Background: Peripheral intravenous catheters (PIVs) are the most frequently used invasive devices in hospitalized patients. Recent evidence has shown that these devices are not benign, and put patients at risk of serious bloodstream infections as well as other complications. Given their ubiquity, PIVs do not exist independently, and are used in a diverse set of circumstances, however clinician awareness of their use is poorly understood. How various concomitant factors, such as the presence of contact precautions, central line use, or an ongoing infusion, affect a clinician’s awareness of a patient’s peripheral IV, has not previously been studied.
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. 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?” At the time of the interview, we documented which patients had multiple PIVs, had presence of a central line, were on contact precautions and/or had an infusion running. 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. Nurses had the greatest awareness of overall PIV presence, correctly assessing PIV presence 98.6% of the time, while attendings were only correct 88.1% of the time, senior residents 88.3% of the time, and interns 90.9% of the time. Nurses were more likely to correctly identify PIV presence in those patients not on contact precautions (99%) as opposed to those who were on contact precautions (96.6%). Attending physicians were more likely to correctly identify PIV presence in patients who did not have a central line (86%) versus those who did (77.5%). The same was true for trainees, with interns correctly identifying PIV presence in an individual without a central line 90.7% of the time versus 85.2% of the time in those who had a central line in place. Senior residents identified peripheral IV presence correctly 87.3% of the time in an individual without a central line while only 72.4% of the time in those with a central line.
Conclusions: Doctors and nurses have differing levels of peripheral IV awareness, with nurses overall far more aware of PIV use than physicians. Physician residents and attendings demonstrated lower awareness of peripheral IVs in those patients with central lines, while nurses were less aware of the PIV catheter for those patients on contact precautions than those without. Given that physicians order and manage PIVs, while nurses place and maintain peripheral IVs, this decreased awareness may have implications for clinical care. This study joins a burgeoning area of literature that suggests that patients on contact precautions receive less healthcare worker contact, delays in care, and increased non-infectious outcomes. Given the ubiquity of PIVs, and the increasing use of contact/special precautions in our pandemic world, as well as central line use in critically and chronically ill individuals, variable awareness of vascular devices needs to be addressed.