A study to find out the barriers and facilitators related to iv line insertion and maintenance in pediatric emergency

Background : IV line insertion and maintenance is very crucial to prevent nosocomial infection in pediatric patients visiting pediatric emergency.PGIMER is a tertiary care hospital that cater to the needs of pediatric clients by providing 24 hours services in Advance Pediatric Center (APC).Pediatric emergency department is located on the ground floor in APC and has capacity of 22 beds and 24 incubators. Daily admission of patient in pediatric emergency is approximately 30-40 children in a day, whereas as early transfer of patients to other units is not feasible. This leads to overcrowding and HCPs have to manage two to three children on single bed. Though in each shift 10-12 nursing officers and 12-14 residents are posted on duty and they strive hard to provide quality care, still there are many barriersrelated to IV line insertion and maintenance.If such barriers are identified and managed time to time the infection rates can be reduced. Keeping this fact in view we conducted this study to find out the barriers and facilitators related to IV line insertion and maintenance.A total of 8 focused group discussion were conducted with the health care personnel of pediatric emergency, out of which 5 were conducted with nursing officers and 3 were conducted with physicians (junior and senior residents). In each FGD 4 to 5 members were included. Discussions were recorded and field notes were taken. Focused group discussion guide was used to know the barriers and facilitators, it included questions aboutHCPs view about current status of infection associated with IV line, possible cause of infection that is phlebitis and infiltration, measures taken by HCPs to prevent IV line related infections, causes of not being able to adhere to infection control measures, suggestive measures to reduce incidence of infection. After conducting discussion interviews were transcribed, read and reread and themes were generated. Physician mentioned about high rates of infection in the unit. According to them themes relatedto the barriers of IV line insertionwere lack of supply of articles, difficult to manage the time, over- crowding of patient, less co-ordination between health care workers, low socioeconomic status of patients. The facilitators identified were availability of tourniquets, available and arranged articles and parental help to restrain the child. The suggested remedial measures were to improve the practices related infection prevention such as to increase hand washing/ hand rubbing and ensure liberal supply of: hand rubs, gloves, additional packs and trays. They also emphasized on the need of assistance form nursing personal to hold the child and fix the cannula. They also highlighted the routine checking of the cannula sites, its fixation and removal of blood from 100cm extensions by nurses. Related to maintenance of iv line they mentioned that HCPs should perform hand hygienebefore touching cannula hub and administering drugs as lack of handhygiene is a source of infection.