It’s one of the most common medical procedures in hospitals around the world.
So why are millions of patients every year getting needled with catheters in places that aren't recommended, and left unused and unmonitored, risking painful malfunctions and infection?
Two in three peripheral intravenous catheters (PIVCs) are inserted into areas not recommended by international guidelines or risk failing before patients get the treatment they need, a major international study shows.
The cannulas - used to give infusions of medications, pain relief, hydration fluids, blood products and nutrients - are inserted into hands, wrists and elbow creases instead of the recommended veins in the forearm, found the Australian-led review of 40,620 PIVCs across 51 countries.
One in 10 catheters were unnecessarily painful or caused inflammation of the veins, concluded the biggest study of its kind published in the Journal of Hospital Medicine.
Another 10 per cent were leaking, blocked or falling out, but were left in place.
“If you walk around any hospital in Australia, you will find that at least 10 per cent of patients will have painful, red and swollen or malfunctioning devices,” said lead author Evan Alexandrou, senior lecturer at Western Sydney University’s school of nursing and midwifery.
“We know up to 90 per cent fail before end-of-treatment,” Dr Alexandrou said. “For something so commonly used, failure rates are unacceptably high.”
Roughly one in six catheters were left in patients for at least 24 hours serving no purpose, unnecessarily raising the risk of infection, and one in five had suboptimal dressings.
More than one in three had no documentation, suggesting they were not being monitored, and nearly half had no documented date or time of insertion.
Almost 2 billion PIVCs are used every year globally.
“This means millions of patients around the world have painful or malfunctioning catheters that staff have not responded to,” Dr Alexandrou said.
When cannulas fail, patients can miss doses of antibiotics, testing and treatments could be delayed, and hospitals stays lengthened.
In the most serious cases, patients develop catheter-associated blood infections.
One in every 1000 PIVCs cause bloodstream infections linked to an increased risk of morbidity and death, Dr Alexandrou said.
“If we don’t improve insertion practices, we will continue to see significant numbers of cannulas failing and patients undergoing unnecessary, painful sticks.”
Sydney independent patient advocate and former nurse Dorothy Kamaker said clinicians often viewed catheters as “of minimal significance” despite them being an invasive procedure.
“I’d say most clinicians expect them to fail [or] fall out after a couple of days and don’t think that’s a big deal. Most interns would list replacing PIVCs as the most time-consuming, irritating chore in their day,” she said.
Wrists and elbow creases were “completely unsuitable” unless it was an emergency.
Dr Alexandrou said catheters were often placed in these areas because veins were easier to find and access for time-poor hospital staff with formidable workloads.
Forearms often needed to be palpated or put under infra-red vein illuminators or ultrasound to find a vein, he said.
Professor Ramon Shaban, clinical chair of infection prevention and control at the University of Sydney, said the location of the catheter was less important than the way they were monitored.
“It doesn’t matter if staff insert the catheter in the safest place possible. If it’s not monitored and managed appropriately, you’re going to get an infection,” he said.
“There are important medical devices that come with risks and should only be inserted for a very good reason and there should be a clear plan to remove it.”
Professor Shaban said that if a catheter was painful, patients should ask their doctor to have a look at it.
Following best-practice guidelines would reduce the rate of painful PIVCs, cut infection rates and delays in treatment, the authors wrote.
“The financial benefit to the Australian healthcare system alone would be in the millions of dollars,” Dr Alexandrou said.
The authors recommended extra training for staff and access to appropriate technology, as well as a stronger focus on monitoring and documenting catheters.
The study was conducted in collaboration with the Alliance for Vascular Access Teaching and Research group at Griffith University, Queensland.