Mechanical Complications are The Main Reason IV Lines Fail
IV lines fail at a miserable rate. The clinical literature tells us that they fail 46% of the time before the end of their intended use. What is causing these failures. The main causes are mechanical. Damaging forces on the line cause IV catheters to pull out of the vein or bust through a vein wall and infuse medication into the soft tissues or infiltration. Damaging forces on the IV line cause the catheter to piston back and forth inside the vein leading to vein irritation or phlebitis. Damaging forces on the line cause IVs to pull out completely, called dislodgement. And lastly, build up of material on the opening of the IV catheter can cause it to stop working properly. This is called occlusion. The table to the right shows the rate at which each of these mechanical complications occur.
Mechanical IV Complications
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. IV dislodgement is very common, occurring 11% of the 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.
Below are pictures of a standard IV adhesive applied to the arm of a 50 year old male with different amounts of force applied. Most adhesives completely pull completely off around 8-pounds of force, with some pulling completely off around five pounds of force. There is a point at which forces on an IV line become very harmful and can reduce the lifespan of the IV. SafeBreak is designed to separate at 4 pounds of force and prevent the most damaging forces from impacting the IV line. If you would like additional technical information about IV dislodgement, click here. If you like more information about forces across IV lines and various securement devices performance, click here.
Infiltration is the most common complication for peripheral IVs, occurring 24% 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 pistoning the catheter are tools in the battle to prevent infiltration. If you would like additional technical information on infiltration, click here.
Phlebitis, or vein irritation as seen in the picture to the right, occurs 15% 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. There are many different ways to try and address mechanical phlebitis, but the bottom line need is to stop the motion of the catheter in the vein. Securement devices, sterile glue, dressings with good adhesives, and/or SafeBreak Vascular all can play a role in solving the mechanical phlebitis problem. If you would like additional technical information on phlebitis, click here.
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 11% average dislodgement rate, refer to www.lineusmed.com/dislodgement.