Background

Peripheral intravenous catheters are an essential medical device which are prone to complications and failure.

Objectives

Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes.

Design

Secondary analysis of twelve prospective studies performed between 2008 and 2020.

Settings

Australian metropolitan and regional hospitals including one paediatric hospital.

Participants

Participants were from medical, surgical, haematology, and oncology units.

Methods

Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant.

Results

Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72–2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33–1.58), (failure; HR 1.36, 95% CI 1.26–1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98–0.99), (failure; 0.99 HR, 95% CI 0.99–0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27–1.53), (phlebitis; HR 1.36, 95% CI 1.18–1.56), (failure; HR 1.26, 95% CI 1.17–1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42–0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23–1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16–1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12–1.45) catheters.

Conclusion

Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.

中文翻译：

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外周静脉导管失败：对 11,830 根导管风险的二次分析

背景

外周静脉导管是一种重要的医疗器械，容易出现并发症和故障。

目标

确定与全因外周静脉导管失败以及个体并发症相关的患者、提供者和设备风险因素：静脉炎、浸润/闭塞和移位，以改善患者预后。

设计

对 2008 年至 2020 年间进行的 12 项前瞻性研究的二次分析。

设置

澳大利亚大城市和地区医院，包括一家儿科医院。

参与者

参与者来自内科、外科、血液科和肿瘤科。

方法

多水平混合效应参数生存回归用于确定与全因外周静脉导管失败、静脉炎、闭塞/浸润和移位相关的因素。我们研究了患者（例如，年龄、性别）、设备（例如，仪表）和提供者（例如，插入临床医生）变量。逐步回归涉及临床和p <0.20 显着变量进入多变量模型。结果以风险比 (HR) 和 95% 置信区间 (CI) 表示；p <0.01 被认为具有统计学意义。

结果

在 11,830 个外周静脉导管（8,200 名参与者）中，36%（n  = 4,263）发生了失败。闭塞/浸润发生率为 23% ( n  = 2,767)，静脉炎 12% ( n  = 1,421) 和移位 7% ( n = 779) 个导管。与失败和并发症显着相关的患者因素是：女性（静脉炎；（HR 1.98，95% CI 1.72–2.27），（浸润/闭塞；HR 1.45，95% CI 1.33–1.58），（失败；HR 1.36, 95 % CI 1.26–1.46)；以及年龄每年增加（静脉炎；0.99 HR，95% CI 0.98–0.99），（失败；0.99 HR，95% CI 0.99–0.99）。最强的风险因素是静脉注射抗生素（浸润/闭塞；HR 1.40, 95% CI 1.27-1.53​​), (静脉炎; HR 1.36, 95% CI 1.18-1.56), (失败; HR 1.26, 95% CI 1.17-1.36). 导管由血管通路团队插入不太可能脱落（HR 0.53，95% CI 0.42–0.67）。与全因故障最相关的设备风险因素是手腕/手（HR 1.34，95% CI 1.23–1.46）、肘窝外周静脉导管（HR 1.29） , 95% CI 1.16–1.44) 和 22/24 规格 (HR 1.27,

结论

确定的因素，包括血管通路团队插入的保护方面，以及与静脉注射抗生素相关的高导管失败率，将允许有针对性地更新外周静脉导管指南和护理模型。