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Majority of intravenous catheters go in suboptimal site: research

Majority of catheters go in the wrong place: research

International research has uncovered major inconsistencies in the way intravenous catheters are used, prompting calls to improve training and standards.

The Australian led study showed that 10% of peripheral intravenous catheters (PIVCs) were painful to the patient or otherwise symptomatic of phlebitis, and another 10% had signs of PIVC malfunction.

Over one-third of PIVCs had no documented daily assessment, and 21% of the dressings were suboptimal. The researchers found that two-thirds of all devices were placed in non-recommended sites, such as the hand, wrist, or antecubital veins.

The study, published in the Journal of Hospital Medicine, was based on an assessment of 40,620 PIVCs across 51 countries. The PIVCs were used primarily for intravenous medication and predominantly inserted in general wards.

Poor catheter practice can have serious consequences

Lead researcher Dr Evan Alexandrou, senior lecturer at Western Sydney University’s School of Nursing and Midwifery and Clinical Nurse Consultant at Liverpool Hospital, told doctorportal that he was not surprised by the results of the study. “There is a lot of literature out there on failure rates with PIVCs – up to 90% fail within a couple of days.”

“What we wanted to do was to look at what was happening at the coalface related to these devices.”

“The unfortunate thing is that the PIVC is seen as the default device and it may not be the most appropriate device to use.”

Failure rates can have significant implications for the patient, such as missed or delayed medication administration, as well as multiple cannulation attempts if they have poor venous access – which can cause pain and anxiety.

If serious enough, poor PIVC practice can lead to catheter-associated bloodstream infection, which is known to increase morbidity and mortality, Dr Alexandrou said.

Call for a national response

Dr Alexandrou said that “I think we need a national response – we need better training at an undergraduate and postgraduate level”.

This would mean an end to the 2 to 4-hour workshops on how to stick a patient. “This is antiquated teaching, and obviously not working when we look at the problems with PIVCs and failure rates with central venous access devices also.”

“We need a national clinical standard from the Australian Commission on Safety and Quality in Health Care, similar to ones we already have on procedure matching and infection prevention so that hospitals are compelled to look at the issue more seriously.”

Dr Alexandrou cited the Difficult Venous Access Pathway which he and a team developed at Liverpool Hospital in Sydney.

“We reduced cannulation attempts significantly by training nurses in ultrasound guided PIVC insertion – the average number of attempts with ultrasound is 1 compared to at least 4 without ultrasound.”

The benefits of improving catheter practice

Dr Alexandrou said there will be significant benefits if we do take steps to improve PIVC practice.

”It can improve the patient experience through the health system, ensure intravenous therapy is administered as prescribed, and potentially reduce hospital length of stay.”

He said that the average cost of a PIVC insertion, as costed by a health economist, is up to $69.

“Reducing failure and unnecessary cannulations can save the health system millions of dollars when you consider some 12 million devices are placed in Australia annually.”