IV Dislodgement: Avoiding Re-Sticking and Waste for Improved Outcomes

By Matt Phillion

Accidental dislodgement of vascular access devices is a common occurrence in healthcare settings, but one that can fly under the radar simply because it’s so commonplace. More than four out of five patients in acute care settings require IV catheters, and complications from their dislodgement and failure commonly interrupt treatment and increase resource consumption when the catheter must be replaced.

A recent profile in the peer-reviewed journal Expert Review of Medical Devices by Nancy Moureau, RN, PhD, BSN, CRNI, CPUI, VA-BC, looks at the Orchid SRV tension-activated breakaway safety release valve and how introducing an accessory between IV tubing and the catheter could protect against dislodgement.

“With over 80% of patients receiving an IV, the inherent risks need to be tackled,” says Dan Clark, CEO of Linear Health Sciences, developer of the Orchid. “We’re talking about the number two unaddressed issue after infections. Because it’s considered standard daily practice to replace IV lines, it becomes more critical to tackle as an unaddressed failure mode.”

Clark points toward a report from the National Institutes of Health, Accepted but Unacceptable: Peripheral IV Catheter Failure, which talks about how peripheral IV catheter insertion is the most common invasive hospital procedure performed worldwide, but is also associated with a wide range of complications—and with a high failure rate: 35% to 50% even under good circumstances.

Catheter failure does not just cause discomfort to the patient; it incurs costs to the health system and forces redundant activity onto already-burdened nursing staff. And thus the industry is primed for a leap forward, Clark notes.

“Catheter failure is a key factor in all these secondary issues,” he says. “Phlebitis, infiltration, infections, these are all symptoms of a dislodgement, and it’s important that we get to the root of these issues, whether dislodgement related or otherwise.”

How (not) to move the needle

In many industries—healthcare among them—it is commonplace to stick with what you know. Whether for comfort, familiarity, reliance, or efficiency, there are many reasons people stick with proven techniques and tactics.

“People do what they’re comfortable with, how they’ve been trained and educated,” says Clark. “Infusion guidelines help push the standard of care forward, two of which are Standard 6, Quality Improvement, and Standard 12, Product Evaluation. Both of these challenge us to learn from our opportunities and keep aware of new developments and technology. The Orchid SRV fits this category well.”

Clark notes that there is an inverse correlation between how long a practitioner has been in practice and how inclined they are toward new techniques. “The longer you get used to the status quo, you have a favorite product, a favorite execution, a favorite process,” he says. “What we’re finding is that in those innovative education facilities, those populations take a bit of the assessment burden on and identify where, in the long run, a new process means less work and more efficiency for them. This of course is not all-inclusive; key thought leaders in vascular access recognize the value and the need for this type of incremental innovation.”

These populations see the potential in newer IV technology: lowering risks of exposure, for example, as well as shortening the time of care by eliminating the need to replace needles or fluids and maximizing therapeutic uptime. “The better we keep IVs up and running for their complete useful life cycle, the sooner our patients are ready to go home,” says Clark.

To introduce a new technology, streamlined implementation is key, Clark notes. “As soon as you start introducing extensive new education, you see loss of viability,” he says. “The SRV tech itself is plug-and-play, so the only education aside from standard of care is observational: Do you see a separated Orchid or not? Breaking the line or receiving an occlusion alarm is not changing the routine of care.”

Clark finds the profile in Expert Review of Medical Devices very encouraging. “It’s always wonderful when we can have someone as pivotal as Dr. Moureau weigh in—she’s one of the most authored people in this space, and the cohort she is a part of literally wrote the textbook,” he says. “One of the biggest takeaways is the identified value by thought leaders who have driven value-based processes in the space over decades—they identify a need and the risk of not having this type of tech.”

The report also discusses what this type of technology can do on the whole, not just for vascular access. “It’s ubiquitous, and it touches the most lives, but [think] about the potential of what it can do across medical tubing: enteral feeding, chest tubes, diabetes pumps, urinary catheters,” says Clark. “I have a niece with diabetes who is very active and she pulls out her catheter all the time [and] is constantly re-sticking herself. We’re looking at the broader sphere, and that’s a takeaway from the platform approach that I greatly appreciated.”

For ubiquitous technology to change, it needs to be an across-the-board shift; Clark mentions the Curos disinfecting caps that are now used everywhere in the industry for disinfecting port protectors. Simplicity comes into play as well.

“When looking at incremental improvements, you can’t fundamentally turn things upside down without creating a barrier to entry,” he says. “You want it to be simple to use, but that does take transparency. There’s nothing like seeing it in action.”

Limiting waste

The first thought with changing ubiquitous technology is of course the benefit to the patient, but the bottom line always looms large, and replacements for even the most basic of IV fluids—which are wasted every time a dislodgement happens—add up fast.

“Twenty years ago, a peripheral line for just saline was $28,” says Clark. “A central line was $2,000. A midline or PICC line? Hundreds. We used those as a baseline to create a value calculator looking at bed turnover rate, dislodgement rate, with the average patient receiving three IVs, and we’ve conservatively estimated that a 200-bed hospital with a 12% dislodgement rate can save over $185,000 a year. And now extrapolate that into current dollar amounts, go beyond saline, and you’re going to see a significant impact.” As just one example, a chemo treatment is $10,000 to $50,000 a bag, hardly cheap to replace.

“One facility told us they could realistically see a half-million dollars in savings,” says Clark. The support for a value-based approach continues to climb, as well. “We’re trending in the right direction. It’s an uphill battle, but those tides are shifting.”

Change is a process and depends on the facility’s or department’s ability to meet the needs of patients now as well as over time. “We need these large, fundamental shifts in the standard of care, but require these incremental shifts to get there,” says Clark. “In our world, over 90% of patients get an IV. It’s the primary format to receive treatment. We don’t have a better option than IV access right now. Ultimately this is the best-case scenario we have in the near term, and in the long term it’s ripe for change.”

The FDA recently granted the Orchid SRV expanded indication for pediatric use; the product can now be deployed for patients two weeks of age or older. It’s been an exciting time for the Orchid’s developers.

“True story: My son got a tonsillectomy/adenoidectomy all at once, which is awful to go through,” says Clark. “We know any time someone comes out of surgery, they can be somewhat unpredictable as they’re confused and thrashing, especially in pediatrics. We were at the facility and I started talking with the patient safety advocate, the head of anesthesiology, and I said, ‘I know my son, he’s going to come out of anesthesia wild, and I want to save him a stick.’ ”

Clark knew there was no way to offer the device on the spot there, but it started a dialogue about having other options to improve the patient experience. “Sure enough, he pulled out his IV, but it reminded me what I’m doing could save him pain and suffering,” says Clark. “In any area of the hospital or continuum of care, when you have to redo something invasive, in the pediatric space it’s noted as a traumatic event, and it’s something patients experience all the time.”

The amount of interest from ICUs looking to use the Orchid has also caught Clark by surprise. “One facility we work with, I said, ‘I’m curious. Your patients are sedated and not moving; what makes you want to use the SRV?’ They told me it’s an insurance policy. The second the patient is out of sedation, IV access is critical, and they need something to support that continuum so they can go right back to the treatment rather than re-sticking a volatile or confused patient.”

Perhaps the biggest challenge to implementing a device that impacts something so ever-present as IVs is that everyone looks at the device from a unique perspective, Clark says. “Everybody identifies the value of it in some way, shape, or form,” he says. “The onus is on us to maintain a focal space while supporting folks downstream, offering the best benefit for our patients and clinicians to make their jobs easier, so we can effect positive change on as many lives as we can.”

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