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Published on: July 13, 2019
Predicting factors for complications in peripheral intravenous catheters in the pediatric population
Ortal Resnick1, Wiessam Abu Ahmad2, Daniel Bancovsky1
1Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel.
Insights
Peripheral intravenous catheter (PIVC) complications in children depend on gauge, age, and insertion site. Infants benefit from smaller gauges (≤24G), while older children (1-6 years) do better with larger gauges (≥22G).
Area of Science:
- Pediatric Medicine
- Medical Devices
- Clinical Research
Background:
- Peripheral intravenous catheters (PIVCs) are crucial for pediatric care.
- Understanding factors influencing PIVC complications is essential for patient safety.
- Previous research has not fully characterized the impact of PIVC gauge and insertion site on complications in diverse pediatric age groups.
Purpose of the Study:
- To investigate the association between peripheral intravenous catheter (PIVC) gauge, patient age, insertion site, and complication incidence in pediatric patients.
- To identify risk factors contributing to PIVC-related complications.
- To provide evidence-based recommendations for optimal PIVC selection and placement in children.
Main Methods:
- A prospective study conducted at Hadassah Medical Center, Jerusalem, involving 113 children and 132 PIVCs.
- Daily evaluation of PIVCs in pediatric inpatients.
- Data collection on PIVC gauge, insertion site, patient age, and observed complications.
Main Results:
- Complications were observed in 40.9% of PIVCs, with dislodgement being the most frequent.
- Higher complication rates were noted for lower limb (60%) and external jugular vein (100%) insertions (p=0.002).
- Infants (<12 months) had higher complication rates with 22G or larger PIVCs (58.7% vs 27.5%; p=0.05), while children aged 1-6 years experienced more complications with PIVCs smaller than 24G (p=0.004). Patients with comorbidities also had a higher complication rate (p=0.003).
Conclusions:
- Comorbidities and non-upper limb insertion sites are significant risk factors for PIVC complications in children.
- For infants, PIVCs of 24G or smaller are recommended to minimize complications.
- For children aged 1-6 years, 22G or larger PIVCs demonstrate superior outcomes regarding complication rates.
Aim:
To characterise the association between peripheral intravenous catheter (PIVC) gauge (G), the patient's age, insertion site and complication incidence.
Methods:
This prospective study was performed in Hadassah Medical Center, Jerusalem, Israel, between June 2018 and March 2019. Children with PIVC admitted to the paediatric departments were included. PIVCs were evaluated daily.
Results:
A total of 113 children with 132 PIVCs were included in the study. The most common site of insertion was the antecubital fossa (43.9%). PIVCs were most commonly used for intravenous (IV) antibiotics (46.6%). Complications were observed for 40.9% PIVCs. Dislodgement was the most common complication. The complication rate was higher for the lower limbs (60%) and external jugular veins (100%) p = 0.002. In infants younger than 12 months, the complication rate was higher for 22 G PIVCs or larger (58.7% versus 27.5%; p = 0.05). In contrast, for the 1-6 years age group, PIVCs smaller than 24 G had a higher complication rate (p = 0.004). Patients with comorbidities had a higher complication rate (p = 0.003).
Conclusion:
Risk factors for complications are comorbidities and sites of insertion other than the upper limbs. In infants, 24 G PIVC or smaller should be inserted, whereas 22 G PIVC or larger are superior for 1- to 6-year-old children.
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