NR 516 Week 8 Practice Question Paper on Flushing Example

Practice Question Paper: Does Flushing Idle Peripheral Catheters Once a Day Instead of Every Eight Hours Change Failure in Adult Inpatients? What Three Trials and One Interview Study Can and Cannot Answer

Student Name

College of Nursing, Chamberlain University

NR 516: Basic Research and Evidence-based Practice

Instructor Name

Month Day, Year

Practice Question Paper: Does Flushing Idle Peripheral Catheters Once a Day Instead of Every Eight Hours Change Failure in Adult Inpatients? What Three Trials and One Interview Study Can and Cannot Answer

The Question and Why It Is Worth Asking

Each unused peripheral line on the 32 beds where I work receives a 10 mL saline flush at 0600, 1400 and 2200. Across the unit that is roughly 60 scheduled flushes a day, each requiring a nurse to prepare a syringe, clean the hub and handle the catheter. This paper argues three things: that the question behind the routine can be searched as written, that the studies retrieved were read against it, and that they answer part of it, but not all. Stated for searching, the question asks whether adult medical-surgical patients whose peripheral lines sit unused fare any differently, in terms of line failure, when those lines are flushed once a day rather than every eight hours or more often.

The question is worth the reading because the routine has costs that nobody counts. Each flush uses nursing time and supplies, and each access is a chance to introduce bacteria or dislodge a catheter. If the routine does not prevent failure, those costs buy nothing.

The Question Can Be Searched as Written

The Week 2 exercise translated the question into PubMed terms: the subject heading Catheterization, Peripheral; the free-text truncation flush*; interval words; and outcome words for occlusion, failure and patency. The search on September 30, 2026 narrowed from 217 records to 23 worth reading, and a randomized-trial limit returned 11. The strings were tested against a known relevant trial, which each captured. The unit's own phrase, "saline lock," would have missed it. The question as written is searchable and repeatable; another nurse running the same strings should find the same core studies.

What Was Retrieved and Read

Three randomized trials addressed flushing frequency for peripheral catheters. An adult pilot trial of 160 medical and surgical inpatients compared flushing every 6 hours with every 24 hours, and 3 mL with 10 mL, in a factorial design (Keogh et al., 2016). A pediatric trial randomized 400 children to flushing every 12 or every 24 hours and was designed to test whether once-daily flushing was noninferior (Schreiber et al., 2015). A pediatric pilot trial of 55 children used the same factorial comparisons as the adult trial (Kleidon et al., 2020). A qualitative study of 25 emergency nurses and doctors explored why clinicians do or do not follow a catheter care standard (Xu et al., 2024).

How Far Each Trial Can Be Trusted

Adult pilot trial. Randomization was done by a centralized web-based service and allocation was concealed until each patient entered the study, both protections against selection bias. The interventions could not be masked, so outcome assessment could be biased, although the authors used dedicated research nurses and standard data collection to limit this. The most important limit is size: the authors calculated afterward that the trial had 14% power to detect a difference in frequency (Keogh et al., 2016). A nonsignificant result from a trial with that power is weak evidence of no difference.

Pediatric noninferiority trial. With 400 children randomized and only three lost to follow-up, this was the largest and most complete trial. It set its noninferiority margin in advance and met it: the 95% confidence interval for the difference in patency, minus 1.6% to 7.7%, stayed above the minus 4% margin (Schreiber et al., 2015). Its limit for my question is population. Children are not adults, and the comparison was 12 hours, not 8.

Pediatric pilot trial. This trial did not meet its screening feasibility criteria, mainly because many children had continuous infusions or catheters already in place too long. Among those eligible, 80% consented, 2% withdrew and protocol adherence was complete. It found no difference in failure by frequency, but its authors state that firm conclusions cannot be drawn from so small a sample (Kleidon et al., 2020).

How Much of the Question the Reading Answers

The reading answers the question partly. It supports the claim that once-daily flushing does not increase catheter failure compared with more frequent flushing: the only adequately powered trial, in children, showed noninferiority, and neither pilot found harm from less frequent flushing. The adult pilot also found that each additional access to a catheter per day raised the hazard of failure, which suggests that scheduled flushes of an idle catheter may add risk rather than remove it (Keogh et al., 2016).

It does not answer the question fully. No trial tested eight hours. The single adult trial was too small to settle the matter. The trials were conducted in Australia and Italy, not the United States, and none reported on patients like mine in detail. The honest summary is that the evidence makes our eight-hourly routine hard to defend as necessary, without proving that once-daily flushing is equally safe for our adult patients.

What the Qualitative Study Adds to the Answer

The interview study does not speak to safety. It speaks to change. Its participants described time pressure, limited training and no feedback on what happened to catheters after insertion as the main barriers to following a catheter standard (Xu et al., 2024). Any change on my unit will face the same pressures, and the easiest to address is feedback: nurses cannot judge a new routine if nobody tells them how catheters fare.

What I Will Propose

I will bring this reading to the unit practice council with a specific proposal: move from eight-hourly to once-daily scheduled flushing for idle peripheral catheters, keep the 10 mL volume unchanged, continue flushing before and after every medication, and track catheter failure monthly for six months before and six months after the change, shared with staff. Because this would be a unit-wide practice change evaluated against the unit's own past, not a comparison between randomly assigned patients, I will ask quality staff to confirm in writing that it falls outside institutional review board review as research. If failures rise, the unit returns to its previous routine.

The question was worth the reading because it turned a habit into a choice that can be defended or changed on evidence, and because it showed exactly where that evidence stops.

None of this depends on the unit's staff reading the trials themselves; it depends on a clear summary, a monthly count and a date on which the council will decide whether to keep the change.

References

Keogh, S., Flynn, J., Marsh, N., Mihala, G., Davies, K., & Rickard, C. (2016). Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: A pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 17(1), Article 348. https://doi.org/10.1186/s13063-016-1470-6

Kleidon, T. M., Keogh, S., Flynn, J., Schults, J., Mihala, G., & Rickard, C. M. (2020). Flushing of peripheral intravenous catheters: A pilot, factorial, randomised controlled trial of high versus low frequency and volume in paediatrics. Journal of Paediatrics and Child Health, 56(1), 22-29. https://doi.org/10.1111/jpc.14482

Schreiber, S., Zanchi, C., Ronfani, L., Delise, A., Corbelli, A., Bortoluzzi, R., Taddio, A., & Barbi, E. (2015). Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: A randomised controlled trial. Archives of Disease in Childhood, 100(7), 700-703. https://doi.org/10.1136/archdischild-2014-307478

Xu, H., Bowdery, J., To, Y., Duff, J., Griffin, B., Ullman, A. J., Rickard, C. M., & Plummer, K. (2024). Peripheral intravenous catheter clinical care standard adherence in emergency departments: A qualitative study underpinned by the behaviour change wheel. Journal of Advanced Nursing, 81(11), 7659-7673. https://doi.org/10.1111/jan.16409