A Common Procedure with Prevalent Complications
Vascular access is the most common inpatient invasive procedure, with more than 300 million peripheral intravenous catheters (PIVCs) sold in the United States each year to meet this demand.¹ Yet, this seemingly routine procedure has a failure rate of 35-50%.¹ Vascular access device failure can result in severe adverse events for patients and has direct financial and administrative consequences for hospitals as well.¹’² A 35-50% failure rate for the most common invasive procedure performed in hospitals is unacceptable, and healthcare organizations are currently addressing this issue to improve both patient and provider well-being.
Two Causes of PIVC Failure: Trauma and Contamination
While a variety of adverse events can result from PIVC failure, the 2 general causes behind such complications are varying degrees of trauma and contamination. The interaction between these two over-arching causes may present as 5 different modes of failure, as seen in the diagram below.²
ECRI: Peripheral Vascular Harm is a Top Patient Safety Concern
It is not surprising that the Emergency Care Research Institute (ECRI) has listed peripheral vascular harm as one of ten top patient safety concerns for 2021.³ Vascular access complications not only cause extended patient time in hospitals and antibiotic treatments but can result in death if such interventions are unsuccessful.³ With PIVCs being the most commonly used invasive device in hospitals, a significant patient population is susceptible to such risks.³ This issue cannot be overstated–up to 69% of PIVCs are removed due to failure or infection before completion of scheduled intravenous therapy.⁴
While infection risk of PIVC failure is often discussed, it is important not to discount other harmful results of PIVC failure. An analysis of 27,320 PIVC adverse events conducted by ECRI and ISMP PSO found 6,119 reported infections and 21,201 non-infection harm events. This meant that approximately 77% of patients suffered from non-infection harm. These can include phlebitis, infiltration, burns, leaks, redness, erythema, swelling, draining issues, and ecchymosis.³
Action Recommendations for Prevention
ECRI recommendations to prevent peripheral vascular harm include, but are not limited to:³
Audit process measures and prmote reporting of events and near misses
Research and acquire proven technology to assist with proper catheter securement
Auditing process measures and reporting both events and near misses is essential to reducing PIVC failure rate.³’⁵ According to the 2021 Infusion Therapy Standards of Practice, best practice includes monitoring dressing sites regularly, conducting detailed assessment of dressing and skin condition. Reporting and recording such data from in-depth, scheduled dressing assessments is essential to addressing PIVC harm at an organizational level.³’⁵
ECRI also recommends continued innovation and use of proven technology to assist with catheter securement.³ Proper dressing and device securement are critically important, as each compromised dressing poses a risk of infection. Multiple dressing disruptions increase that risk incrementally, with a second dressing disruption resulting in a three-fold increase in catheter-related infection risk.⁶
References
Helm R, Klausner JD, Klemperer JD, et al. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs.2015; 38 (3): 189–203. https://journals.lww.com/journalofinfusionnursing/Abstract/2015/05000/Accepted_but_Unacceptable__Peripheral_IV_Catheter.3.aspx
Helm R. Accepted but Unacceptable: Peripheral IV Catheter Failure. 2019 Follow-Up. J Infus Nurs. 2019; 42 (3): 140-150.
ECRI Special Report. Top 10 Patient Safety Concerns 2021.
Blanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control. 2019 Jul 22;8:124. https://pubmed.ncbi.nlm.nih.gov/31367345/doi: 10.1186/ s13756-019-0581-8.
Gorski, LA, Hadaway, L, Hagle, ME, et al. Infusion Therapy Standards of Practice. 8THJ Infus Nurs. Revised 2021.
Timsit, JF, Bouadma L, Ruckly S, Schwebel C, Garrouste-Orgeas M, Bronchard R, Calvino-Gunther S, Laupland K, Adrie C, Thuong M, Herault MC, Pease S, Arrault X, Lucet JC. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med.2012;40:1707-14.