Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

Abstract

\n Objective:Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify factors that predict premature PIVC failure.Methods:We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary goal was to identify demographic, clinical, and PIVC related variables that predicted PIVC failure. Univariate and multivariate analyses were employed to identify risk factors for PIVC failure.Results:In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of subcutaneous edema [AOR 8.29 (1.50, 45.8) p = 0.0153], an above average neutrophil to lymphocyte (N:L) ratio [AOR 4.63 (1.06, 20.3) p = 0.0422], and the administration of an irritant/vesicant [10.3 (1.46, 72.6) p = 0.0.192] were associated with increased likelihood of premature PIVC failure. Conclusions:PIVC failure is related to clinical and ultrasonographic variables associated with inflammation: elevated N:L ratio, use of caustic medications, and presence of subcutaneous edema on ultrasound. Reducing inflammation of the vein may lead to better PIVC survival outcomes. Further large-scale randomized controlled trials are needed to validate and build upon the concepts in this study.