Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial

Wallis, Marianne C., McGrail, Matthew, Webster, Joan, Marsh, Nicole, Gowardman, John, Playford, Geoffrey and Rickard, Claire M. (2014) Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infection Control and Hospital Epidemiology, 35 1: 63-68. doi:10.1086/674398

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Author Wallis, Marianne C.
McGrail, Matthew
Webster, Joan
Marsh, Nicole
Gowardman, John
Playford, Geoffrey
Rickard, Claire M.
Title Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial
Journal name Infection Control and Hospital Epidemiology   Check publisher's open access policy
ISSN 0899-823X
1559-6834
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1086/674398
Open Access Status File (Publisher version)
Volume 35
Issue 1
Start page 63
End page 68
Total pages 6
Place of publication New York, NY, United States
Publisher Cambridge University Press
Language eng
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).
Formatted 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.
Keyword Public, Environmental & Occupational Health
Infectious Diseases
Public, Environmental & Occupational Health
Infectious Diseases
INFECTIOUS DISEASES
PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, SCI
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Electronically published: 2 December 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Created: Wed, 15 Jan 2014, 00:08:58 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work