Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure” Marsh et al (2017).
BACKGROUND: Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy.
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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% C-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.
Marsh, N., Webster, J., Larson, E., Cooke, M., Mihala, G. and Rickard, C.M. (2017) Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients: A Multivariable Analysis of Peripheral Intravenous Catheter Failure. Journal of Hospital Medicine. October 18th. [epub ahead of print].
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