The DRIP Criteria: Reducing the Frequency of Peripheral Intravenous Catheter Insertion in Hospitalized Patients

Patient harm attributed to invasive devices is a global concern. Around 18% to 54% of all catheter-related hospital-acquired bloodstream infections (HABSIs) are attributable to peripheral intravenous cannulas (PIVCs). Between 4% and 28% of PIVCs placed in hospitalized patients and up to 50% of emergency department (ED) PIVCs are not used. Avoiding insertion of the "just in case" PIVC where safe to do so has potential to reduce patient risk.

The DRIP mnemonic (Deterioration, Rehydration, Intravenous medications, Procedure) was designed around four simple questions to guide clinicians' decision-making relating to PIVC insertion. DRIP can also be used to support the daily review of existing cannulas to confirm ongoing need. Both applications align to daily workflows to promote a culture of safety.

DRIP has assisted in reducing the number of idle PIVCs reported in monthly quality and safety audits from 8.3% to 1.8%. Removal of these PIVCs was possible after confirmation with treating teams that the device was not clinically indicated. This has reduced patient exposure to HABSI. During a 15-month period, independent assessment of PIVC insertion requests by the Vascular Access Team found that 3,103 PIVC requests (10.1%) were deemed not clinically indicated and were not inserted. None met DRIP criteria, which suggests independent expert clinician assessment aligns well to the DRIP criteria in practice.

DRIP has shown that elimination of cannulation where not clinically indicated is achievable. Use of the DRIP tool can support safe organizational culture by encouraging staff to question the need for a PIVC to reduce or eliminate the "just in case" or idle cannula. Formal validation of DRIP across multiple settings would strengthen the evidence base underpinning PIVC decision-making.