Some very informative sessions were presented at the Association for Vascular Access 2013 Annual Meeting in Nashville. The latest word on peripheral intravenous (PIV) catheter replacement came in the form of a plenary session. Claire Rickard, RN, PhD, Director of the Australian Vascular Access Teaching and Research Group at Griffith University delves deeply into PIV failure, not only assessing worldwide incidence, but instituting research protocols aimed at understanding causality and prevention.
Bringing her message to the AVA attendees, she prompts the forum to contemplate why a 26% failure rate for PIV catheters is generally acceptable, asking, “Should 26% of cardiac pacemakers fail? Should 26% of blood glucometers… hip prostheses…PICCs fail?” Though the worldwide average is 26%, there is a wide variance across countries where PIV failure rate can be “as high as 100%”.
- 26% of PIV Catheters Fail
- 20% develop an occlusion or infiltration
- 10% of patients have their PIVs fall out
- 7% of patients develop phlebitis
- 1 in 5 PIVs are redundant
- A PIV in the hand or antecubital area has a 150% and 130% increased chance, respectively, of having an occlusion or infiltration vs. the lower arm
- A PIV in the hand or antecubital area has a 250% and 170% increased chance, respectively, of having the IV accidentally removed vs. the lower arm
- Catheter gauges larger than 20 have a 150% increase in chance of phlebitis occurring
- Regular flushing… [is] likely to reduce PIV failure
In her team’s latest research, predictors of occlusion/infiltration, accidental removal, and phlebitis have been teased out. Among other predictors, a patient is significantly more likely to have an occlusion/infiltration event if the catheter is placed in the hand, if the patient is female or if IV antibiotics or hydrocortisone is delivered. Catheter placement in the hand is also predictive of accidental removal along with placement by non-IV teams or IV gauge less than 20. Female patients are also at high risk for phlebitis along with other predictors such as prior infections and IV meds.1
Her team will begin numerous studies to investigate factors surrounding successful PIV placement and care such as flushing protocols, securement devices, and catheter monitoring. In addition the team has created a global PIV prevalence study aimed at collecting comprehensive data on one-million PIV placements in order to document worldwide standards of care and complications.2
No doubt IV nurses in attendance at AVA 2013 and those who were unable to attend will be waiting for the results of these research endeavors.
- Rickard, Claire. Peripheral IV Catheters: The New World of Clinically Indicated Replacement. Association for Vascular Access Annual Meeting, Nashville, Tennessee. 2013.
- One Million Global Catheters PIVC Worldwide Prevalence Study.