Risky Business: Peripheral and Central Venous Catheters Both Pose Risks


  • Lynette Hathaway Patient Safety Authority
  • Mary C. Magee Patient Safety Authority




peripheral venous catheter, central venous catheter, patient safety


Venous access is an essential method of providing life-saving therapy. As part of intensive efforts to decrease the incidence of central line–associated bloodstream infections (CLABSIs), healthcare facilities may be increasing the use of short (noncentral) peripheral venous catheters (PVCs). To investigate this, the Patient Safety Authority (PSA) sought to explore the relationship of actual to predicted complications per central venous catheters (CVCs) and PVCs over a nine-year period. In addition, as PVCs are not without risk and CVCs pose risks aside from infection, we sought to identify the type and relationship of PVC to CVC complications and to quantify the timing and types of PVC and CVC complications and their associated risk factors.

A query of the PSA’s statewide event reporting database, the Pennsylvania Patient Safety Reporting System (PA-PSRS), for venous catheter complication events and a query of the National Healthcare Safety Network (NHSN) database for both primary bloodstream infections (BSIs) and CLABSIs occurring at inpatient facilities from January 1, 2009, through December 31, 2017, yielded 115,937 events. A methodical sampling of PA-PSRS yielded 2,413 PVC and CVC events. These were analyzed for the timing of complications reported, the type of complication reported, and any identified risk factors.

Overall reports of PVC complications increased, and the correlation between actual and predicted PVC events over the nine years studied is strong and statistically significant. The slight decrease in the number of reported CVC complications was not statistically significant. The authors used regression analysis to determine the best-fitting line through the predicted and actual observed events during the period of observation. These data are not intended to present a predictive model of future events. No correlation was found between the numbers of PVC and CVC complications.

The greatest number of PVC complications, particularly infiltration, occurred during catheter maintenance. Excluding NHSN-reported CLABSIs, the greatest number of CVC complications, particularly pneumothorax, occurred during catheter insertion.

Education and training are key to preventing intravascular device–associated complications. Healthcare facilities are encouraged to evaluate policy, procedures, and actual practices to eliminate complications and improve outcomes. In addition, quality improvement efforts aimed at decreasing CLABSIs should include measuring and all PVC complications as a balancing metric.



Miliani K, Taravella R, Thillard D, Chauvin V, Martin E, Edouard S, Astagneau P, CATHEVAL Study Group. Peripheral venous catheter-related adverse events: evaluation from a multicentre epidemiological study in France (the CATHEVAL Project). PLoS ONE. 2017;12(1):e0168637. Also available: http://dx.doi.org/10.1371/journal.pone.0168637. PMID: 28045921.

Mattox EA. Complications of peripheral venous access devices: prevention, detection, and recovery strategies. Crit Care Nurse. 2017 Apr;37(2):e1-e14. Also available: http://dx.doi.org/10.4037/ccn2017657. PMID: 28365664.

Infusion therapy standards of practice. J Infus Nurs. 2016 Jan-Feb;39(1S):S1-S158.

Alexandrou E, Ray-Barruel G, Carr PJ, Frost S, Inwood S, Higgins N, Lin F, Alberto L, Mermel L, Rickard CM. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015 Aug;10(8):530-3. Also available: http://dx.doi.org/10.1002/jhm.2389. PMID: 26041384.

Zingg W, Pittet D. Peripheral venous catheters: an under-evaluated problem. Int. J. Antimicrob. Agents. 2009;34 Suppl 4:S38-S42. Also available: http://dx.doi.org/10.1016/S0924-8579(09)70565-5. PMID: 19931816.

Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015 Jul-Sep;5(3):170-8. Also available: http://dx.doi.org/10.4103/2229-5151.164940. PMID: 26557487.

O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph A, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2011. 80 p. Also available: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.

Intravascular device infection. In: APIC Text Online (ATO). Arlington (VA): Association for Professionals in Infection Control and Epidemiology, Inc. (APIC); 2014 Oct 3. Also available: http://text.apic.org/toc/prevention-measures-for-healthcare-associated-infections/intravascular-device-infection.

