Why IV Lines Fail: A Crazy Little Thing Called Dislodgement

With something like 300 million peripheral IV lines sold in U.S. each year – and a failure rate that’s often cited as being 50% – researchers continue to try to understand a problem that’s a daily headache in vascular access and infusion therapy.

Common causes of line failure are dislodgement, infection, thrombosis, phlebitis and occlusion. Peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) tend to be better secured than peripheral IVs, but they are also subject to high failure rates.

“Intravenous catheter dislodgement is a significant and avoidable problem,” said vascular access consultant Leigh Ann Bowe-Geddes, BSN, RN, CRNI, VA-BC, a well known vascular access clinical consultant and former president of the Association for Vascular Access.

“At the very least, dislodgement may require a painful insertion of a new peripheral intravenous catheter,” Bowe-Geddes told us. “For the increasing number of patients with difficult venous access, this can be a challenge. In a worst case scenario, a strong enough pull on a central venous catheter, even a sutured one, could dislodge the catheter, putting the patient at risk for life-threatening air embolism.”

With the stakes that high, it would be helpful for us to understand: What causes so many IV lines to fail before therapy is finished?

There is no definitive answer to that question. But two studies about central lines shed more light on part of the answer.

The larger of these two studies was a meta-analysis of central vascular access devices (CVADs) in pediatric patients. The title of the study, published in Pediatrics in November 2015, was “Complications of Central Venous Access Devices: A Systematic Review.”

Even with better-secured lines for pediatric patients, the analysis revealed a failure rate of 25%. Overall, the authors said, pediatric IV catheter failure rates are “unacceptably high.”

Researchers winnowed their meta-analysis down to 74 studies that met inclusion criteria. They looked at complications such as bloodstream infection, occlusion (blockage), thrombosis and dislodgement. The latter happens when lines are subject to macro forces, against which suture securement/stabilization devices cannot always protect.

“The outcomes of PICCs used in clinical practice need to be cautiously and systematically monitored,” the paper said. “Clinicians should be made aware of the high rates of failure associated with their use….”

While infection, occlusion and thrombosis have been the subject of a number of studies, there appears to be a paucity of data about dislodgement. This study sheds some light on the prevalence of that complication. Researchers estimated that in the several dozen studies they examined, 4.7% of CVADs experienced dislodgement/migration complications.

Again, this is in a patient population that is more closely monitored than adults, and one where catheters are more likely to be carefully secured with a stabilization device. Yet dislodgement remains a challenging clinical issue.

“The results clearly show that failure of CVADs throughout pediatrics is a substantial and significant problem, with 1 in 4 failing,” the authors wrote.

The second, more recent study was by Dauphine Grau and colleagues in Montpellier, France. It was published this January in Antimicrobial Resistance in Infection Control. The authors looked at the prevalence of PICC-related complications and found a surprisingly high rate of complications.

The overall complication rate was 30.2%. Occlusions accounted for 8.9% of overall complications, with infections being 6.3%, venous thrombosis 1.6% and hematoma 1%

Again in this study, accidental withdrawal (dislodgement) was a key factor, responsible for 8.9% of overall complications.

As Bowe-Geddes and others have long advocated, preventing dislodgement is one key to lowering the troublingly high rate of catheter-related complications. “A technology that prevents catheter dislodgement, while protecting the catheter and infusion tubing set from contamination that could lead to infection, would be a valuable tool,” she said.