Effect of vein imaging device use on first-attempt peripheral intravenous catheter insertion success and catheter complications in children: A randomized controlled trial.

To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in dogs hospitalized in the critical care unit (CCU). 107 dogs admitted to the CCU between October 2022 and March 2023. This prospective, observational clinical trial was performed at a single veterinary teaching hospital. Dogs hospitalized in the CCU for at least 24 hours were evaluated for enrollment. PIVC were placed following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. Median PIVC dwell time was 46.50 hours (range, 24.25 to 159.25 hours). Overall PIVC complication rate was 12.1% (13/107), with phlebitis (4/107 [3.7%]) and extravasation (4/107 [3.7%]) being the most frequently recorded complications. Multivariable analysis identified increasing length of hospitalization (LOH; OR, 1.43; 95% CI, 1.04 to 1.97; P = .029), an acute patient physiologic and laboratory evaluation full (APPLEFULL) score > 35 (OR, 4.66; 95% CI, 1.09 to 19.90; P = .038), and having 2 PIVCs placed at admission (OR, 10.92; 95% CI, 1.96 to 60.73; P = .006) as risk factors for PIVC complication. Increasing LOH, an APPLEFULL score > 35 and having 2 PIVCs placed at admission were associated with increased odds for PIVC complication in this study. Although these are independent risk factors for PIVC complication, the combination of increasing LOH, an APPLEFULL score > 35, and having 2 PIVCs placed at admission may represent a more severely ill population, drawing attention to a vulnerable group of dogs at risk for PIVC complication.

Factors affecting the patency and complications of peripheral intravenous catheters in newborns.

Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta analysis

The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study

To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in cats hospitalized in the critical care unit (CCU). 120 cats admitted to the CCU between October 2022 and September 2023. This prospective, observational study was performed at a single veterinary teaching hospital. Cats hospitalized in the CCU for ≥ 24 hours were evaluated for enrollment. Peripheral intravenous catheters were placed by trained personnel following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. Median PIVC dwell time was 42.25 hours (range, 24.25 to 164.25 hours). Overall PIVC complication rate was 18.3% (22/120), with extravasation (7/120 [5.8%]) and dislodgement (7/120 [5.8%]) being the most frequently recorded complications. Multivariable analysis identified that for each kilogram increase in body weight there is a higher likelihood of a PIVC complication (OR, 1.46; 95% CI, 1.03 to 2.05; P = .03). Additionally, use of a larger-gauge (20-gauge vs 22-gauge) PIVC is associated with a significantly lower likelihood of a PIVC complication (OR, 0.13; 95% CI, 0.03 to 0.56; P = .006). These results suggest that smaller-gauge (22-gauge) PIVCs and greater body weights are associated with an increased risk of complications in cats hospitalized in the CCU. When possible, a larger-gauge (20-gauge) PIVC should be placed in cats admitted to the CCU.

To determine whether the use of a force-activated separation device (FASD) lowers the incidence risk of peripheral intravenous catheter (PIVC) complications in hospitalized dogs. 367 dogs that were hospitalized and received IV fluids between January 11 and March 25, 2021. A prospective, randomized controlled clinical trial was performed. Dogs hospitalized and receiving IV fluids for at least 24 hours were randomized to the FASD group or control group. PIVCs were placed following a standardized protocol. Dogs in the FASD group had the FASD device attached to their PIVC according to manufacturer instructions. For both groups, all PIVC complications were documented, and each complication was classified as extravasation, phlebitis, dislodgement, occlusion, or line breakage. Results from 367 dogs (FASD group = 180, control group = 187) underwent analysis. The proportion of PIVC complications was significantly (P = .004) lower for the FASD group (8.9% [16/180]) versus the control group (24.6% [46/187]). Following adjustment for differences in hospitalization time, the odds of a dog in the FASD group having a PIVC complication was approximately one-third the odds of those in the control group (OR, 0.33; 95% CI, 0.17 to 0.63; P = .001). Results indicated that the use of a FASD in hospitalized dogs receiving IV fluids is warranted to lower the incidence of PIVC complications and may also limit patient discomfort, owner expense, and staff time devoted to managing PIVC complications. Further research investigating its use in cats and other species should be considered.

