Misconceptions About Peripheral Intravenous Catheter Complications Rate Based on Insertion Settings: A Comprehensive Literature Review

Purpose: With more than 300 million IV catheters sold and 60% to 90% of hospitalized patients requiring PIVC access in the United States, this intervention is the most common, invasive, patient procedure performed worldwide (Helm et al., 2015). Current guidelines for PIVC care suggest that complication rates may be increased when access is obtained in pre-hospital or emergency department settings over those placed in the inpatient care units. The 2011 CDC published guidelines state there is no need to replace PIVC more frequently than 72 to 96 hours in order to decrease the risk of complications in adult patients (CDC, 2011). However, the CDC does not offer any further recommendations in regards to the removal and replacement of PIVC’s when clinical indications of complications are not present – this is an issue the CDC acknowledges requires further attention (CDC, 2011). Through this literature review, the published original research reports were appraised through studies in order to determine if adult patients in the United States who required PIVC access in the pre-hospital and emergency department settings were at an increased risk for PIVC complications, in comparison to patients who had PIVC’s initiated in the in-patient units.

Methods: This literature review was performed through systematic research of professional databases such as Ovid, CINAHL, and PubMed with access from MCPHS University with select keywords. To be eligible for inclusive research, the research needed to be conducted in the United States and include primary data within the last 10 years (2006-2016). The keywords included combinations of "intravenous therapy and equipment," "peripheral intravenous therapy," "infection," "phlebitis," "infiltration," "prehospital," "emergency care" and "peripheral catheterization". The articles utilized in this review are primary quantitative research reports, with the infection and complications of peripheral IV’s as the dependent variable.

Results:  Results suggest that the area of patient care with the highest incidents of PIVC complication rates are inpatient care units, with the fewest incidents of complications being the emergency department. Peripheral intravenous catheters (PIVC) placement guidelines, particularly those published by the CDC, suggest that the area of patient care in which initial IV access is obtained may be directly correlated to the development of complications from IV access.Studies showed that complication rates are relatively low for PIVC’s inserted in the pre-hospital setting, with phlebitis as the most often noted complication.There were less complications correlated with emergency department PIVC insertion in comparison to PIVC’s initiated in the pre-hospital setting.While in the inpatient units, patients often have the same PIVC in place for several days. Due to the increase in time with the same PIVC, complications such as phlebitis are common.

Conclusion: The information compiled through this literature review revealed the rates of PIVC complications only varied slightly between all the areas of care evaluated. Clinical manifestations of a complication, patient complaints of pain/discomfort, and nurses’ clinical judgment should be considered the determining criteria for removal or replacement of peripheral IV’s. Although the CDC based much of their recommendations on dwell time for determining PIVC replacement or removal, there is more evidence that indicates clinical manifestation of a complication should be used to make that determination to fully decrease any risks posed to the patient. The Infusion Nursing Society’s 2016 recommendations point to a standard of care for PIVC’s and all things pertaining to infusion, which includes standards pertaining to education, implementation, and risk reduction which is based on relevant, recent evidence collected throughout varying patient care settings. If professionals adhered to the INS recommendations and guidelines and those like it, perhaps many of the complications discussed in this literature review could be decreased further, leading to the improvement of patient care and satisfaction.