Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients: A Multivariable Analysis of Peripheral Intravenous Catheter Failure
BACKGROUND: Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy.
OBJECTIVE: To identify risk factors associated with PIV failure.
DESIGN: A single center, prospective, cohort study.
SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia.
PARTICIPANTS: Adult patients requiring a PIV.
MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal.
RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06). Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)–(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% CI 0.22-0.46)–(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement.
CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
© 2017 Society of Hospital Medicine
CONCLUSION
Our study confirms the high rate of catheter failure in acute care hospitals, validates existing evidence related to PIV failure, and identifies new, potentially modifiable risk factors to improve PIV insertion and management. Implications for future research were also identified.
Acknowledgments
The researchers acknowledge and thank the nurses and patients involved in this study. The authors would also like to acknowledge Becton Dickinson for partly funding this study in the form of an unrestricted grant-in-aid paid to Griffith University. Becton Dickinson did not design the study protocol, collect or analyze data, and did not prepare or review the manuscript.
Disclosure
On behalf of NM and CMR, Griffith University has received unrestricted educational and research grants and consultancy payment for lectures from 3M and Becton Dickinson. On behalf of NM, MC, and CMR, Griffith University has received unrestricted investigator-initiated research grants from Centurion Medical Products and Entrotech Lifesciences (manufacturers of PIV dressings) and Becton Dickinson (manufacturer of PIVs). On behalf of MC, Griffith University has received a consultancy payment to develop education material from Baxter. On behalf of CMR, Griffith University has received unrestricted donations or investigator initiated research grants unrelated to this research from Adhezion, Angiodynamics, Baxter, Carefusion, Cook Medical, Hospira, Mayo, Smiths Medical, and Vygon. On behalf of CMR, Griffith University has received consultancy payments for educational lectures or professional opinion from B. Braun, Bard, Carefusion, Mayo, ResQDevices, and Smiths Medical. On behalf of EL, Griffith University has received consultancy payments for educational lecture from 3M. On behalf of MC, Griffith University has received a consultancy payment to develop education material from Baxter. As this was an observational study, no products were trialed in this study. JW and GM have no conflicts of interest.
