Critical Care Nurses’ Knowledge of Correct Line Types for Administration of Common Intravenous Medications: Assessment and Intervention Study (Preprint)

Abstract

There is a paucity of information in the literature on core nursing staff knowledge on the requirements of specific intravenous administration lines for medications regularly given in critical care. There is also a lack of well-researched and appropriate information in the literature for intravenous administration line selection, and the need for filtration, protection from light, and other line-material selection precautions for many critical and noncritical medications used in these settings to maintain their potency and efficacy.

We aimed to assess the knowledge gap of clinicians with respect to intravenous administration line set material requirements for critical care medications.

Data were drawn from a clinician knowledge questionnaire, a region-wide database of administered infusions, and regional data on standard and special intravenous administration line consumption for 1 year (2019-2020) from an enterprise resource planning system log. The clinician knowledge questionnaire was validated with 3 groups (n=35) and then released for a general survey of critical care nurses (n=72) by assessing response dispersal and interrater reliability (Cronbach α=.889). Correct answers were determined by referencing available literature, with consensus between the team’s pharmacists. Percentage deviations from correct answers (which had multiple possible selections) were calculated for control and test groups. We reviewed all 3 sources of information to identify the gap between required usage and real usage, and the impact of knowledge deficits on this disparity.

Percentage deviations from correct answers were substantial in the control groups and extensive in the test group for all medications tested (percentage deviation range –43% to 93%), with the exception of for total parenteral nutrition. Respondents scored poorly on questions about medications requiring light protection, and there was a difference of 2.75% between actual consumption of lines and expected consumption based on medication type requirement. Confusion over the requirements for low-sorbing lines, light protection of infusions, and the requirement for filtration of specific solutions was evident in all evidence sources. The consumption of low-sorbing lines (125,090/1,454,440, 8.60%) was larger than the regional data of medication usage data would suggest as being appropriate (15,063/592,392, 2.54%).

There is no single source of truth for clinicians on the interactions of critical care intravenous medications and administration line materials, protection from light, and filtration. Nursing staff showed limited knowledge of these requirements. To reduce clinical variability in this area, it is desirable to have succinct easy-to-access information available for clinicians to make decisions on which administration line type to use for each medication. The study’s results will be used to formulate solutions for bedside delivery of accurate information on special intravenous line requirements for critical care medications.