Imagine a patient is admitted overnight for a mild UTI. In the ED, she is told that a peripheral IV catheter (PIVC) needs to be inserted. She asks why—after all, she is volume neutral, taking her daily medications by mouth without issue, and her CBC/CMP are unremarkable. “It is just a precaution,” she is told—just a benign step in the protocol. For the two days the patient is hospitalized, the catheter remains inserted but is never touched, flushed, or used. It exists solely as an object of EMR documentation and intermittent check-ups.
This phenomenon of placing PIVCs with no clear clinical rationale is something we have all observed and likely questioned at some point. While it is true that unused PIVCs rarely cause direct harm to patients, I began to wonder how much harm is being done by its economics. To date, there is no study quantifying the cost of unused PIVCs to the U.S. health care system, so I wanted to crunch the numbers and see how big of a cost burden this phenomenon really is.
The scope
First, let us estimate the scope of this issue. An estimated three hundred million PIVCs are inserted annually across inpatient, emergency, and procedural settings in the U.S., according to national usage data. A 2025 meta-analysis of twenty-five studies found that the median unused PIVC rate in the U.S. is 26.7 percent, as reported in unused PIVC rate research. This is not an issue specific to the U.S., as the median unused PIVC rate is 31.7 percent in Europe and 26 percent in Australia. The analysis also revealed that the problem is most pervasive in the pre-hospital and ED setting with a median unused rate of 32.3 percent, compared to 19 percent in inpatient hospital wards.
Thus, a conservative estimate for the rate of unused PIVC insertion in the U.S. is 25 percent. This means there are an estimated 300,000,000 × 0.25 = seventy-five million unused IVs placed every year in the U.S.
The associated costs
To quantify the national cost of these unused IVs, we can capture the expenses of associated supplies, labor, and documentation/monitoring. There are several other downstream costs of unused PIVCs such as resultant costs of complications, unneeded IV fluids, and delays in transitioning to oral medications, but the goal here is to make a baseline estimate:
Consumable supply costs: Catheters range from $3 to $10, and supplies such as extension tubing, Tegaderm, flushes, and gloves are $5 to $10. We can estimate the cost of PIVC insertion consumables to be $15. Multiple insertion attempts, which are common, would significantly increase the supply cost. For instance, a multicenter randomized trial found a 17 percent failure rate for first-attempt PIVC insertion in surgical patients. Similarly, a resource utilization study in pediatric hospitals showed that 28 percent of children required three or more IV insertion attempts, raising the cost to $69–$125. As a conservative estimate, we can quantify the supply cost to be $15 per PIVC insertion.
Labor costs: A training program on PIVC insertion found that the average procedure takes 9.2 to 12 minutes. This means a nurse spends about fifteen minutes (0.25 hours) to set up, insert the PIVC, and clean up. The average hourly wage of a nurse or IV technician is $50 per hour in the U.S., resulting in a labor cost estimate of $12.50 for each unused insertion, assuming no failed attempts.
Documentation and monitoring: Even when unused, PIVCs require EMR documentation, dressing changes, and intermittent nursing assessments of patency and dressing status, which together take about five minutes (0.083 hours) of a nurse’s time. Compliance research indicates that PIVC maintenance is performed in 86 percent of cases. This leads to a documentation and monitoring cost of $3.56 per unused PIVC.
Complications and risk mitigation: An analysis of more than five hundred thousand U.S. hospitalizations found that 1.76 percent of patients experienced a PIVC-related complication such as cellulitis, bloodstream infection, thrombophlebitis, extravasation, or other infection. Since there is no specific data for unused PIVCs, these complication costs are not included in the baseline estimate, but their burden could be significant.
Total health care costs per unused IV catheter
Adding all the costs:
- Supplies: $15.00
- Labor: $12.50
- Documentation/monitoring: $3.56
- Total per unused IV: $31.06
Thus, a conservative estimate of the total health care cost in the U.S. associated with unused PIVCs amounts to 75,000,000 × $31.06, approximately $2.4 billion.
The importance of EHR-based solutions
While more stringent evidence-based PIVC insertion criteria, along with regular audits, daily assessments of catheter need, and staff training, would certainly be beneficial, these types of solutions require behavioral changes that are not always long-lasting, enforceable, or scalable. A more immediate and durable approach lies within EHR-based algorithms that provide automated clinical decision-making support. Such systems could assess whether an admitted patient would benefit from a PIVC and recommend removal orders for those that have not been used within a certain timeframe.
This is not a marginal issue. This baseline estimate indicates that breaking the routine of inserting PIVCs for patients who lack a clear clinical indication would save the U.S. health care system nearly $2.4 billion every year.
Piyush Pillarisetti is a medical student.
