Impact of the failure of initial insertion of a peripheral intravascular catheter on the development of adverse events in patients admitted to the intensive care unit from the emergency room: A post hoc analysis of the AMOR-VENUS study.

Abstract

To investigate an association between failure of initial peripheral intravascular catheter (PIVC) insertion and adverse events in patients admitted to the intensive care unit (ICU) from the emergency room (ER). This study was a post hoc analysis of the AMOR-VENUS study, a multicenter cohort study that included 22 institutions and 23 ICUs in Japan between January and March of 2018. Study participants included consecutive adult patients admitted to the ICU with PIVCs inserted in ICU during the study period exclusively from the ER. The primary outcome was adverse events. Adverse events were composite of arterial puncture, hematoma, extravasation, nerve injury, tendon injury, compartment syndrome, pain, redness, bad location, and effusion. Multivariate logistic regression analyses were performed to assess the association between adverse events and the failure of initial PIVC insertion. In total, 363 patients and 1121 PIVCs were analyzed. Moreover, 199 catheters failed to insert properly, and 36 patients and 107 catheters experienced adverse events. After performing multivariate logistic regression analysis, there were statistically significant associations in the odds ratio (OR) and 95% confidence interval (CI) for the failure of initial insertion (OR, 1.66 [1.02-2.71]; p = 0.04). Failure of initial insertion may be a risk factor for adverse events. We could potentially provide various interventions to avoid failure of initial PIVC insertion. For example, PIVC insertion could be performed by experienced practitioners.