Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters

Abstract

Background: Peripheral intravenous catheters are an essential medical device which are prone to complications and failure.

Objectives: Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes.

Design: Secondary analysis of twelve prospective studies performed between 2008 and 2020.

Settings: Australian metropolitan and regional hospitals including one paediatric hospital.

Participants: Participants were from medical, surgical, haematology, and oncology units.

Methods: Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant.

Results: Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters.

Conclusion: Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.

Keywords: Administration, intravenous; Catheterization, peripheral; Catheters, indwelling; Infusion, intravenous; Nurse; Phlebitis; Thrombophlebitis; Vascular access device.

Conflict of interest statement

Declaration of Competing Interest NM reports, Griffith University has received on her behalf, speaker fees from 3M, investigator-initiated research grants from Becton Dickinson and Cardinal Health, and a consultancy payment from Becton Dickinson for clinical feedback related to catheter placement and maintenance (unrelated to the current project). EL's employer, Griffith University, received, on her behalf, an investigator-initiated grant-in-aid from Cardinal Health (formerly Medtronic) (unrelated to the current project) and an educational scholarship (conference attendance) from Angiodynamics (unrelated to the current project). TK reports investigator-initiated research grants and speaker fees provided to her employer Griffith University from 3M Medical, Becton Dickinson, Medical Specialties Australia and Smiths Medical, and a consultancy payment provided to Griffith University from Access Scientific for consultancy work (unrelated to the current project). SK reports speaker fees provided to QUT and research consultancy monies via Griffith University from BD Medical. AJU reports investigator-initiated research grants and speaker fees provided to Griffith University from vascular access product manufacturers (3M Medical, Becton Dickinson-Bard, and Cardinal Health) (unrelated to the current project). CMR's (Griffith University) employer has received, on her behalf investigator-initiated research or educational grants from: Becton Dickinson-Bard, Cardinal Health, and consultancy payments for educational lectures/expert advice from 3M Medical and Becton Dickinson-Bard (unrelated to the current project). MT, GM, and VC have nothing to declare.

Copyright © 2021. Published by Elsevier Ltd.