Prospective Study of Incidence and Predictors of Peripheral IV Catheter–Induced Complications
Authors: Abolfotouh Mostafa , Salam Mahmoud , Mustafa Ala'a Bani , White David , Balkhy Hanan 
Published: July 2019

Background

Peripheral intravenous catheters (PIVs) are invasive catheters that may endure risks of clinical complications affecting health care outcomes and patient satisfaction. Patients requiring frequent PIV insertions due to an extended length of stay of one week or more would undergo multiple PIV pricks during their course of hospitalization. The combined factors of multiple PIV insertions and extended hospital stay make chronic patients especially at a higher risk for phlebitis and subsequently infection No studies in the literature review discussed the phlebitis rates and risks when toxic medications were infused using a peripheral catheter. The aim of this study was to determine the pattern and incidence of PIV complications among patients admitted to a tertiary care military health care facility in central region of Kingdom of Saudi Arabia. This was achieved through the following objectives: (1) Estimation of the cumulative incidence and incidence density for major PIV complications (catheter occlusion, dislodgment, infiltration, and phlebitis) during a period of 1 month, (2) Identification of significant risk factors for PIV complications such as patient related characteristics (gender, age, co-morbidities) or catheter related characteristics (catheter size, dressing, site of insertion, type of infusion, dwell times), and (3) Determination of the time line for the occurrence of various PIV complications.

Methods

An observational prospective cohort study investigated PIV pattern and complications among 359 adults with 842 PIV catheters, admitted to various wards at KAMC with a total of 2505 catheter days. Data on patient characteristics (age, gender, and health complaints) and PIV characteristics (Catheter size, duration, insertion site, nature of PIV infusate, and type of dressing) was collected. PIV catheters-related clinical outcomes (Pain, Phlebitis, leaking and others) were recorded on 12–hour intervals, using the Visual Inspection Phlebitis (VIP) scale. Phlebitis was defined as the presence of two or more signs of pain, tenderness, warmth, erythema, swelling, or a palpable cord, with or without purulent drainage from the catheter insertion site. Infusion Phlebitis scale can range from (0), indicating no symptoms of phlebitis, to (5), with signs of purulent drainage, redness, and a palpable cord greater than 3 inches. Infiltration was defined as permeation of intravenous fluid into the interstitial compartment, causing swelling of the tissue around the site of the catheter. All PIV catheters were changed for a score of 2 or more, determined by the presence of a cold/warmth skin region around the insertion site, pain, redness, and/or edema extending from 1 to 2 inches above the PIV site. Incidence density (DI) and cumulative incidence (CI) of complications were calculated. Regression analyses were applied to determine the significant predictors of complications. Significance limits were set at P < 0.05.

Results

One half of all patients were 65 years and above, with no significant sex difference. The majority of patients (76.88%) had medical chief admission complaints, whereas (51.53%) were admitted in cardiac wards. Complicated catheters were found in 141(39.3%) patients, with 273 complications (32.4/100 catheters), 190 complicated catheters (CI =  22.56/100 catheters & DI =  75.84/1000 catheter days). Phlebitis ranked first among complications, with a CI of (17.58%), followed by pain (7.60%), leaking (3.92%) and dislodgement (2.38%), and extravasations and occlusion (0.48% each). When the analysis was based on failure per 1000 device days, and after adjusting for all possible confounders, female gender remained as a significant predictor of higher incidence of overall complications (p = 0.00001), phlebitis (p = 0.000003) as well as other complications (p = 0.0.0003). Insertion in fore/upper arm was a significant predictor of both phlebitis (0.024) and other complications (0.049), while medical infusion was a significant predictor of phlebitis (0.02) and overall complications (0.006).

Conclusion

Incidence of complications in this study is comparable with figures in previous studies, however, better insertion techniques may be sought to lower the incidences of PIV complications, thus extending their onset beyond day 3. Changing catheters is recommended when clinically indicated rather than routinely post 72 hours of insertion which in return minimizes the frequency of insertions per patient and subsequently complications.