Peripheral Intravenous Catheter Management and Outcomes

Peripheral intravenous catheters (PIVCs) remain the most common invasive device in clinical practice, employed for fluid administration, medication delivery and blood sampling. Despite their ubiquity, PIVC failure rates approach one in three insertions, leading to treatment delays, patient discomfort and increased healthcare costs. Common complications include phlebitis, occlusion, mechanical dislodgement and catheter-related bloodstream infections. Dwell time and insertion technique have long been debated: routine resite at fixed intervals has given way to clinically indicated resite strategies, underpinned by evidence that prolonged in situ use does not increase infectious risk when appropriate care protocols are observed. Advances in catheter materials, securement devices and imaging-guided insertion protocols have sought to minimise mechanical irritation and vessel trauma. Emerging sensor technologies aim to detect early extravasation events, while computational fluid dynamic models elucidate how infusion rates, tip position and insertion angle influence local haemodynamics and failure mechanisms. A multifaceted approach that integrates patient-specific risk assessment, standardised care bundles and continuous staff training is essential to optimise PIVC outcomes globally.

Research from Nature Portfolio

Computational fluid dynamic simulations have provided new insight into failure pathways, demonstrating that high infusion rates and unfavourable tip orientations can amplify wall shear stress and blood trauma, thereby predisposing to thrombosis and phlebitic changes. Such models suggest that limiting peak infusion rates and refining insertion angle can mitigate mechanical strain on the vein wall. Complementary intervention studies have shown that ultrasonographic assessment of vein calibre and catheter tip position combined with the use of flexible polyurethane catheters reduces mechanical irritation and unplanned catheter removal by over 50 per cent compared with conventional care, underscoring the value of image-guided cannulation and material selection in prolonging catheter survival.

Peripheral Intravenous Catheter Management and Outcomes publication trend

The graph below shows the total number of articles in peripheral intravenous catheter management and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Extravasation: The unintended leakage of intravenous fluid into surrounding tissue.

Phlebitis: Inflammation of a vein, often manifesting as pain, erythema and swelling.

Catheter dwell time: The total duration for which a catheter remains inserted in a patient.

Mechanical irritation: Vessel trauma caused by catheter movement or stiffness against the vein wall.

Computational fluid dynamics: Numerical simulation of fluid flow used to assess haemodynamic forces around the catheter.

References

1. Sensing Technologies for Extravasation Detection: A Review. ACS Sensors (2023).
2. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. International Journal of Nursing Studies (2023).
3. Early Release - Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland - Volume 30, Number 1—January 2024 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2023).
4. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project). PLOS ONE (2017).
5. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial. BMC Medicine (2010).
6. The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study. Scientific Reports (2018).
7. Preventing peripheral intravenous catheter failure by reducing mechanical irritation. Scientific Reports (2020).