Peripheral intravenous catheters (PIVCs), also known as short peripheral catheters (SPCs), are among the most commonly used medical devices in hospitals—yet they are also a frequent source of preventable harm.1,2 Infiltration and extravasation events, particularly in high-risk patients or during rapid infusion therapies, can result in tissue damage, nerve injury, and costly litigation.
Despite their prevalence, peripheral IV infiltration remains a persistent and preventable challenge in clinical care, driven by a combination of patient complexity, device limitations, and workflow gaps. As patient acuity rises and clinicians care for more individuals with difficult venous access, traditional approaches to IV placement and monitoring are increasingly strained. Addressing infiltration risk requires a broader view—one that considers not just catheter choice, but placement strategy, monitoring, and system-level support.
The Problem: Too Short, Too Risky
Standard-length (PIVCs)—particularly smaller gauges such as 22G and 24G commonly used in pediatrics—are often positioned only a few millimeters inside the vein. While this may produce an initial flashback and allow flushing during insertion, it leaves the catheter vulnerable to dislodgement once the patient begins moving. This risk is further amplified in pediatric patients and during procedures that involve changes in arm positioning or infusion dynamics.
Clinical guidance recommends that at least 80% of the catheter length dwell within the vein to reduce the risk of dislodgement and infiltration. However, many facilities continue to rely on short cannulas that fail to meet this threshold, increasing the likelihood of infiltration events. Longer peripheral catheters (e.g., 6 cm) placed with ultrasound guidance offer a safer alternative in many cases—but their benefits and risks vary by patient population.
The DIVA Population: Higher Risk, Higher Stakes
Patients with Difficult Intravenous Access (DIVA) present unique challenges for safe and reliable IV therapy. These patients often have venous characteristics or clinical histories that make peripheral access particularly difficult, including:
- Small, fragile, or deep veins (common in pediatric, oncology, and elderly populations)
- A history of multiple IV attempts or failed cannulations
- Chronic illness or frequent hospitalizations
- Obesity or significant edema
- Dehydration or low circulating blood volume
For DIVA patients, standard short cannulas and blind insertion techniques frequently fail—leading to repeated attempts, delays in therapy, and a significantly higher risk of infiltration. Ultrasound-guided placement of longer peripheral catheters has become a critical strategy for improving access and first-stick success in this population.
However, when ultrasound-guided placement results in catheter positioning within deeper veins located below the deep fascia—a common occurrence with longer catheters—the risk of infiltration and delayed detection may increase.
Catheter-to-Vessel Occupancy: Minimizing Complications
Proper catheter-to-vessel occupancy is a critical factor in reducing complications such as infiltration and vessel irritation. Smaller-diameter vascular access devices help decrease turbulent blood flow around the catheter and reduce the risk of the catheter rubbing against the vessel wall. To minimize these risks, clinical guidance recommends that catheter-to-vessel occupancy remain below 45.1%.
Prevention Best Practices:
- Choose the smallest peripheral cannula possible—typically 24G or 22G—and place it as far down the arm as possible, avoiding areas of flexion unless absolutely necessary.
- Select cannula size based on required flow rates and insertion site; larger gauges like 18G and 20G should be used cautiously.
- Inspect vascular access devices at least once per shift, flush regularly, and remove the device promptly if it is malfunctioning or no longer needed.
Flow rate reference for infusion requirements³:
The Solution: Technology, Pathways, and Culture
Even in hospitals without dedicated vascular access, teams must prioritize safe IV therapy by adopting comprehensive strategies, including:
- Using ultrasound-guided long peripheral cannulas for patients with Difficult Intravenous Access (DIVA)
- Establishing formal difficult IV access pathways to standardize care
- Educating clinical staff on catheter-to-vessel ratios and infiltration risks
- Implementing continuous IV monitoring technology to catch complications early
ivWatch’s biosensor technology continuously monitors tissue for early signs of infiltration, often notifying clinicians before visible symptoms appear. This early warning enables faster intervention, reduces injury severity, and supports safer use of peripheral lines—even with high-risk medications.
Prevention Is a System, Not a Single Step
Peripheral IV safety isn’t just about choosing the right catheter—it’s about building a system that supports safe placement, securement, ongoing monitoring, and timely escalation when issues arise. Knowing the right tools and protocols exist should make patient harm from infiltration no longer be accepted as a normal complication in healthcare.
Learn more about how ivWatch is helping hospitals reduce infiltration injuries and improve patient safety. Visit ivWatch.com or schedule a demo today.
1 Spencer & Mahoney 2017; Sharp et al. 2015
2 Lv & Zhang 2020; Welyczko 2020).
3 https://www.ivwatch.com/wp-content/uploads/2025/01/NIVAS-Extravasation-Toolkit-.pdf