Cooke M, Ullman AJ, Ray-Barruel G, Wallis M, Corley A, Rickard CM. Not “just” an intravenous line: consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS ONE. 2018;13(2):e0193436. Also available: http://dx.doi.org/10.1371/journal.pone.0193436. PMID: 29489908.

Sato A, Nakamura I, Fujita H, Tsukimori A, Kobayashi T, Fukushima S, Fujii T, Matsumoto T. Peripheral venous catheter-related bloodstream infection is associated with severe complications and potential death: a retrospective observational study. BMC Infect Dis. 2017 Jun 17;17(1):434. Also available: http://dx.doi.org/10.1186/s12879-017-2536-0. PMID: 28623882.

Centers for Disease Control and Prevention (CDC). Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection). Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2019 Jan. 45 p. Also available: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf.

Microsoft Office Professional Plus 2016. [software]. Microsoft Excel MSO (16.0.4738.1000) 32-bit: Microsoft Corporation; 2016.

2017 Patient Safety Authority Annual Report. Harrisburg (PA): Patient Safety Authority; 73 p. Also available: http://patientsafety.pa.gov/PatientSafetyAuthority/Documents/annual_report_2017.pdf.

Danski MT, Johann DA, Vayego SA, Oliveira GL, Lind J. Complications related to the use of peripheral venous catheters: a randomized clinical trial. Acta Paul Enferm. 2016;29(1):84-92.

Davis J. Peripheral vascular catheter-related infection: dwelling on dwell time. Pa Patient Saf Advis. 2014 Mar;11(1):30-5. Also available: http://patientsafety.pa.gov/ADVISORIES/Pages/201403_30.aspx.

Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, Lin F, Alberto L, Mermel L, Rickard CM, OMG Study Group. Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide. J Hosp Med. 2018 May 30;13(5) Also available: http://dx.doi.org/10.12788/jhm.3039. PMID: 29813140.

Nagpal AS, Benfield JA, Dy RT. Longitudinal tear of the biceps brachii from peripheral intravenous catheter infiltration. Muscles Ligaments Tendons J. 2015 Apr-Jun;5(2):120-3. PMID: 26261791.

Davis J. Central-line-associated bloodstream infection: comprehensive, data-driven prevention. Pa Patient Saf Advis. 2011 Sep;8(3):100-5. Also available: http://patientsafety.pa.gov/ADVISORIES/Pages/201109_100.aspx.

Marco M, Roman-Pognuz E, Anna B, Alessio S. Air embolism after central venous catheter removal: fibrin sheath as the portal of persistent air entry. Case Rep Crit Care. 2013;2013:403243. Also available: http://dx.doi.org/10.1155/2013/403243. PMID: 24829822.

Rambhatla T, Miller A, Mina B. Central venous catheter removal: a procedure well performed? Chest. 2014 Oct;146(4 Suppl 2):565A. Also available: https://journal.chestnet.org/article/S0012-3692(16)49823-5/pdf.

Al-Benna S, O’Boyle C, Holley J. Extravasation injuries in adults. ISRN Dermatol. 2013 May 8;2013:856541. Also available: http://dx.doi.org/10.1155/2013/856541. PMID: 23738141.

Doellman D, Hadaway L, Bowe-Geddes LA, Franklin M, LeDonne J, Papke-O’Donnell L, Pettit J, Schulmeister L, Stranz M. Infiltration and extravasation: update on prevention and management. J Infus Nurs. 2009 Jul-Aug;32(4):203-11. Also available: http://dx.doi.org/10.1097/NAN.0b013e3181aac042. PMID: 19605999.

Intravenous therapy: risk of injury from inflitration. PSO Navigator. 2011 Feb;3(1):1-8.

Kagel EM, Rayan GM. Intravenous catheter complications in the hand and forearm. J Trauma. 2004 Jan;56(1):123-7. PMID: 14749578.

