Impact on peripheral catheter failure with the use of an extension set with integrated needleless connector compared...

Failure of peripheral intravenous catheters (PIVCs) is a significant clinical issue. Evidence is needed on the impact of different PIVC systems on outcomes.

To analyse the effect of add-on extension sets with integrated connectors on PIVC outcomes in real-world practice.

A prospective, open-label, quasi-experimental study with a blinded analyst was conducted at a tertiary hospital in Barcelona, Spain, comparing two PIVC systems. The control system (standard winged PIVC with add-on needleless connector) was evaluated from 1^st March to 6^th April 2022, and the study system (with add-on extension set and integrated needleless connector) was evaluated from 9^th September to 14^th December 2023. The primary endpoint was overall PIVC failure per 1000 PIVC-days, analysed as relative rate.

In total, 1019 PIVCs (607 patients) in the control group and 1028 PIVCs (634 patients) in the study group were followed. Groups had similar length of hospital stay, dwell time, and mortality. Patients in the study group were more likely to have heart disease and chronic obstructive pulmonary disease, and to be physically restrained. Overall, 795 (39.7%) PIVCs failed, a rate of 86.0 per 1000 PIVC-days. The most common reasons for unplanned removal were extravasation (10.6%), occlusion (8.1%), accidental removal (7.7%), phlebitis (7.4%) and discomfort (5.5%). PIVC failure was significantly lower in the study group compared with the control group (37.2% vs 42.1%; P=0.025). Failure per 1000 PIVC-days showed a non-significant reduction (rate ratio 0.89; 95% confidence interval 0.77-1.03).

PIVC failure remains high. PIVCs with an add-on extension set and integrated needleless connector did not show a significant reduction in failure rate.