Debra Runyan

Reducing Phlebitis through Peripheral IV Securement

Debra Runyan

Debra Runyan, MT, CIC
Pennsylvania Hospital
Philadelphia, PA

“Part of our job is to take the art of medicine and make it a science of best practices.”
– Debra Runyan

This is the credo that Director of Infection Prevention Debbie Runyan brings to work every day at Pennsylvania Hospital. Her efforts to reduce the incidence of IV phlebitis and its associated complications provide a perfect example of how she puts this philosophy into practice.

In late 2008, Runyan was alerted to an emerging issue: During the preceding 18-month period, 13 patients had healthcare-associated infections (HAIs) related to peripheral IVs.

“We knew there had been an issue with IV phlebitis,” recalls Runyan. “We conducted a one-day peripheral IV point prevalence study – checking dressing, securement, length of placement, etc. The 13.5 percent phlebitis rate we uncovered that day compelled us to search for a long-term solution.”

Standardizing dressing- and IV-placement procedures with hundreds of staff was impossible. Instead, Runyan and her team identified two ways to tackle the problem – establish a dedicated IV placement team, or standardize use of an IV securement device. The device was by far the less expensive option.

Runyan obtained funding to launch a six-month pilot study in the hospital’s medical/surgical and critical care units. It generated dramatic results:

  1. Peripheral IV life was extended from 72 to 96 hours – saving nursing time.
  2. Less pain and worry increased patient satisfaction.
  3. Zero bloodstream or skin and soft tissue infections attributable to IV phlebitis for six months, and only one over the following year.

As a result, the new devices became standard of care. A follow-up study conducted in March 2010 showed that the overall phlebitis rate had dropped to 2.8 percent. The phlebitis rate among patients with the IV securement device was only 1.1 percent. At $3 per device (across 22,500 peripheral IVs per year), the annualized cost is approximately $67,500.

“At the health-system assigned cost of $19,000 per bloodstream infection, there was a minimum cost avoidance of $152,000,” said Runyan. “The cost-effectiveness is fairly easy to document. This savings doesn’t include the skin and soft-tissue infections that were also prevented, so the return on investment is most likely greater.”