“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

Abstract

Background Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians’ concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms. Methods Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually. Results A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms. Conclusions VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs.

Development of a Medical Device in Response to a Fatal Self-Injection of Non-prescribed Opioids: A Case Report

“…The device may alleviate fears that providers have expressed about placing VADs in PWID [ 10 ]. The device would also potentially allow for outpatient parenteral antimicrobial therapy often limited secondary to fear of SIVAD by patients with OUD [ 4 , 11 ]. VAD protection can help keep medical costs down by preventing line infections, endocarditis, prolonged hospitalization, and patients leaving AMA [ 5 ].…”

“…This poses a dilemma for both the patient and the provider. PWID have a higher risk of self-injecting during a time when they may be experiencing withdrawal or cravings [ 4 , 7 , 10 ]. Medical providers must balance the risks of VAD and the risk of SIVAD by the patient leading to additional complications [ 7 ].…”

“…Direct observation, detection devices, or removing the access site between infusions were the standards of care [ 10 ]. Furthermore, there was a lack of reported evidence regarding the risks associated with a PWID and receiving intravenous therapy in either the inpatient or outpatient setting [ 4 ]. Studies published since our initial research reported up to 40% of OUD patients with SIVAD intended for antimicrobial use [ 5 ].…”

“…Efforts have focused on restricting the opioid prescription supply, but this does not address the needs of the patients requiring intravenous therapy [3]. Patients who inject drugs (PWID) are at greater risk for complications with a vascular access device (VAD) including bloodstream infections, line infections, bacteremia, endocarditis, overdose, and death [4][5][6]. The costs associated with the complications of self-injection of non-prescribed substances into vascular devices (SIVAD) are associated with increases in length of stay (LOS) readmissions and increased healthcare costs [6,7].…”

Evaluation of the Functionality in an Emergency Department Setting of an Intravenous Protection Device to Prevent Self-Injection

“…Alternately, many institutions limit the number of IVs placed. 9 This restricts the quality of care available to the patient. Patients may require prolonged hospitalizations to receive IV medications if they are deemed to be unsafe to discharge with a PICC (peripherally inserted central catheter) due to a history of substance abuse.…”