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The Art and Science of Infusion Nursing

Alvisa Palese, MNS, RN Catia Cassin, MNS, RN

Andrea Cassone, MNS, RN Sandra Cialdella, MNS, RN
Annamaria Kulla, MNS, RN Giuseppe Floridia, MNS, RN
Sabrina Dorigo, RN Boris Nadlišek, MNS, RN
Jesse Magee, RN Annamaria Palcic, MNS, RN
Marco Artico, MNS, RN Giulia Valle, MNS, RN
Francesco Camero, MNS, RN Paola Sclauzero, MNS, RN

Factors Influencing Nurses’ Decision-Making

Process on Leaving in the Peripheral
Intravascular Catheter After 96 Hours
A Longitudinal Study

ABSTRACT at 96 hours after its positioning, in accordance with

The clinical and research debate on the peripheral
intravascular (PIV) catheter length of stay in situ is
ongoing. The principal aim of this study was to
explore the factors behind a nurse’s decision to leave
a PIV in place for more than 96 hours. The study
focused on 7 northern Italian hospitals in 2009. A
consequent sample of 269 PIV catheters was includ-
ed. Direct observation and interviews were adopted.
The time of the expected PIV replacement was fixed
the international guideline. Several factors were
taken into account in regard to replacement of the
PIV catheters by nurses, ranging from analysis based
on their own clinical experience with PIV complica-
tions and analysis of the patient’s clinical situation to
the critical analysis of their own work situation. This
clinical decision-making process is valuable: leaving
the PIV in place for more than 96 hours is a complex
decision and not simply a guideline violation.

Author Affiliations: University of Udine (Mss Palese and Dorigo) and University of Udine and Trieste (Messrs Floridia, Cassone, Camero,
Nadlišek, and Artico, and Mss Cialdella, Valle, Kulla, Palcic, Sclauzero, and Cassin), Udine, Italy; and Wilmington University, Wilmington,
Delaware (Mr Magee).
Alvisa Palese is an Associate Professor in Nursing Science and a teacher in evidence-based nursing courses.
Andrea Cassone, Annamaria Kulla, Francesco Camero, Sandra Cialdella, Boris Nadlišek, and Giulia Valle are members of the nursing
team and members of the CIPE96’ Group Research team.
Sabrina Dorigo is a collaborator in research at Udine School of Nursing.
Jesse Magee is a research project assistant.
Marco Artico, Catia Cassin, Giuseppe Floridia, Annamaria Palcic, and Paola Sclauzero are members of the nursing team and members
of the CIPE96’ Group Research team.
Corresponding Author: Alvisa Palese, MNS, RN, School of Nursing, Udine University, Viale Ungheria 18, 33100 Udine, Italy
(alvisa.palese@uniud.it).
DOI: 10.1097/NAN.0b013e3182290a20

