Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations

Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Due to its inherently invasive nature, intravenous (IV) therapy is associated with a number of potential complications, many of which are directly relevant to patient safety (PS). PIV-related morbidity may be due to mechanical or nonmechanical factors. The most frequent nonmechanical peripheral venous catheterization adverse events (PVCAEs) include insertion site pain, phlebitis, hematoma formation, and infusate extravasation. The most common mechanical PVCAE is catheter obstruction/occlusion and dislodgement. Significant complications can also occur with the administration of incorrect type or wrong amount of IV fluids. Moreover, simultaneous infusion of incompatible medications can result in infusate precipitation. Finally, less frequent but significant complications have been reported, including bloodstream and local infections, air embolization, nerve damage, arterial puncture, skin necrosis associated with vasopressor infusions, and limb-threatening forgotten tourniquet events. Taken together, the above complications can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. Efforts to prevent PVCAEs and improve patient outcomes should involve thorough provider education, clinical vigilance by all involved healthcare providers, health service level strategies, as well as the proactive participation of all stakeholders, including patients and their families.