{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:18:47Z","timestamp":1787897927938,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Central venous lines (CVLs) and arterial lines (ALs) are commonly used for patients in the intensive care units (ICUs) to facilitate the administration of medications and haemodynamic monitoring. In an ICU in Queensland, Australia (AU), saline (sodium chloride 0.9%) flush bags used for these lines were routinely changed every 24\u2009h following organizational policy that all intravenous fluid bags are to be changed within a 24\u2010h period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This quality improvement (QI) project aimed to evaluate current practice guided by the Plan\u2010Do\u2010Study\u2010Act (PDSA) model of QI and implementation science. Benchmarking practices with other ICUs was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A narrative literature review focused on evaluating the safe interval for changing flush solutions every 24\u2009h was performed using EBSCO Medline, CINAHL, Cochrane Library, Embase and Google Scholar databases for citations up to November 2022. Bloodstream infection rates attributed to CVLs and\/or ALs were monitored. Economic analysis was performed. End\u2010user feedback was sought. A change of practice was implemented for a 1\u2010year study period (March 2023 \u2013 March 2024) to extend dwell times of flushing solutions for CVLs and ALs from every 24\u2009h to every 96\u2009h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One\u2010year post\u2010implementation, no bloodstream infections were linked to CVLs or ALs. A simplified economic analysis was performed based on costs of 0.9% sodium chloride 500\u2010mL fluid bags, which revealed that changing the fluid bags once every 96\u2009h resulted in a per patient saving of AU$3.21 for any individual AL or CVL and up to AU$6.42 per patient where both an AL and CVL are in situ, based on fluid bag cost at AU$1.07 per bag. This saving excludes potential savings from reduced nursing time, infection\u2010related costs and recycling costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A sustainable practice change based on evidence was implemented in the local ICU. The use of the PDSA model of the QI process and the principles of implementation science strengthened the buy\u2010in and implementation of the project.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>This practice change was examined through lenses of evidence\u2010based practice, environmental sustainability (minimizing environmental footprint by limiting plastic bag usage), patient safety, cost minimization, and reduced nursing workload.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70034","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T02:39:09Z","timestamp":1743993549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Extending the interval for changing flushing solutions for central venous and arterial line systems in the intensive care unit: An evidence\u2010based quality improvement project"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0937-838X","authenticated-orcid":false,"given":"Junel","family":"Padigos","sequence":"first","affiliation":[{"name":"School of Public Health The University of Queensland  Herston Queensland Australia"},{"name":"Intensive Care Unit, Sunshine Coast Hospital and Health Service  Birtinya Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-1525","authenticated-orcid":false,"given":"Lauren","family":"Murray","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sunshine Coast Hospital and Health Service  Birtinya Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3956-1940","authenticated-orcid":false,"given":"Olivia","family":"Bredhauer","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sunshine Coast Hospital and Health Service  Birtinya Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7933-7620","authenticated-orcid":false,"given":"Jenny","family":"Jaspers","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sunshine Coast Hospital and Health Service  Birtinya Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9494-3709","authenticated-orcid":false,"given":"Sue","family":"Bethune","sequence":"additional","affiliation":[{"name":"SCHI Library, Sunshine Coast Hospital and Health Service  Birtinya Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-68270-5_1"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-21991-7"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.5812\/aapm\u2010113345"},{"key":"e_1_2_11_5_1","volume-title":"Intra\u2010Vascular Device Management (Recommendations for the Prevention of Infection in Intra\u2010vascular Device [IVD])","author":"Queensland Health","year":"2019"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.87"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2020.12.003"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2023.05.004"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.7196\/AJTCCM.2022.v28i1.175"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/NAN.0000000000000532"},{"key":"e_1_2_11_11_1","unstructured":"Centers for Disease Control and Prevention.Guidelines for the prevention of intravascular catheter\u2010related infections (2011).2011."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/NAN.0000000000000396"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1986.03370070070028"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.5731\/pdajpst.2018.009019"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0196\u20106553(88)90061\u20102"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199409000-00012"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0147\u20109563(98)90008\u20105"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102702.2012.04346.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109343(91)90369\u20109"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0195941700063335"},{"key":"e_1_2_11_21_1","volume-title":"Evidence\u2010Based Practice across the Health Professions","author":"Hoffmann T","year":"2024"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/wvn.12621"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-070962"},{"key":"e_1_2_11_24_1","unstructured":"Standards for Quality Improvement Reporting Excellence.Revised standards for quality improvement reporting excellence SQUIRE 2.0.2015.https:\/\/www.squire-statement.org\/index.cfm?fuseaction=Page.ViewPage&PageID=471"},{"key":"e_1_2_11_25_1","unstructured":"The Deming Institute.The PDSA cycle.2024.https:\/\/deming.org\/explore\/pdsa\/"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/1983\u20101447.2023.20220159.en"},{"key":"e_1_2_11_27_1","unstructured":"Institute for Health Care Improvement.Plan\u2010Do\u2010Study\u2010Act (PDSA) Worksheet.2024."},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010020\u20104981\u20105"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/0759106315597389"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)00351\u20102"},{"key":"e_1_2_11_31_1","volume-title":"Shortage of Intravenous (IV) Fluids","author":"Therapeutic Goods Administration","year":"2024"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70034","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.70034","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70034","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:41:41Z","timestamp":1787895701000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.70034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,6]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/nicc.70034"],"URL":"https:\/\/doi.org\/10.1111\/nicc.70034","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,6]]},"assertion":[{"value":"2024-09-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70034"}}