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I
ntravenous therapy is frequently used in hospitalized
patients and the peripheral intravascular (PIV)
catheter is the device adopted by nurses to perform
intravenous administrations. Current guidelines rec-
ommend that the PIV catheter should be replaced after
72 to 96 hours to prevent phlebitis.1 This recommendation
is ranked at level 1B (strongly recommended for implemen-
tation and supported by some experimental, clinical, or epi-
demiologic studies) and is based on 1 study,2 according to
the references reported in the guideline. Notwithstanding the
contents of the guideline,1 the length of stay in situ is still
debated. Recent literature3-8 and clinical practice data9 show
the tendency to maintain the catheter over the prescribed
96 hours. This lack of guideline adherence seems to be sup-
ported by several factors: (a) for nurses, it is difficult to
explain to and argue with the patients about the need to
replace a properly functioning PIV catheter4,9; (b) the
replacement may have a negative impact, such as discom-
fort and pain, on patients4; (c) the replacement might also
increase the risk of infection, because each time skin
integrity is breached, a potential portal for pathogens is
provided4; and (d) the recent systematic review made by
Webster and colleagues5 found no conclusive evidence in
the need for catheter replacement every 72 to 96 hours.
In their daily practice, nurses make the decision to
leave the catheter in situ over the 96 hours or to replace
it. This decision is made on the basis of clinical infor-
mation and circumstances as stated by Johansson and
colleagues,9 who have described under a qualitative
study design combining observations and interviews,
the decision-making process adopted by 43 nurses in
their natural setting. Exploring the factors involved in
the decision-making process affecting the PIV catheter’s
length of stay in situ and capturing the variability and
richness of the nurses’ clinical decision making in prac-
tice was the general aim of this study.
AIMS
Exploring the factors behind a nurse’s decision to leave a
PIV catheter in place for more than 96 hours was the
principal aim of the study.
STUDY DESIGN
Researchers adopted a prospective observation study design.
SETTING
The study took place in 2009, involving 7 hospitals (each
with at least 600 beds) located in northern Italy; for each
hospital, the available medical and surgical wards (N ⫽ 14),
which had on average 30.3 beds (⫾10.1; range, 13-45),
were included in the study. Protocols based on the inter-
national guideline1 recommending the need to replace a
320
Copyright © 2011 Infusion Nurses Society. Unauthorized reproduction of this article is prohibited.
PIV catheter within 72 to 96 hours of its positioning were
available in the hospitals. These recommendations were
implemented during recent years with 1 or more strategies
(eg, educational courses, sheets, brochures, and protocols)
developed at the institutional level.
SAMPLE AND SAMPLING
A consequent sample of 269 PIV catheters measuring less
than 3 inches positioned in peripheral veins was included.
Peripheral intravascular catheters were excluded if they
were in the following categories: (a) more than 3 inches
in length (eg, midline)10; (b) positioned in the feet; (c)
placed in urgent or emergent conditions; (d) placed
during a night shift; (e) replacing previous PIV catheters;
(f ) used for administering lipids, chemotherapies, and
hyperosmolar solutions; (g) used in patients younger
than 18 years; or (h) if it was not possible to monitor
the catheter continuously until the 96th hour after posi-
tioning (eg, patient transferred to intensive care unit).
DATA COLLECTION PROCEDURES
Direct observations of the nurse’s daily practice and an
interview with the nurse responsible for each patient were
adopted. The researchers (13 total) were appropriately
educated with a 4-hour course focusing on the aim of the
study and on the data collection procedures. Preliminarily,
a pilot phase observing 11 PIV catheters, not included in
this report, was done. Each researcher observed 10-28 PIV
catheters and interviewed 10-28 nurses, in accordance
with the number of PIV catheters observed.
Observation
Each new intravenous catheter positioned was observed
2 times per day, every 12 hours (8 times in total per
catheter) until the 96th hour after its positioning. For
each PIV catheter, patients’ documentation was consult-
ed to collect data on the positioning day/hour and on
infusion(s) prescribed (eg, none, intermittent during the
first 96 hours). Direct observation was done at the bed-
side, collecting data on PIV laterality (right-/left-hand
side), exposure (front or rear), vein site (eg, basilic,
cephalic), and catheter lumen size (mm) according to
International Organization for Standardization stan-
dards.11 When nursing records reported incomplete
data on the hour of positioning, researchers have
assumed 9:00 AM and 4:00 PM as a standard reference,
according to the ward’s routine, which scheduled new
PIV positioning at these times.
Interview
The nurse responsible for the patient was interviewed 1
time but with 2 different sets of questions according to the
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PIV length of stay in situ: (a) for the PIV catheters removed
before the 96 hours, the nurse responsible was asked when
removal occurred, and for which reason(s); (b) for the PIV
catheters present in situ at 96 hours, the nurse was asked
the reason(s) why he or she decided to leave the catheter in
place after the deadline recommended by the international
guideline,1 with the reasons ranked in priority (first, sec-
ond, and third reasons). All the responses were collected by
researchers and reported exactly according to the nurse’s
answer. No modifications in the responses were made dur-
ing the data collection process.
QUANTITATIVE AND QUALITATIVE
DATA ANALYSIS
Quantitative data were elaborated with SPSS version
18.00. For quantitative variables, average, median, stan-
dard deviations (⫾), frequencies, and proportions were
calculated. The ␹2 test, ANOVA test (or Student t test),
and relative risk (RR) (95% confidence interval [CI]),
when appropriate, were calculated. The statistical signifi-
cance level was positioned at P ⬎ .05.
Factors determining the PIV catheter removal before
the 96 hours were categorized according to the reasons
reported by nurses (occlusion, phlebitis, extravasations,
and infusion interruption); frequencies and percentages
were then calculated.
For the PIV catheters remaining more than 96 hours,
the reasons reported by the nurses at the 96th hour were
organized on the basis of the modified categories that
emerged with Johansson and colleagues.9 For each catego-
ry that emerged in the original qualitative study,9
researchers decided the significance to give in accordance
with the aim of this study. Then, sample answers obtained
from the participants were appropriately included in the
categories to explain each unequivocally (Table 1).9 To
avoid personal bias, this process was first conducted by

