Table 2

Ratings on a 48-item scale by 11 experienced clinicians: items rated three or four on a four-point relevance scale

ItemDescriptionC1C2C3C4C5C6C7C8C9C10C11Number in agreementItem CVI
1Key principle: the presence of an IV device should be assessed each shift111.00
2Does the patient have an IV device? (Inspect the patient and ask the patient if unsure)111.00
3Has the patient had an IV device removed in the past 48 hours? (Ask the patient)90.82
4If the patient has had an IV device removed in the past 48 hours, observe site for complications (post-infusion phlebitis and purulence)100.91
5Key principle: the need for the IV device should be assessed each shift100.91
6Has the IV device been used in the past 24 hours, or is it likely to be used in the next 24 hours?111.00
7Can the patient switch to oral medications? Discuss with pharmacist and treating team100.91
8When no longer needed, the IV device should be removed111.00
9Key principle: effective flow and flush of the IV device should be assessed each shift111.00
10Does the IV device flow well?90.82
11Does the IV device flush well?100.91
12If the IV device does not flow and flush, it should be removed90.82
13Key principle: the IV site should be assessed for complications or concerns each shift111.00
14Patient-reported pain ≥2 out of 10?100.91
15Redness >1 cm from insertion site111.00
16Swelling >1 cm from insertion site111.00
17Any discharge at site111.00
18Infiltration (IV fluid in surrounding tissues)111.00
19Hardness (induration) of insertion site111.00
20Palpable cord100.91
21Other concerns? (itch, rash, blistering, etc.)111.00
22If complications occur, the IV device should be removed, after consultation with the treating team. Insert new IV device if needed111.00
23Key principle: infection prevention and control practices should be performed each shift111.00
24Use aseptic non-touch technique111.00
25Hand hygiene111.00
26Scrub the hub as per protocol and allow to dry before accessing IV device111.00
27Any fever of unknown origin?80.73
28Elevated white blood cell count?60.55
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 infection100.91
30Purulent discharge at the insertion site?P100.91
31If the IV site has purulent discharge, the IV device should be removed and the IV site cultured as a possible source of bloodstream infection70.64
32Key principle: dressing and securement practice should be assessed each shiftP111.00
33Is the IV dressing clean, dry, and intact?111.00
34If the IV dressing is moist, visibly soiled or has loose/lifting edges, it should be changed111.00
35Is the IV device and infusion tubing secured?111.00
36Secure well with securement device, tape net or bandage.100.91
37Key principle: the patient/family’s knowledge and education needs should be assessed each shift, if possible90.82
38Evaluate patient/family understanding of reason for IV and plan for removal, if possible80.73
39Educate patient/family as needed, if possible100.91
40Key principle: the IV assessment and actions taken should be documented each shift111.00
41Insertion date and time111.00
42I-DECIDED assessment and relevant action taken111.00
43Removal date and time111.00
44Key principle: the decision to continue or remove the IV device should be based on assessment and consultation with the treating team and the patient100.91
45Decision 1. IV device should remain in place. No other change100.91
46Decision 2. IV device should remain in place, but dressing change done. IV and infusion tubing well secured111.00
47Decision 3. IV device removed and not replaced, in consultation with the treating team111.00
48Decision 4. IV device removed and replaced. Consulted with patient and team about best device and site111.00
Proportion relevant0.901.000.961.001.000.940.901.000.941.000.650.96
(mean)
0.93
(mean)
Mean clinician proportion 0.94
  • C, clinician; CVI, content validity index; IV, intravenous.