Think before you insert an intravenous catheter

To the Editor: Dendle and colleagues1 challenge the well established and empirically based practice of the “idle IV” — an unused peripheral intravenous catheter (PIVC) inserted in the emergency department (ED) in case it is needed subsequently, but which frequently remains unused. However, the risks associated with unused PIVCs are not the whole story.

The practice emerged because of adverse outcomes noted in patients who were admitted to hospital from the ED without a PIVC, who then required urgent PIVC insertion in the ward — when and where there were less optimal patient and staffing conditions.

The authors refer to unnecessary patient discomfort and financial costs resulting from the 43% of inserted PIVCs that remained unused at 72 hours at their hospital. However, they assume that ED staff can reliably predict which patients being admitted will not subsequently require a PIVC, and that unused PIVCs have an adverse risk profile comparable to that of used PIVCs. We need better data, comparing the risk–benefit profiles and clinical outcomes of patients whose PIVCs are inserted in the ED, used and unused, with those of patients whose PIVCs are inserted subsequently, often as an emergency, in the ward.

I do not advocate PIVC insertion for all patients admitted to hospital via the ED. However, we must not forget why the practice arose and should consider whether the less frequent but high-impact risks of not inserting a PIVC in the ED might outweigh the implied but unclarified risks of an unused PIVC.