The High Stakes of Lifesaving: The Problem with IVs
A simple procedure that has a 73% error rate because of simple mistakes
if you’ve ever been to a hospital, you have probably seen one of these:
That is called an IV (or intravenous) , a tube delivering medications and fluids directly into your bloodstream. But the scary thing is, if there is even the most minor mistake, it could turn a regular medical procedure into a life-threatening one.
In this article, we’ll will dive into the space of medical errors with IVs and the severe infections they can cause, revealing how a simple oversight in this common hospital practice can have dire consequences.
So what’s wrong with IVs?
While these tubes are crucial in delivering essential medications and fluids, there are some risks. The harm they can cause is more significant than you might think.
Every year, healthcare providers insert approximately 200 million peripheral venous catheters into adult patients in the United States alone. On the surface, this routine procedure seems simple, but here’s the thing: the incidence of bloodstream infection associated with these catheters is around 0.18. That may sound like a small number, but the impact is substantial.
Imagine a single error in the preparation and administration of IV medication can skyrocket the risk of harm to a staggering 73%.
Nearly three-quarters of the time, things could go wrong due to a minor mistake.
Not only that, the consequences can be hazardous. IV-related infections contribute to a shocking 27% mortality rate. That means nearly one in three patients who develop an infection stemming from their IV may not make it out of the hospital alive :(
So, with those numbers, around 97,200 people die each year in the United States due to IV-related infections. That’s more than just numbers; it’s lives lost and families forever changed due to something so simple.
Why is this even happening?
The problem of IV infections has its roots in a web of interconnected issues. At the heart of it all are bacterial infections that can cause many problems for a patient’s health. These infections, often linked to IVs, occur due to a chain of seemingly minor missteps in the medical process. One significant contributor is improper hand hygiene, where healthcare providers may inadvertently transfer harmful bacteria from their hands to the patient’s IV site.
Another reason is the failure to disinfect the insertion site properly, leaving an open invitation for bacteria to enter the body. The last main reason is that the medical fluids can be contaminated. When fluids or medications are tainted, they become carriers of infection, threatening the lives they are meant to save.
Out of these root causes, the issue of contaminated medical fluids stands out as one of the worst. These fluids, often delivered from IV bags, are meant to be a lifeline to patients in-need. However, the quality and safety of these fluids can be compromised at various points in their journey from the manufacturer to the patient’s bedside.
Inadequate sterilization or filtration during the production process can introduce harmful contaminants. Contaminated vials or containers can lead to the inclusion of impurities in the final product. Furthermore, errors during the preparation of medications, such as incorrect dilutions or mixing, can result in harmful consequences.
Surprisingly, medication expiration often goes unnoticed — a fundamental communication breakdown in the healthcare system. It’s a startling fact that around 36% of medications expire before they are used, and these medications are often pre-packaged into IV bags, which is not even known by the doctors and nurses administering them. This systemic issue puts patients at risk and shows the urgent need for reform in the medical supply chain and communication processes.
Breaking down the steps + identifying the problems
On average, there are around seven steps for IV insertion, and here are some of the issues that come with it (note: some hospitals probably have different procedures as to how they do this, but here’s what I’ve found)
Step 1: Patient Assessment
Standard Procedure: The process typically begins with assessing the patient’s medical history, current condition, and the need for IV therapy.
The Problem: Inadequate patient assessment can lead to the inappropriate use of IVs. Patients may receive IV therapy without a thorough evaluation when oral medications or other alternatives might be more suitable. This can increase the risk of unnecessary complications and costs.
Step 2: Hand Hygiene
Standard Procedure: Healthcare providers must practice proper hand hygiene, including washing hands thoroughly and using hand sanitizer.
The Problem: Despite the awareness of its importance, hand hygiene compliance can be inconsistent. Providers may skip steps or neglect hand hygiene altogether, potentially introducing harmful bacteria to the IV site.
Step 3: Sterilization of Equipment
Standard Procedure: Equipment and the IV insertion site are supposed to be sterilized appropriately with antiseptic solutions.
The Problem: Sterilization procedures can be rushed, leading to incomplete disinfection. This oversight may expose patients to contamination and increase the risk of infections.
Step 4: Medication Preparation
Standard Procedure: Medications are prepared according to prescribed dosages and concentrations, and labels are checked for accuracy.
The Problem: Medication errors, including the use of expired drugs, can occur due to rushed or inadequate checks. Expired medications can be ineffective or even harmful to patients.
Step 5: Insertion of IV Catheter
Standard Procedure: The healthcare provider inserts the IV catheter into a peripheral vein, typically in the arm or hand.
The Problem: Catheter insertion, if not performed correctly, can lead to complications such as infiltration, phlebitis, or accidental punctures. These complications can cause pain, tissue damage, and delays in treatment.
Step 6: Monitoring and Maintenance
Standard Procedure: After insertion, the IV site should be monitored regularly for signs of complications, and the dressing should be changed as needed.
The Problem: Inconsistent monitoring and maintenance can lead to late detection of issues like infection or infiltration, putting patients at risk of serious complications.
Step 7: Documentation
Standard Procedure: Accurate documentation of the IV procedure, including medication administration and site condition, is essential for patient care and legal purposes.
The Problem: Documentation errors or omissions can lead to incomplete patient records, making it challenging to track and address issues that arise during IV therapy.
📈 How Can We Improve IV Insertion and Care?
Addressing these flaws in the current IV insertion process is essential to safeguard patients and enhance the quality of care. Here are some steps that can help bring about meaningful improvements:
Comprehensive Training -> Healthcare providers, should undergo comprehensive training emphasizing the importance of proper hand hygiene, proper sterilization procedures, and consistent checks for medication expiration. Regular refresher courses and assessments help reinforce these critical aspects of IV care.
Standardized Protocols -> Hospitals and healthcare facilities should establish standardized IV insertion and care protocols. These protocols should include clear guidelines for hand hygiene, sterilization, and medication checks, leaving no room for ambiguity or oversight.
Technological Solutions -> Leveraging technology, such as electronic labeling systems for medications with built-in expiration date alerts, can help reduce the risk of medication errors. Electronic health records can also assist in tracking and documenting each step of the IV care process.
Culture of Safety -> Promoting safety within healthcare facilities is essential. Encouraging open communication about concerns and near misses can lead to continuous improvement in IV care practices.
While IVs remain indispensable in modern medicine, there is a urgent need to address the flaws within the current IV insertion process. By focusing on enhanced training, standardized protocols, technology integration, and fostering a safety culture, we can take significant strides toward minimizing the risks associated with IV care and ensuring that these lifesaving interventions remain safe and effective for all patients.
The Future of a Safer Procedure
While there are solutions to the flaws in the standard IV insertion process, the reality is that achieving mass implementation of these solutions may prove to be a considerable challenge. Transforming the complex space of healthcare procedures requires time, effort, and a collective commitment to change. However, despite the difficult road ahead, there is still hope for change.
Addressing the seemingly small yet profoundly impactful issues within IV care — such as improving hand hygiene, refining sterilization procedures, and ensuring proper medication checks — can yield significant improvements in patient safety.
These incremental changes can collectively create a safer, more effective environment for IV therapy. By recognizing that the journey to safer IV care is a marathon, not a sprint, and focusing on resolving these seemingly minor yet concerning issues, we can navigate the path toward better patient outcomes and ensure that every IV inserted is a lifeline, not a risk.
If you enjoyed this article, give a round of applause. Make sure to check out some of my other articles as well.
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