Ray-Barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract. 2014 Apr;20(2):191-202. Also available: http://dx.doi.org/10.1111/jep.12107. PMID: 24401116.

Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A, Marque S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D, 3SITES Study Group. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015 Sep 24;373(13):1220-9. Also available: http://dx.doi.org/10.1056/NEJMoa1500964. PMID: 26398070.

Bowdle A. Vascular complications of central venous catheter placement: evidence-based methods for prevention and treatment. J Cardiothorac Vasc Anesth. 2014 Apr;28(2):358-68. Also available: http://dx.doi.org/10.1053/j.jvca.2013.02.027. PMID: 24008166.

Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, Karavergou A, Rapti A, Trakada G, Katsikogiannis N, Tsakiridis K, Karapantzos I, Karapantzou C, Barbetakis N, Zissimopoulos A, Kuhajda I, Andjelkovic D, Zarogoulidis K, Zarogoulidis P. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015 Mar;3(3):40. Also available: http://dx.doi.org/10.3978/j.issn.2305-5839.2015.02.11. PMID: 25815301.

Hewlett AL, Rupp ME. New developments in the prevention of intravascular catheter associated infections. Infect Dis Clin North Am. 2012 Mar;26(1):1-11. Also available: http://dx.doi.org/10.1016/j.idc.2011.09.002. PMID: 22284372.

Chopra V, O’Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. Also available: http://dx.doi.org/10.1086/671737. PMID: 23917904.

Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006 Sep;81(9):1159-71. PMID: 16970212.

Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, Wilson LE, Kainer MA, Lynfield R, Greissman S, Ray SM, Beldavs Z, Gross C, Bamberg W, Sievers M, Concannon C, Buhr N, Warnke L, Maloney M, Ocampo V, Brooks J, Oyewumi T, Sharmin S, Richards K, Rainbow J, Samper M, Hancock EB, Leaptrot D, Scalise E, Badrun F, Phelps R, Edwards JR, Emerging Infections Program Hospital Prevalence Survey Team. Changes in prevalence of health care-associated infections in U.S. hospitals. N Engl J Med. 2018 Nov 01;379(18):1732-44. Also available: http://dx.doi.org/10.1056/NEJMoa1801550. PMID: 30380384.

Austin ED, Sullivan SB, Whittier S, Lowy FD, Uhlemann AC. Peripheral intravenous catheter placement is an underrecognized source of staphylococcus aureus bloodstream infection. Open Forum Infect Dis. 2016 Mar;3(2):ofw072. Also available: http://dx.doi.org/10.1093/ofid/ofw072. PMID: 27191005.

Deutsch E. Safety stories: it takes a village. Pa Patient Saf Advis. 2018 Dec;15(4) Also available: http://patientsafety.pa.gov/ADVISORIES/Pages/201812_SafetyStories_Village.aspx.

Wallace SC, Mamrol C, Finley E. Promote a culture of safety with good catch reports. Pa Patient Saf Advis. 2017 Sep;14(3) Also available: http://patientsafety.pa.gov/ADVISORIES/Pages/201709_goodcatch.aspx.

Marella W. Why worry about near misses? Patient Saf Qual Healthc. 2007 Sep-Oct; Also available: https://www.psqh.com/sepoct07/nearmisses.html.

Zhang L, Cao S, Marsh N, Ray-Barruel G, Flynn J, Larsen E, Rickard CM. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016 Sep;17(5):207-13. Also available: http://dx.doi.org/10.1177/1757177416655472. PMID: 28989482.

Medical Care Availability and Reduction of Error (MCARE) Act of March 20, 2002, P.L. 154, No. 13, Cl. 40. Available: http://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2002&sessInd=0&act=13.

Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep. 2012 Jul;4(3). Also available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227315/

Image of Peripheral venous and Central venous catheters



How to Cite

Hathaway, . L. ., & Magee, M. C. (2019). Risky Business: Peripheral and Central Venous Catheters Both Pose Risks. Patient Safety, 1(1), 28–39. https://doi.org/10.33940/vascular/2019.9.4



Original Research and Articles
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