Peripheral Intravenous Catheters – “They Don’t Get No Respect”

BACKGROUND: Over 300 million peripheral intravenous catheters (PIV) are used yearly in the United States resulting in up to 146,000 cases of bloodstream infection. Despite their importance, relatively little effort has been invested in understanding their use and minimizing their risk. METHODS: A series of point-prevalence surveys were conducted over a 10 week period on all inpatient units at the Nebraska Medical Center, a 689-bed academic medical center, to ascertain patterns of intravascular catheter use, securement techniques, dressing integrity, and evidence of phlebitis. RESULTS: All inpatient units were surveyed at least three times by specially-trained observers resulting in assessments of 1,217 patients: 87 (7%) had no IV access, 667 (55%) had PIV only, 395 (32%) had central venous catheters (CVC) only, and 68 (6%) had both PIV and CVC. Not surprisingly, patients in the ICU were more likely to have a CVC than patients cared for on the ward (P < 0.001). PIV were located in the following anatomic sites: hand (27.1%), wrist (16.5%), forearm (26%), antecubital (25.1%), upper arm (3.9%), foot (0.5%) and other (0.9%). 99% of PIVs were covered with a transparent dressing. Only 1% of PIVs were dressed with gauze and tape and 6.5% were further covered with occlusive wraps. In addition, some PIVs were secured with tape (58.5%) or a device (9.2%). Secondary anchors, tape, or foam pads, were used to secure the IV tubing in 60.2% of patients. PIV dressing condition was assessed and 46.8% had significant edge lift and 21.5% had blood or fluid under the dressing. 24% of the PIV dressings had an application date noted. Patients in the ICU were more likely to have a PIV dressing application date noted on the dressing than ward patients (31% vs 23%, respectively, P = 0.047). Five percent of PIVs exhibited signs of phlebitis. CONCLUSION: PIVs and other vascular access devices are nearly universal in hospitalized patients. There is great variability in the anatomic location of PIVs and in the manner they are dressed and secured – resulting in an opportunity for standardization and risk reduction. DISCLOSURES: All authors: No reported disclosures.