vascular access infection prevention
Paying Attention to PIVCs Can Achieve Higher Quality of Care , Cost Savings
Attention to the level of waste and inefficiency with insertion and management of PIVCs can result in a higher quality of care , fewer complications , longer device survival and significant cost savings .
Peripheral venous catheters ( PIVC ) are used for the delivery of medical treatment for almost every patient admitted to acute-care and represent 95 percent of all vascular access devices . The common usage of PIVCs makes them often overlooked by medical and nursing professionals , an afterthought at best , to insert , remove , replace , as needed without careful scrutiny . Little thought is given to the sheer volume of PIVCs attempted and used in acute-care , the rate of failure , the causes of failure , the number of failed attempts and the impact on patients , the PIVC cost per patient admission , and the association of PIVCs to other outcomes such as infection and central line-associated bloodstream infections ( CLABSIs ). Attention to the level of waste and inefficiency with insertion and management of PIVCs can result in a higher quality of care , fewer complications , longer device survival and significant cost savings .
Consideration of the volume of PIVCs purchased , inserted , and wasted in acute care is likely higher than once thought . According to iData Research Vascular Access Report published for 2020 , the number of PIVCs purchased in 2020 exceeded 380 million . The total patient admissions for the more than 6,000 hospitals in the U . S . are more than 36 million per year as reported by the American Hospital Association ( AHA ). Doing the math equates to over 10 PIVCs per patient admission . With a national average for a hospital stay of 4.5 days according to the Agency for Healthcare Research and Quality ( AHRQ ), each patient would receive more than two PIVCs or PIVC attempts per day . According to Rickard and Marsh , 30 percent to 50 percent of PIVC insertions require multiple attempts . Published evidence by Helm and Kache and associates indicate only 37 percent of PIVCs reach the end of treatment , up to 63 percent fail and require replacement . According to a recent systematic review of PIVC dwell times by Hopkinson and associates , the dwell time of a PIVC does not typically exceed an average of 3.5 days . Considering average patient length of stay ( LOS ) and PIVC dwell time 10 PIVCs per patient stay represents either a tremendous level of waste or an incredible number of failed PIVC attempts .
Clinicians have become complacent regarding the impact of PIVC failure and common complications of phlebitis , infiltration , and occlusion , each attributed to PIVC failure , but often not documented in the patient record . Documentation in the patient medical
• record is rarely accurate in recording the number of clinicians ’ attempts to insert PIVCs and lacking in reasons for PIVC failure . In a randomized trial , Wallis and associates studied risk factors for PIVC failure ; they noted occlusion , accidental removal , and phlebitis as the reasons for catheter failure and risk factors of poor insertion location , antibiotic infusion , and current infection , to name a few . In an analysis of a U . S . hospital discharge database by Lim and associates , they reported patients with documented PIVC complications had an average hospital LOS 33 percent higher with 5.9 days versus 3.9 days with concurrent cost increase of 36 percent ; most importantly , those with complications had a higher risk of death .
With the high failure rate of PIVCs and the increasing burden of PIVC complications , measures to prevent these complications are rarely considered in day-to-day practice . As hospitals and clinicians are striving to reduce the use of central venous access devices ( CVADs ) to avoid the financial impact of CLABSI , the volume of PIVCs is increasing along with concerns over complications . An increasing number of publications are highlighting concerns around PIVC infections and the potential impact of PIVC contamination impact on CVADs when both are present for the delivery of patient treatment . In a systematic review by Mermel in 2017 , he noted a 2-64-fold greater risk of catheter related bloodstream infections from central catheters rather than PIVCs , however the volume of PIVC infections , based on the high number used per year represents a growing concern . Tagalakis and associates studied thrombophlebitis and found 5 percent to 25 percent of PIVCs are colonized at the time of removal . Even the high number of PIVC replacements and attempts contribute to a higher infection rate . Hadaway in 2012 in a published literature review conservatively estimated 165,000 patients become infected annually . Much emphasis has been given to reduction of CLABSI over the past two decades . It is now time to re-evaluate the need for educational efforts aimed at implementing preventative strategies known to reduce infection and all PIVC complications .
Strategies to reduce PIVC complications begin with education on the basic education emphasizing aseptic non touch technique , increasing clinician understanding of clean practices , skin antisepsis leading to good skin preparation prior to insertion .
www . healthcarehygienemagazine . com • september 2021
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