IV dislodgement

While dislodgement is a scarcely researched issue, clinical literature that does reference it cites IV dislodgement rates between 3.3 and 36%.  Since IV dislodgement is not the focus of many of these papers, patients that are agitated or mentally impaired are often excluded from the studies. These are the very patients that are most likely to dislodge their IVs. We believe the rate of IV dislodgement in clinical studies is artificially low due to the exclusion criteria commonly used by these studies.

PIV lines dislodge, IV dislodgement, IV dislodgment, patient, peripheral IV, PIV, hospital

The clinical studies that referencing peripheral and central venous catheter dislodgement rates focus on varying issues such as pediatric patients, oncology patients, emergency room patients.  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 above 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 to the right is 7.3%.

7.3% of PICC lines dislodge, PICC, hospital, peripherally inserted IV catheter, IV catheter, IV complications, IV failure

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.  

6.3% of central lines dislodge, central line, IV dislodgment, IV dislodgement, hospital, patients, IV failure, IV complications

There are very few clinical studies on CVCs that report dislodgement rates.  The average from the two studies to the right 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.

Independent research conducted at Deaconess Midway and Deaconess Gateway hospitals analyzed 50 consecutive dislodgements and found that each peripheral IV dislodgement cost the hospital an average of $48. This research was presented at the 2018 Association of Vascular Access Annual Scientific Meeting. For the full white paper on this research click on the button below.

a solution to the dislodgement problem

When a harmful force goes across the IV line, rather than trying to hang onto an IV line, let's create a controlled separation.  The IV can be saved, the patient avoids a restick, the nurse can do value added work, the hospital saves money and everyone saves the stress, time and expense involved with an IV restart.  The video introduces SafeBreak Vascular®, a Patient Safety Disconnect, which is designed to remove harmful mechanical forces from the IV line and catheter.  

MKG-0028 09/17

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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