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Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters
Amanda J Ullman1, Mari Takashima2, Tricia Kleidon3
1Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Queensland Children's Hospital, South Brisbane, Queensland, Australia.
Insights
Global pediatric peripheral intravenous catheter (PIVC) practices show significant inconsistencies, potentially leading to patient harm. Improvements in PIVC insertion, dressing, and catheter size selection are crucial for better outcomes.
Area of Science:
- Pediatrics
- Vascular Access
- Infection Control
Background:
- Peripheral intravenous catheters (PIVCs) are essential for pediatric care.
- Global variations in PIVC practices may impact patient safety and outcomes.
- Understanding these variations is key to developing standardized, evidence-based guidelines.
Purpose of the Study:
- To characterize worldwide practices related to pediatric PIVCs.
- To identify performance metrics and risk factors associated with pediatric PIVC use.
- To highlight global inconsistencies in pediatric PIVC management.
Main Methods:
- Secondary analysis of a global, cross-sectional study involving pediatric patients (<18 years).
- Data collected on PIVC demographics, diagnostics, utility, management, performance, and resources.
- Multivariate regression analysis was used to identify risk factors for PIVC complications.
Main Results:
- Data from 4206 children across 47 countries revealed significant regional differences in PIVC insertion practices, catheter gauges, and insertion sites.
- Most PIVCs outside Australia/New Zealand were inserted by nurses, with dedicated teams rare globally.
- Poor dressing integrity and prolonged dwell times were significant risk factors for PIVC complications.
Conclusions:
- There is substantial global inconsistency in pediatric PIVC practices.
- These variations in practice, including catheter size and dressing management, may contribute to patient harm.
- Enhancements in pediatric PIVC placement techniques, dressing protocols, and catheter gauge selection are urgently needed.
Purpose:
To describe worldwide characteristics, performance and risk factors of peripheral intravenous catheters (PIVCs), in pediatrics.
Design:
A secondary, subgroup analysis of pediatric (<18 years) data was undertaken, using a global, cross-sectional study of PIVCs. Practice characteristics included: demographic, diagnostic, utility, management, performance and resources. Multivariate regression identified complication risks factors.
Results:
Data from 4206 children in 278 hospitals across 47 countries. Most PIVCs (outside of Australia, New Zealand) were inserted by nurses (71%; n = 2950), with dedicated teams only common in North America (23.2%; n = 85). Large gauges (≤18G) were mostly used in South America, Europe and Africa. Regions predominantly placed 24G (49%; n = 2060) except in Australia and New Zealand, who more commonly placed 22G (38.7%; n = 192). The most common placement was the hand (51%; n = 2143), however North America, Australia and New Zealand frequently utilised the antecubital fossa (24.5%, n = 90; 21.4%; n = 106). Polyurethane dressings were most used (67.1%; 2822), and many were not clean, dry and intact (17.1%; n = 715). Over 8% of PIVCs were idle, with the highest rates in North America (21.2%; n = 78). PIVC local complication risk factors included: >2 years age (odds ratio [OR] > 1.58; 1.2-2.1); ambulance/emergency insertion (OR 1.65; 1.2-2.3); upper arm/antecubital placement (OR 1.44; 1.1-2.0); poor dressing integrity (OR 5.4; 4.2-6.9); and 24-72 h dwell (OR > 1.9; 1.3-2.6).
Conclusions:
There is global inconsistency in pediatric PIVC practice, which may be causing harm.
Clinical Implications:
Improvements in pediatric PIVC placement, dressings, and gauge selection are needed.
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