Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study)

Hideto Yasuda,Kosuke Sekine,Taku Furukawa,Toru Hifumi,Toru Takebayashi,Takayuki Abe,Masahito Horiguchi,Masahiro Yoshida ,Takuya Shiga,Masami Inaba ,Rintaro Yano,Kenichiro Fujii,Yuki Kotani,Sarah Murakami,Izumi Nakayama,Maki Murata,Natsuki Kondo,Mikihiro Maeda,Kiyoyasu Kurahashi,Masaaki Sakuraya,Tetsuro Kamo,Masaki Nakane,Yuki Kishihara,Yoshihiko Hayashi ,Nobuaki Shime,Keita Morikane,Sachito Fukuda,Kohei Ota,Yusuke Yasumoto,Ryohei Yamamoto,Tomoaki Yatabe,Junki Ishii

doi:10.1186/s40560-020-00518-4

Abstract

BackgroundThe lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU).MethodsThis prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay.ResultsWe included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively.ConclusionPIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients.Trial registrationUMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

Highlights

The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures
PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% of patients (6.3 cases / 100 catheter-days)
In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% and 9.1, respectively

Summary

Introduction

The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. We aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU). Peripheral intravascular catheters (PIVCs) are the most commonly used invasive medical devices in the intensive care unit (ICU), but complications associated with PIVCs, such as phlebitis, often occur [1]. Other PIVC-related complications, such as accidental removal, occlusion, thrombosis, and PIVC-related infection, are problematic [5,6,7,8,9,10]. The occurrence of PIVC-related complications, including phlebitis, accidental removal, occlusion, thrombosis, and catheterrelated blood stream infection (CRBSI), is 20–50% [8, 17,18,19]. The external validity of these findings to the ICU population is questionable

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