How Often Do We Place Intravenous Catheters We Don't Use?
Half of all IV catheters placed in an Australian emergency department were never used to infuse fluids or medications.
Peripheral intravenous catheters are painful, are time-consuming to insert, and can cause infections ranging from phlebitis to staphylococcal bloodstream infections and sepsis. Investigators determined the proportion of IV catheters placed in a large urban Australian emergency department (ED) that were never used to infuse fluids or medications.
The researchers reviewed the electronic medical records for 3829 ED visits by adults. An IV catheter was placed at 570 of these visits, and was not used to infuse fluids or medication in 284 (50%). Use of IV catheters for phlebotomy was not assessed.
COMMENT
Much of our early emergency medicine practice was by rote (“IV, O2, bedside glucose, monitor, ECG, labs”) without regard to patient comfort or waste. Modern practice teaches us to establish control and gather information in an evidence-based way, optimizing decision making and minimizing adverse consequences. Just as (belated) recognition of their role in urinary infection motivated us to be highly selective about Foley catheter placement, so too should we carefully consider whether an IV catheter (and, for that matter, blood testing) is important for the evaluation and management of every individual patient. It is perfectly acceptable to overshoot a bit to ensure good access, but 50% clearly is excessive.
CITATION(S):
- Limm EI et al. Half of all peripheral intravenous lines in an Australian tertiary emergency department are unused: Pain with no gain? Ann Emerg Med 2013 Apr 23; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.annemergmed.2013.02.022)
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