Can ‘just in case’ PIVC placement still be justified?

Emergency departments (EDs) have recently been experiencing an unprecedented surge in activity while our health economy resettles after the COVID-19 pandemic waves. This has led us to have to quickly rationalise and reframe how we provide our emergency care.

We know that peripheral IV cannulation (PIVC) is one of the most commonly performed invasive procedures in the ED. We also know that up to 40% of all PIVCs placed are not used or are used for only a secondary purpose, such as collection of blood samples (Thomas et al, 2020). IV access specialists have long advocated that IV access devices should only be placed if IV therapy is definitely required.

The first question of the Vessel Health Preservation Framework is whether there is a ‘genuine need for vascular access’ (Hallam, 2020). PIVC insertion can be painful for patients and comes with risks such as infection, bleeding and thrombosis. From an organisational perspective, it also adds cost and clinician time, both of which, in today's health economy, need to be carefully rationalised. So is it now time to actively challenge the notion of providing IV access ‘just in case’?