Addressing the Challenge of IV Dislodgement

By Matt Phillion

IV dislodgements happen on a daily basis, so common that everyone in the hospital environment is aware of them. Whether it’s a caregiver tripping over tubing or a patient rolling over in their sleep, these incidents are understandable. But because they’re so universal, IV dislodgements cost the U.S. healthcare system as much as $2 billion annually.

So what can the industry do to improve patient safety in the event of a dislodgement? In an effort to address this question, Linear Health Sciences has developed a tension-activated, breakaway release valve designed to reduce the risk of IV catheter failure in hospitals.

Dan Clark, co-founder, president, and COO of Linear, notes that “we don’t have quantifiable data outside of offshoot reports and findings” regarding IV dislodgement. He observes that the occurrence is “accepted as status quo,” as described in the research paper “Accepted but Unacceptable: Peripheral IV Catheter Failure.”

Linear began developing the safety release valve after its co-founder and CEO Dr. Ryan Dennis, a practicing hospitalist, was working with a patient with a chest tube. The exhausted patient asked for a few hours of sleep to rest, but just 10 minutes after falling asleep, she rolled over, dislodged the chest tube, and kicked the emergency call button onto the floor, leaving her struggling to breathe as her lung deflated. The patient recovered, but her tube had to be surgically replaced.

“Dr. Dennis looked at the process and said, ‘There’s got to be a better way to do tubing,’ ” says Clark.

The big numbers in IV dislodgement

According to a recent study of 1,500 doctors, 58% of survey respondents said that IV dislodgements happened at least daily, and over 90% reported they occurred weekly. That makes IV dislodgement “the number two or three unaddressed issue in vascular access today,” says Clark. Other studies looked at pediatric patients and found that more than 60% of polled caregivers said IV dislodgement was top of mind. “Historically, it’s a large issue, but we need to continue to dive further into this,” says Clark.

IV dislodgement leads to a loss of continuity of care as the fluid—saline, chemo meds, blood, or other substances—continues to pump onto the floor after dislodgement. “If the patient is in chemo and a dislodgement occurs, [the caregiver has] no idea what’s been lost on the floor,” says Clark. Dislodgement also hampers healthcare professionals from practicing at the top of their license, since they must stop what they are doing to reinsert the line.

The conversation is moving toward creating transparency about this issue so more discussions can happen around how to stop it. “That’s both the challenge and the fun part, the education component,” says Clark. “Saying, ‘This is what’s happening; do you see it too?’ ”

The idea is to ensure a method of IV use that offers one-stick treatment. “Fundamentally, the patient should not have to get more than one stick,” says Clark.

How the safety valve works

Clark describes the concept of the valve with a specific analogy: “Have you ever seen someone drive away from the gas station with the hose still in their car?” he says. “The hose goes with the car, but the terminal stays up, and no gas is coming out of the terminal, and no gas is coming out of the hose still on the car.”

This is because there’s a valve that seals on both sides, a barrier that prevents gas from leaking out. “You then replace the valve and put the hose back on. We did the same thing, we just did it for your veins,” he says.

The device is placed using standard luers between the extension set and the IV administration set. “On tension, the device separates and creates a sterile barrier,” Clark says. “You’re not getting backflow, so the patient is not bleeding. You’re not pumping the drug or fluid onto the ground, so you’ve retained continuity, but you’ve also occluded the line.”

The concept is intended to not impose new education on clinicians, using the same protocol they’re used to while letting them know something’s going on downstream thanks to an occlusion alarm. “We’ve also made it purple so it’s very apparent,” says Clark. “Afterward, you put a sterile SRV back on and go back to treatment.” This means the entire IV treatment is not lost upon dislodgement.

Clark offers a personal example of the difference this could make. His stepfather was undergoing significant treatment, and because of the number of times he’d been treated, he needed to receive chemo through a peripheral IV. If a doctor were to trip over the line and dislodge it, says Clark, “the chemo is on the floor, which presents a toxicity issue.” Caregivers also wouldn’t be able to tell how much of the drug had actually been administered before the incident. They would err on the side of caution to avoid overtreatment, but that means the patient would likely be underdosed instead.

Preventing pain and risk to the patient isn’t the only benefit to stopping this type of incident, though. With traditional hardware, a dislodgement means the hospital loses a significant amount of an expensive life-saving drug and must also pay for the replacement bag. The patient, meanwhile, simply “goes home and hopes for the best,” says Clark. “Very early on in the concept, we said this is why we’re doing this—if we can save one Greg, then we’ve made a fundamental difference.”

The estimated cost to replace a peripheral IV is roughly $28—considering just the basic costs of the line, saline, and the time for the nurse to perform the action. That last component looms large as the country continues to face a nursing shortage, with every hour counting more than ever.

“We can start saving conservatively around $200,000 per average hospital a year, just using saline and a peripheral line. A conservative estimate is that we waste just under a billion dollars a year with this issue,” says Clark. That figure jumps higher with more expensive treatments. Lost or dislodged central lines can cost $2,000 before the medication is taken into consideration.

A moral hazard

Technology presents an opportunity, Clark says, to overcome an issue that has long been accepted as inevitable. “It’s almost a moral hazard” to not do something, he says. Linear Health Sciences is hoping to innovate not just for IVs, but for all medical tubing that could be accidentally dislodged.

If there’s been any pushback, it’s the understandable fear of asking already-burdened staff to master yet another device. “But the bar to education is so low,” he says. “You show someone how it works once, they hear the audible click as the valve shuts.”

The device is still in early stages as it begins to deploy in U.S. and Canadian hospitals. “We’ve designed this from the ground up to address fundamental problems,” says Clark, with revisions based on feedback from the medical community.

Linear is also releasing its Type D iteration, which is designed for drainage and uses the same core technology. The modularity of the device enables it to be used in a range of applications where dislodgement can occur—“enteral feeding applications, for example,” says Clark.

Ideally, the safety device will end up being, from the ground up, ubiquitous in function and execution for the clinician. “We’re excited to get this to market and further quantify it,” says Clark. “We’re looking forward to working with clinicians to expand this not just to IVs but beyond and unmask the true potential of the SRV platform.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.