When Catheter Stabilization Isn’t Enough for Patient Safety

1462041601658Many drivers have experienced the kind of fender-bender or sudden stop that made them glad they were wearing a seat belt. But a seatbelt can only protect us from so much — which is why airbags and more advanced safety approaches were invented.

To use another auto analogy, think of the breakaway hoses at gas stations pumps. They prevent the full hose from being pulled out of the pump when an absent-minded driver drives away without removing the nozzle from the gas tank.

Similarly in nursing care, there’s only so much that catheter stabilization can do when it comes to protecting IV lines. Given those limitations, a better safety option is now being developed to address a pain point for nurses: accidental dislodgement of IV lines.

Central lines are frequently held in place with catheter stabilization devices to minimize minor movements of the catheter along with the complications and catheter restarts they can cause. Many peripheral IVs (PIVs) also get a stabilization device — but many other are held in place with just a tape-based technique.

But catheter stabilization (also called securement) can give clinicians and hospital administrators a false sense of security. Stabilization devices aren’t always strong enough to prevent catheter dislodgement when catheter movements are not minor – that is, when a macro force is applied to the catheter inadvertently.

As many bedside nurses have seen, it’s possible for an IV catheter to be subjected to a force strong enough to pull it out – such as when the line becomes snagged in bedding or is caught in the bed’s guardrail. Patients may be confused and tug on their catheter or completely pull it out. A catheter for an ambulatory patient may be dislodged when the patient move about the hospital. A catheter can also be pulled out when patients are being transported.

Traditional stabilization methods often fail when subjected to this kind of sudden, forceful yanking because they were never designed to prevent this level of mishap.

We recently spoke with an expert on this subject. Nancy Moureau, BSN, CRNI, is a nationally known consultant, lecturer, and author on IV therapy-related issues.

“Accidental dislodgement is a somewhat common occurrence in today’s acute care,” said Moureau. “Administering IV medication requires a patient to be connected via tubing and a medication bag. Even during normal patient activities, pressures may be exerted on the tubing in a way that can impact patient safety.”

For a patient who has a peripheral IV, dislodgement means a restart with a cost that experts estimate at $30. With central venous catheters and PICCs, the potential consequences can be much worse. The concern for patient safety includes circumstances that could lead to a fatality. “In a worst case scenario, a catheter dislodgment can lead to a bleedout, an air embolism, or a bloodstream infection that results in the patient’s death,” Moureau said.

To address the problem and dangers of IV dislodgement, a new category of device – an “IV safety release valve” (SRV) — is being developed and is expected to be widely available in the coming months. This valve attaches to the luer between the IV extension set and administration set.

If a sudden strong force from a patient movement or snagged tubing pulls on the catheter, the SRV separates from the catheter and seal off both sides of it. This helps prevent the potentially serious consequences of dislodgement. It also makes it relatively quick and easy to restore the flow of medications, without having to clean up the site and without difficulties in tracking dosage that can result from lost medication. That’s a much simpler and less time-consuming process than a catheter restart, and it will also cut supply costs.

“With these safety concerns associated with tubing and catheter dislodgement, product improvement is needed,” said Moureau. “Studies show that dislodgements occur in more than 5% of IV catheters, and while most don’t threaten a patient’s life, some events can be quite dangerous. Even without the dangers of dislodgement, delays in medication administration can definitely affect patient progress to healing and discharge.”

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