The SPECTRA study compared first-attempt success between ultrasound-guided and conventional peripheral intravenous catheter (PIVC) insertion. This subanalysis evaluated the control group results to determine the number of puncture attempts until successful or failed venous device insertion, stratified according to the Adult Difficult IntraVenous Access Scale (A-DIVA). Secondary analysis of the SPECTRA randomized clinical trial (RCT). Patients from the control group who underwent PIVC insertion without ultrasound guidance were included and stratified as high risk or low/moderate risk according to the A-DIVA. Statistical comparisons between the groups were conducted on the number of puncture attempts, insertion failures, catheter dwell time, and clinical outcomes related to PIVC insertion. Of all 84 patients analyzed, 35 were classified as high risk, and 49 as low/moderate risk; 53 (63.1%) were female, mean age 59 ± 16 years. The main reason for hospitalization was infection; high-risk patients experienced more punctures, with 20 (57%) undergoing four punctures, compared to only 8 (16%) of the low/moderate-risk group, p < 0.001; the overall success rate of PIVC insertion was 17 (48.5%) in high-risk patients versus 43 (88%) in low/moderate-risk patients. Insertion failure occurred in 18 (51.5%) high-risk versus 6 (12%) low/moderate-risk patients, p < 0.001; the high-risk group had a shorter PIVC dwell time: 3 (2-8) days versus 8 (2-8) days in low/moderate-risk group, p = 0.065; PIVC removal due to negative outcomes (obstruction, infiltration, accidental removal) was higher in high-risk patients: 32 (91%) versus 24 (49%), p < 0.001. Patients classified as high risk in the A-DIVA scale required more puncture attempts, had shorter PIVC dwell times, and experienced more negative outcomes. Using technologies such as ultrasound is beneficial for patients at high risk of failure on the first attempt.

The aim of the study is to identify the hospitalized children at risk of peripheral intravenous catheter (PIVC) complications by severity prediction. The study included the data of 301 hospitalized children with PIVC complications in 2 tertiary teaching hospitals. A researcher-designed tool was used to collect risk factors associated with PIVC complications. Predictors of PIVC complications at univariate analysis and multivariable logistic regression analysis by backward stepwise. A nomogram was constructed based on the results of the final multivariable model, making it possible to estimate the probability of developing complications. A total of 182 participants (60.5%) had a moderate injury from PIVC complications. Multivariable logistic regression analysis indicated that the vascular condition, limb immobilization, needle adjustment in venipuncture, infusion length, infusion speed, and insertion site were independent predictors. The nomogram for assessing the severity of PIVC complications indicated good predictive accuracy (area under the curve = 0.79) and good discrimination (concordance index = 0.779). Decision curve analysis demonstrated that the nomogram was a good clinical value with a wide range of threshold probabilities (4%-100%). The risk prediction model has good predictive performance, and the nomogram provides an easy-to-use visualization to identify the severity of PIVC complications and guide timely nursing care management.

In an era of pediatric emergency department (PED) overcrowding and diminishing health care resources, routine peripheral intravenous (PIV) catheter placement in the pediatric population requires evaluation because it might directly impact PED efficiency. This study aims to determine the utility of routine PIV catheter placement during phlebotomy. Electronic medical and billing records from 2 tertiary care PEDs during 1 year in patients 21 years or younger were analyzed. Data on the presence of PIV catheter placement in the PED, subsequent PIV catheter usage, chief complaint, and demographics were tabulated and analyzed. During the study period, there were 131,003 PED visits analyzed and 26,776 PIV catheters placed. Of those placed, 12,475 (47%) were not used. The median age of the patients who received a PIV catheter that was not subsequently used was 36 months. The frequency of unused PIV catheters correlates with lower initial triage acuity. The highest rate of unused PIV catheter was in those 1 to 6 months old (63%), followed by that in groups younger than 1 month (57%), older than 6 to 24 months (52%), and older than 24 months (41%). Nearly half of the PIV catheters placed in the PED were unused. Unused PIV catheters represent an inefficient use of limited resources that could be redistributed to improve ED efficiency, flow, and resource use.

