Intravenous Catheter Infiltration Reduction Initiative: Enhancing Patient Safety in the Operating Room
Background:
Intravenous (IV) catheter infiltrations are a preventable complication in the operating room (OR), contributing to delayed treatment, patient discomfort, and increased healthcare costs. A rise in infiltration events at Froedtert Hospital prompted a student-led quality improvement initiative to identify contributing factors and propose strategies to reduce OR infiltration rates. This project aimed to identify procedural and provider-related risk factors for IV infiltrations and develop targeted interventions to improve patient safety.
Design & Methodology:
We conducted a retrospective electronic medical record (EMR) review of patients who experienced IV infiltrations during OR procedures at Froedtert Hospital between January 2022 and December 2023. Using standardized Excel-based forms, we collected data on surgical positioning, procedure type and duration, inserter role, IV site and laterality, catheter gauge and length, number of attempts, perceived difficulty, ultrasound use, and presence of complications. Descriptive statistics were used to identify high-risk patterns. Based on findings, we proposed targeted training, insertion protocol standardization, and real-time monitoring using control charts.
Results:
Infiltrations most frequently occurred in the forearm (60%) and with arms tucked (65%), particularly during lengthy procedures in the supine position. The majority of IVs were placed by registered nurses (69%), and 77% occurred on the first attempt, even when ultrasound guidance was used in over half of cases. The anesthesia service accounted for 29% of all infiltrations. These findings suggest modifiable procedural risks and highlight the need for role-specific training and securement strategies.
Conclusions:
Forearm placement and limited visualization due to arm positioning are consistent contributors to infiltration risk. First-attempt success does not ensure long-term IV integrity. Findings support the need for standardized insertion and securement practices tailored to OR challenges.
Reflections & Lessons Learned:
Technique variation and inconsistent training across teams likely contribute to poor outcomes. Our review identified procedural gaps and informed proposed interventions focused on site selection, securement, and provider education. Though interventions are pending, the analysis demonstrates how student-led, EMR-based quality review can identify interprofessional safety concerns and guide systems-level improvements.
Priority Criteria:
This project supports the Quadruple Aim by identifying preventable harm, informing cost-reducing interventions, and promoting team-based safety solutions. Medical student leadership and interprofessional application of findings are central throughout.