Intravenous Infiltration Risk by Catheter Dwell Time Among Hospitalized Children

Area of Science:

• Pediatric nursing
• Intravenous therapy
• Patient safety

Background:

• Peripheral intravenous (IV) catheters are essential for administering fluids and medications in pediatric patients.
• Catheter-related complications, such as infiltration, can lead to patient discomfort, delayed treatment, and increased healthcare costs.
• Understanding the risk factors and temporal trends of IV infiltration is critical for optimizing patient care.

Purpose of the Study:

• To investigate the cumulative risk of peripheral IV catheter infiltration in pediatric patients.
• To identify general and catheterization-specific characteristics associated with increased infiltration risk over IV catheter dwell time.

Main Methods:

• Secondary data analysis of 1596 pediatric patients receiving peripheral IV therapy.
• Kaplan-Meier survival analysis was used to determine infiltration risk over catheter dwell time.
• Data collected from an academic medical center in South Korea between August and October 2011, and June 2013.

Main Results:

• The cumulative risk of infiltration rapidly increased from 1.5% at 24 hours to 17.3% at 96 hours of dwell time.
• Significantly higher infiltration risks were observed in surgical departments, lower extremities, and with the use of 10% dextrose, ampicillin/sulbactam, vancomycin, high-concentration electrolytes, and phenytoin.
• Risk factors included patient characteristics and specific infusates.

Conclusions:

• Cumulative infiltration risk escalates significantly after 24 hours, particularly with certain medications like 10% dextrose, high-concentration electrolytes, and phenytoin.
• Patients with identified risk factors face a higher cumulative risk of infiltration at similar dwell times.
• Enhanced, hourly monitoring of IV sites is recommended after 24 hours, especially when infusing irritants, to ensure safer IV therapy practices in pediatric patients.