Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations

Abstract

Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Due to its inherently invasive nature, intravenous (IV) therapy is associated with a number of potential complications, many of which are directly relevant to patient safety (PS). PIV-related morbidity may be due to mechanical or nonmechanical factors. The most frequent nonmechanical peripheral venous catheterization adverse events (PVCAEs) include insertion site pain, phlebitis, hematoma formation, and infusate extravasation. The most common mechanical PVCAE is catheter obstruction/occlusion and dislodgement. Significant complications can also occur with the administration of incorrect type or wrong amount of IV fluids. Moreover, simultaneous infusion of incompatible medications can result in infusate precipitation. Finally, less frequent but significant complications have been reported, including bloodstream and local infections, air embolization, nerve damage, arterial puncture, skin necrosis associated with vasopressor infusions, and limb-threatening forgotten tourniquet events. Taken together, the above complications can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. Efforts to prevent PVCAEs and improve patient outcomes should involve thorough provider education, clinical vigilance by all involved healthcare providers, health service level strategies, as well as the proactive participation of all stakeholders, including patients and their families.

Characterising the types of paediatric adverse events detected by the global trigger tool – CareTrack Kids

“…8 The management of virtually all emergencies involves an IV line, whether for medication, fluids, blood products, or contrast injection. 40 Although significant harm related to IV was not detected in this study, the extravasation of any IV fluid, site infection, haematoma, and phlebitis can cause serious and potentially permanent harm. 40 Adverse events associated with IV access are largely preventable, although the safe management of IV lines requires many reliable processes to be undertaken over hours or days.…”

“…40 Although significant harm related to IV was not detected in this study, the extravasation of any IV fluid, site infection, haematoma, and phlebitis can cause serious and potentially permanent harm. 40 Adverse events associated with IV access are largely preventable, although the safe management of IV lines requires many reliable processes to be undertaken over hours or days. 40 Our study may point to further quality improvement projects being warranted in emergency departments and inpatient units related to management of IV lines.…”

“…40 Adverse events associated with IV access are largely preventable, although the safe management of IV lines requires many reliable processes to be undertaken over hours or days. 40 Our study may point to further quality improvement projects being warranted in emergency departments and inpatient units related to management of IV lines. 41 Delayed or failed diagnose comprise about one-third of the clinical process/procedure adverse events and 5% of all.…”

Reducing Risks and Improving Vascular Access Outcomes

“… 16 Phlebitis from failed SPC insertion can lead to infection, blood clot, or deep venous thrombosis. 28 Suboptimal SPC stabilization can also lead to other undesirable outcomes, which include IV fluid leakage and infiltration into surrounding tissue. 29 Use of integrated closed catheter systems like those used after VAM program implementation may reduce the incidence of such complications.…”

Usability Assessment of an Innovative Device in Infusion Therapy: A Mix-Method Approach Study

“…Peripheral intravenous catheters (PIVC) are the most used invasive devices in hospitals [ 1 , 2 ], with over a billion PIVC being inserted each year in hospitalized patients worldwide [ 3 ]. However, there is a wide range of complications associated with PIVC insertion [ 4 , 5 , 6 ], such as phlebitis [ 7 , 8 , 9 ], accidental removal, occlusion [ 10 ] and bloodstream infection [ 11 , 12 , 13 ].…”