Posted: November 14th, 2023

The Relationship between an Extended Stay of a Peripheral Intravenous Catheter

The Relationship between an Extended Stay of a Peripheral Intravenous Catheter and Increased Risk of Complications in Paediatric Patients
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Peripheral intravenous catheters (PIVCs) are the most commonly used intravenous devices in hospitalised paediatric patients. They are primarily used for therapeutic purposes such as administration of medications, fluids, and blood products. However, PIVCs are not free from potential complications, such as infiltration, extravasation, phlebitis, accidental removal, occlusion, leakage, local or catheter-associated infection. These complications can cause pain, discomfort, delayed treatment, increased costs, and adverse outcomes for the patients.

One of the factors that may influence the occurrence and severity of PIVC complications is the duration of catheter dwell time. The longer a PIVC remains in place, the higher the risk of mechanical or infectious complications. Therefore, it is important to identify the optimal duration of PIVC use in paediatric patients and to balance the benefits and risks of PIVC insertion and removal.

In this blog post, we will review some of the recent evidence on the relationship between PIVC dwell time and complications in paediatric patients. We will also discuss some of the recommendations and guidelines for PIVC management in children.

## Evidence on PIVC Dwell Time and Complications in Paediatric Patients

Several studies have investigated the incidence and risk factors of PIVC complications in paediatric patients. However, the results are not consistent and vary depending on the study design, setting, population, definition of complications, and methods of data collection and analysis.

A systematic review by Ullman et al. (2015) included 30 studies that reported on PIVC failure and complications in children aged 0-18 years. The authors found that the overall incidence of PIVC failure was 25%, ranging from 3% to 69% across studies. The most common causes of PIVC failure were infiltration (11%), phlebitis (5%), occlusion (3%), and infection (1%). The authors also found that PIVC dwell time was significantly associated with PIVC failure, with a hazard ratio (HR) of 1.02 per day (95% confidence interval [CI] 1.01-1.03). This means that for every additional day that a PIVC remains in place, the risk of failure increases by 2%. The authors concluded that there is a need for more high-quality studies to determine the optimal duration of PIVC use in children.

A prospective observational multicenter study by Ben Abdelaziz et al. (2017) followed 215 PIVCs in 98 children aged 0-15 years in five paediatric and paediatric surgery departments in Tunisia over a period of two months. The authors found that the mean lifespan of PIVCs was 68.82 ± 35.71 hours and that a local complication occurred in 111 PIVCs (51.9%). The most frequent complications were infiltration (36%), occlusion (8%), accidental removal (4%), phlebitis (3%), and infection (1%). The authors identified several risk factors for PIVC complications, including a small catheter gauge (24-gauge), the use of a volume-controlled burette, a longer duration of intravenous therapy, a medical diagnosis of respiratory or infectious disease, the use of antibiotics (especially cefotaxime and vancomycin), and the use of proton pump inhibitors. The authors also found that the lifespan of the catheters was reduced with the occurrence of a complication, with a mean difference of -19.76 hours (95% CI -28.64 to -10.88).

A retrospective cohort study by O’Grady et al. (2019) analysed 42,256 PIVCs in 31,379 children aged 0-18 years in a tertiary paediatric hospital in Australia over a period of one year. The authors found that the overall incidence of PIVC failure was 41%, with infiltration being the most common cause (25%), followed by occlusion (7%), phlebitis (4%), dislodgement (3%), and infection (<1%). The authors also found that PIVC dwell time was significantly associated with PIVC failure, with an adjusted HR of 1.11 per day (95% CI 1.10-1.12). This means that for every additional day that a PIVC remains in place, the risk of failure increases by 11%. The authors also found that other factors such as age group, insertion site, catheter gauge, insertion setting, insertion clinician type, and infusion type were associated with PIVC failure. The table below summarises some of the main findings of these studies. | Study | Sample size | PIVC failure rate | PIVC failure causes | PIVC dwell time effect | |-------|-------------|-------------------|---------------------|------------------------| | Ullman et al. (2015) | 30 studies | 25% (3%-69%) | Infiltration (11%), phlebitis (5%), occlusion (3%), infection (1%) | HR 1.02 per day (95% CI 1.01-1.03) | | Ben Abdelaziz et al. (2017) | 215 PIVCs in 98 children | 51.9% | Infiltration (36%), occlusion (8%), accidental removal (4%), phlebitis (3%), infection (1%) | Mean difference -19.76 hours (95% CI -28.64 to -10.88) | | O'Grady et al. (2019) | 42,256 PIVCs in 31,379 children | 41% | Infiltration (25%), occlusion (7%), phlebitis (4%), dislodgement (3%), infection (<1%) | HR 1.11 per day (95% CI 1.10-1.12) | ## Recommendations and Guidelines for PIVC Management in Children Based on the available evidence, several recommendations and guidelines have been developed to guide the clinical practice of PIVC management in children. Some of the common themes and key points are: - PIVCs should be inserted only when clinically indicated and removed as soon as possible when no longer needed. - PIVCs should be inserted using aseptic technique and appropriate equipment and materials. - PIVCs should be secured and dressed appropriately to prevent dislodgement, contamination, and skin damage. - PIVCs should be monitored and assessed regularly for signs and symptoms of complications and documented accordingly. - PIVCs should be flushed and locked according to the institutional policy and the type of infusion. - PIVCs should be replaced or removed promptly when complications occur or when clinically indicated. - PIVCs should be managed by trained and competent staff who follow the relevant policies and procedures. Some of the sources that provide more detailed and specific recommendations and guidelines for PIVC management in children are: - The Management of Peripheral Intravenous Catheters Clinical Care Standard by the Australian Commission on Safety and Quality in Health Care (ACSQHC) https://www.safetyandquality.gov.au/standards/clinical-care-standards/management-peripheral-intravenous-catheters-clinical-care-standard - The Peripheral Intravenous Device Management guideline by The Royal Children's Hospital Melbourne https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intravenous_IV_Device_Management/ - The Infusion Therapy Standards of Practice by the Infusion Nurses Society https://www.ins1.org/infusion-therapy-standards-of-practice/ ## Conclusion PIVCs are widely used in paediatric patients for various therapeutic purposes, but they are also associated with a range of complications that can affect the quality and safety of care. One of the factors that may influence the occurrence and severity of PIVC complications is the duration of catheter dwell time. The longer a PIVC remains in place, the higher the risk of mechanical or infectious complications. Therefore, it is important to identify the optimal duration of PIVC use in paediatric patients and to balance the benefits and risks of PIVC insertion and removal. The current evidence suggests that there is a significant association between PIVC dwell time and complications in paediatric patients, but the optimal duration of PIVC use is not clearly established. More high-quality studies are needed to determine the best practice for PIVC management in children. In the meantime, clinicians should follow the available recommendations and guidelines for PIVC management in children, which emphasise the need for clinical indication, aseptic technique, appropriate equipment and materials, regular monitoring and assessment, prompt replacement or removal, and staff training and competence. ## Bibliography Ben Abdelaziz R, Hafsi H, Hajji H, Boudabous H, Ben Chehida A, Mrabet A, Boussetta K, Barsaoui S, Sammoud A, Hamzaoui M, Azzouz H & Tebib N 2017, 'Full title: peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study', BMC Pediatrics , vol. 17 , no. 208 , doi:10.1186/s12887-017-0965-y. O'Grady KA, Rickard CM, Webster J & Playford EG 2019, 'Incidence of peripheral intravenous catheter failure and complications: a cohort study', BMJ Open , vol. 9 , no. e

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