Peripheral intravenous catheters (PIVCs) are the most commonly used invasive devices in healthcare, with 60% to 90% of hospitalized patients requiring IV therapy during their stay.1,2
But routine does not mean risk-free.
Despite their routine use, IV infiltrations remain among the most common causes of peripheral IV failure and a significant source of preventable patient harm.1,3
Understanding the Scope of the Problem
A systematic review of more than 478,000 peripheral IV catheters found that 36.4% failed before treatment was completed.
The question is: How often are they happening in your organization, and how early are you identifying them?
For healthcare leaders, the challenge is that peripheral IV complications can be difficult to see at the organizational level. They are often managed as individual bedside events, with reporting that can vary across units and organizations. But their impact extends far beyond the bedside.
A failed IV can interrupt essential therapy, require additional invasive attempts, increase nursing workload and affect the patient experience. Infiltrations and extravasations can also result in tissue injury, with severity influenced by the medication or fluid involved, the volume delivered and how long the leakage continues.
The 2024 evidence-based PIVC consensus developed with experts from organizations including AVA, INS, AACN and ECRI highlights the frequency of PIVC failure and the need for greater standardization of peripheral IV practice.
Peripheral IV complications represent an important patient safety issue with implications for financial performance, quality outcomes, patient experience, accreditation readiness and organizational risk.
Financial Impact: A Patient Safety Issue with Fiscal Consequences
Published literature reports infiltration rates ranging from approximately 13% to 20% of peripheral IV catheters, while overall peripheral IV catheter failure rates may range between 35% and 50%. Given the enormous number of peripheral IVs used across U.S. hospitals annually, even small improvements in IV reliability and early complication recognition can have meaningful clinical and operational implications.3
At a minimum, the event typically requires additional nursing time, replacement supplies, repeat catheter insertion, documentation and clinical reassessment. More severe infiltrations may require wound care consultations, specialist evaluation, imaging studies, antidotes and extended monitoring.1,4
The downstream financial implications can be even more significant. Infiltration-related catheter failure may delay medications, prolong care delivery, increase resource utilization, contribute to longer hospital stays and increase the likelihood of additional procedures.1
For health systems focused on operational efficiency and margin preservation, IV infiltrations represent a potentially significant source of avoidable cost and organizational risk, yet those costs are often dispersed across departments rather than captured as a single line item.
Take the Next Step: Understand Your Organization's PIVIE Risk
If you’re a healthcare leader looking to better understand your organization’s peripheral IV risk, start by asking the questions that can reveal what may be happening beneath the surface.
Talk with your CNO, nursing leadership, vascular access and patient safety teams:
- Are we tracking PIVIEs? If so, are we capturing all events, not just the most severe injuries?
- Are we grading PIVIEs consistently? Do we use a standardized grading or severity scale?
- Do we know our PIVIE rate? And how does it compare across units, patient populations and therapies?
- What is our current PIVIE protocol? Does it extend beyond oncology to include non-vesicant infiltrations and extravasations?
- How quickly are PIVIEs identified and escalated? Do our protocols define clear response timelines?
- What does pharmacy see? How frequently are extravasation treatments or antidotes, such as hyaluronidase, being requested or administered?
- What are our most common contributing factors? Are certain medications, patient populations, units or insertion sites associated with higher rates?
- Are we measuring the impact? Are we tracking repeat IV attempts, therapy interruptions, tissue injury, length of stay or other downstream consequences?
You may be surprised by what the data reveals.
You can’t improve what you don’t measure, and you can’t address a risk you can’t see.
What Does a Strong IV Safety Strategy Look Like?
Once a health system understands the scope of its PIVIE risk, the next question is: What can we do about it?
Reducing IV-related harm requires more than relying on individual vigilance. It requires a consistent, system-level approach that supports clinicians throughout the life of the peripheral IV, from selection and insertion through ongoing assessment and removal.
A comprehensive IV safety strategy should consider:
- Standardized insertion practices and appropriate catheter and site selection
- Securement and dressing practices that maintain catheter stability and allow the insertion site to remain visible
- Consistent, evidence-based assessment of the IV site
- Clear protocols for identifying, grading and escalating PIVIEs
- Medication-specific guidance, including clear processes for managing extravasations and accessing appropriate antidotes
- Education and competency assessment for clinicians caring for peripheral IVs
- Reliable reporting and data collection to identify trends and opportunities for improvement
- Early recognition and monitoring between routine clinical assessments
The goal isn’t to suggest that one intervention will eliminate PIVIEs. Peripheral IV failure will continue to occur. The opportunity is to recognize it earlier and minimize the potential for patient harm.
Moving From Reactive to Proactive IV Safety
Traditional IV assessment remains an essential part of clinical practice. Touch, look and compare assessments provide clinicians with valuable information about the IV site and the patient’s condition.
But every assessment occurs at a point in time. What happens between those assessments?
For patients receiving high-risk therapies, or those who may be unable to communicate changes at the IV site, healthcare organizations may benefit from additional layers of surveillance that complement, not replace, routine nursing assessment.
Technology-enabled monitoring is one emerging approach that provides continuous surveillance of the IV site between routine clinical checks, helping clinicians identify changes earlier.
The objective isn’t to replace the nurse at the bedside. It’s to give the nurse another set of eyes.
Could Continuous Monitoring Add Another Layer of IV Safety?
Learn how continuous IV site monitoring can complement routine nursing assessment and help clinicians identify potential infiltrations and extravasations earlier.
- Bahl A, Haddad L, Hoerauf K, Mares A, Alsbrooks K. The clinical and economic burdens of infiltration and extravasation with peripheral intravenous catheters: a contemporary narrative review. Int J Nurs Health Care Res. 2023;6:1436.
- Zingg W, Barton A, Bitmead J, et al. Best practice in the use of peripheral venous catheters: a scoping review and expert consensus. Infect Prev Pract. 2023;5(2):100271. doi:10.1016/j.infpip.2023.100271
- Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203.
- Gibian JT, Zakria D, March C, Schaheen B, Drolet BC. Outcomes and management of peripheral intravenous infiltration injuries. Hand (N Y). 2022;17(1):148-154. doi:10.1177/1558944720906494