Doomed peripheral intravenous catheters: Bad Outcomes are similar for emergency department and inpatient placed catheters: A retrospective medical record review

Abstract

Introduction: The survivorship of peripheral intravenous catheters (PIVCs) placed in hospitalized patients is shockingly poor and leads to frequent reinsertions. We aimed to evaluate differences in failure rates and IV insertion practices for PIVCs that are placed in the emergency department (ED) compared to those placed in the inpatient (IP) setting. Methods: We conducted a retrospective electronic medical record review of PIVC survival at a single-site suburban, academic tertiary care referral center with 130,000 annual ED visits and 1100 inpatient beds. Adult patients admitted requiring at least one PIVC were included. The primary outcome was incidence of premature failure of PIVCs. Secondary outcomes included dwell time, completion of therapy, catheter diameter, and site of insertion as they relate to PIVC survival. Results: Between January 2018 and July 2019, 90,743 IV catheters were included from 47,272 unique patient encounters in which 35,798 and 54,945 catheters were placed in the ED and IP units, respectively. There was no significant difference in failure rate between the ED and IP PIVCs, with 53.1% of ED PIVCs failing and 53.4% of IP PIVCs failing ( p = 0.35). Mean dwell time for ED PIVCs was 3.4 days compared to a mean of 3.2 days for IP placed PIVCs ( p < 0.001). 48% of ED PIVCs achieved completion of therapy at the first insertion compared to 59% of IP PIVCs ( p < 0.001). The antecubital fossa and forearm had the lowest failure rate of 53% and 50%, respectively, and 22 gauge PIVCs had the highest failure rate of 60.5%. Conclusion: PIVCs have similar poor survival rates regardless of ED versus IP location of the insertion. The forearm and antecubital fossa sites should be preferentially used. Smaller diameter (22G) catheters have highest complications and poorest survival regardless of site of insertion. Larger diameter catheters (18 or 20 gauge) may offer improved outcomes.

A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

“…1–3 Despite being the most commonly performed invasive procedure, the estimated failure rate of traditional blind PIVC placement ranges from 36% to 63%. 2,4–7 Catheter complications include phlebitis, infiltration, occlusion, dislodgement, and infection. More serious events such as infection and thrombosis are likely unrecognized and under reported.…”

Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

“…As the wrist and hands have the worst outcomes and no catheters in our study were placed in these locations, this variable was not a relevant predictor in our cohort. 4 Additionally, a catheter to vein ratio of less than 0.33 has been identi ed as a risk factor for catheter failure. In our study over 80% of the catheters were 20-gauge in diameter and the average catheter to vein ratio was 0.36, suggesting that the impact of catheter diameter on PIVC failure was also likely minimal in our cohort.…”

“…1 Unfortunately, PIVCs have high failure rates ranging from 36% to 63% leading to signi cant patient safety and cost implications. [2][3][4] Patients may suffer a multitude of sequelae from PIVC failure including extravasation with skin necrosis, catheter associated bloodstream infections, interruption of medical therapies, and longer hospital stays. [5][6][7] Further, PIVC failure results in additional invasive procedures to obtain vascular access often requiring multiple needle sticks and reinsertions that may lead to venous depletion leaving limited or no viable peripheral venous access options.…”

Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data

“…It is estimated that up to 90% of patients require intravenous (IV) access during their hospitalization [ 3 – 5 ]. Unfortunately, PIVCs have high failure rates with up to 63% failing prematurely [ 3 , 6 ]. PIVC failure leads to significant patient harm in the form of repeated insertion attempts, treatment delays, venous depletion, prolongation of hospital stay, psychological and physical stress from needlesticks, and increased rates of nosocomial infections [ 7 – 10 ].…”