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Published on: July 13, 2019
Factors affecting the patency and complications of peripheral intravenous catheters in newborns
Ju-Huei Tseng1, Ying-Fang Elaine Chen2, Sun-Peng Chang3
1Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
Insights
Intermittent flushing is better than continuous intravenous drip for maintaining pediatric peripheral intravenous catheters (PICs). Higher infusion rates increase PIC complications and reduce patency.
Area of Science:
- Neonatal and Pediatric Intensive Care
- Vascular Access Devices
- Clinical Pharmacy
Background:
- Peripheral intravenous catheters (PICs) are crucial for administering fluids, nutrients, and medications to pediatric patients.
- Accessing and maintaining PICs in young infants presents significant challenges.
- Identifying factors influencing PIC complications and patency is vital for improving infant care.
Purpose of the Study:
- To identify risk factors associated with complications and patency of peripheral intravenous catheters (PICs) in neonates and infants.
- To evaluate the impact of different maintenance methods and infusion parameters on PIC outcomes.
Main Methods:
- A retrospective cohort study analyzed 315 PICs inserted in neonates and infants (<4 months old).
- Variables included patient demographics, insertion site, maintenance methods (continuous intravenous drip [CIVD] vs. intermittent flushing), infusion rate, osmolarity, and antibiotic concentrations.
- Statistical analyses (binary logistic regression, general linear model) assessed the effects on PIC complications and lifespan.
Main Results:
- The overall complication rate for PICs was high (82.2%), with infiltration and leakage being most common.
- PIC patency was negatively correlated with infusion rate and significantly reduced by CIVD with hypertonic solutions compared to intermittent flushing.
- Increased patient age correlated with decreased complication risk, while increased infusion rate elevated complication risk.
Conclusions:
- Intermittent flushing is recommended over CIVD to enhance PIC patency in infants.
- Optimizing infusion rates and antibiotic concentrations (e.g., ampicillin <50 mg/dL) can mitigate PIC complications.
- Understanding these factors can improve the safety and efficacy of PIC use in pediatric populations.
Background:
Peripheral intravenous catheters (PICs) are necessary for medication, nutrient, and fluid administration in pediatric patients. However, PICs are uneasy to access and maintain in young infants. This study identified risk factors affecting the complications and patency of PICs.
Methods:
This retrospective cohort study included neonates and infants aged <4 months. All PICs inserted in the neonatal intensive care unit and intermediate care nursery were analyzed more than 5 months. The variables included gestational age, age and body weight at PIC insertion, insertion site, methods to maintain PIC patency (continuous intravenous drip [CIVD] versus intermittent flushing), fluid infusion rate and osmolarity, and ampicillin and cefotaxime concentrations. The effects of these variables on PIC complications and lifespan were assessed using binary logistic regression analysis and a general linear model, respectively.
Results:
In total, 315 PICs were analyzed. The mean indwelling time was 33.8 ± 21.5 h and complication rate was 82.2%. The most frequent complications were infiltration (55.9%) and leakage (22.2%). The infusion rate and method to maintain PICs significantly impacted PIC patency. A negative correlation was noted between the infusion rate and PIC patency, with the patency decreasing by 0.9 h (p = 0.047) on increasing the infusion rate by 1 mL/h. Notably, compared with intermittent flushing, CIVD using a hypertonic solution significantly decreased PIC patency by 14 h (p = 0.006). As the patients' age increased by a month, the complication risk decreased by 35% (p = 0.027). However, as the infusion rate increased by 1 mL/h, the complication risk increased by 17% (p = 0.018).
Conclusions:
Intermittent flushing may be preferred over CIVD to preserve PIC patency. An increased infusion rate is correlated with decreased PIC patency and increased complications. For the peripheral administration of ampicillin, we recommended preparing final concentrations below 50 mg/dL to prevent PIC complications.
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