The Current State of IV Therapy: Potential Harm, Costs, and Solutions
IV catheter placement remains the most common invasive hospital procedure performed worldwide with more than 330 million1 peripheral IV catheters sold each year in the US alone. Between 60% to 90% of hospitalized patients require an IV catheter during their hospital stay.2,3 IV therapy is so commonplace, one might forget potential harm to the patient.
Studies indicate between 35% and 50%2 of IV catheters in hospitalized patients fail. Catheter failure is considered to have occurred when an IV catheter stops effectively or safely working before its intended dwell time. Common types of failure include:
- Infiltration: Inadequate PIVC securement can lead to increased catheter tip motion leading to vessel wall injury or loss of integrity.
- Extravasation: Occurs when vesicant medication seeps into surrounding tissues.
- Phlebitis: May also be caused by movement of the catheter relative to the vessel wall.
- Occlusion or mechanical failure: Catheter movement can lead to vessel wall trauma and associated thrombosis.
- Dislodgment: When an IV insertion site is not protected the catheter can become dislodged accidentally or be removed by the patient.
Placing an IV catheter in an area of flexion increases the chance of IV therapy complications, which leads to painful and costly restarts. A straightforward first attempt insertion costs between $28 and $354 and costs rise with repetitive attempts. Personnel time is the largest cost factor in the establishment of a successful PIV insertion.
For patients, common IV therapy complications lead to pain and delay of treatment which could impact treatment options. These delays may also increase their hospital stay and increase cost of care, all of which have an effect on patient satisfaction and may be reflected in hospital Consumer Assessment of Healthcare Providers and Services survey scores that impact hospital reimbursement.
Best Practices / Solutions
The Infusion Nurses Society recommends avoiding the placement of a peripheral IV catheter in areas of flexion,5 however this is difficult with pediatric, disoriented, or uncooperative patients. When it is necessary to use these areas for treatment care must be taken to properly stabilize the joint and secure the IV insertion site.
Touch / Look / Compare
Originally developed by a large pediatric hospital, I.V. House recommends the Touch, Look, and Compare method6 to provide nurses with a memorable technique for evaluating a patient’s IV insertion site.
- Touch: IV insertion site should feel soft, warm, dry, and pain free.
- Look: IV insertion site should be uncovered, dry, and without redness.
- Compare: IV insertion site and surrounding tissue should be the same size as the opposite extremity without swelling.
The I.V. House product line was developed in order to improve patient safety and increase nurse efficiency.
- TLC® Splint is ergonomically designed to stabilize the joint while supplying access for faster visual and manual assessments.
- I.V. House UltraDome® secures and protects the IV catheter and loop of tubing to prevent bumps and snags that lead to dislodgement.
- I.V. House UltraDressing® has a soft fabric wrap to reduce tape usage that can lead to skin damage including epidermal stripping.
- Vascular Access Educator’s Survey Finds IV Tubing Dislodgment Occurs Frequently, Threatening Patient Safety, Cision PR Newswire, PICC Excellence, Dowling, Liz, Moreau, Nancy, (2017) Accessed June 12, 2018
- Accepted but Unacceptable, Peripheral IV Catheter Failure. (2015). Journal of Infusion Nursing, Vol 38, No.
- Improving Vascular Access Outcomes and Enhancing Practice. (2018). Journal of Infusion Nursing, Vol. 41, No. 6
- Impact and Safety Associated with Accidental Dislodgment of Vascular Access Devices: A Survey of Professions, Settings, and Devices. (2018). The Journal of the Association for Vascular Access, Vol. 23 No. 4
- Infusion Nurses Society Textbook: Infusion Nursing: An Evidence-Based Approach, Pages 430-431, 464-465, 561 & 580. 2010 Ed. 3, Saunders/Elsevier, St. Louis, MO
- Cincinnati Children’s Hospital Medical Center, TLC For Safety Touch, Look and Compare poster