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Factors associated with intraoperative intravenous catheter extravasation in children
Marc D Mecoli1, Lili Ding2, Gang Yang2
1Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.
Insights
Peripheral intravenous extravasation in children during surgery is rare (0.06%). Higher risk is linked to patient health status, inpatient procedures, and ultrasound-guided catheter placement.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
- Medical Device Complications
Background:
- Peripheral intravenous (PIV) catheters are crucial for intraoperative fluid and medication delivery in pediatric patients.
- Extravasation injuries, though infrequent, can lead to significant patient harm.
- Understanding risk factors for PIV extravasation during surgery is essential for developing preventative strategies.
Purpose of the Study:
- To determine the incidence of peripheral intravenous extravasation in pediatric patients during the intraoperative period.
- To identify factors associated with the occurrence of PIV extravasation in this population.
- To inform the development of mitigation strategies to reduce PIV extravasation events.
Main Methods:
- Retrospective study of 56,777 pediatric patients undergoing general anesthesia and PIV placement.
- Data collection included patient demographics, American Society of Anesthesiologists Physical Status Classification, cannulation details, and surgery characteristics.
- Peripheral intravenous extravasation was the primary outcome, assessed using a standardized tool.
Main Results:
- An overall incidence of significant PIV extravasation was 0.06% (1 in 1620 venous catheters).
- Factors significantly associated with PIV extravasation included higher American Society of Anesthesiologists Physical Status Classification (3-5 vs. 1-2), inpatient versus outpatient surgeries, and ultrasound-guided PIV placement.
- Ultrasound guidance was associated with an 8-fold increased odds of extravasation (OR 8.01).
Conclusions:
- Intraoperative peripheral intravenous extravasation in pediatric patients is uncommon but associated with specific risk factors.
- Higher patient acuity, inpatient status, and ultrasound-guided PIV placement are linked to increased extravasation risk.
- Findings can guide the development of targeted interventions to minimize harm from PIV extravasation in pediatric surgical patients.
Abstract:
SummaryThis retrospective study aimed to determine the incidence of and factors associated with peripheral intravenous extravasation in paediatric patients in the intraoperative setting. We conducted a retrospective study of 56,777 patients who underwent general anaesthesia and had peripheral intravenous catheter placement at Cincinnati Children's Hospital between 1 January 2015 and 1 January 2017. Data collected included age, American Society of Anesthesiologists Physical Status Classification, catheter site, number of cannulation attempts, ultrasound use for cannulation, surgery duration, and surgery class. Primary outcome was peripheral intravenous extravasation using an extravasation assessment tool. Some 64,814 peripheral venous catheters were placed in patients undergoing general anaesthesia. Significant extravasation was documented in 40 catheters with an estimated incidence of 1 in 1620 venous catheters (0.06%). Of those 40 catheters, 47.5% (n = 19) were placed using ultrasound and 37.5% (n = 15) required more than one cannulation attempt. In multivariable analysis, peripheral intravenous catheter extravasation was associated with American Society of Anesthesiologists Physical Status Classification (3, 4, 5) versus (1, 2) (odds ratio 2.42 (95% CI 1.08 to 5.41)), inpatient versus outpatient surgeries (odds ratio 2.99 (95% CI 1.31 to 6.81)), and intravenous catheters placed with ultrasound guidance (odds ratio 8.01 (95% CI 4.12 to 15.57)). Our study identified factors associated with intraoperative peripheral intravenous extravasation, and will help develop mitigation strategies to minimise harm to patients.
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