Peripheral IV catheters are extremely common, but they often fail early, go unused, or cannot safely deliver the therapy patients need, which means they frequently do not meet clinical or comfort needs for many patients. Matching device choice to therapy, vein quality, and duration of treatment (including use of midlines or PICCs) is essential to avoid unnecessary sticks, complications, and non-indicated lines.
High failure and complication rates
- More than half of peripheral IVs placed in hospitalized adults fail before completing therapy, leading to repeated insertion attempts and additional pain.
- Common complications include infiltration, phlebitis, dislodgement, and occlusion, which interrupt treatment and can delay medications or fluids.
- Longer dwell times increase risks such as local infection and bloodstream infection, especially when catheters are left in without daily reassessment.
Non-Indicated IVs and unused catheters
- A substantial proportion of PIVs are inserted but never used; some estimates suggest around one quarter sit idle, offering no benefit while still posing risk.
- Idle catheters may not function when urgently needed, forcing additional IV attempts at the worst possible time.
- Unused lines consume nursing time, supplies, and patient veins, undermining efficiency and patient-centered care.
Mismatch between device and therapy
- PIVs are best suited for short-term therapy (typically under about a week) with non-vesicant, non–extreme pH, lower-osmolarity solutions.
- Many patients receive irritant or high osmolarity drugs, or require therapy longer than a few days, where a midline or central device is safer and more reliable.
- Using a PIV for medications is not designed to handle can increase phlebitis, infiltration, and tissue injury, compromising both comfort and outcomes.
Patient experience and vein preservation
- Frequent PIV failures translate into multiple needle sticks, which are painful, anxiety provoking, and particularly burdensome for patients with difficult access.
- Repeated short peripheral attempts can exhaust superficial veins, making future access harder and sometimes forcing escalation to central lines purely because peripheral options are no longer viable.
- Poor stabilization and placement near areas of flexion add to discomfort and failure risk, further eroding patient trust and satisfaction.
Better to match access to patient needs
- Peripheral IVs should be questioned daily: if there is no expected need for IV therapy in the next 24 hours, removal is recommended instead of keeping a line “just in case.”
- For patients needing longer therapy, multiple IV drugs, or frequent blood draws, early consideration of midline or PICC placement can reduce sticks and improve reliability.
- Strategies such as ultrasound-guided insertion, pharmacy consultation for IV-to-oral switches, and vascular access teams help ensure the chosen device truly aligns with the patient’s clinical and comfort needs.
Explore our range of vascular access solutions. Our portfolio allows clinicians to choose the appropriate device for the level of care required. Please contact us today for more information about our products and for a custom quotation.
Health Line International Corp. is not responsible for any errors, omissions, injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the contents of this document or any of the source materials. This content is not intended to replace professional medical advice.
References
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Kache, S. et al., (2022, January 23) Doomed peripheral intravenous catheters: Bad Outcomes are similar for emergency department and inpatient placed catheters: A retrospective medical record review. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/33234001/
Zanella, M. et al., (2025, April 24) Dwell Time and Risk of Bloodstream Infection With Peripheral Intravenous Catheters. JAMA Network. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833188
Barruel, M. et al., (2023, January) CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. American Journal of Nursing. https://journals.lww.com/ajnonline/Fulltext/2023/01000/CE__Evidence_Based_Practice_for_Peripheral.15.aspx
1 Comment
A thoughtful examination of the limitations of peripheral IVs and their impact on patient care. It effectively highlights the need for more tailored vascular access solutions to improve safety, comfort, and clinical outcomes.