New ways of improving the effectiveness of dressings and securements for the prevention of peripheral intravenous catheter (PIVC) failure in adults is urgently required.

This is according to Professor Claire Rickard from the Alliance for Vascular Access Teaching and Research, a part of Griffith’s Menzies Health Institute Queensland, following new research published in The Lancet medical journal.

PIVCs are the most common invasive medical devices used in hospitals. Around 2 billion devices are sold globally each year, and most patients who are admitted to hospital require intravenous therapy.

PIVC failure is unacceptably common: up to 69 per cent of devices require removal due to dislodgement, pain, occlusion, leakage or infection.

“PIVC failure can lead to pain and anxiety, interrupted therapy, and morbidity and mortality associated with infection, and additional procedures are often needed to replace catheters, all of which substantially increases healthcare costs and workload,” says Professor Rickard.

The National Health and Medical Research Council funded the research which took place in Brisbane at the Royal Brisbane and Women’s Hospital and the Princess Alexandra Hospital.

The trial took 1807 eligible patients aged 18 and over who required PIVC insertion for clinical treatment required for longer than 24 hours, and randomly assigned them to receive tissue adhesive with polyurethane dressing, bordered polyurethane dressing, a securement device with polyurethane dressing, or polyurethane dressing (control group).

“Overall, 41 per cent of patients had all-cause PIVC failure. We compared three alternative dressings and securements with low-cost polyurethane dressings, but none of the interventions significantly reduced PIVC failure,” says Professor Rickard.

“All products tested, including polyurethane were associated with PIVC failure and often needed reinforcement. Thus innovation to develop effective, durable products is urgently needed.”

Substantial savings

She says the study indicates that substantial savings could be made for the Australian health system if clinicians use low-cost polyurethane dressings for PIVCs, in the absence of a clinical rationale for use of a more expensive product.

Professor Samantha Keogh, President of the Australian Vascular Access Society congratulated Professor Rickard and her team for completing much needed rigorous trial research in this area.

“An overwhelming majority of patients (90%) in Australian hospitals require some sort of vascular access device for delivery of essential treatment or sampling. More investment in innovative and effective vascular access practice and products is required, as well as the quality research evaluating and implementing these.

“This study highlights that PIVC failure is continuing at an unacceptably high rate which has significant implications for the patient’s IV experience, as well as for healthcare costs.”