Introduction / Summary

It is estimated that over 350 million peripheral intravenous catheters (PIVCs) are inserted in the United States annually, making PIVC insertion the most commonly performed invasive procedure for patients.^1–3 Peripheral intravenous catheters are often inserted for infusion of fluids, medications, administration of blood products, and the withdrawal of blood.⁴

Vascular access device selection is a collaborative effort with the health care team taking into consideration the patient's history, condition, and infusion needs.⁴

Venous vasculature is assessed through inspection, palpation, and visualization technology. The typical approach to prepare the vessel for PIVC

Abstract

Introduction: Reliable venous access is a cornerstone in delivery of cytotoxic drugs, and subcutaneous venous ports (SVPs) are commonly used. Pocket infection is a major complication that can lead to SVP removal and treatment delay. Consensus is lacking whether a suspected port infection is a contraindication to continued use. Our aim was to examine the extent of pathogen transfer into a SVP by puncturing an in vitro contaminated injection membrane and to evaluate techniques to reduce this transmission.

Method: Four pathogens were applied to SVP membranes in concentrations mimicking clinical infection, and the membranes punctured with or without flow through the needle. The port was then flushed with saline, and samples from the outlet were analyzed.

Results: Microorganisms were transported into the SVP when puncturing the contaminated membrane. The number of microorganisms transferred was related to the concentration of microorganisms on the membrane and varied with species. Flow through the needle during insertion reduced the number of bacteria transported through the SVP membrane.

Discussion: Our results indicate that a limited number of pathogens are likely to be introduced into the SVP chamber when puncturing a contaminated membrane. The number of bacteria transferred could be reduced by applying flow during puncture.

Abstract

Purpose: In clinical settings, ultrasonography (US) has recently been used to aid in the insertion of peripheral intravenous catheters (PIVCs). This cross-sectional study aimed to verify the reliability and validity of a tablet-type device in assessing vein size and depth for catheter site selection and detecting thrombus with resultant subcutaneous edema as a cause of catheter failure using US.

Methods: Adult patients receiving infusions via a PIVC at a university hospital between January and February 2017 were included. All participants underwent US at the PIVC site. An expert sonographer and a nurse blinded to all information, except for ultrasonograms, evaluated the data. Intraclass correlation with 95% confidence interval (CI) was used to evaluate interrater and intrarater reliability of US assessment. To assess criterion-related validity, a high-end US notebook device was used for reference data collection. Pearson's correlation coefficient was used to evaluate criterion-related validity.

Results: We observed 21 patients with 26 catheters. Intraclass correlations (95% CI) for the measured vein diameters and depths were as follows: intrarater reliability, 0.92 (0.57–0.98) and 0.78 (0.10–0.95); interrater reliability, 0.95 (0.78–0.99) and 0.94 (0.77–0.99); and Pearson's correlation coefficient for criterion-related validity, 0.74 (P = 0.02) and 0.77 (P = 0.02), respectively. However, the analysis of causes of catheter failure did not show reliable validity.

Conclusion: This pilot study suggests that the tablet-type device is useful for assessing peripheral veins in clinical settings.

Highlights

Lean leadership for process improvement.
Prospective comparator multimodal design study.
Vascular access specialty team (VAST group 2) versus generalist nursing model (group 1).
First stick success of 96%.
Statistically significant improvement in dwell time with VAST versus generalist nursing model (89% versus 15% lasting until end of therapy).
Projected 2.9 million in savings annually.
Peripheral intravenous catheter team centralized proposal to Chief Nursing Officer (CNO) with acceptance based on outcomes.
Reduction in cost per bed per year using a vascular access specialty team of $3376.

Abstract

Background: Peripheral intravenous catheter (PIVC) sales per year exceed that of the number of people in the United States (US), 350 million. With only 37 million US hospital patient admissions per year, these data indicate an average usage of 10 PIVCs per patient admission, suggesting a very high failure, very low success rate, and excess cost associated with PIVC insertions. Patients often complain of multiple catheter insertion attempts, and published data reveal up to 53% of PIVCs fail before therapy ends.

Methods: Hartford Hospital (Hartford, CT) conducted a prospective comparator single-center clinical superiority design study to determine the impact of bundled practices including device insertions using vascular access specialty team (VAST) intravenous trained nurses versus current practice. The study used a 5 step multimodal best practice intervention strategy designated as the PIV5Rights Bundle with an aim to determine if the intervention outcomes and dwell time improved over current PIVC practices. The study group applied a Lean health care standard work process with a Six Sigma design, define, measure, analyze, improve, control approach that included VAST PIVC dwell time, complications, and economic impact compared with current state general nursing practice.

Results: Outcomes of the PIV5Rights Bundle in Group 2 (experimental) using a trained vascular access nursing team for insertion and management achieved a statistically significant result of 89% of catheters achieving end of therapy with a cost saving per bed of $3376 ($1405 versus $4781) per year as compared to standard practice (Group 1; control). Results of Group 1 reflected PIVC dwell time to end of treatment in only 15% of catheters. Prestudy catheter consumption analysis was 4.4 catheters per patient hospital admissions, reflecting waste within labor and supply costs for PIVC insertion and usage. Peripheral intravenous catheter retrospective audits for current practice demonstrated more than 50% catheters failed within the first 24 hours. This application of Lean methodology by Hartford Hospital with infusion therapy resulted in a projected $2.9 million annual savings of $3376 per bed per year for house-wide application.

Conclusions: Implementation of the PIV5Rights^™ Bundle with a dedicated VAST proved to be a successful model, both from a patient and financial perspective. The journey to nursing excellence included identification of core measures and best practice evidence for PIVC placements as a procedure that affects nearly every patient entering a hospital. By centralizing ownership of vascular access with the team for insertion, management, and securement, the PIV Five Rights is the right approach to achieve the right results in transformation of hospital infusion therapy practices. Bundled approaches have often been used for central catheter infection reduction. This is the first study the authors have identified focusing on 1 PIVC per patient visit as a result of an evidence-based bundle and VAST.

A Guide to “Measures of Association” for Vascular Access Professionals: Foundational Support

Gregory E. GilbertEdD, MSPH, PStat®, AVA Foundation Secretary 2025–2026

Great Stories Begin at the Association for Vascular Access

An Exciting Time for Vascular Access

The Use of Visualization Technology for the Insertion of Peripheral Intravenous Catheters

Introduction / Summary

CE Article: Transfer Rate of Pathogens Through In Vitro Contaminated Venous Port Membranes Varies With Species, Concentration, and Injection Technique

Abstract

Using Tablet-Type Ultrasonography to Assess Peripheral Veins for Intravenous Catheterization: A Pilot Study

Abstract

Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit With Lean Multimodal Strategy: the PIV5Rights^™ Bundle

Highlights

Abstract

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A Guide to “Measures of Association” for Vascular Access Professionals: Foundational Support

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