TABLE 1

Factors Determining the Decision to Leave the

Peripheral Intravascular Catheter in Place After
96 Hours: Categories Adopted and Definitions
Category Redefined by Researchers and Examples of
Main Categories9 Subcategories9 Answers Obtained at 96 Hours by Nurses’ Participanta
Individual patient situation The patient need for PIV catheter Patient does not need PIV catheter in the near future:“I left
it more than 96 hours because it would be removed soon
according to his/her clinical conditions.” (N111)

The PIV catheter’s applicability Patient does not have other veins available: “I preserved
the veins leaving the PIV in situ because if I remove it
I am not sure I would find another vein.” (N56)

Patient situation in relation to PIV catheter Patient is severely ill (morbidly), disoriented, afraid of
replacement limits injections, or does not want replacements: no
appropriate answers have emerged. (⫺)

Nurse’s work situation Time aspects PIV catheter replacement has low priority because of the
workloads: “I had to replace it today, but the workload
was high.” (N76)

Routines for planning and following up There is a lack of standardization in the PIV management:
PIV catheter “No appropriate answers have emerged.” (⫺)

Nurse’s attitudes toward PIV management The nurse is responsible for the patients: “I would give the
best individualized PIV care and for this reason, I have
decided to leave the catheter in situ.” (N5)

Experience of PIV management Experience of PIV complications Nurses have no experience of complications: “I have never
seen complications after 96 hours.” (N150)

Nurse’s capability There is a lack of capability within the nursing staff in the
insertion of the PIV: “Is better to leave the actual PIV
because we are without experts.” (N93)

Abbreviation: PIV, peripheral intravascular.

a
Number of interviews at the 96th hour (from 1 to 166).

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TABLE 2 TABLE 2 Continued

Characteristics of the Frequencies

Peripheral Intravascular Characteristics

Infusion prescribed
(N ⴝ 269) %

Catheter Observed No 13 4.8

Frequencies Continuously 29 10.8
Characteristics (N ⴝ 269) % Intermittently 46 17.1
Outside diameter of catheter tube10 Mixed (continuously and intermittent) 181 67.2
1.9, 2.0, 2.1, 2.2 0 … Abbreviation: PIV, peripheral intravascular.
a
Out of 103 removed before 96 hours.
1.6-1.8 4 1.5
1.2-1.3 108 40.2
1.0-1.1 117 43.5 3 researchers, who worked independently: each answer
collected was included in 1 or more categories according
0.8-0.9 38 14.1
to the framework established by Johansson and col-
Missing 2 0.7 leagues.9 Later, another researcher compared each catego-
Positioning day/hour reported in nursing records rization made by the previous researchers and prepared a
final file highlighting the discordances between the cate-
Yes 205 76.2
gories. These discrepancies were discussed and agreed on
No 64 23.7 by all the researchers, and all of the responses were then
PIV catheter permanence, h categorized in their final location appropriately.

Average ⫾ 80.2 ⫾ 23.7

ⱕ24 13 4.8 ETHICAL CONSIDERATIONS
25-48 29 10.8
The internal review boards of the hospitals involved
49-72 46 17.1
approved the project after having received information
73-95 15 506 on the aim, methodology, and confidentiality of the data
166 61.7 collected. Each nurse involved was informed about the
ⱖ96
a
study and gave her or his consent before the interview.
Removal day/hour reported in nursing records
Yes 32 31.1
RESULTS
No 71 68.9
Site laterality
Peripheral Intravascular Catheter
Right-hand side 94 34.9 Characteristics
Left-hand side 175 65.1 The PIV catheters included were observed in medical (175;
65.1%) and surgical wards (94; 34.9%). The catheters
Exposure
were in situ for an average of 80.2 hours (median 96 hours,
Front 113 42 ⫾23.7); 166 (61.7%) PIV catheters were left more than 96
Rear 156 58 hours, while 103 (38.3%) remained from 8 to 95 hours.
Catheters that remained less than 96 hours were removed
Site: vein
for occlusion (6; 5.8%), phlebitis (4; 3.9%), and extrava-
Hand veins 44 16.3 sations (2; 2.0%), and because patients needed no further
Cephalic 91 33.8 infusions (91; 88.3%). The main characteristics of the
catheters observed are recorded in Table 2.
Basilic 45 16.7
Median cubital 58 21.6 PIV Factors Associated With a Permanence
Ulnar 19 7.1 of 96 Hours or More
Brachial 12 4.5
Peripheral intravascular catheters positioned in
(continues) patients admitted in medical wards showed a higher

