From fragile lines to fortified care: A nursing-led revolution in iv dwell time at Kauvery hospitals

Rajeswari. R1*, Kalaivani2, Sabari Divya Nandhini3

1Deputy Nursing Superintendent, Kauvery Hospital, Vadapalani, Chennai, Tamil Nadu

2Vascular Access Device team, Kauvery Hospital, Vadapalani, Chennai, Tamil Nadu

3Nurse Educator, Kauvery Hospital, Vadapalani, Chennai, Tamil Nadu

*Correspondence

Abstract

Background: Peripheral intravenous catheters (PIVCs) are the most common invasive procedure in hospitals, yet their failure is often accepted as inevitable. At Kauvery Hospital Vadapalani, we confronted a reality where one in three PIVCs failed before their intended dwell time, subjecting patients to repeated painful insertions and increasing the risk of infection.

Local Problem: The pre-intervention phase (February-April 2025) revealed a PIVC failure rate of 33%, with accidental dislodgement being the leading cause, followed by infiltration and occlusion. Only 1.3% of lines were lasting beyond 72 hours. The primary issues were inconsistent insertion techniques, inadequate securement, and a lack of standardized monitoring.

Methods: We employed a SMART PDCA improvement model. The core intervention was the conceptualization and deployment of a dedicated, 24/7 Vascular Access Device (VAD) team. This team of trained nurses became the “guardians of the line,” responsible for insertions, daily rounds, patient education, and rigorous auditing.

Interventions: Key changes included transitioning to a closed-system connector, replacing traditional micropore taping with advanced securement devices, and developing a powerful in-house educational video for staff competency. The VAD team provided continuous, real-time feedback at the bedside.

Results: The intervention yielded a dramatic, phased improvement in PIVC longevity. By August 2025, the percentage of lines lasting >72 hours skyrocketed from a baseline of 1.3% to 34%. Conversely, lines falling before 48 hours plummeted from 87% to just 10%. Complications like infiltration and phlebitis showed marked declines.

Conclusions: This project demonstrates that PIVC failure is not an inevitability but a preventable condition. A nurse-led, dedicated VAD team, empowered with the right training, tools, and autonomy, can fundamentally transform the patient’s experience, enhance clinical outcomes, and optimize resource utilization. This model of care elevates PIVC maintenance from a task to a specialized discipline.

Keywords: Peripheral Intravenous Catheter (PIVC); Dwell Time; Vascular Access Device (VAD) Team; Quality Improvement; Patient Safety; Infiltration, Phlebitis.

Introduction

The Silent Suffering of the “Simple” IV Line, in the bustling corridors of modern hospitals, the peripheral intravenous catheter (PIVC) is so ubiquitous it is often rendered invisible. Deemed a “simple” procedure, its insertion and maintenance are frequently relegated to a task on a checklist. Yet, this invisibility masks a silent epidemic of patient discomfort and clinical failure. International standards, including INS 2021, report that 30-50% of PIVCs fail prematurely. At Kauvery Hospital Vadapalani, we were living this statistic. Our patients were enduring the pain and anxiety of repeated vending surgery, their treatment interrupted, and their risk of infection heightened by lines that simply did not last. We recognized that we had not just a clinical problem, but a failure in our model of care. This article chronicles our journey to make the “simple” IV line a symbol of robust, compassionate, and highly skilled nursing practice.

Methods

Building a Team of “Line Guardians”. Our pre-intervention data (February-April 2025) painted a clear picture of the problem. Analysis of 3,637 PIVCs across 2,166 admissions revealed a 33% failure rate. Accidental dislodgement was the primary culprit, pointing directly to insecurement as a critical weakness. Inconsistent flushing techniques and missed monitoring rounds compounded the issue. Only 1.3% of lines reached the 72–96-hrs mark, a benchmark of optimal care.

Our SMART aim was clear: to increase the average dwell time of IV lines, with a specific focus on maximizing those lasting beyond 72 hours. The intervention was not a single change, but a paradigm shift. We moved from a decentralized, task-oriented approach to a centralized, specialized one.

