“Up to 90% of hospitalized patients can require a PVAD during their stay, however, greater than 60% of PVADs fail due to dislodgement, phlebitis, occlusion, infiltration, or infection.”¹ PVAD infections are so prevalent that the topic “Infections from Peripherally Inserted IV Lines” became number 9 in the ECRI Institute’s 2019 Top 10 Patient Safety Concerns. In a 2019 webinar summarized below, Russell Nassof, JD, and Marcia Ryder, PhD, MS, RN presented legal and clinical examinations on PVAD‐related infection.²
Part I: A Legal Perspective²
Russell Nassof presented a few legal factors relating to PVAD‐related infection supporting that they’re underrecognized.
Nassof examined that PVADs are not given the caution they deserve from the start. He explained that the word, peripheral, has demoted this type of infection because it means outside or less important. Nurses could associate PVADs with less concern compared to Central Vascular Access Devices (CVAD).
Nassof analyzed the neglection of PVAD maintenance. Current Standard of Care (SOC) bundles contain insertion, care/maintenance, and removal. However, focus is on insertion and necessary maintenance is overlooked. He stressed that the goal is PVAD removal but execution towards that goal is lacking.
Nassof stressed that some PVAD guidelines may not be evidence based. Guidelines that aren’t evidence based could be based on professional opinion, for example, regarding what they think represents an intact dressing, and could be underdeveloped. He encouraged evidence based criteria that is current with discoveries and technology to avoid malpractice. If a healthcare provider isn’t current on field evidence, that lack of knowledge can be used against them in a malpractice lawsuit. Nassof stated that “malpractice laws change not because of the law but because of current technology available.” Negligence is not an excuse for malpractice.
Nassof ended with reiterating that the lack of PVAD maintenance and underdeveloped SOC bundles/maintenance guidelines breach the evidence based SOC. This negligence can cause PVAD‐based infection and could result in legal action.
Part II: A Clinical Perspective²
Marcia Ryder began with a call for rethinking PVAD in terms of prevention and diagnosis from a clinical perspective. Ryder delved into sterilization practices needed to prevent PVAD‐related infection. She stressed that examining the causation of bacterial transfer within these situations can establish new protocols to avoid infection.
Ryder simplified bacterial transfer as follows: organisms get into/onto devices and into the bloodstream, causing infection. She mentions many post insertion protective technologies for prevention of extraluminal bacterial transfer like continuous antimicrobial protection at the insertion site and insertion site stabilization. She stated that dressing securement should be a priority involving liquid adhesive/adhesive remover and a transparent dressing.
Repeated insertion site antisepsis and standard ANTT (aseptic non touch technique), documentation, and/or CHG bathing should all be adhered to during site monitoring. Ryder commented that CHG bathing should receive further exploration due to it being advantageous in the prevention of CLABSI.
She then asked: how is infection happening if we’re following the standards? The Journal of Infusion Nursing states that “aseptic technique is adhered to during all aspect of VAD placement.”3 However, further down within this standard there are conflicting statements such as that “sterile gloves are not required” even though “no‐ touch” technique is encouraged, and that “one should consider increased attention to aseptic technique for peripheral catheters.”³ Ryder declared this protocol contradictory and in need of revision.
In conclusion, Ryder called for healthcare professionals to ask themselves “is this the right thing to do” during PVAD insertion and maintenance while considering consequences of patient harm.
Both presenters scrutinized current PVAD instruction followed or neglected by institutions and called for improvement. Nassof and Ryder emphasized legal and clinical outcomes of poor PVAD care leading to infection which should encourage healthcare providers to tune their current PVAD guidelines.
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- Helm, RE, et al. Accepted But Unacceptable: PIV Catheter Failure. Infus. Nurs. 2015;38:189‐202.
- Nassof R, Ryder M. Peripheral Vascular Access Device‐Related Infection: Clinical and Legal Perspectives. September, 2019.
- Journal of Infusion Nursing. Infusion Therapy Standards of Practice. 2016;39: S64‐S65