Assessment over assumption.

Peripheral intravenous catheters (PIVCs) are among the most used and common devices in healthcare.¹ Yet despite their frequent use, selection often relies on product availability or organizational defaults rather than careful individualized patient assessment. One size rarely fits all—and vascular access is no exception.

Over the past decade, clinicians have become more deliberate about larger vascular access decisions, such as choosing between peripheral and central lines or short- versus long-term devices.^2,3 When it comes to PIVCs, however, decisions often focus narrowly on catheter length or gauge, without fully considering the patient’s overall context.

Recent work by an international panel of vascular access experts, using a structured modified Delphi process, offers clarity. By combining real-world experience with a careful review of emerging evidence, the panel identified broad consensus at 80% that patient assessment, clinician capability and therapy requirements are likely more influential determinants of PIVC success than catheter design alone.⁴

In other words, using more advanced or complex devices than necessary does not automatically improve outcomes.

Standardization can help—but only when paired with assessment. Standardization of products can simplify supply management, training and workflow. But when defaults replace judgment, patients may receive devices that do not meet their specific needs.

PIVCs are used across a wide range of settings—from brief emergency department (ED) visits to prolonged inpatient therapies for medically complex patients. Expecting a single catheter design to perform equally well in every scenario ignores both clinical experience and emerging evidence: Context matters.

For short, anticipated dwell times, differences between catheter technologies may be less influential on overall outcomes than insertion technique, vessel selection and maintenance practices. As therapy duration or patient complexity increases, other factors outweigh the device itself. These include inserter skill, vein and site selection, catheter size, securement and ongoing monitoring.

In higher-acuity patients or those requiring longer therapy, integrated PIVC designs may offer benefits and in selected patients requiring longer dwell times, difficult access management or therapies unsuitable for repeated short PIVC replacement, alternative devices such as midline catheters may warrant consideration.

The Delphi panel reached broad consensus that clinician-related factors—including assessment, insertion skill, vein and site selection, appropriate sizing, securement and adherence to best practices—are likely more influential on PIVC outcomes than device features alone.

Technology can enhance care, but only when paired with skilled clinicians and robust institutional processes. Data-driven vascular access algorithms help match devices to patients most likely to benefit, while supporting training, competency and process accountability.

The structured Delphi process brings together diverse expert perspectives to provide guidance where high-quality trials are limited. By integrating real-world experience with emerging evidence, the panel produced practical, consensus-based recommendations that are immediately relevant to clinical practice.

This work contributes to the literature by clarifying factors that influence PIVC success, highlighting the importance of clinician skill and patient context over device features, and offering guidance for future research, guidelines and institutional protocols.

Anticipated dwell time and PIVC decision-making

Figure 1. Conceptual summary of expert consensus themes related to anticipated dwell time and PIVC decision‑making. Full results forthcoming in peer-reviewed publication.