(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has not been used for the previous 24 hours and has no plans for use for the next 24 hours. Following treatment, a PIVC may be left in place until someone remembers to remove it. Shockingly, up to one-fourth of PIVCs are inserted but never used. It’s time to question the ‘just in case’ PIVC.

Staff time and convenience.

Having a PIVC in situ may give you a sense of control, that if an emergency occurs the patient will have ready intravenous (IV) access. If the patient is medically unstable or needs short-term IV therapy, having a patent PIVC in place is important.

However, a stable patient will almost never require emergency access, and appropriate vascular access can be inserted when it is needed. A PIVC that has already been indwelling for more than a day or so without use may not function effectively when you try to access it, requiring a new PIVC to be inserted and fewer veins available for access. That means two or more IV insertion attempts, which is a waste of staff time and hospital resources, as well as painful for the patient.

Bloodstream infection risk.

Bloodstream infection is usually considered to be caused by more invasive central vascular access devices. If you think that PIVCs are a benign device and rarely lead to bloodstream infection, I urge you to reconsider. The rates of PIVC-associated bloodstream infection are often unknown and rarely quantified. But there is increasing evidence that PIVCs pose just as much risk as central devices, which makes sense. After all, any vascular access device is a portal straight into the bloodstream. Furthermore, PIVCs are often treated with less care than central devices. My team did a global prevalence audit of PIVCs and identified one in five PIVC dressings were soiled or loose: a red flag for potential infection.

Vessel health and preservation.

Vessel health and preservation is increasingly on the nurse’s radar. And rightly so. Veins are a limited resource, from infancy to advanced years. Many patients require multiple insertion attempts to achieve functional vascular access, and each insertion attempt can leave veins bruised and nonviable. If a PIVC is inserted and not used, this is a waste of viable veins that may be needed for urgent care at a later time. Nurses should be advocates for the patient and speak up when routine IV cannulation is not in the patient’s best interests.

A little critical thinking goes a long way.

A PIVC should not be the default option for every patient. There are many ways nurse can advocate for patients’ vessel health. Here are some suggestions:

  • Think twice before inserting an IV.
  • Use ultrasound guidance for patients with known difficult intravenous access.
  • Consult a pharmacist to spread out intravenous medication times so that one IV is sufficient, even with drug incompatibilities, or to identify alternate drug administration options.
  • And every day, question if the PIVC can come out. Consider if the patient can manage with oral medications and fluids. Do some local audits and see how many patients in your unit have a PIVC that hasn’t been used recently.
  • Follow up patients who have a PIVC inserted to monitor infections or other complications.
  • If your hospital policy insists that every patient have a PIVC inserted, regardless of indication, challenge it.

‘Just in case’ is not good enough. Let’s aim to do better.

Gillian Ray-Barruel, PhD, RN, MACN, is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health.