVs) are widely used in pediatric care, but are associated with high complication rates, particularly peripheral intravenous infiltrations and extravasations (PIVIEs). PIVIEs can result in pain, swelling, infection, tissue necrosis, and potential loss of function, negatively impacting patients, families, and healthcare systems. Given the global frequency of PIV placement, improving care and maintenance practices is essential. Evidence supports that the implementation of a standardized PIV care bundle enhances catheter preservation and promotes early recognition of infiltration, improving outcomes and reducing costs. METHODS: A literature review was conducted using PubMed and CINAHL, with full-text, peer-reviewed articles published between 2012 and 2023 included. Ten high-quality studies were selected following quality and eligibility screening. Synthesis of findings showed that structured PIV assessment bundles, including standardized tools, frequent assessments, education, and family engagement, were associated with significant reductions in infiltration and extravasation events, improved detection and documentation, and decreased event severity in pediatric populations. RESULTS: The S.A.F.E. bundle was developed following a literature review and synthesis of findings. A PDSA cycle plan would be utilized to implement a bundle using a pre–post quality improvement design in pediatric inpatient units, targeting nursing leadership and bedside registered nurses. Following integration of education and the evidence-based PIVIE bundle into routine practice, post-implementation data could demonstrate improvements in nurse knowledge, PIV assessment practices, and decreased rates of PIVIEs. A comparison of pre- and post-intervention data over six months could indicate reductions in PIVIE incidents and improve consistency in assessment and management. Descriptive analysis of nurse surveys could further support increased confidence, awareness, and adherence to best practices after implementation. IMPLICATIONS FOR PRACTICE: Implementation of a PIVIE bundle promotes standardized, evidence-based PIV assessments, reducing infiltration rates and adverse events while improving patient safety. Integrating structured assessments into routine care and providing competency-based education enhances nurses’ knowledge, confidence, documentation, and assessment frequency. Effective implementation relies on leadership engagement, data monitoring, and adaptability, with nurse leaders supporting best practices and continuous improvement. Evaluation of outcomes informs future initiatives and supports organization-wide adoption to further reduce complications and improve care quality.