322 Journal of Infusion Nursing

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length of stay in situ (average 87.8 hours, ⫾17.8)
compared with those observed in surgical wards
(average 66 hours, ⫾26.7). This difference is statisti-
cally significant (P ⫽ .000). No difference emerged in
the average catheter’s permanence or lumen size (F ⫽
2.391, P ⫽ .06).
The probability of the PIV catheters’ remaining in place
after the 96 hours is no different in PIV catheters docu-
mented in the nursing records than in those that are not
(RR, 0.84; 95% CI, 0.69-1.02). There is no difference in
the length of PIV permanence within catheters recorded
for day and hour of placement in the nursing records and
those not recorded (RR, 0.84; 95% CI, 0.69-1.02).
Peripheral intravascular catheters positioned in the left
arm have more probability to be in place longer than 96
hours than those positioned in the right arm (RR, 7.57;
95% CI, 4.33-13.22). Catheters positioned in the forearm
rear (116/156) have more probability to be in place after
96 hours (RR, 1.80; 95% CI, 1.38-2.3) than those posi-
tioned in the forearm front (50/113). Also, those posi-
tioned in the forearm veins have a greater probability to
remain more than 96 hours than PIV catheters positioned
in the veins of the hands (RR, 1.82; 95% CI, 1.35-2.45).
Decision-Making Factors Pertaining to More
Than 96 Hours’ Catheter Permanence
For the 166 PIV catheters that remained more than
96 hours, nurses have reported 256 reasons, on average
1.5 (median 1; ⫾0.7; minimum 0; maximum 3) per each
PIV catheter left in situ. Out of 166 interviews made at
the 96th hour, 68 (26.5%) nurses have reported 2 rea-
sons, and 21 (8.3%) have reported 3 reasons (Table 3).9
Nurses working in surgical wards have reported more
reasons (average 1.8, ⫾ 0.7) than those working in med-
ical wards (1.5, ⫾ 0.6) (P = .00). Table 3 reports the fre-
quencies that emerged for each factor and the priority
given by nurses.

TABLE 3

Factors Determining the Decision to Leave Peripheral

Intravascular Catheter In Situ at 96 Hours
Total no.
of Reasons
Definition (in Current Reported ⴝ Frequencies 1st no. ⴝ 2nd no. ⴝ 3rd no. ⴝ
Categories9 Subcategories9 Study) 256 (%) no. ⴝ 256 (%) 167 (%) 68 (%) 21 (%)
Individual The patient need of Patient does not need PIV 73 (28.6) 57 (22.2) 28 (16.7) 20 (29.4) 9 (42.8)
patient PIV catheter catheter in the near future.
situation
The PIV catheter’s Patient does not have other 16 (6.2) 9 (5.3) 4 (5.8) 3 (14.2)
applicability veins available.

Patient situation in … …
relation to PIV
replacement limits
Nurse’s work Time aspects PIV catheter replacement 49 (19.1) 43 (16.8) 35 (20.9) 8 (11.7)
situation has low priority because of
the workload.
Routines for planning … …
and following up
PIV catheter
Nurses’ attitudes The nurse is responsible 6 (2.3) 1 (0.5) 4 (5.8) 1 (4.7)
toward PIV for the patients.
management

Experience Experience of PIV— Nurses have no experience 134 (52.3) 81 (31.6) 53 (31.7) 26 (38.2) 2 (9.5)
of PIV man- complications of complications.
agement
The nurse’s capability There is a lack of capability 53 (20.7) 41 (24.5) 6(8.8) 6 (28.5)
in the insertion of the
PIV catheter within the
nursing staff.

Abbreviation: PIV, peripheral intravascular.

