In most healthcare settings, short Peripheral Intravenous Catheters (PIVCs) are a critical tool in the delivery of patient care. PIVCs enable vital therapies such as medications, fluids and nutrition to reach patients quickly and effectively through the bloodstream. According to a study performed at the Mayo Clinic, PIVCs are now the most commonly used type of device for vascular access, with more than 300 million used each year in U.S. hospitals alone.
Despite the frequency of PIVC insertion, there are several potential risks involved in their use. The exact number of intravenous therapy complications is difficult to quantify, as it is not common practice for healthcare institutions to collect and analyze this kind of data. But it has been well documented that PIVC complications happen regularly and can result in fatality, a rise in healthcare costs from prolonged hospitalization, extended use of IV antibiotic therapy and possible surgical intervention. One study, reported in the Journal of Infusion Nursing, found an overall complication rate for PIVCs in place for 96 hours to be close to 50 percent.
The Centers for Disease Control and Prevention (CDC) has recognized the importance of reducing complications related to IV therapy due to the health hazards frequently posed to both patients and clinicians. Some of the most commonly recognized complications of PIVCs include phlebitis, occlusion, infiltration and extravasation, and IV infection.
Phlebitis, defined as an inflammation of the vein, is among the most common complications of IV therapy. Studies estimate that anywhere from 20 percent to 80 percent of patients receiving IV therapy develop phlebitis.
Possible causes of phlebitis may be chemical (caused by the substance being infused), mechanical (movement of the catheter while inside the vein) or bacterial (either intrinsic or extrinsic). The Infusion Nurses Society (INS) encourages the use of a standardized phlebitis scale for assessing and reporting this complication of IV therapy.
When a patient develops signs of phlebitis (warmth, tenderness, redness around the site or a swollen or visibly raised vein), appropriate interventions include removing the PIVC and, if continued therapy is needed, restarting another PIVC in a different site or determining another route for medical therapy.
Because phlebitis is an inflammatory response by the vein to trauma, symptoms may not become evident until well after removal of the device.
Occlusion: Non-thrombotic or thrombotic
Another potentially dangerous complication that can arise during IV therapy is thrombotic or non-thrombotic occlusion. An occlusion is an obstruction that restricts or prevents the administration of fluids through the PIVC. Thrombotic occlusions are blood clots that develop in or around the catheter tip or in the surrounding vessel. Non-thrombotic occlusion can be due to trauma to the vein wall from IV catheter movement once inside the vessel. Occlusions represent a significant threat to patient outcomes and require high cost interventions.
When a PIVC is occluded, treatment is likely to be interrupted and/or the PIVC must be replaced.
Occlusions account for as many as one in four of the complications associated with PIVCs.
An occlusion that is not observed and acted on promptly may lead to a further intravenous therapy complications, such as phlebitis, infiltration, extravasation or infection.
Infiltration or Extravasation
Additional complications of PIVC therapy are infiltration or extravasation, both involving leakage of IV fluids, which can cause pain and serious long-term effects for both the patient and the healthcare facility.
Infiltration is the leaking of IV fluid into the tissue surrounding the vein. This occurs when IV fluids continue to be delivered even though the tip of the catheter is no longer in the vessel or is blocked. Although most infiltrations do not cause tissue damage, the potential for serious harm does exist. When a large amount of IV solution enters the tissues, nerve compression injuries from compartment syndrome can result. An infiltration is likely to cause disruption in IV therapy, patient discomfort and require the restart of a PIVC in a different location, consuming nursing time and increasing the cost of supplies.
Extravasation is an infiltration involving the leakage of vesicant fluids into the tissues. Vesicants are substances known to be more caustic than regular IV fluids, and are capable of causing physical harm unless they are kept strictly in the vascular space. These chemical or drug substances can cause blistering and burning in the tissue and, although small extravasations may not result in patient injury, large amounts of vesicant fluids can cause severe damage.
It is widely recognized that early detection and intervention is critical to the prevention of potentially serious adverse outcomes. Failure to detect infiltration or extravasation promptly can leave the patient with permanent disfigurement and loss of function and potentially result in litigation.
The incidence of local or catheter-related bloodstream infections (CRBSIs) associated with PIVCs has historically been reported to be low. However, a recent study conducted by Rhode Island Hospital, found that more than one in ten CRBSIs in their hospitalized patients were caused by infected PIVCs.
IV catheter-related sepsis can occur from poor catheter insertion technique or when phlebitis progresses. Bacteria from an IV site can migrate through the bloodstream, causing fever, chills, malaise and an elevated white blood cell count.
When IV infections are present, appropriate interventions include discontinuing the infusion, removing the PIVC, and instituting other local or medical interventions as necessary to treat the infection. All of these actions result in an interruption of therapy with associated consequences.
In order to deliver therapies as needed, PIVCs must function without complications. Both the vein and the catheter must remain open and allow fluids to flow freely through and around the PIVC. Loss of free flow can result from something as simple as a patient’s position to more complex causes. Clinical outcomes can range from successful resolution of the problem to replacement of the PIVC with permanent damage to the vasculature and lifelong discomfort.
As the number of patients with peripheral IV catheters increases each year, patient safety is the main goal for clinicians who are responsible for inserting PIVCs, monitoring existing IV sites and administering IV therapies. Frequent assessment of IV sites can prevent devastating patient injuries.
The NovaCathTM Integrated IV Catheter System is designed to address many of the IV complications associated with IV therapy. NovaCath features advanced integrated stabilization technology designed to minimize catheter movement, improve patient comfort, reduce IV catheter restarts, extend dwell times, and significantly reduce overall complications of existing short-peripheral IV catheters.
In addition, NovaCath has a design element that provides an internal 180-degree fluid path turn. This unique tubing management feature eliminates the need for an external “J-Loop,” which is needed to redirect IV fluids back towards the patient. Elimination of the external “J-Loop” minimizes potential IV therapy complications associated with tubing snags and IV catheter dislodgement.
NovaCath is the only FDA 510(k) cleared Safety IV Catheter system and patent protected technology that uniquely offers Advanced Catheter Stabilization, Next Generation Tubing Management and Passive Needle Encapsulation. To view a demo video, click here.