Peripheral IV Failure
IV lines are stressed each day they are in use. Our normal activities of daily living, stretch and pull on the IV line. These forces can be transmitted to the dressing, surrounding skin, and/or the IV catheter that is in the vein. Some levels of force are acceptable and others reach a point where they become harmful to the IV and can lead to failure of the line. Clinical studies show us that on average, IVs fail 46% of the time in major clinical centers before the IVs reach the end of their intended use.(1)
46% is an astounding number, and it is almost hard to believe. Helm et al performed a review of all the available literature and published in May/June 2015 an article titled, "Accepted but Unacceptable: Peripheral IV Catheter Failure" in the Journal of Infusion Nursing. When the authors reviewed the literature for all of the randomized controlled clinical trials (highest level of study besides a blinded trial), they found nine studies to analyze. These studies were done in major medical centers with dedicated IV teams performing the procedures. The failure rate was as high as 63% with an average of 46%. If this is the rate at major medical centers, what is it in the average hospital?
Mechanical Forces on IV Lines
Below are pictures of a standard IV adhesive with different amounts of force applied on the IV line. Most adhesives completely pull off the skin starting somewhere around eight pounds of force, with some pulling completely off around five pounds of force. It is impossible to eliminate all the forces that might pull on an IV line and some forces are probably fine, like those associated with activities of daily living. There is a point at which those forces turn harmful and can possibly shorten the lifespan of the IV. In the four-pound pull force image to the far right, the skin is starting to tent dramatically, the catheter hub has moved inside the dressing significantly and the angle of the IV catheter might cause the function of the catheter to be compromised. Click here to learn more about forces across IV lines and various securement devices performance
Common IV Complications
Infiltration is the most common complication for peripheral IVs, occurring 23.9% of the time on average.(1) Infiltration occurs from erosion or penetration of the catheter into or through the vein wall. It results in the infusion of medicine into the surrounding soft tissues as can be seen in the image to the right. The erosion of the vein wall can be caused by forces on the IV line causing the IV catheter to move back and forth in the vein, injury due to the caustic medicine being infused, or needle injury to the vein during insertion. Securing and preventing harmful forces from moving the catheter are tools in the battle to prevent infiltration.
Phlebitis, or vein irritation as seen in the picture to the right, occurs 15.4% of the time on average in peripheral IVs and is the second most common mechanical complication.(1) There are three different types of phlebitis: mechanical, chemical and infectious or any combination of the three. Mechanical phlebitis is caused by the traumatic movement of the IV catheter against the vessel wall and stabilization devices have shown improvements in phlebitis rates in some studies. Eliminating harmful forces from reaching the catheter is an important point in trying to eliminate mechanical phlebitis.
Dislodgement occurs when forces across the IV line are stronger than the adhesives and securement devices ability to hold onto the IV line, making it a purely mechanical complication. A slow motion image of a dislodgement captured in a lab setting is shown to the right. Clinical studies show that IV dislodgement is a common complication, occurring 10.8% time on average.(2) Dislodgement can occur either on purpose or accident with some of the most common reasons being: patient transfer from one bed to another, patients with cognitive issues unknowingly pulling out their IV, and IV lines getting caught underneath hospital bed rails. Click here for more information on IV dislodgement.
1 Helm, R.E., et al., Accepted but Unacceptable: Peripheral IV Catheter Failure. Journal of Infusion Nursing. 2015; 38(3):189-203.
2 For full reference list that determines the 10.8% average dislodgement rate, refer to www.lineusmed.com/dislodgement.