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DISCUSSION
Limitations and Strengths
The study has several limitations. A limited number of
PIV catheters were followed, and with the specific
inclusion criteria adopted, the external validity of the
results may be reduced, since the results are generalized
only to PIV catheters positioned in patients admitted to
medical and surgical wards, in nonurgent or emergent
conditions, and for nonirritable infusions. The high
number of the researchers involved (13) might have
also threatened the accuracy of the data collection
process, although, to reduce bias, specific education on
data collection was provided. In accordance with the
aim of the study, nurses interviewed by researchers
were not assessed on their educational background,
competencies, and clinical experience. Also, few data
were collected on patients, which has limited the ability
to consider the relevance of nurses’ competence as well
as the patient’s clinical condition and its effect on the
nurses’ clinical judgment.
In addition, to account for the variability of the fac-
tors influencing the decision-making process of the
nurses involved, the reasons determining the decision to
leave the PIV catheter in situ for more than 96 hours
have been collected as the nurses reported verbatim.
The subsequent categorization process, on the basis of
the factors documented in the literature available, was
done by triangulating the judgment of 3 researchers.
Moreover, the focus of the research was mainly on the
PIV catheters. The involvement of several hospitals
reflects the efforts to develop an extensive image of PIV
management and daily variability among Italian institu-
tions, a variation not previously documented.
Factors Related to the PIV Length of
Stay In Situ
Scheduled replacement of intravascular catheters has
been proposed as a standard method to prevent
phlebitis and catheter-related infections.1 The incidence
of thrombophlebitis and bacterial colonization of
catheters increases when catheters are left in place more
than 72 hours; however, rates of phlebitis are not sub-
stantially different in peripheral catheters left in place
72 hours compared with 96 hours,2 which was assumed
as the reference time for the study.
Several patients received PIV catheters during their
hospitalization, and more than half (61.7%) remained
in situ for more time than recommended by the litera-
ture. Peripheral intravascular catheters remained longer
in patients admitted in medical wards compared with
those in surgical wards, a fact that might be explained
by the short length of stay and the different clinical con-
ditions of the 2 groups of patients. The nursing records
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are lacking for both PIV catheter insertion and removal,
as documented by Ahlqvist and colleagues,12 but this is
not associated with the length of stay in situ. Moreover,
creating a structured nursing record highlighting specif-
ic items on PIV data per hour application, site, lumen,
and other variables, might help nurses register these
important data. Nurses’ PIV surveillance might be
affected by the lack of documentation, which also
threatens future comparative research.
The main cause of a PIV catheter’s early removal is
the interruption of the infusion, as recommended by the
guideline,1 which suggests promptly removing any
intravascular catheter that is no longer essential (category
IA).1 Under this point of view, the aptitudes of the nurses
involved are adherent to the international guideline.
Other causes of early removal are, in order of frequency,
occlusion, phlebitis, and extravasations. The occurrence
of occlusions (defined as failure to infuse) must be
carefully compared with the results documented by
Randolph and colleagues,13 because data on the patency
strategy adopted (heparin vs physiologic solutions) were
not collected. Bregenzer,6 Fujita,8 and their colleagues
have documented occlusion occurrence ranging from
6.0% to 6.9%, more than what was observed in our
study. The phlebitis ratio was similar to those docu-
mented on the third day by Homer and Holmes14 and
less than what Fujita and Namiki8 have documented
(11.1%). Extravasations have been observed on only
2 occasions, less than documented by Fujita and
Namiki.8
Several decisions made by nurses at the time of the PIV
catheter positioning influence its permanence. In fact, PIV
catheters positioned in the left arm, in the rear surface,
and in the arm veins (eg, in the basilic or cephalic) have
shown higher probability to remain after 96 hours. From
the results of this study, when nurses make an insertion
site decision, they create the initial conditions for a more
stable PIV site, which can be important for patients need-
ing it. Most patients, who are predominantly right-hand
dominant,12 use the left arm less, reducing movements
that might increase the risk of catheter traumas. Also, the
PIV catheters positioned on the rear surface of the fore-
arm have more probability to remain in situ over the 96th
hour; this can be explained with the usual bed position
adopted by most patients (arms alongside the body with
palms resting on the sheets), which can be maintained
during infusions. The lumen of the cephalic and basilic
veins compared with hand veins is important, and this
can prevent local irritation documented by Maki15 and
Catney et al.16 The observed PIV catheters were never
positioned in the wrists, which are considered a critical
point, because it increases the risk of continuing move-
ment and creates dependency in the patient, who cannot
freely move the hand.
After the site decision, which can influence the
permanence of the PIV catheter, the next decision made
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by nurses17 is whether to leave the PIV in situ after
96 hours. This clinical decision seems to be multidi-
mensional. In fact, each nurse has reported more than
1 factor involved in the decision-making process. The
factors that emerged were appropriately placed in the
