Table 1

Ratings on a 48-item scale by seven vascular access experts: items rated three or four on a four-point relevance scale

ItemDescriptionE1E2E3E4E5E6E7Number in agreementItem CVI
1Key principle: the presence of an IV device should be assessed each shift71.00
2Does the patient have an IV device? (Inspect the patient and ask the patient if unsure)71.00
3Has the patient had an IV device removed in the past 48 hours? (Ask the patient)71.00
4If the patient has had an IV device removed in the past 48 hours, observe site for complications (post-infusion phlebitis and purulence).71.00
5Key principle: the need for the IV device should be assessed each shift71.00
6Has the IV device been used in the past 24 hours, or is it likely to be used in the next 24 hours?71.00
7Can the patient switch to oral medications? Discuss with pharmacist and treating team.71.00
8When no longer needed, the IV device should be removed.71.00
9Key principle: effective flow and flush of the IV device should be assessed each shift60.86
10Does the IV device flow well?60.86
11Does the IV device flush well?50.71
12If the IV device does not flow and flush, it should be removed.60.86
13Key principle: the IV site should be assessed for complications or concerns each shift71.00
14Patient-reported pain ≥2 out of 10?71.00
15Redness >1 cm from insertion site71.00
16Swelling >1 cm from insertion site71.00
17Any discharge at site71.00
18Infiltration (IV fluid in surrounding tissues)71.00
19Hardness (induration) of insertion site71.00
20Palpable cord71.00
21Other concerns? (itch, rash, blistering, etc)71.00
22If complications occur, the IV device should be removed, after consultation with the treating team. Insert new IV device if needed71.00
23Key principle: infection prevention and control practices should be performed each shift50.71
24Use aseptic non-touch technique71.00
25Hand hygiene71.00
26Scrub the hub as per protocol and allow to dry before accessing IV device71.00
27Any fever of unknown origin?50.71
28Elevated white blood cell count?50.71
29If the patient has a fever and/or elevated white blood cell count, with no obvious source of infection, the IV device should be removed and the IV site cultured as a possible source of bloodstream infection60.86
30Purulent discharge at the insertion site?60.86
31If the IV site has purulent discharge, the IV device should be removed and the IV site cultured as a possible source of bloodstream infection71.00
32Key principle: dressing and securement practice should be assessed each shift71.00
33Is the IV dressing clean, dry and intact?71.00
34If the IV dressing is moist, visibly soiled or has loose/lifting edges, it should be changed71.00
35Is the IV device and infusion tubing secured?71.00
36Secure well with securement device, tape, net or bandage60.86
37Key principle: the patient/family’s knowledge and education needs should be assessed each shift, if possible20.29
38Evaluate patient/family understanding of reason for IV and plan for removal, if possible.40.57
39Educate patient/family as needed, if possible.50.71
40Key principle: the IV assessment and actions taken should be documented each shift71.00
41Insertion date and time60.86
42I-DECIDED assessment and relevant action taken60.86
43Removal date and time71.00
44Key principle: the decision to continue or remove the IV device should be based on assessment and consultation with the treating team and the patient71.00
45Decision 1. IV device should remain in place. No other change60.86
46Decision 2. IV device should remain in place, but dressing change done. IV and infusion tubing well secured60.86
47Decision 3. IV device removed and not replaced, in consultation with the treating team60.86
48Decision 4. IV device removed and replaced. Consulted with patient and team about best device and site60.86
Proportion relevant0.960.920.980.830.980.850.850.87 (mean)0 .91 (mean)
Mean expert proportion=0.91
  • CVI, content validity index; E, vascular access expert; IV, intravenous.