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Accepted but Unacceptable: Peripheral IV Catheter Failure

The Art and Science of Infusion Nursing

Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals  pportunities for improvement.
Keywords: bloodstream infection , dislodgment , infiltration , occlusion , peripheral intravenous catheter failure , phlebitis

Resource Utilization and Cost of Inserting Peripheral Intravenous Catheters in Hospitalized Children


OBJECTIVE: The goal of this study was to measure the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children; measures of resource utilization. We measured the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children. This common procedure has implications for the utilization of hospital resources.
METHODS: This was a prospective, large-scale observational study in 2 southeastern US pediatric teaching hospitals evaluating 592 children needing peripheral IV catheters in the inpatient setting. The median age was 2.25 years with an age range of 2 days to 18 years. Costs were estimated by using directly measured staff time and national salary data. Analyses included costs according
to patient characteristics (age, weight, dehydration, and difficulty of stick attempts), and nurse characteristics (experience in years and anticipated difficulty).
RESULTS: The median cost of the pediatric IV insertions was $41, and 60% of the placements were obtained with the first nurse. Seventy-two percent of the children had a successful IV insertion in 1 to 2 attempts and accounted for 53% of total costs. However, the 28% of children who required ≥3 IV attempts had a cost range of $69 to more than $125, and they consumed 43% of the total IV costs. This subset was often <2 years old or dehydrated (P = .0002).
CONCLUSIONS: The insertion of peripheral IV catheters in an inpatient setting can be time intensive and requires significant skill. Our study suggests that resource utilization may improve when nurses and personnel proficient in starting peripheral IV catheters are used when the initial nurse has failed to obtain IV access. This systems improvement should result in shortened time to administration of parenteral therapies, positively improving outcomes and lessening length of stay, as well as improving patient/family satisfaction due to reduced perceptions of pain.

Under-Reporting of a Critical Perioperative Adverse Event: Intravenous Infiltration and Extravasation

This article was published in the following Dove Press journal: Drug, Healthcare and Patient Safety

Abstract: A critical step in understanding and preventing potentially disastrous complications in the perioperative period is the accurate recording of their occurrence and subsequent analysis. However, the recording of intravenous infiltration and extravasation is likely inaccurate due to several factors: rare serious complications associated with infiltration/extravasation, limitation in ICD-10 codes to describe the injury, reliance on coders to record these events in searchable databases, and limited quality measures in anesthesiology to record these events. Although current literature cites results of studies that found rates of 16% and higher for
intravenous infiltration, a limited internal review at University Hospital in Newark, NJ found significantly lower rates with only 14 instances recorded in an 18-month period across the institution. This leads the author to conclude that interventions are required to better track these events including such steps as staff education and more efficient/accessible reporting systems. The accurate recording and analyzing of data related to adverse events, and in particular regarding infiltration and extravasation, require revision and reinterpretation to gain an accurate picture of their rates.

Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit with LEAN Multi-Modal Strategy: The PIV5Rights Bundle

Presented at the Association for Vascular Access Annual Scientific Meeting, October 2019, Las Vegas, NV

Results : The study measured multi-modal (PIV5 Rights) best practice bundle with a VAST versus current state complication outcomes, dwell time (success rate), and cost associated with multiple PIVC restarts (Tables 2 and 3).

Securing All intraVenous devices Effectively in hospitalised patients-the SAVE trial: Study protocol for a multicentre randomised controlled trial

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/282153312

Introduction: Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3–4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload.

Intravenous Smart Pumps
Usability Issues, Intravenous Medication  Administration Error, and Patient Safety


  • Although the use of intravenous smart pumps has been associated with reductions in medication error rates, they have not eliminated error.
  • Current data do not support that the use of intravenous smart pumps has had a measurable impact on decreasing adverse drug events.
  • The administration of multiple intravenous infusions, secondary infusions, intravenous boluses,
    and titrated doses are particularly prone to errors.
  • Intravenous smart pump programming errors often result from use errors related to the infusion device interface.
  • There is a clear need for innovation in intravenous smart pumps to address usability and safety challenges.

Prolonging the Life of a Patient’s IV:
An Integrative Review of Intravenous Securement Devices

Continuing Nursing Education

This integrative review described current research on the effectiveness of IV securement devices. Over-whelmingly, results demonstrated use of IV securement devices decreased complications associated with peripheral IV catheters, and prolonged their longevity and patency. However, future studies are needed to identify which securement devices produce the most cost savings while also decreasing the risk of needlesticks in health care workers.

Infection prevention practices and the use of medical tapes

American Journal of Infection Control

Background: Medical tapes are ubiquitous in healthcare and there are currently no guidelines for their storage and use. Tapes cannot be cleaned or disinfected; yet, several clinicians may use a given roll for any number of patients. Reports of tape contamination associated with clinical infection have been published.
Purpose: We reviewed the literature reporting microbiological studies, case reports of infections, and nosocomial outbreaks associated with the use of medical tapes and other adhesive devices to assess the prevalence of this problem.
Methods: We conducted a literature search for cross-contamination due to medical tape use in 6 databases in June 2020 using indexing terms for surgical tape, adhesive agent, adhesives or the keyword for tape. We compiled available evidence on tape contamination as a cause for healthcare-associated infections (HAIs).
Main findings: Forty-two publications reported relevant microbiological studies, case reports of infections, and/or nosocomial outbreaks. Results demonstrated that tape rolls handled with questionable practices can harbor pathogens. Some studies showed the association between contaminated tape and HAIs, which in some cases even led to death.
Conclusions: The time has come to establish national guidelines to help reduce the risk of cross-contamination from medical tapes. We offer suggested elements for these guidelines. The COVID-19 pandemic brings greater scrutiny to eliminate any avoidable
cause of infection transmission.