Addressing PIVC complications to improve patient outcomes.

October 7, 2021 Whitney Line

Patient receiving care.

Often perceived as simple to use and low risk, peripheral intravenous catheters (PIVC) are the most common and widely known intravenous devices utilized across healthcare, with approximately 330 million sold annually in the United States.1 However, many of us may not realize that their failure can lead to both significant health complications, but also costs related to nursing care and maintenance. Complications could include infection, phlebitis, infiltration, dislodgement, and mechanical failure and occlusion.

Minimizing the risk of failure is essential to improving patient outcomes. This begins by understanding the potential risks associated with PIVCs, comparing historical and current guidelines and standards, and changing practices to reduce bloodstream infections and other complications.

An overview of how PIVC standards and guidelines have shifted over the years.

Historically, PIVCs were changed more frequently than clinically indicated. This was based on common hospital policies such as removal every 24 hours, however these guidelines evolved in the early 2000s based on new evidence.2-4

In 2002, the U.S. Centers for Disease Control and Prevention (CDC) recommended increasing PIVC dwell time from 72 to 96 hours due to lack of clinical evidence that changing them less frequently was unsafe. This was also aligned with some nurses’ preference to not remove a PIV catheter at 72 hours without symptoms of complications. This change in guidelines potentially led to cost savings of $168 per day or $61,200 per year – a substantial amount.4

Most recently, current guidelines from the Infusion Nurses Society (INS) recommend that health practitioners should remove a PIVC if it is no longer included in the plan of care for the patient or if it has not been used in 24 hours or more. The INS have also advised removing the PIVC when clinically indicated based on findings from site assessment and symptoms of health complications.5

The price of PIVC failure on patients and hospitals.

Failure of the PIVC can be quite significant – creating a burden on both patients and hospitals. On average, inserting a short-term PIVC in the US costs between $28 and $35 for first-stick insertions – this includes both the products used and the nurses’ time.9

However, the cost can vary and hike depending on the number of attempts, products selected, and supportive technologies used (e.g., skin protectant, stabilization devices). Typically, it takes two attempts to place a peripheral IV. If the first attempt is unsuccessful, both the cost and risk of subsequent catheter failure increases.6-8

Unsurprisingly, the complication and failure rates of PIVCs are high. In a review of randomized controlled studies from 1990-2014, Helm found the mean overall failure rate of a PIVC was 46%. That means nearly half of all peripheral IV catheters placed will fail before their intended dwell time is complete. This may have negative impacts on patients and outcomes.9

Understanding causes of PIVC complications.

Occurring in 15.4% of all PIVCs, phlebitis is the inflammation of the vein wall and is common with PIVCs. No patient’s skin can be completely sterilized, and when unsecured catheters move, they can push bacteria into the bloodstream, causing bacterial phlebitis.9

Infiltration is another common form of IV catheter failure, occurring in 23.9% of PIVC complications. It can be caused by venous wall injury from inflammation, trauma from catheter movement or needle injury at the time of insertion or previous attempt.5,7,9-11

Mechanical failure and occlusion has a mean incidence rate of 18.8% can be caused by the catheter kinking or dead-ending into a vessel wall. Damaged blood vessels can also initiate inflammatory thrombosis and occlusion of the catheter. Additionally, a change in coagulation can cause thrombosis. The difficulty of differentiating occlusion from other catheter failure etiologies leads to a broad range of incidence.2,9,11-14

While PIVCs are the most prevalent intravenous devices in hospitals, their failure can lead to significant health complications and costs. With guidelines shifting to longer dwell times and clinically indicated removal, it’s critically important to understand the risks of PIVCs to minimize the possibility of infections. See our next article to learn more about prevention and interventions for PIVC failure.

 

References:

  1. Hadaway L. Short peripheral intravenous catheters and infections. J Infus Nurs. 2012;35(4).
  2. O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193.
  3. Lai KK. Safety of prolonging peripheral cannula and i.v. tubing use from 72 hours to 96 hours. Am J Infect Control 1998; 26:66–70.
  4. Keleekai, NL, Schuster, CA, Murray, CL, King, MA, Stahl, BR, Labrozzi, LJ, et al. (2016). Improving nurses' peripheral intravenous catheter insertion knowledge, confidence, and skills using a simulation-based blended learning program: a randomized trial. Simulation in Healthcare, 11(6), 376.
  5. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion Therapy Standards of Practice. J Infus Nurs. 2016; 39(suppl 1): S1-S59.
  6. Hadaway L. Infiltration and extravasation. Am J Nurs. 2007; 107(8): 64-72.
  7. Webster, J., Osborne, S., Rickard, C. M., & New, K. (2013). Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews2013(4), CD0077981-1.
  8. Rickard CM, Webster J, Wallis MC. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomized controlled equivalence trial. Lancet. 201;380(9847):1066-1074.
  9. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J Infus Nurs. 2015; 38(3): 189-203.
  10. Hadaway L. Infiltration and extravasation. Am J Nurs. 2007; 107(8): 64-72.
  11. Jackson A. Retrospective comparative audit of two peripheral IV securement dressings. British J of Nurs. 2012; 21. 10-5
  12. Amy Leung, Clare Heal, Jennifer Banks, Breanna Abraham, Gian Capati, and Casper Pretorius, “The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients,” Thrombosis, vol. 2016, Article ID 6043427, 6 pages, 2016. doi:10.1155/2016/6043427
  13. Zingg W, Pittet D. Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents. 2009;34(4)(suppl):S38-S42.
  14. Trinh TT, Chan PA, Edwards O, et al. Peripheral venous catheter-related Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2011;32(6):579.

About the Author

Whitney Line

[enBio=Prior to joining 3M, she practiced as a trauma nurse at an area Level 1 trauma center and was a Patient Care Supervisor with the University of Minnesota-Solid Organ Transplant program. She focused on design and implementation of optimal processes and workflows, while managing a team of clinical nurse transplant coordinators. Her work is driven within the framework of improving the lives of patients globally; and supporting nurses in their drive to provide excellent patient care. This past year, she has worked to support nurses around the world to better understand the varying types of respirator products, and the ever-changing guideline and regulatory landscape. She has contributed to medical education delivered around the world, and has presented education on medical respiratory protection, process improvement, and vascular access care across the United States. ],[enJob=Application Engineer, Medical Soluions Division, 3M],[frBio=Avant de rejoindre 3M, elle a exercé comme infirmière en traumatologie dans un centre de traumatologie de niveau 1 de la région et a été superviseure des soins aux patients dans le cadre du programme de transplantation d’organes solides de l’Université du Minnesota. Elle s’est concentrée sur la conception et la mise en œuvre de processus et flux de travail optimaux, tout en gérant une équipe d’infirmières cliniciennes coordinatrices de transplantation. Son travail s’inscrit dans le cadre de l’amélioration de la vie des patients dans le monde et du soutien aux infirmières dans leur volonté de fournir d’excellents soins aux patients. L’année dernière, elle a travaillé pour soutenir les membres du personnel infirmier du monde entier pour mieux comprendre les différents types de produits respiratoires ainsi que les directives et le paysage réglementaire en constante évolution. Elle a contribué à l’enseignement médical dispensé dans le monde entier et a présenté des formations sur la protection respiratoire médicale, l’amélioration des processus, et les soins d’accès vasculaire aux États-Unis.],[frJob=Ingénieure d’application au sein de la Division des solutions médicales de 3M]

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