IV Failure And Complications
IV lines are stressed each day they are in use. During normal activities of daily living, tugs and pulls on the IV line occur and are largely unavoidable. These forces can be transmitted to the dressing, surrounding skin, and/or the IV catheter that is in the vein. Some levels of force are acceptable and others reach a point where they become harmful to the IV and can lead to failure of the line. Clinical studies show us that on average, IVs fail 46% of the time in major clinical centers before the IVs reach the end of their intended use.
46% is an astounding number, and it is almost hard to believe. Helm et al performed a review of all the available literature and published in May/June 2015 an article titled, "Accepted but Unacceptable: Peripheral IV Catheter Failure" in the Journal of Infusion Nursing. When the authors reviewed the literature for all of the randomized controlled clinical trials (highest level of study besides a blinded trial), they found nine studies to analyze. These studies were done in major medical centers with dedicated IV teams performing the procedures. The failure rate was as high as 63% with an average of 46%. If this is the rate at major medical centers, what is it in the average hospital?
Mechanical Forces On IV Lines
Below are pictures of a standard IV adhesive with different amounts of force applied on the IV line. Most adhesives are completely pulled off the skin starting somewhere around eight pounds of force, with some pulling completely off around five pounds of force. It is impossible to eliminate all the forces that might pull on an IV line and some smaller forces, like those associated with activities of daily living, are normal. There is a point at which forces turn harmful and can shorten the lifespan of the IV.
In the 3 pound and 4-pound pull force images above, the skin is starting to tent dramatically, the catheter hub has moved inside the dressing significantly and the angle of the IV catheter might cause the function of the catheter to be compromised. SafeBreak Vascular is designed to separate at 4 pounds to release the harmful force from the IV line. Keep in mind that the arm shown in the pictures below is a 50 year old male’s arm. The amount of skin tenting shown at each level of force would be even more dramatic in a 70 year old male or female. Click here to learn more about forces across IV lines and various securement device’s performance.
Common IV Complications
There are four common complications that occur with peripheral IVs: dislodgement, infiltration, occlusion, and phlebitis. With all of these complications, harmful forces on the IV line are a major precipitating factor. The four complications related to mechanical forces are described below.
Dislodgement
Dislodgement occurs when forces across the IV line are stronger than the adhesives’ and securement devices’ ability to hold onto the IV line, making it a purely mechanical complication. Clinical studies show that IV dislodgement is a common complication, occurring 11% time on average.(2) Dislodgement can occur either on purpose or accident with some of the most common reasons being: patient transfer from one bed to another, patients with cognitive issues unknowingly pulling out their IV, and IV lines getting caught underneath hospital bed rails.