1. Figure 1. Onset of PIV catheter complications
Mostafa A. Abolfotouh1, Mahmoud Salam1, David White2,
Hanan Balkhy3
1King Abdullah International Medical Research Center (KAIMRC), King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, 2 Nursing department &
3Infection control department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Peripheral Intravenous Catheters: Pattern and complications in Saudi adults
Table 1. Summary of study results
Introduction
Results
Gender: Males = 56.8% vs females = 43.2%.
Dressing type: Transparent = 82.7%. Catheter size: G20-22= 74.3%
Infusate type: hydration = 45.9% , other therapies combined = 47.63%.
Insertion sites: hand/wrist area=60.9% and mid/upper arm=39.1%.
Incidence of complications: About 40% of patients showed one or more complications( Phlebitis=54.1%, pain=23.4%, and leaking=12.1%) with an average mean time of onset of , , and hours respectively, Figure 1. Incidence density (DI):75.84/1000 catheter days., Cumulative incidence (CI): 22.56/100 catheters.
Predictors of complications: By applying logistic regression, female gender (P= ) and medication infusions (P=0.006) were the only significant predictors of general PIV complications. Female groups (p= ), upper arm areas (p=0.024), and medication infusions (p=0.02) were significant predictors of phlebitis.
There was a positive linear relationship between the frequency of insertions per patient and occurrence of complications (p<0.001), Figure 2.
No significant difference in the outcomes between catheters changed 3 days versus 4days post insertion (19.7% versus 19.8%, p=0.977).
Number of patients
359 patients
Number of PIV catheters
842 catheters
Total Catheter duration (days)
2505 days
Number of complications
273 complications
Number of patients with complications
141/359 (39.3%) patients
Number of complicated catheters
190/842 (22.6%) catheters
Cumulative incidence (%)
22.56 catheters per 100 catheters
(95%CI=19.87 – 25.51)
Incidence density by patient (per 1000 catheter days)
56.28 patients per 1000 catheter days
(95%CI= )
Incidence density by catheter (per 1000 catheter days)
75.84 catheters per 1000 catheter days
(95%CI=66.10–86.80)
Peripheral Intravenous Catheter (PIV) insertion is a commonly performed procedure in hospitalized patients1. PIVs are invasive catheters that may endure risks of clinical complications affecting health care outcomes and patient satisfaction 2.
It is estimated that in the UK, 20-80% of patients with PVC develop phlebitis.3 It is essential for nurses to be able to identify patients who are at risk of phlebitis.
The aim of this study was to assess the pattern and complications of PIV catheters at King Abdulaziz Medical City (KAMC), Riyadh, KSA.
Fig 2. Response degrees of overall perception
Methodology
Figure 1. Onset of PIV catheter complications
Timeline in days
Study Design. An observational prospective cohort study investigated PIV pattern and complications among 359 adults with 842 PIV catheters, admitted to various wards at KAMC.
Data Collection. Patient characteristics (age, gender, and health complaints) and PIV characteristics (Catheter size, duration, insertion site, infusates, dressing) were investigated for their clinical outcomes (Pain, Phlebitis, leaking and others) on 12-hour intervals, using an internationally adopted and validated tool 3.
Data Analysis. Descriptive and analytic statistics were applied to determine the significant predictors of complications. Incidence density (DI) and cumulative incidence (CI) of complications were calculated. Significance limits were set at P <0.05.
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.
References
Todd, J. (1999). Peripherally inserted central catheters and their use in IV therapy. British Journal of Nursing
Maki, D., Kluger, D., & Crnich, C. (2006). The Risk of Bloodstream Infection in Adults with Different Intravascular Devices: A Systematic Review of 200 Published Prospective Studies. Mayo Foundation for Medical Education and Research. 81(9):
Gallant & Schultz (2006). Evaluation of a Visual Infusion Phlebitis Scale for Determining Appropriate Discontinuation of Peripheral Intravenous Catheters. Journal of Infusion Nursing
days
Figure 2. Impact of frequent PIV catheter insertions on incidence of complications.