ID: HR19-1333

Presenting author: Melissa Nicholson

Presenting author biography:

Melissa is a clinical nurse educator working at an inner city hospital in Vancouver, Canada. Clinical experience consists of 11 years of nursing in a variety of settings with a focus on inpatient care for marginalized populations. Research interests include health equity within the inpatient and emergency department settings.

Intravenous catheter harm reduction: Is it a hard line?

Melissa Nicholson, Emma Garrod, Jocelyn Hill, Will Connors, Laura Holland, Nadia Fairbairn

Issue:
Infections among persons who inject drugs (PWID) are common and often require long term intravenous (IV) antibiotics. Hospitalized patients have disclosed use of IV lines to inject illicit drugs when other venous access isn’t readily available. Data from our hospital-based, peer-witness overdose prevention site (OPS) indicates that 5% of clients inject via existing IV lines at the site. Injecting into IV lines is discouraged by health care providers, citing concerns about line malfunction, as well as increased infection and overdose risk. However, much of the literature is speculative, with little demonstrated evidence to date.

Setting:
St. Paul’s Hospital is an inner-city facility specializing in HIV and substance use care in Vancouver, Canada. Provincially, it sees the highest rates of opioid overdoses and is a leader in hospital implementation of harm reduction initiatives, including an OPS on hospital grounds.

Project:
An interdisciplinary team was assembled to address current practices with patients injecting into IV lines. Processes included a literature review, expert consultation (including patients and peers), and hearing physicians, nurses, risk management and ethics concerns. Two protocols were developed and implemented on harm reduction strategies for substance use via IV lines; one for OPS peer staff to use when educating clients and one for nurses to provide supplies and educate patients in hospital.

Outcomes:
This project demonstrates a novel application of harm reduction principles by providing supplies and education regarding IV line use among hospitalized PWID. The protocols supported peer staff at the OPS and hospital nurses caring for hospitalized PWID, while aligning with nursing practice standards and organizational harm reduction policies. Ongoing evaluation of IV line complications in hospital and rates of safer IV line use at the OPS following implementation of these protocols lay the groundwork for future research to accurately characterize risks of IV line use.