Focus on Prevention of Vascular Access Device Complications: Prevention is the key for IV Devices

Abstract

ith the wide range of vascular access devices utilized within the patient population, our goals should be focused on prevention rather than reactive management of complications. This article will provide an overview of vascular access device (VAD) complications. Progressing from digital veins in the hand to deep central veins of the chest and neck, we will address devices and complications presented at each level. VADs have common complications, which if antidpated, may be prevented completely. The first level of venous access is the peripheral catheter. Inserted in the veins of the hand, lower arm, antecubital region or occasionally the lower extremities, these peripheral catheters are the most commonly used devices for the administration of intravenous therapy. Short peripheral catheters are chosen when therapy is not expected to exceed 5 days. Complications arise when peripheral therapy is extended from a few days to a week or more. According to the Intravenous Nurses Society (INS) 1998 Revised Standards of Practice, peripheral cannula insertion sites are to be rotated every 48 hours. If supporting documentation demonstrating few complications is present covering at least 3 months, the device site rotation may be extended to 72 hours. As access sites are depleted over time, the temptation is to allow the peripheral device to remain greater than 72 hours. Complications develop with peripheral cannula when site rotation is ignored. The Center for Disease Control's Guideline for Prevention of Intravascular Device-Related Infections lists factors associated with infusion-related phlebitis for peripheral venous catheters as: • Stiffness of the cannula material, • Catheter size, • Site of insertion, • Experience of personnel inserting the device, • Duration of catheterization, • Composition of infusate to be delivered, • Frequency of dressing change, • Catheter-related infection inddence, • Skin preparation, • Host. factors, and • Emergency room insertion.