The Role and Risks of Peripheral Intravenous Catheters
Peripheral intravenous catheters (PIVCs) are a fundamental tool in modern medicine, providing a temporary port for administering fluids, medications, and blood products directly into a patient's bloodstream. They are one of the most common invasive medical devices used in healthcare today. While generally safe, their use is not without risks, and various complications can arise, leading to treatment delays, increased healthcare costs, and patient distress. Recognizing these issues and implementing effective prevention and management strategies is vital for patient care.
The Most Common Peripheral IV Complications
Phlebitis
Phlebitis, or inflammation of a vein, is one of the most common complications of PIVCs, often causing redness, swelling, tenderness, and warmth along the vein. It can result from mechanical irritation due to catheter movement, chemical irritation from infused solutions with high or low pH, or bacterial contamination from poor aseptic technique. Untreated phlebitis can lead to more serious issues like thrombophlebitis (inflammation with a clot) and, in rare cases, bloodstream infection. Healthcare professionals can assess the severity of phlebitis using tools like the Visual Infusion Phlebitis (VIP) score.
Infiltration and Extravasation
These two complications involve the leakage of fluids from the vein into the surrounding tissue.
- Infiltration: Occurs when non-vesicant fluid (solutions that don't cause severe tissue damage, such as saline) leaks into the surrounding tissue. Signs include swelling, coolness, and discomfort at the site, along with a potential decrease in infusion rate. While often not severe, it can be painful and requires the catheter to be removed and re-sited.
- Extravasation: A more serious form of leakage involving a vesicant drug, which is a substance that can cause severe tissue damage, blistering, and necrosis if it leaks out of the vein. Common vesicants include certain chemotherapy drugs, vasopressors, and high-concentration electrolyte solutions. The consequences of extravasation can be devastating, including permanent nerve damage or loss of function, and require immediate and specific interventions.
Hematoma
A hematoma is a localized collection of blood outside the blood vessels, appearing as a bruise and swelling at the insertion site. It is often caused by trauma to the vessel during insertion, multiple insertion attempts, or improper pressure applied after catheter removal. Patients on anticoagulant therapy are at an increased risk. A hematoma typically resolves on its own, but proper pressure application during and after catheterization is key to prevention.
Occlusion and Dislodgement
- Occlusion: Refers to a blockage of the catheter, which can be caused by a mechanical issue (e.g., kinking), formation of a blood clot, or precipitation of incompatible medications. It stops or slows the infusion and can be detected by sluggish or absent flow.
- Dislodgement: Occurs when the catheter accidentally comes out of the vein due to poor securement or patient movement. This necessitates a new catheter insertion, delaying treatment and causing patient discomfort.
Infection
PIVCs create a potential entry point for bacteria, leading to infection. This can range from a localized site infection to a serious bloodstream infection (BSI).
- Local infection: Signs include redness, warmth, pain, and purulent drainage at the insertion site.
- Bloodstream infection (CRBSI): A more severe systemic complication, where the infection travels through the bloodstream. While less common with PIVCs than central lines, CRBSI is a serious risk factor, especially with prolonged catheter use. Prevention focuses on strict hand hygiene, aseptic technique during insertion and maintenance, and regular site assessment.
Nerve Injury
Though rare, nerve injury can occur during catheter insertion due to direct trauma or later due to compression from a hematoma or significant infiltration. It can cause immediate sharp, shooting pain, numbness, or tingling that may persist, potentially leading to chronic pain or impaired function. Avoiding high-risk insertion sites and recognizing abnormal sensations are important preventive measures.
A Comparison of Common IV Catheter Complications
| Feature | Phlebitis | Infiltration | Extravasation |
|---|---|---|---|
| Cause | Mechanical, chemical, or bacterial irritation of the vein wall | Leakage of fluid into surrounding tissue from catheter dislodgement or vessel damage | Leakage of a vesicant drug into surrounding tissue |
| Fluid Type | Any infusate, but especially irritating or concentrated ones | Non-vesicant fluids (e.g., normal saline) | Vesicant drugs (e.g., chemotherapy, vasopressors) |
| Signs/Symptoms | Redness, warmth, swelling, palpable cord, tenderness along the vein | Swelling, coolness, pallor, discomfort, decreased flow rate | Initial signs similar to infiltration, progressing to blistering, necrosis, severe pain |
| Severity | Mild to moderate, can increase risk of thrombosis or infection | Typically mild, causes discomfort and treatment interruption | Potentially severe, can cause permanent tissue damage, nerve injury, or loss of function |
| Intervention | Remove catheter, apply warm compress, elevate limb | Stop infusion, remove catheter, elevate limb, apply warm/cool compress | Stop infusion, notify provider, remove catheter, may require antidote injection |
Preventing Complications and Ensuring Patient Safety
Best practices and vigilant care are critical to reducing the incidence of PIVC complications. The Centers for Disease Control and Prevention (CDC) provides guidelines to minimize infection risk, which also help prevent other complications.
Best Practices for Insertion and Maintenance
- Proper site selection: Use an upper extremity site and choose the most appropriate vein, avoiding areas of flexion like the antecubital fossa where movement can increase mechanical phlebitis risk.
- Appropriate catheter selection: Use the smallest gauge catheter that will accomplish the prescribed therapy. A smaller catheter allows for greater blood flow around the tip, which helps dilute the infusate and minimize irritation.
- Aseptic technique: Maintain strict hand hygiene and use aseptic techniques during catheter insertion and maintenance to prevent bacterial contamination.
- Securement: Properly secure the catheter with sterile, transparent dressings to minimize movement and protect the insertion site.
- Regular monitoring: Regularly assess the catheter site for any signs of inflammation, swelling, or malfunction.
- Timely removal: Remove the catheter as soon as it is no longer clinically necessary or if complications arise. A PIVC should not be left in longer than required, as prolonged dwell time increases risk.
Conclusion
While peripheral intravenous catheters are an indispensable tool for delivering care, the potential for complications must always be considered. Phlebitis, infiltration, extravasation, hematoma, occlusion, and infection are among the most common adverse events, though serious complications like nerve injury can also occur. Proactive management, including careful technique during insertion and vigilant monitoring throughout a patient's treatment, is essential to minimize risks and ensure patient safety. By adhering to best practices and promptly recognizing and treating any issues, healthcare providers can significantly reduce patient discomfort and improve outcomes associated with peripheral intravenous catheter use.
For more detailed guidance on prevention strategies, consult the official recommendations from the Centers for Disease Control and Prevention (CDC).
