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

Abstract

BACKGROUND\nPeripheral intravenous catheters are an essential medical device which are prone to complications and failure.\n\n\nOBJECTIVES\nIdentify 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.\n\n\nDESIGN\nSecondary analysis of twelve prospective studies performed between 2008 and 2020.\n\n\nSETTINGS\nAustralian metropolitan and regional hospitals including one paediatric hospital.\n\n\nPARTICIPANTS\nParticipants were from medical, surgical, haematology, and oncology units.\n\n\nMETHODS\nMultilevel 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.\n\n\nRESULTS\nOf 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n\xa0=\xa04,263). Occlusion/infiltration incidence was 23% (n\xa0=\xa02,767), phlebitis 12% (n\xa0=\xa01,421), and dislodgement 7% (n\xa0=\xa0779) 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.\n\n\nCONCLUSION\nFactors 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.