Infection Control & Hospital Epidemiology
Table 2. PIVC Dwell Time (Hours) for the Entire Cohort as well as Those With and Without PIVC Failure
PIVC failure: Yes 118 PIVC failure: No 273 Entire cohort
391
N Median Lower Quartile Upper Quartile 24.1 29.9 28.5
11.7 20.7 17.4
Note. PIVC, peripheral intravenous catheter/cannula.
Table 3. Reasons for PIVC Failure and Removal for Entire Cohort N
% of Total (n=391)
PIF Type
PIVC infiltration Occlusion
38 17
Pain/PVAS>214 Dislodgement
Patient pulled it out PIVC removal
Removed for patient safety
27 22
10 5 3 7 6
% PIF (n=118) 32 15 12 23 19
% PIVC removal (n=273) 31 1
Changed to other VAD 13 Unable to identify
Transferred to other hospital
12
3 3
5 4
82 3
Routine removal at 72 h 17 Deceased
No longer required 1 219
4 0
56
6 0
80
Note. PIVC, peripheral intravenous catheter/cannula; PIF, postinsertion failure; PVAS, peripheral vascular access score; VAD, vascular access device.
Skin condition Fair vs poor
Good vs poor Insertion site Forearm vs upper arm Wrist vs upper arm
Antecubital fossa vs upper arm Back of hand vs upper arm
Triage category Life-threatening vs less urgent
Clinician role Consultant vs med student Intern vs med student Nurse vs med student
Phlebotomist vs med student RMO vs med student
Registrar vs med student Not significant
50.8 49.8 50.8
Table 4. Multivariate Results From Analyzing Time to PIVC Failure Variable
HR
Patient Gender Female vs male
Patient age For a 1-year increase
95% CI Not significant 1.02 1.01–1.03 <.0001
1219
P Value
6.86 0.82–57.68 6.96 0.80–60.80 11.25 1.39–91.14 12.75 1.47–110.31
2.04 1.39–3.01
0.43 0.16–1.15 0.21 0.09–0.49 0.60 0.24–1.51 0.27 0.11–0.67 0.37 0.19–0.72 0.31 0.14–0.68
Aseptic nontouch technique No clinical breach vs clinical breach 0.63 0.42–0.96
Ultrasound Yes vs no
inserted in the upper arm (HR, 11.3; 95% CI, 1.39–91.1 and HR, 12.8; 95% CI, 1.47–110.3, respectively). The clinician variable significantly related to PIVC failure in the
final multivariate model was clinician role (P=.0095). PIVCs inserted by clinical personnel in certain roles were significantly less likely to fail than PIVCs inserted by medical students: registrars (HR, 0.31; 95% CI, 0.14–0.68); registered medical officers, (HR, 0.37; 95% CI, 0.19–0.72); interns (HR, 0.21; 95% CI, 0.09–0.49); and phlebotomists (HR 0.27, 95% CI, 0.11–0.67). Whether the clinician used or did not use an aseptic nontouch technique approach defined as clinical breach was significant (P=.032) in the final multivariate model. PIVCs inserted without any observed compromise of clinical breach (eg, using an aseptic nontouch technique) were associated with less PIF than those PIVCs inserted while compromising an aseptic nontouch approach (HR, 0.63; 95% CI, 0.42–0.96). Furthermore, patients requiring an ultrasound- guided PIVC (USG-PIVC) insertion were significantly (P=.0011) more likely to have PIVC failure than patients not requiring an ultrasound (HR, 6.52; 95% CI, 2.11–20.1). Table 4 lists all the multivariate results from analyzing time to PIVC failure.
Discussion
In this study, almost 1 in 3 PIVCs (30%) failed due to a com- plication. This rate is only slightly lower than that of another study reporting 34% failure,4 and it is in agreement with recent findings from multiple studies that PIF is a highly prevalent problem in healthcare.3,5 It has been established that first-time insertion success rates are varied and need to improve.20 Addi- tionally, these results provide rates of PIF that are a cause for concern and will inform any planned quality initiatives or further interventional studies. For example, in the older population, increasing age was significantly associated with PIF. Patients with higher ATS scores who required immediate and urgent ED care were significantly more likely to have PIVC PIF. This finding is not surprising given the large number of intravenous interven- tions that occur in this patient cohort, and perhaps more haste is taken in placement in these patients, which results in this higher PIF rate. The other significant patient finding from the multi- variate model was that PIVCs inserted into the ante cubital fossa
6.52 2.11–20.10 Note. HR, hazard ratio; CI, confidence interval; RMO, registered medical officer.
.0337
.0003 .0095
.0326 .0011
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