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Risk Factors for Peripheral Intravenous Catheter Failure: A Multivariate Analysis of Data from a Randomized Controlled Trial

Published online by Cambridge University Press:  10 May 2016

Marianne C. Wallis*
Affiliation:
School of Nursing and Midwifery, University of the Sunshine Coast, Sippy Downs, Queensland, Australia National Health and Medical Research Council Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Nathan, Queensland, Australia
Matthew McGrail
Affiliation:
Monash University, Gippsland Campus, Victoria, Australia
Joan Webster
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Nathan, Queensland, Australia Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
Nicole Marsh
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Nathan, Queensland, Australia Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
John Gowardman
Affiliation:
Intensive Care Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
E. Geoffrey Playford
Affiliation:
Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Claire M. Rickard
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Nathan, Queensland, Australia
*
School of Nursing and Midwifery, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland 4558, Australia (mwallis@usc.edu.au)

Abstract

Objective.

To assess the relative importance of independent risk factors for peripheral intravenous catheter (PIVC) failure.

Methods.

Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal.

Setting.

Three acute care hospitals in Queensland, Australia.

Participants.

The trial included 3,283 adult medical and surgical patients (5,907 catheters) with a PIVC with greater than 4 days of expected use.

Results.

Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28–1.68], 1.27 [95% CI, 1.08–1.49], and 1.25 [95% CI, 1.04–1.50], respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08–2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 [95% CI, 0.67–0.94]). Modifiable risks for accidental removal included hand or antecubital fossa insertion compared with forearm (HR, 2.45 [95% CI, 1.93–3.10] and 1.65 [95% CI, 1.23–2.22], respectively), clinical staff insertion compared with intravenous service (HR, 1.69 [95% CI, 1.30–2.20]); and smaller PIVC diameter (HR, 1.29 [95% CI, 1.02–1.61]). Female sex was a nonmodifiable factor associated with an increased risk of both phlebitis (HR, 1.64 [95% CI, 1.28–2.09]) and occlusion (HR, 1.44 [95% CI, 1.30–1.61]).

Conclusions.

PIVC survival is improved by preferential forearm insertion, selection of appropriate PIVC diameter, and insertion by intravenous teams and other specialists.

Trial Registration.

The original randomized controlled trial on which this secondary analysis is based is registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTRN12608000445370).

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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