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review.

This randomized controlled crossover study, conducted in a university hospital, aimed to compare the success of the first attempt at peripheral intravenous catheter (PIVC) insertion using 2 technologies of the visualization of veins in children at risk of difficult intravenous access (DIVA) guided by light-emitting diodes (LEDs) or infrared radiation (IR). The allocation of the type of technology initially used was determined by randomization. The primary outcome was successful insertion of the PIVC on first attempt. Data were analyzed using the McNemar test, paired t-test, and multiple logistic regression models. This crossover study included 143 children: 69 in Group A and 74 in Group B. The first-attempt PIVC insertion success rate with IR and LED was 65.2% and 44.9% in Group A and 55.4% and 50.0% in Group B, respectively, without statistical significance (P =.720). The results also showed that 51.5% of patients with difficult-to-see vessels (P =.022) and 49.8% with previous complications related to intravenous therapy (P =.008) had first-attempt PIVC insertion success using either transillumination device. The first-attempt PIVC insertion success was statistically similar between the groups. The device also assists in visualizing the veins in children at risk of DIVA.

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.

The objective of this study was to implement an evidence-based practice project to improve peripheral intravenous catheter (PIVC) insertion confidence and competence and to improve first-attempt success. The researcher used a blended online learning module and live simulation to increase PIVC insertion confidence and competence. Internal application of a blended curriculum model improved the first-attempt PIVC insertion success of nurses. A validated confidence assessment was completed by participants (n = 38) preintervention, immediately postintervention, and 30 days postintervention. A Mann-Whitney U test determined that nurses' confidence was significantly higher immediately following the intervention compared with preintervention (P = .003), and the increase was sustained 30 days after the intervention (P < .001). While placing a PIVC in simulation, the observer measured competence using a validated tool verifying 28 steps required, with a 76% success rate for all 28 steps. Nurses' self-reported first-attempt PIVC success increased significantly from the preintervention survey to the 30-day postintervention survey (P = .00004).

Impact of catheter dwell time on peripheral-venous-catheter-associated bloodstream infections.

ObjectivesThe aim of the present study was to identify patient, vein and operator factors associated with first-attempt success of peripheral intravenous catheter (PIVC) insertion in cats presenting to an emergency room.MethodsA prospective study was conducted in the emergency room of a university small animal hospital between February and April 2024. Cats requiring PIVC insertion were enrolled. Data collected included patient signalment, vein visibility and palpability, catheter size, indication for catheterization and operator characteristics (role, years of experience and estimated number of previous PIVC insertions). First-attempt success was defined as catheterization with visible blood flashback and successful flushing without extravasation or discomfort. Univariable and multivariable logistic regression analyses were performed to assess associations with first-attempt success.ResultsA total of 97 PIVC insertions in 95 cats were analyzed. Overall, first-attempt success was 85.6% (n = 83/97). Most insertions involved the cephalic vein (96.9%) and 22 G catheters (57.7%). Neither catheter size, target vein nor indication for insertion was significantly associated with success. Operators with 8–15 years of experience had significantly higher odds of success compared with those with 2 years or less (P = 0.03). Operators who had inserted more than 500 intravenous catheters had greater odds of success than those with fewer than 100 insertions (odds ratio [OR] 8.63, 95% confidence interval [CI] 1.48–50.12; P = 0.02). Vein visibility was strongly associated with first-attempt success (OR 7.78, 95% CI 2.29–26.42; P = 0.001), while palpability was not. In the final multivariable model, both vein visibility (OR 8.0, 95% CI 2.16–30) and more than 500 prior insertions (OR 13.24, 95% CI 1.54–144) remained independently associated with success.Conclusions and relevanceFirst-attempt intravenous catheter insertion success in cats was strongly influenced by operator experience and vein visibility. These findings highlight the clinical importance of operator training and vein assessment during catheter insertion in feline emergency patients.