**Author details**

patient safety is a "team sport" [111, 112]. Consequently, active participation of all stakeholders is required to optimize patient outcomes. This involves active involvement of all those who directly or indirectly participate in IVT—providers, patients, and families. Our *Clinical Vignette* demonstrates the dangers inherently associated with increasingly complex systems, where transitions of care occur frequently and where several different teams care for the same patient over a period of just several hours. In such environments, even the smallest mistake

In this chapter, we outlined key considerations around two primary types of PVCAEs—local and systemic. We also discussed intra-arterial PIV catheter placement and the rare but devastating scenario involving the "forgotten tourniquet." Each topic was presented in a clinically relevant fashion, incorporating a brief description, diagnosis, management, and finally prevention. Clinical approach to preventing PVCAEs is multipronged and includes a broad variety of considerations, such as checklists, knowledge of procedures and equipment, proper sterile technique, and the maintenance of appropriate PIV site cleanliness. Providers must also be aware of subtle clinical signs of PVCAEs, including PIV site erythema, IVT-related tissue injury, manifestations of air embolization, and signs of PIV catheter occlusion [2, 113]. In addition, each of the sections outlined specific strategies to prevent PVCAEs and PIV catheter failure. With growing numbers of patients needing vascular access for a range IVTs, providers need to show an understanding of the broad range of vascular access devices and corresponding clinical management aspects, including specific indications for various device types. Finally, providers need to be aware of patient needs, preferences, and concerns. After all, for many patients it is not the procedure that is of maximum concern but rather the clinician's communication skills, competence, and appropriate selection of PIV insertion site [114]. Patients and their families may be greatly untapped allies in preventing, monitoring, and

In summary, PVCAEs continue to be quite common and can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. To improve patient outcomes, enhance patient safety, and reduce healthcare costs, there has been a substantial interest to implement measures aimed at reducing the incidence of PVCAEs [2]. Efforts to prevent PVCAEs should involve thorough provider education, clinical vigilance by all involved healthcare providers, as well as the proactive participation of all

The authors would like to thank Dr. Stanislaw P. Stawicki for providing generous assistance

can result in catastrophic sequelae.

128 Vignettes in Patient Safety - Volume 4

reporting adverse events [101].

stakeholders, including patients and their families.

and input regarding this chapter and its scientific content.

**10. Conclusion**

**Acknowledgements**

Parampreet Kaur<sup>1</sup> \*, Claire Rickard2,3,4, Gregory S. Domer<sup>5</sup> and Kevin R. Glover<sup>6</sup>

\*Address all correspondence to: parampreet.kaur@sluhn.org

1 Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States

2 National Centre of Research Excellence in Nursing Interventions, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Australia

3 Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Australia

4 Princess Alexandra Hospital, Woolloongabba, Australia

5 Department of Surgery, Division of Vascular Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States

6 B. Braun Medical, Inc., Bethlehem, Pennsylvania, USA
