Securing peripheral venous access is a hospital’s most performed interventional procedure. It is done in patients of virtually all age groups - neonates to elderly [1], [2]. Studies show that nearly 70% of patients in the Emergency Department (ED) receive a peripheral intravenous catheter (PIVC). [3], [4]PIVC insertion is done mainly for hydration, restoring electrolyte balance, blood transfusion, anaesthesia, intravenous antibiotic therapy, administration of intravenous drugs as well as contrast agents for imaging [5] and drawing blood [6] making PIVC extremely important in almost all clinical settings – from indoor to outdoor and emergency. Estimates place the global usage of PIVCs at over 1.2 billion units annually [7]. However, a significant proportion of these are wasted since not all PIVC insertions are successful on the first attempt. Studies show that the around 1.3 attempts are required per patient for a successful PIVC insertion [8], [9], [10]and the rate of success on the first attempt varies between 51 and 91%. [8], [11], [12], [13], [14], [15], [16], [17].

On average, patients receiving multiple skin pricks experience greater pain levels and less overall satisfaction with the treatment they receive. [18] Venous depletion due to multiple failed attempts is not only uncomfortable to the patient but also increases the need for using more invasive, risky and costly vascular access devices. [19] Each unsuccessful attempt increases the required resources, generating waste and driving up the procedure’s overall cost. [5], [9] Placing a PIVC is already known to be a costly affair, with some estimates as high as $30–40 per patient [20] while others put that number around $13. [9] However, these costs vary considerably, depending on the base material costs as well as the success rate of insertion. Through this study, the authors aimed to calculate the total cost of the materials required and identify the patient factors that influenced the success rate.

Another objective of the study was to quantify the number of unsuccessfully placed PIVCs that end up as waste. While there is existing literature on the factors influencing the success rate of PIVC insertion, little attention is paid to the amount of waste the procedure generates and its financial as well as environmental implications. Traditionally, evaluation of healthcare procedures focuses on health outcomes. However, provision of healthcare has a large environmental footprint, which often goes unnoticed. [21] Single-use medical supplies such as PIVCs and dressing materials greatly contribute to waste generated by healthcare facilities. The emergency department alone generates about 2 kg of waste per day per patient encounter, the vast majority of which is single-use plastic items such as the ones needed for PIVC insertion. This is estimated to result in the release of over 3 tonnes of carbon dioxide equivalent daily. [22], [23] Determining the waste generated and identifying the factors leading to it could help optimise the process, reduce unnecessary expenses, and positively impact the overall patient experience.