No one likes needles, but establishing an IV line is an important part of delivering care to patients. Approximately 90% of people admitted into a hospital have an IV line inserted, so it is relatively common for patients to experience the pain involved in placing an IV line. When a medical professional can't find a vein easily, then even more discomfort is experienced. If IV dislodgement occurs, then the patient and medical professional have to go through the whole experience again.
There are over 200 million peripheral IVs placed in the United States annually and over 1 billion globally. IV lines are used to help patients in many different ways; rehydration, delivery of antibiotics and chemotherapy drugs, and the administration of anesthesia among others. There are several different types of intravenous devices used for IV therapy. Click here to learn more about the basics of IV access.
IV Clinical Studies
Many clinical studies on peripheral IVs and central line IVs exist. Most of the studies focus on securement methods, blood infections related to IVs, and how often IVs should be replaced. Medical complications incurred during the studies such as phlebitis (inflammation of a vein due to trauma) and IV dislodgement are sometimes reported in the results. Dislodgement to date has not been the focus of these papers, but the prevalence of IV dislodgement is identified in the papers as being between 3.3 and 36%. Since IV dislodgement is not the focus of these papers, many times patients that are agitated or mentally impaired are excluded from the studies. These are the very patients that are most likely to dislodge their IV. We believe the rate of IV dislodgement in clinical studies is artificially low due to the exclusion criteria that is commonly adopted.
The clinical studies that list dislodgement rates focus on varying issues such as pediatric patients, oncology patients, emergency room patients as well as different types of IV lines such as peripheral and PICC lines. The hospitals range from children's hospitals, general hospitals, level 1 trauma centers to skilled nursing facilities. The papers are from all over the world: USA, Australia, UK, Spain, and others, which shows us that dislodgement is a global issue. The chart below shows clinical paper information for only peripheral IVs. The overall dislodgement rate average is 10.8% for all of the studies.
Peripherally Inserted Central Catheters (PICC) are more expensive to install and more complicated than a traditional peripheral IV. Clinical studies on PICC lines have a very similar dislodgement rate to peripheral IVs. The dislodgement rate average from the six studies below is 7.3%.
Central Venous Catheters (CVC) or Central Lines are the most expensive vascular access devices to install. They are frequently used to deliver chemotherapy drugs and often require the patient to be anesthetized during insertion of the device. There are very few clinical studies on CVCs that report dislodgement rates. The average from the two studies below is 6.3%. One study focuses on oncology patients receiving chemotherapy drugs while the second study focuses on patients in an Intensive Care Unit. These are two very different patient populations with treatment occurring in very different departments of the hospital. As one might expect, the dislodgement rates are very different as well.
We are not aware of an existing study that discusses the overall cost of IV dislodgement, which would include: cost to clean-up a patient's room, the cost of replacement medicine, the cost of additional IV access kits, the cost of delayed medical treatment and the cost of the medical professional reinserting the IV. Lineus Medical is undertaking a study to establish a benchmark on the rate at which IV dislodgement occurs in all patients and the overall cost of IV dislodgement.
2015 Nurses Survey
Lineus Medical performed a survey of nurses in 2015 to learn more about the vascular access market and dislodgement. A few key results from that survey are presented in the infographic below and highlight the need for a solution to IV dislodgement.
Nurses are on the front-line of healthcare experience the bulk of the frustrations that come from dislodged IV lines. Below are an assortment of quotes that were collected during the survey and show nurses' personal experiences with IV dislodgement:
1. Bausone-Gazda D, et al. A randomized controlled trial to compare the complications of 2 peripheral intravenous stabilization systems. J Infus Nurs. 2010 ; 33( 6 ): 371-384.
2. McNeill E, et al. A clinical trial of a new all-in-one peripheral short catheter. JAVA 2009; 14(1): 46-51.
3. Gallant P, et al. Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 2006 ; 29(6): 338-342.
4. Dillon, MF, et al. Factors that affect longevity of intravenous cannulas: a prospective study. Quarterly Journal of Medicine 2008, 101:731-735.
5. Malyon, L, et al. Peripheral intravenous catheter duration and failure in pediatric acute care: A prospective cohort study. Emergency Medicine Australasia 2014; 26: 602–608.
6. Wallis MC, et al. Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infect Control Hosp Epidemiol. 2014; 35(1): 63-68.
7. Rickard CM, et al. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial. BMC Med. 2010; 8(53): 1-10.
8. Martínez, JA, et al. Evaluation of add-on devices for the prevention of phlebitis and other complications associated with the use of peripheral catheters in hospitalised adults: a randomised controlled study. J Hosp Infect. 2009; 73(2): 135-142.
9. Mestre-Roca, G, et al. Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: an observational cohort study. Med Clin (Barc). 2012; 139(5): 185-191.
10. Royer T. Improving short peripheral IV outcomes: a clinical trial of two securement methods. J Assoc Vascular Access. 2003; 8(4):45-49.
11. Jackson, A. Retrospective comparative audit of two peripheral IV securement dressings, British Journal of Nursing 2012.
12. Budgen, K, et al. Skin glue reduces the failure rate of emergency department–inserted peripheral intravenous catheters: a randomized controlled trial. Annals of Emergency Medicine, August 2016; 68(2): 196–201.
13. Dargin JM, et al. Ultrasonography guided peripheral intravenous catheter survival in ED patients with difficult access. American Journal of Emergency Medicine. 2010; 28(1): 1-7.
14. Valbousquet, S, et al. Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy. Journal of Vascular Access 2015; 16(4): 299-308
15. Baudin, G, et al. Evaluation of peripherally inserted central catheters in pediatric population. Archives of Pediatrics 2013; 20(10): 1089-1095.
16. Cotogni, P, et al. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study. Supportive Care in Cancer 2015; 23: 403-409.
17. Chopra, V, et al. Peripherally inserted central catheter use in skilled nursing facilities: a pilot study. Journal of the American Geriatric Society 2015; 63(9): 1894-1899.
18. Grau, D, et al. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrobial and Resistance and Infection Control 2017; 6:18
19. Bertoglio, S, et al., PICCS in Cancer patients Under Chemotherapy; A Prospective Study on the Incidence of Complications and Overall Failures. Journal of Surgical Oncology, 2016; 113:708-714
20. Morano, G. S., et al., Early and Late Complications Related to Central Venous Catheters in Hematological Malignancies: a Retrospective Analysis of 1102 Patients. Mediterranean Journal of Hematology and Infectious Diseases, 2014:6
21. Sundararajan, K., et., Impact of Delirium and Suture-less securement on accidental vascular catheter removal in the ICU. Anaesthesia Intensive Care, 2014: 42(4):473-479