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From insertion to removal: A multicenter survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department

Published online by Cambridge University Press:  10 September 2018

Peter J. Carr Open the ORCID record for Peter J. Carr [Opens in a new window] ,
James C.R. Rippey ,
Marie L. Cooke ,
Niall S. Higgins ,
Michelle Trevenen ,
Aileen Foale  and
Claire M. Rickard
Peter J. Carr*
Affiliation:
School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia Emergency Medicine, School of Medicine, The University of Western Australia, Nedlands, Australia
James C.R. Rippey
Affiliation:
School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia Emergency Medicine, School of Medicine, The University of Western Australia, Nedlands, Australia Sir Charles Gairdner Hospital, QEII Medical Center, Nedlands, Perth, WesternAustralia
Marie L. Cooke
Affiliation:
School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
Niall S. Higgins
Affiliation:
School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia The Royal Brisbane and Women Hospital, Brisbane, Australia Queensland University of Technology, Brisbane, Australia
Michelle Trevenen
Affiliation:
Centre for Applied Statistics, The University of Western Australia, Nedlands, Australia
Aileen Foale
Affiliation:
Fiona Stanley Hospital, Murdoch, Australia
Claire M. Rickard
Affiliation:
School of Nursing and Midwifery, the Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia The Royal Brisbane and Women Hospital, Brisbane, Australia
*
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
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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).

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1216 - 1221
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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