Previously, we explored why “trusting the flush” and waiting to see if an IV failure occurs is a dangerous approach that poses serious risks to patient safety. Here we’re taking a look at the various causes of IV failure and the dangers they present to patients.
According to a study by Robert E. Helm, MD, published in the Journal of Infusion Nursing, “Peripheral IV catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.”
Imagine if the tools that we use daily like cell phones or cars – failed half of the time we tried to use them. Your car drives but only gets you halfway to work or won’t go faster than 10 mph. Your cell phone drops 50% of your calls or you only hear every other word, maybe it’s okay a few times, but what if that call was really important and you needed it right now? You wouldn’t accept this with your phone or your car, you’d go out and buy a new one or be determined to find a solution. No one would accept these failure rates in their daily life, but unfortunately we accept them in healthcare everyday. If your IV is failing 50% of time or only delivering 10% of the medication – you have a problem, whether you see it or not.
The title of the Helm study is “Accepted but Unacceptable: Peripheral IV Catheter Failure,” and this is exactly what we at ivWatch believe about the rates of IV failure. It represents an underestimated problem in our healthcare system for a variety of reasons, but technological advances have been made, and there is no longer any reason to live with the potentially life-threatening risks IV failure poses.
The vast majority of hospital patients up to 90% – receive an IV, and IV failure can occur for a number of reasons:
Infiltration
Catheter infiltration is a common complication of IV therapy that occurs when fluid leaks from a vein into nearby tissue. IV failure can also be caused by extravasation, which is when a vesicant drug leaks from the vein. Both infiltration and extravasation can lead to serious consequences, including tissue damage, amputation, and even death. Symptoms include pain, swelling, or burning around the IV site; tightness of the skin; and inflammation.
Causes of infiltration include:
- Improper insertion: The catheter may have been inserted incorrectly, or the needle size may have been wrong
- Vein fragility: Aging, sun exposure, genetics, and certain medications can weaken veins
- Vein porosity: Poor vein porosity allows fluid to leak through the vein walls
- Mechanical irritation: The catheter may cause irritation to the vein
IV-Related Infection
IV-related infections can occur when an IV is used for an extended period of time or when the IV is not properly cared for. These infections can be serious, costly, and can lead to poor patient outcomes. Symptoms include redness, swelling, or warmth at the catheter site; pain or discomfort at the catheter site; fever, chills, or rigors; malaise, nausea or vomiting; unexplained hypotension; yellow or green drainage; or crusting or scabbing near the IV site.
Causes of IV-relation infection include:
- Contamination at insertion: Poor aseptic technique can contaminate the IV when it’s inserted.
- Skin flora: Skin organisms can migrate along the IV’s external surface.
- Contaminated fluids: Contaminated fluids infused through the IV can cause infection.
- Hematogenous spread: Infections from other parts of the body can spread through the bloodstream to the IV.
- Contaminated hub: The hub of the IV can become contaminated by bacteria from the patient’s skin or from healthcare workers’ hands.
- Bowel movements: Bacteria from a bowel movement can contaminate the IV.
- Urine from the catheter bag: Urine from the IV bag can flow backward into the bladder and cause infection.
Phlebitis
Also known as thrombophlebitis, phlebitis is inflammation of the vein. It is a common complication of IV therapy that can lead to IV failure when a catheter is removed prematurely or replaced due to complications. Symptoms include tenderness, redness, swelling, or warmth around the IV; itchy skin; and a throbbing or burning sensation at the IV site.
There are three primary causes of phlebitis:
- Mechanical: Friction from the IV catheter damaging the vein wall
- Chemical: Irritation from medications infused through the IV
- Bacterial: Contamination at the insertion site, in the IV solution, or in the tubing
IV Occlusion
Catheter occlusion is a blockage in an IV that can occur due to mechanical failure, thrombosis, or other factors, and can lead to IV failure. Symptoms include vein distension; swelling at the IV site, hands, arms, face, and shoulder; pain near the IV site; numbness or tingling in the fingers, hands and arms; inability to flush or infuse; changes in skin temperature or color, especially in the hands and arms; lack of blood return; and prominent venous pattern over the chest.
Causes of IV occlusion include:
- Thrombosis
- Mechanical failure: Kinking, angulation, or malposition of the catheter
- Infusion precipitates: Buildup of residue or precipitates from medications or parenteral formulas
- Lipid residue: Buildup of fat deposits from intravenous fat emulsions
- Inadequate flushing: Not flushing the catheter enough, or flushing it incorrectly
- Improper sealing: The catheter isn’t sealed properly
- Damaged catheter wall: The catheter wall is damaged
Accidental IV Removal/Dislodgement
The accidental removal or dislodgement of a patient IV can lead to IV failure. In addition to having to restart an IV, consequences include delayed treatment, the need for more invasive procedures such as inserting a central line, infection, hemorrhage, or in severe cases, death.
Causes of accidental IV Removal or dislodgement include:
- Patient confusion: Patients who are confused or delirious are more likely to dislodge their catheter.
- Bed transfers: Moving patients between beds can cause catheters to dislodge.
- Poor vein health: Aging, genetics, and long-term use of certain medications can cause fragile veins.
IV failure is common and unfortunately it is accepted as something that just happens in healthcare. Although it is true that IVs will fail and you might not be able to do anything to prevent it, the most common failure, infiltration and extravasation do have a solution.
ivWatch can step in and be a second set of eyes to monitor your patients IV site for signs of infiltration beginning – and with this technology injury rates can be reduced if not prevented. Embracing a proactive, comprehensive approach such as IV monitoring is changing the way clinicians monitor IVs for infiltrations and extravasations, offering an alternative to the way things have always been.
The truth is IV failure can be difficult to diagnose. The different types of IV failure often look similar when symptoms begin and can be difficult to assess what the cause is and how best to intervene. ivWatch can help give confidence to your assessments and offer you peace of mind to protect your patients from the risk of IV injuries related to this common type of IV failure – extravasation.
If you need more information about the most common type of IV failure, infiltration and extravasation, download The Causes Tool – a resource for the different ways an IV can infiltrate, and how to better assess them.