Nicole Marsh1,2,3, Joan Webster1,4,5, Emily Larson1,4,3, Marle Cooke4,3, Gabor Mihala4,3,6,7, Claire M Rickard1,4,3. 1. 1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 2. School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia. nicole.marsh@health.qld.gov.au. 3. Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia. 4. School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia. 5. School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia. 6. School of Medicine, Griffith University, Brisbane, Queensland, Australia. 7. Centre for Applied Health Economics, Menzies Health Institute, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE: To identify risk factors associated with PIV failure. DESIGN: A single center, prospective, cohort study. SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS: Adult patients requiring a PIV. MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal. RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06).Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)-(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% C-0.46)-(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
BACKGROUND: Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE: To identify risk factors associated with PIV failure. DESIGN: A single center, prospective, cohort study. SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS: Adult patients requiring a PIV. MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal. RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06).Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)-(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% C-0.46)-(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
Authors: Emily N Larsen; Gillian Ray-Barruel; Mari Takashima; Nicole Marsh; Christopher R Friese; Vineet Chopra; Evan Alexandrou; Claire M Rickard Journal: Aust J Cancer Nurs Date: 2022-05
Authors: Emily N Larsen; Nicole Marsh; Catherine O'Brien; Emily Monteagle; Christopher Friese; Claire M Rickard Journal: Support Care Cancer Date: 2020-07-24 Impact factor: 3.603
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