NSG 324 Unit 1 clinical question from practice example

Two Nurses, One Working IV: Turning a Disagreement About Routine Catheter Replacement Into a Clinical Question

Student Name

Department of Nursing, Herzing University

NSG 324: Evidence Based Practice in Nursing

Instructor Name

January 21, 2026

Two Nurses, One Working IV: Turning a Disagreement About Routine Catheter Replacement Into a Clinical Question

What I Noticed

On the 32-bed composite medical-surgical floor where I work nights, policy requires peripheral intravenous catheters to be replaced every 96 hours. During one week in December, I saw two experienced nurses handle this rule differently for the same kind of patient. At 4 a.m., one nurse restarted the IV of an older woman with heart failure whose catheter had reached 96 hours. The site was clean, the catheter flushed easily, and the patient had no pain. It took three attempts and an ultrasound-trained colleague to place the new one, and the patient cried during the second attempt. Two nights later, another nurse left a similar 96-hour catheter in place for a man with difficult veins, documented that the site showed no redness, swelling, or tenderness, and told me she would rather watch a working line than cause a new puncture.

Both nurses cared about the same things, the patient's comfort and the risk of infection or phlebitis, and both believed they were doing the safer thing. That disagreement is what made this a question rather than a preference.

Why the Question Is Open on This Unit

The hospital's 96-hour policy is based on a national guideline for preventing catheter-related infections, which stated that peripheral catheters in adults need not be replaced more often than every 72 to 96 hours, and which explicitly made no recommendation about replacing them only when clinically indicated, calling that an unresolved issue (O'Grady et al., 2011). The current national standards for infusion nursing, published more recently, favor removal based on regular site assessment and clinical need rather than on a fixed schedule (Nickel et al., 2024). The unit's policy therefore rests on the older of two sources that point in different directions, which is exactly the situation in which a clinical question is worth asking.

The Question in PICOT Form

In hospitalized adults with a peripheral intravenous catheter (P), does replacing the catheter only when clinically indicated (I), compared with the current fixed 96-hour change (C), change the rate of phlebitis and catheter-related bloodstream infection (O) during the period the catheter is in place (T)?

This is an intervention question, because it compares two courses of action. That matters for the search, since intervention questions are best answered by randomized controlled trials and by systematic reviews of those trials; for questions about the effect of an intervention, those designs give the strongest answers (Melnyk & Fineout-Overholt, 2023).

Defending Each Element

Population. I chose hospitalized adults rather than only medical-surgical patients or only older adults. The practice question applies across the hospital, and narrowing the population too far could exclude the trials most likely to answer it. Children are excluded because their catheters, veins, and guidelines differ.

Intervention. "Clinically indicated" must be defined, or the question cannot be answered. I mean removal when the catheter is no longer needed or when the site shows signs of a problem, such as phlebitis, infiltration, occlusion, leakage, or infection, found through site assessment at set intervals. Without the assessment, clinically indicated replacement becomes "leave it until something goes wrong," which is not what the second nurse was doing.

Comparison. The comparison is the current policy, routine replacement at 96 hours, not "no replacement." Comparing against current practice keeps the question about the actual decision on this unit.

Outcomes. Phlebitis and catheter-related bloodstream infection are the outcomes both nurses were worried about, so they are the primary outcomes. Bloodstream infection from a peripheral catheter is rare, which means a study may be too small to detect a difference in it, so phlebitis is likely to be the outcome the evidence can speak to most clearly. I considered and kept secondary outcomes that matter to patients and the unit: the number of insertion attempts, patient-reported pain, and catheter-related costs. I excluded length of stay, because too many other factors affect it for catheter policy to move it measurably.

Time. The timeframe is the dwell time of the catheter, not a fixed number of days, because the intervention itself changes how long catheters stay in.

Framings I Considered and Set Aside

My first draft asked, "Is it safe to leave peripheral IVs in longer than 96 hours?" That version had no comparison and no defined intervention; "longer" could mean five days or two weeks, and "safe" did not say safe from what. A second draft asked whether ultrasound-guided insertion reduces the number of attempts in patients with difficult veins. That is a good question, and it came from the same night, but it answers a different problem: how to place a new catheter well, not whether a working one needs replacing at all. I kept it as a possible follow-up question for the unit's practice council. The final version keeps the decision the two nurses actually faced at the center, which is the test I used for every element: would the answer tell a nurse at 4 a.m. what to do with this catheter?

What the Question Is Not

The question does not ask whether the second nurse was right to break the policy. Individual nurses do not change policy by deciding to ignore it, and part of the reason for asking the question formally is to bring the disagreement to the unit's practice council with evidence rather than leaving it to each nurse's judgment at 4 a.m. It also does not ask about midline or central catheters, whose risks and guidelines are different.

What Would Answer It

A useful answer would come from randomized trials comparing the two strategies in hospitalized adults, or from a systematic review of such trials, with phlebitis and bloodstream infection as outcomes. If the evidence showed no difference in harm between the strategies, the unit would need to weigh that against the fewer needle sticks and lower costs of replacing catheters only when needed. If it showed more harm with clinically indicated replacement, the current policy would be supported, and the first nurse's 4 a.m. restart would have a clear reason. Either way, the next step is a search, which is the work of the following unit.

References

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice, 9th edition. Journal of Infusion Nursing, 47(1S), S1-S285. https://doi.org/10.1097/NAN.0000000000000532

O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., Masur, H., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A. G., Rupp, M. E., Saint, S., & Healthcare Infection Control Practices Advisory Committee. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162-e193. https://doi.org/10.1093/cid/cir257