Background: Peripheral intravenous catheters (PIVs) are the most frequently used invasive devices in hospitalized patients. Although they are considered to pose a low risk of adverse events, complications associated with peripheral IVs such as phlebitis, bloodstream infection, and extravasation are not uncommon. Recent evidence suggests that all-cause mortality does not differ between peripheral catheter bloodstream infection and those that originate from central venous catheters. In order to reduce risk of complications from PIVs, awareness of presence and early removal are necessary. However, how often nurses, physicians and trainees are aware of PIV presence is unknown.
Methods: We conducted a multicenter, prospective observational study to assess awareness of PIV presence in clinicians caring for hospitalized, non-critically ill patients in four Michigan hospitals. Between May 2018 and February 2019, we performed face-to-face interviews with patients to determine whether they had a PIV and where it was located in the patient’s body (e.g., left vs. right arm). After surveying patients, we interviewed care providers (e.g., nurses, attending physicians and trainees including medical students and residents) and asked them “Does your patient have a PIV? If so, where is it located?” Care providers were defined as attendings, senior residents, interns, medical students and bedside nurses responsible for patient care. To ensure generalizability, we included patients from a broad range of subspecialties including internal medicine, cardiology, gastroenterology, hematology and oncology services. We hypothesized that nurses would have greater awareness of PIV presence and location than physicians. Differences in awareness by provider type was assessed via chi-square tests; p< 0.05 was considered statistically significant. Analyses were performed on Stata MP v16 (College Station, TX).
Results: A total of 1,682 patients and 4,961 providers across four Michigan hospitals were interviewed and included in this study. Of 1,682 patients, 1,420 had a PIV in place at the time of interview. Among patients who had a PIV in place (n=1,420), bedside nurses were aware of PIV presence 97% of the time, students were aware 88% of the time, house-staff 87% of the time, and attendings 86% of the time. However, when no PIV was present (n=262), awareness varied substantially with many responding a PIV was in place when in fact, it was not. Among patients with no PIV, nurse awareness of lack of PIV presence was 60%, students 31%, house-staff 18%, and attendings 13%. Attendings were significantly less likely to correctly identify the location than house-staff (13.5% vs 36.8%, p<0.0001). Physicians (attending physicians, interns and residents) were significantly less likely to correctly identify PIV location compared to bedside nurses (16.17% vs 60.17%, p<0.0001).
Conclusions: In this multicenter study of almost 5,000 clinicians, we found that bedside nurses were most aware of the presence and location of a peripheral IV catheter. In contrast, few physicians were able to identify absence of a PIV, suggesting an element of conjecture in responses. Given the ubiquity of these devices and concerns related to safety, strategies to improve physician awareness of PIV presence appear necessary.