Infection Control & Hospital Epidemiology (2018), 39, 1216–1221 doi:10.1017/ice.2018.190
Original Article
From insertion to removal: A multicenter survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department
Peter J. Carr RN, PhD, MMedSc, BSc1,2, James C.R. Rippey MBBS, DCH, DDU, FACEM1,2,3, Marie L. Cooke RN, PhD1, Niall S. Higgins RN, PhD1,4,7, Michelle Trevenen BComm, BSci (Hons)5, Aileen Foale MD6
and Claire M. Rickard RN, PhD1,4 1School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 2Emergency Medicine, School of Medicine, The University of Western Australia, Nedlands, Australia, 3Sir Charles Gairdner Hospital, QEII Medical Center, Nedlands, Perth, Western Australia, 4The Royal Brisbane and Women Hospital, Brisbane, Australia, 5Centre for Applied Statistics, The University of Western Australia, Nedlands, Australia, 6Fiona Stanley Hospital, Murdoch, Australia and 7Queensland University of Technology, Brisbane, Australia
Abstract
Background: Most patients admitted to the hospital via the emergency department (ED) do so with a peripheral intravenous catheter/ cannula (PIVC). Many PIVCs develop postinsertion failure (PIF). Objective: To determine the independent factors predicting PIF after PIVC insertion in the ED. Methods: We analyzed data from a prospective clinical cohort study of ED-inserted PIVCs admitted to the hospital wards. Independent predictors of PIF were identified using Cox proportional hazards regression modeling. Results: In 391 patients admitted from 2 EDs, the rate of PIF was 31% (n=118). The types of PIF identified were infiltration, occlusion, pain and/or peripheral intravenous assessment score >2 (ie, the hospital’s assessment of PIVC phlebitis), and dislodgement (ie, accidental securement device failure or purposeful removal). Of the PIVCs that failed, infiltration and occlusion combined were the most common causes of PIF (n=55, 47%). The median PIVC dwell time was 28.5 hours (interquartile range [IQR], 17.4–50.8 hours). The following variables were associated with increased risk of PIF: being an older patient (for a 1-year increase, hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01–1.03; P=.0001); having an Australian Triage Scale score of 1 or 2 compared to a score of 3, 4, or 5 (HR, 2.04; 95% CI, 1.39–3.01; P=.0003); having an ultrasound-guided PIVC (HR, 6.52; 95% CI, 2.11–20.1; P=.0011); having the PIVC inserted by a medical student (P=.0095); infection prevention breaches at insertion (P=.0326); and PIVC inserted in the ante cubital fossa or the back of hand compared to the upper arm (P=.0337). Conclusion: PIF remains at an unacceptable level in both traditionally inserted and ultrasound-inserted PIVCs. Clinical trial registration: Australian and New Zealand Trials Registry (ANZCTRN12615000588594).
(Received 11 February 2018; accepted 11 July 2018)
The peripheral intravenous catheter/cannula (PIVC) is the most commonly used vascular access device in healthcare today.1 Generally, patients admitted to hospital have a PIVC due to clinical needs, the need for prescribed intravenous therapy and/or medicines, the need for procedures, or the need for diagnostics such as a computerized tomography scanning. Premature failure of the PIVC after insertion reveals undesirable rates of failure, with 30%–50% postinsertion failure (PIF) before the completion of therapy.2–5 Most strategies are targeted to reduce infection; however, although infection is the most harmful to patients, it is
Author for correspondence: Peter J. Carr, The Alliance for Vascular Access Teaching
and Research Group, Menzies Health institute, Griffith University, Gold Coast Campus, Queensland 4222. E-mail:
peterj.carr@
griffith.edu.au
Cite this article: Carr PJ, et al. (2018). From insertion to removal: A multicenter
survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department. Infection Control & Hospital Epidemiology 2018, 39, 1216–1221. doi: 10.1017/ice.2018.190
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
also the least likely to occur.6 Highly prevalent forms of PIF include infiltration/extravasation; occlusion; dislodgement (acci- dental-securement device failure or purposeful removal); and phlebitis/thrombophlebitis due to pharmacological, mechanical, and infective causes.4 Some PIF risk factors are modifiable, such as the use of tissue
adhesive after a successful PIVC insertion to avoid accidental dislodgement.7 Despite such advances, patients are commonly exposed to repeated PIVC insertions when appropriately placed and functional PIVCs are not achieved.8 Consequently, alter- native devices such as midlines, peripherally inserted central catheters, or central venous catheters may be required. Focusing on the emergency department (ED) environment where many patients are exposed to their first hospital PIVC insertion could achieve implementation of improvement strategies at the source of this clinical issue. We investigated insertion-related risk factors and predictors for PIF in patients admitted to hospital through
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