Peripheral IV catheters are the most frequently utilized in-dwelling device. Nearly all hospitalized patients have an IV catheter inserted during their stay. However, these devices are not risk-free and are prone to complications and failures that can interfere with the treatment course.
To determine the extent of these problematic issues, investigators conducted a secondary analysis of 12 prospective studies that were conducted between 2008 and 2020 that involved 8,197 patients and 11,830 peripheral IV catheter insertions.
Data were utilized from the Alliance for Vascular Access Teaching and Research database. The analysis included 10 randomized, controlled trials and two prospective observational studies that were conducted in two large metropolitan hospitals, two regional hospitals, and one pediatric specialty hospital in Australia.
The patient population consisted of medical, surgical, hematology, and oncology patients (adult and pediatric). Catheter sites were inspected by nursing staff following the second day of insertion and upon discontinuation of the IV catheter. All-cause peripheral IV catheter failure was defined as the unplanned removal of the catheter before completion of IV therapy.
The outcome was a composite of occlusion (i.e., catheter fails to flush or leaks when flushed), infiltration (i.e., movement of IV therapy into surrounding tissues), and phlebitis (i.e., >2 of the following: pain, tenderness, redness, swelling, palpable cord, vein streak, purulence, or patient reported that the IV site was too painful to tolerate).
The researchers identified patient, provider, and device characteristics that were associated with peripheral IV catheter failure. They also noted the peripheral IV catheter dwell time, which was calculated by subtracting the date/time of catheter removal from the date/time of catheter insertion.
The study population was primarily male (59%). The median age for adults was 58 years and 6 years for pediatric patients. Most patients (63%) were surgical patients, and almost one-fifth of patients (19%) had an infection at the time of recruitment.
An analysis of the peripheral IV catheter characteristics revealed that most had been inserted on a medical/surgical ward (71%). A 20-gauge needle was utilized in about half of the patients (49%). The most common insertion site was the forearm, which was used in 50% of patients. Over 40% of patients required multiple insertion attempts.
In total, all-cause peripheral IV catheter failure occurred in 36% of patients and resulted from multiple individual catheter complications, most commonly infiltration/occlusion (23%), phlebitis (12%), and catheter dislodgement (7%).
The patient characteristic that contributed most to peripheral IV catheter failure was female gender. Women had a 98%, 45%, and 36% increased risk of developing phlebitis (hazard ratio [HR] 1.98, CI 1.33-1.58), infiltration/occlusion (HR 1.45, CI 1.33-1.58), and all-cause peripheral IV catheter failure (HR 1.36, CI 1.26-1.46), respectively. Interestingly, for each increased year of life, there was a 1% lower risk of catheter failure and for developing phlebitis.
Among the provider characteristics, having the catheter inserted by a vascular access team was associated with a 47% lower risk of experiencing catheter dislodgement (HR 0.53, CI 0.42-0.67). Antibiotic administration was significantly associated with an increased risk for infiltration/occlusion, phlebitis, and all-cause failure with risk increased 40%, 36%, and 17%, respectively.
Device characteristics associated with peripheral IV catheter failure included placing the IV catheter in the wrist, hand, or the antecubital fossa and using a 22- or 24-gauge needle.
As pharmacists work with nurses to optimize patient therapy, this study sheds light on the problems and pitfalls of IV catheter therapy and identifies patients who require extra vigilance when an IV catheter is required as part of the treatment regimen.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
« Click here to return to Infusion Pharmacy Update.