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EDITORIALS: Dennis G Maki Improving the safety of peripheral intravenous catheters BMJ 2008; 337: a630 [Full text]

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Peripheral intravenous catheter complications - its not who puts them in, its down to who looks after them.

Steven J Kennish   (19 July 2008)

Peripheral intravenous catheter complications - its not who puts them in, its down to who looks after them. 19 July 2008
Steven J Kennish, Specialist Registrar in Radiology Leeds General Infirmary, Leeds, LS1 3EX. Send response to journal: Re: Peripheral intravenous catheter complications - its not who puts them in, its down to who looks after them.	Maki gets a little carried away by asserting that the incidence of intravenous catheter complications is greatly reduced when highly experienced nurses insert catheters.(1) The single reference provided to support this statement makes interesting reading.(2) This randomized controlled trial compares complications with 2 main groups of patients. Those patients who are cannulated by house doctors and followed up by ward staff and those patients who are under the care of the intravenous (iv) therapy team. The latter group are checked daily for complications by experienced nurses but their cannulas are inserted by doctors and nurses in similar numbers. The intravenous therapy nurses do a sterling job it seems between 9am and 5pm but in time honoured tradition it is the house doctors who perform all intravenous cannulation between 5pm and 9am and at weekends. Indeed the paper states that the complication rates for patients who are subsequently followed up by the iv therapy nurses show a slightly higher complication rate for the nurse inserted cannulas (9.3%) than the doctor inserted cannulas (6%). The 3 episodes of line related sepsis in the house doctor group (not undergoing routine daily review) seem to be related to duration in situ rather than any other factor. One of these 3 cannulas was actually inserted by paramedics rather than the house doctors. The paper clearly states that the maintenance and timely removal of iv catheters is more important than the specific personnel inserting the catheters in determining the occurence of complications. It is reassuring to see that doctors are competent and safe at performing tasks traditionally undertaken by doctors. Intravenous cannulation is an essential life saving skill, even after 5pm. It is also reassuring to see that nurses are good at nursing, and daily review of cannula sites and nursing care help reduce complications. It is however frustrating to see an editorial review make a rather sweeping statement which is not supported by the relevant citation. 1. BMJ 2008; 337:a630 doi:10.1136/bmj.a630 2. Soifer NE, Borzak S, Edlin BR, Weinstein RA. Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. Arch Intern Med 1998; 158:473-7. Competing interests: None declared