Abstract:
A 40-year-old woman with sickle cell disease and a history of numerous deep vein thromboses presented to the emergency department in an acute pain crisis with pain focused in her hips and lower back. A peripheral intravenous catheter (PIVC) was placed in her left arm for fluid administration.
The PIVC infiltrated and was no longer usable by the next day. The patient’s clinical status remained stable, and her pain was controlled with oral analgesics, albeit at a higher dose than her home regimen. Even though the patient was able to hydrate with oral fluids, the medicine team placed another PIVC in her left arm as a precaution. Soon thereafter, the second PIVC infiltrated and the patient’s left arm became swollen and tender at the insertion site. She reported sweats and general malaise. Multiple unsuccessful attempts were made to place another PIVC to administer antibiotics for possible infectious phlebitis. While waiting for PIVC placement, the patient began treatment with a course of oral antibiotics. The following day, a PIVC was placed in her right forearm. This third PIVC subsequently infiltrated, and the insertion site became inflamed. Results of an ultrasonography showed phlebitis in both arms. Despite a lack of intravenous access, the patient improved with oral antibiotics, oral pain medications, and oral rehydration (ie, electrolyte replacement solutions and water) and without further complication until she was discharged to home.
Reference:Silk T, Windheim J, Chugh S. Rethinking Routine Peripheral Intravenous Line Placement: A Teachable Moment. JAMA Intern Med. 2021 Apr 19. doi: 10.1001/jamainternmed.2021.1212. Epub ahead of print. PMID: 33871537.
What a really interesting and thought provoking read. Three peripheral IV catheters fail due to infiltration and infusion phlebitis over a period of a few days as described in this case study. The study also highlights the impact of the oral route as a potential successful IV alternative for treatment and rehydration in certain patient groups.