Peripheral Intravenous Administration of High-Risk Infusions in Critical Care: A Risk-Benefit Analysis

In critical care, the short peripheral intravenous catheter is an essential venous access route, often used in emergency situations to administer high-risk medications and fluid resuscitation. This route of administration is generally viewed as routine and benign. However, a growing body of evidence indicates that the risks inherent to this route are much higher than reported and represent a significant area of patient harm. Few standardized definitions and surveillance methods exist for peripheral intravenous catheter–related complications such as phlebitis, bloodstream infection, and extravasation. Recommendations for peripheral intravenous catheter replacement are based on clinical indications rather than routine replacement, so standards of practice for catheter insertion and management must be consistently applied. This article reviews recent studies that challenge the need for central catheter placement for vasopressor therapy, current knowledge of peripheral intravenous catheter–related adverse events, and evidence-based standards of care for short peripheral intravenous catheter insertion and maintenance.