categories developed by Johansson and colleagues9: this
methodological approach gives value to the results and
hypothesis originated in qualitative studies, building on
new results with a quantitative approach. With this
methodology, it is possible to develop progressively
increased levels of evidence,18 strengthening their force.
Deciding not to adhere to the international guideline1
implies a sophisticated clinical judgment based on several
factors and not simply a violation19: in order of frequency,
nurses have critically analyzed their personal experience
with PIV management (52.3%), then the individual
patient situation (28.6%), and the nurses’ work experience
(19.1%). Inside each category, as aggregated by Johansson
and colleagues,9 some specific factors have emerged as
priorities.
Complications in PIV management in the nurses’ pre-
vious personal experiences emerged as a priority: nurs-
es who did not have any experience with PIV complica-
tions after 96 hours seem to be more comfortable leav-
ing the PIV catheter for a longer period. This is a risk
because it indicates an attitude in which only what has
been experienced creates concerns. Nurses need to base
their judgments also on what could happen, or what is
described as a risk in a particular situation, so that
unnecessary complications do not occur. It is important
to counteract this unnecessary risk during nurses’ bach-
elor’s-level education and also through continuing edu-
cation courses. This can be achieved simply through
presenting examples (such as photos or lectures given by
nurses with experience) to develop awareness of the sev-
eral complications that can occur with peripheral
catheterization.
The second priority that was given was regard for the
patient’s needs: the patient’s improved clinical condition
and the patient’s no longer requiring the infusion
through the PIV catheter are the criteria that are consid-
ered at the 96th hour in the decision to leave the PIV
catheter for a few additional hours instead of replacing
it. This decision should be considered appropriate: it
protects the patient from pain and discomfort, reduces
the risk of introducing pathogens through the skin, and
also minimizes the consumption of valuable hospital
resources.
The third priority given was again the experience of
the nurses: this should be considered appropriate but
should be acted on cautiously. Nurses involved have
recognized their lack of experience in the reinsertion of
PIV catheters. This may be improved with a combina-
tion of courses providing instruction on insertion of PIV
catheters and ad hoc strategies (such as an outreach
team, which is not available in Italy, and/or mixing the
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composition of the staff, including experts and nonex-
perts) because the lack of capability might have also
negative effects on urgent or emergent cases.
Two factors documented by Johansson and colleagues,9
who conducted their study in Sweden, were not consis-
tent with the results of this study (Table 3). The absence
of Johansson and his colleagues in the decision-making
process might be related to the specific characteristics of
the Italian nursing practice and may need to be studied
further in the future.
In this study, having excluded the PIV catheters posi-
tioned during the night, it was not possible to describe
the factors supporting the clinical decision-making
process developed by nurses during the night shift for
catheters that had reached the 96th hour.
CONCLUSIONS
Implications for Practice
The clinical and research debate on PIV catheter length
of placement is still ongoing. The nurses’ clinical deci-
sion to leave the PIV catheter in place is multifactorial.
Because of the site decided by the nurses at the time of
the insertion, some PIV catheters have more probability
to stay in place for a longer time: this seems to be the
prerequisite when nurses need a catheter available for
an extended period (eg, patient in unstable condition).
At the moment of the expected replacement, fixed at
96 hours after the positioning in accordance with the
available guideline, several cognitive factors are taken
into account by nurses. These factors range from an
analysis based on their own clinical experience with PIV
complication and analysis of the patient’s clinical situa-
tion, to the critical analysis of their experience with
inserting PIV catheters. This decision-making process is
valuable: leaving the PIV catheter for more than 96 hours
is a complex decision-making process and not simply a
guideline violation. Health care organizations might
change their policies regarding the need to replace
catheters by considering if it is clinically indicated. This
would have a significant effect on cost savings and would
also have a positive impact on patients, who would be
spared the unnecessary pain of routine reinsertion in the
absence of clinical indications.
Implications for Research
Several questions might arise from the results of this
study. Confronting the interreliability factors influencing
nurses’ decision making regarding whether or not to
leave the PIV catheter in situ and individuating discor-
dances and agreements at different stages of a nurse’s
competence and expertise can provide valuable informa-
tion on the process of PIV management. Also, developing
a multinational project to investigate differences within
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nurses’ aptitudes in this critical decision, and the propor-
tion of PIV cases left in situ after 96 hours in daily prac-
tice, might also contribute to PIV management practices
across the world. Finally, monitoring the negative out-
comes (eg, phlebitis) and their occurrence after 96 hours
and involving nurses and patients at an international level
might help to provide a more in-depth understanding of
when, and in which conditions, nurses can safely decide
to leave PIV catheters in situ after 96 hours.
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