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Peripheral intravenous catheter duration and failure in paediatric acute care: A prospective cohort study
Lorelle Malyon1, Amanda J Ullman, Natalie Phillips
1Department of Emergency Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Queensland, Australia; Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
Insights
High failure rates were observed for paediatric peripheral intravenous catheters (PIVCs), with infiltration being the most common cause. PIVC placement in the antecubital fossa increased failure risk, suggesting a need to minimize its use.
Area of Science:
- Medical Device Securement
- Paediatric Acute Care
- Intravenous Therapy
Background:
- Peripheral intravenous catheters (PIVCs) are essential for treating children in hospitals.
- Current practices for PIVC securement and dressing in paediatric acute care are not well-documented.
- Understanding PIVC duration and failure is crucial for optimizing patient care.
Purpose of the Study:
- To investigate current practices in PIVC securement and dressing in paediatric acute care.
- To determine the duration and failure rates of PIVCs in children.
- To identify factors associated with PIVC failure.
Main Methods:
- Prospective cohort study at a major Australian children's hospital.
- Inclusion of patients aged 0-15 years requiring PIVC insertion during emergency admission.
- Data collection on PIVC duration, failure modes, securement, and dressing.
Main Results:
- Median PIVC duration was 29 hours; 24.8% of devices failed.
- Infiltration (14.3%) and accidental dislodgement (5.0%) were the most frequent failure modes.
- PIVC placement in the antecubital fossa was linked to increased failure risk (P=0.03).
Conclusions:
- Observed PIVC failure rates are high, with no established benchmark for acceptability.
- Many PIVCs remained in place longer than necessary.
- Minimizing antecubital fossa PIVC placement is recommended to reduce paediatric PIVC failure.
Objective:
Children admitted to hospital commonly require peripheral intravenous catheters (PIVCs) for treatment. This study sought to address a gap in the literature about current practice in the securement and dressing of PIVCs in paediatric acute care, and to ascertain the duration and failure of these devices.
Methods:
A prospective cohort study conducted at the Royal Children's Hospital in Queensland, Australia. All patients aged 0-15 years, who presented to the ED between 16 July and 16 October 2012, and had a PIVC inserted prior to emergent admission to the hospital were included.
Results:
Of 458 participants, median device duration was 29 h (IQR 13-58 h), and ranged from less than 1 h to 16 days. One quarter (113/456, 24.8%) of PIVCs were removed due to device failure, presenting as: infiltration (65/456, 14.3%); accidental dislodgement (23/456, 5.0%); blockage (12/456, 2.6%); phlebitis (7/456, 1.5%); or 'other' (6/456, 1.3%). PIVC securement and dressings were predominantly bordered polyurethane dressings and splints (n = 457/458, 99.8%). PIVC placement in the antecubital fossa, in comparison to the hand, was significantly associated with an increased risk for failure (P = 0.03). No other patient and device characteristics had a significant association with device failure (P > 0.05). The median dwell time of PIVCs that failed was significantly longer than the PIVCs that did not fail (44.0 vs 25.5 h; P = 0.002). Less than half (53/113, 46.9%) of failed catheters were replaced with a new PIVC.
Conclusions:
Observed failure rates were high for a clinically essential device; however, there is no established rate of acceptability against which the results can be benchmarked against to facilitate effectiveness of practice. Many PIVCs appeared to remain in place longer than needed. Dressing and securement practice was homogenous. PIVC placement in the antecubital fossa should be minimised to reduce the risk of paediatric PIVC failure.