The Heart of the Intervention: The VAD Team

We established a dedicated Vascular Access Device (VAD) team, a multi-disciplinary group led by nursing, including the Head of Nursing, DNS, Nurse Educator, Infection Control Nurse (HIC), and most importantly, a newly created role: the IV Nurse. One designated IV Nurse per shift became the single point of contact for all things vascular access.

  • 24/7 Availability: The team’s coverage ensured no shift change meant a lapse in line care.
  • Ownership & Accountability: The VAD nurses took full ownership. They performed difficult insertions, but their primary role was maintenance. They conducted daily rounds, auditing every single PIVC for patency, signs of phlebitis (using the VIP score), and securement integrity.
  • Real-Time Intervention: They didn’t just collect data; they acted on it. A line showing early signs of phlebitis was addressed immediately, and family education was reinforced on the spot.

Empowering Change through Education and Tools

We understood that knowledge without the right tools is ineffective.

  • Advanced Securement: We moved beyond the traditional, ineffective “micropore and tape” method. We introduced integrated securement dressings and closed-system connectors, creating a stable, protected line environment that was harder for patients to accidentally dislodge.
  • A New Way to Learn: Traditional training sessions were supplemented with a powerful internal resource. Our DNS and team created a high-quality educational video, featuring our own staff, demonstrating correct techniques. This fostered peer-to-peer learning and created a lasting, accessible training tool for all shifts.
  • Patient as Partner: The VAD team made “patient family education” a core responsibility. They explained the “why” behind the securement, teaching patients to be active partners in protecting their own lines.

Results

The Numbers tell a story of triumph

The transformation was not instantaneous but progressive, as the culture of care took root.

  • The “Failure Zone” Shrinks: In the pre-intervention phase, a staggering 87% of lines were failing before 48 hours. By August 2025, this number had collapsed to just 10%. We had effectively eliminated the mindset that a short-lived line was acceptable.
  • The “Success Zone” Expands: The most compelling evidence of our success is the growth in lines lasting beyond 72 hours. From a meager 1.3% (Feb-April), this figure climbed to 34% by August 2025. For the first time, a significant portion of our patients were receiving the full intended benefit of a single PIVC.
  • Complication Rates Decline: This wasn’t just about time; it was about quality. The incidence of infiltration and phlebitis dropped sharply post-intervention, a direct result of the VAD team’s vigilant daily rounds and proactive VIP scoring.

Qualitative Impact: Beyond the spreadsheet

While the data is compelling, the true impact was felt at the bedside. Nurse confidence soared as they developed mastery over a complex skill. Patients expressed greater satisfaction, no longer dreading the “stick” every other day. The clinical team recognized the VAD nurses as invaluable specialists, and we celebrated a significant reduction in the cost and labor associated with frequent PIVC reinsertions.

Discussion

The “Guardian” Model of Care. This project has fundamentally altered our understanding of PIVC care. The key takeaway is simple yet profound: PIVC fail not because they are inherently fragile, but because our systems of care around them are. By creating a dedicated team of “line guardians,” we transformed a fragmented, low-attention task into a high-reliability, specialized practice.

The success of the VAD team lies in its multi-pronged approach. It wasn’t enough to just provide better security devices; we needed the daily, expert eyes of the VAD nurse to ensure they were used correctly. It wasn’t enough to train staff once; we needed the continuous reinforcement of the educational video and real-time bedside coaching. This created a “safety bubble” around every PIVC.

Conclusion: A Call to Action for Nursing Leaders

The Kauvery Hospital experience proves that significant improvements in PIVC outcomes are achievable with existing resources, reimagined. We did not wait for new technology to save us; we built a new team structure. Our journey from 1.3% to 34% of lines lasting beyond 72 hours is a testament to the power of nursing leadership, specialized education, and unwavering ownership.

We challenge other institutions to look beyond their failure rates and see the system that creates them. Invest in your nurses, give them the autonomy to become specialists, and watch as the simple IV line becomes a cornerstone of excellence in patient care. The solution was not in a box; it was in the hands and minds of our nursing staff, waiting to be unlocked.

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