Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study.

Abstract

Children and their families have reported peripheral intravenous catheter (PIVC) insertion as the most stressful part of their emergency department (ED) encounter, with some enduring multiple attempts without a successful insertion. The purpose of this study was to identify factors associated with abandonment of paediatric PIVC insertion. A retrospective cohort study was conducted at the Gold Coast University Hospital. All patients 16 years of age and younger, presented in 2019 with a PIVC insertion attempted in the ED were eligible. The electronic medical records were screened by two reviewers to identify those who required a PIVC insertion. Logistic regression analysis was performed to assess variables associated with PIVC insertion abandonment. Of 6394 records screened, 2401 (8.3%) had a PIVC insertion attempted, with 99 (4.1%) being abandoned. Age <12 months was the strongest predictor of PIVC abandonment at a rate of 11.3% (38/336), with a >10-fold increased risk for infants less than 3 months old and 3-12 months old; adjusted odds ratio (95% confidence interval) 12.4 (5.1-30.2) and 14.8 (5.8-37.4), respectively. Indications of 'infection' or 'rehydration' were associated with a decreased likelihood of abandonment when compared to 'investigation only' in multivariate modelling (odds ratio (95% confidence interval): 0.181 (0.099-0.332) and 0.262 (0.100-0.686), respectively). This study suggests the rate of PIVC insertion abandonment in children is relatively infrequent. However, more than one in 10 children aged <12 months had PIVC attempts without successful insertion. PIVC abandonment was less likely when there was an indication that necessitated PIVC insertion, such as a serious bacterial infection.