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Think before you insert an intravenous catheter

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To the Editor: Peripheral intravenous catheter (PIVC) infection has been highlighted by one of us (R L S) and colleagues as an important, costly and dangerous complication of PIVCs.1 Infection prevention programs often employ multifaceted interventions and, in the case of PIVC, much debate has been directed towards aseptic insertion and appropriate dwell times, but little attention has been directed to whether the PIVC is required.2

The concept of the “idle IV” catheter was introduced over 20 years ago,3 yet at our tertiary hospital emergency department (ED), we found that half of PIVCs inserted were unused. In 43% of patients admitted to the hospital, the PIVC remained unused at 72 hours.4 Patients presenting with obstetric, gynaecological and neurological symptoms were significantly more likely to have an unused PIVC.4

Focus group testing revealed that it had become a culture within our ED to insert a PIVC in most patients “just in case”. We have started a program encouraging staff to think before they insert an IV catheter,…