ISSUE

Short Peripheral Intravenous Catheter (PIVC) setups typically consist of a peripheral catheter, anywhere from 1⁄2” to 2” in length, connected to extension tubing and other components that deliver intravenous therapies to the patient. When catheter securement fails, and movement or poor insertion techniques compromise the integrity of this setup, a wide range of complications and safety issues can occur.

According to one expert source, the term "stabilization" is generally used when referring to the catheter itself and the term "securement" when referring to tubing and junctions. So catheters are stabilized, while tubing junctions are secured; but a review of the literature shows that these two terms are often used interchangeably.

CHALLENGES

Traditionally, PIVCs have been secured with medical tape, tape with transparent dressings, or tape and gauze. One study documented the use of IV catheter securement with tape as resulting in only an eight percent PIVC success rate. In addition, excess use of tape may obscure the IV site, preventing early detection of complications, and increasing the potential for infection.

Complications arise when IV catheters and tubing connections are not properly secured. Some consequences of poor catheter securement include phlebitis, infiltration, dislodgement, leaking, infection, patient pain and dissatisfaction, patient safety concerns, nursing interruptions, and additional costs. In many cases, the PIVC needs to be removed and another restarted in a new location.

According to a large study comparing catheter stabilization devices to tape, unscheduled restarts (when PIVCs are replaced after one or more have already failed),  account for between 40 percent and 70 percent of all PIVC insertions. Complication rates have been shown to be directly related to the method used for securing the PIVC setup to the patient.

PIVC restarts increase the healthcare worker’s risk of exposure to bloodborne pathogens, and every time it is necessary to re-stick a patient there is the potential for a healthcare worker to suffer a needlestick injury. With better stabilization and longer dwell times, healthcare institutions can reduce the risk to healthcare workers, patient discomfort, and accidental catheter dislodgement.

SOLUTION

One article on choosing the right IV device advises clinicians to use the one that is the least invasive with the lowest risk of complications, and the one that will last the length of IV therapy with minimal replacements.

The 2011 Infusion Nursing Standards of Practice includes a standard on catheter stabilization that says, “Vascular access device (VAD) stabilization shall be used to preserve the integrity of the access device, minimize catheter movement at the hub, and prevent loss of access.”

The 2011 CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections states: “Use a suture-less catheter securement device to reduce the risk of infection for intravascular catheters.” While this statement is most often associated with the risk of infection with central lines, recent evidence published in Infection Control and Hospital Epidemiology shows that the risk of infection with short PIVCs may be an under-recognized complication.

The Infusion Nursing Standards of Practice no longer list dressings alone as catheter stabilization devices. Although dressings protect the insertion site, there is little to no evidence that they enhance catheter stabilization by themselves or in combination with tape. The chosen catheter stabilization method should let you assess the catheter insertion site easily and should not alter the flow of blood or fluid through the catheter.

A randomized, controlled trial showed that the built-in stabilization platform of a closed IV catheter system used with an IV securement dressing provided effective stabilization. This combination provided significantly reduced dislodgement and could reduce the need for restarts and the associated costs.

The size of the footprint of the stabilization appears to be a critical component. This would be either a stabilization device added to a traditional catheter hub or a platform built into the catheter design in combination with a dressing for catheter securement. One study documented a cost savings from fewer restarts and reduced nursing time when hospitals changed to a combined PIVC and stabilization device, even though upfront costs were higher.

The CDC has recently stated that peripheral IVs may stay in place for 96 hours or more, as long as they are functioning well. Hospitals can realize significant cost savings by using devices with superior securement to ensure that PIVCs stay in place as long as they are needed.

The NovaCathTM Integrated IV System is designed to address the issues associated with PIVC stabilization and securement. NovaCath features advanced stabilization technology designed to:

• Minimize catheter movement at the hub and prevent loss of access

• Reduce IV catheter restarts

• Improve patient comfort

• Extend dwell time of existing catheters

• Significantly reduce complications associated with IV therapy.

In addition, NovaCath includes a design element that provides an internal 180-degree fluid path turn. This unique tubing management feature eliminates the need for an external “J-Loop,” which is usually necessary in order to redirect IV fluids back toward the patient. Elimination of the external “J-Loop” minimizes potential complications associated with tubing snags and IV catheter dislodgement.

NovaCath is the only FDA 510(k) cleared Safety IV Catheter system and patent protected technology that uniquely offers Advanced Catheter Stabilization, Next Generation Tubing Management and Passive Needle Encapsulation. To view a demo video, click here.