Catheters are some of the most commonly used medical devices in the world. Every day, close to 1 million patients have a catheter placed, meaning over 307 million catheters are used every year in the USA alone. Because of their widespread use, catheters end up causing a great deal of complications. In fact, 30-46% of all catheters, or over 75 million catheters per year, fail due to complications. That translates to an annual estimated cost of almost $2 billion. That’s a lot of money going towards fixing mistakes.
Let’s take a look at eight of the most common catheter-related complications and the best ways to avoid them.
The most common catheter-related complication by far is dislodgement. Dislodgement is when the catheter is inadvertently removed from the vein, and it can be caused by all sorts of things – improper placement, lack of securement, clinicians tripping over tubing, patient interference, etc. Anything can cause dislodgement, even the sheets or turning over in bed! Dislodgement can result in loss of use, delayed medication delivery, and another insertion procedure, wasting time and money. Reducing catheter movement lessens the chance of dislodgement, and the best way to reduce catheter movement is by securing the catheter properly.
CRBSI (catheter-related bloodstream infection) or CLABSI (central line-associated bloodstream infection) can occur with migration of skin flora through the percutaneous entry site. Catheter motion and pistoning can increase this risk. The INS & CDC recommend use of catheter securement devices to reduce catheter motion and motion-related complication risk.
Infiltration is when the tip of the catheter passes through the wall of the vein. Extravasation is infiltration that leads to vescient fluids leaking into the surrounding tissue which can cause further complications. An improperly secured catheter can move through the vessel wall leading to infiltration or extravasation. Reducing catheter microtugs and micromovements with proper securement can help reduce this risk.
4. Mechanical Phlebitis
Mechanical phlebitis is when a catheter moves back and forth and up and down within the vessel, causing friction, which in turn can trigger an inflammatory response in the vessel. Reducing these micro-movements can help decrease the risk of mechanical phlebitis. Securing the catheter properly can help reduce this risk.
5. Pressure Injury
Pressure injuries, or pressure ulcers, are caused from medical devices rubbing on the skin and causing irritation or staying on the skin for too long. Pressure injuries can appear as bruising, lesions, and ulcers. Catheters that are secured in a manner that pushes the catheter hub down onto the skin can cause device-related pressure injury. One way to reduce the risk of pressure injuries is by ensuring that the catheter hub and Luer nut junction is cushioned and that the dressing is changed according to best practice protocols.
Catheter occlusion is when there is a build up of fibrin around the catheter or around the interior walls of the vein, reducing blood flow. Mural thrombus formation may occur when the catheter moves and rubs up against the vein wall, causing clotting. Keeping the catheter as stable as possible helps to reduce this risk.
7. Insertion Site Infection
Insertion site infection is any infection that affects the catheter insertion site. It can be caused by poor prepping, poor maintenance, or micropistoning of the catheter leading to migration of skin flora into the insertion site. The best ways to reduce the risk of insertion site infection are to follow best practices guidelines for skin prep, insertion technique, and by protecting the site and catheter with proper catheter securement and dressing.
8. Tip Movement/Malposition
Tip movement is when the tip of the catheter moves away from the intended location. This can force the need to pull and replace, causing loss of use, delayed infusion, and another insertion procedure. Strong and stable securement helps reduce this risk.
Following the latest best practice guidelines related to VAD insertion and maintenance are key to keeping catheters and patients well. Every maintenance bundle has tools in its arsenal which help reduce complication risk. One such tool is catheter securement. Proper catheter securement can save both time and money.