Predisposing factors for peripheral intravenous puncture failure in children

Daniela Cavalcante De Negri,Solange Andreoni,Ariane Ferreira Machado Avelar,Mavilde Da Luz Gonçalvez Pedreira

doi:10.1590/s0104-11692012000600009

Daniela Cavalcante De Negri, Solange Andreoni + Show 2 more

Open Access

https://doi.org/10.1590/s0104-11692012000600009

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Abstract

To identify predisposing factors for peripheral intravenous puncture failure in children. Cross-sectional cohort study conducted with 335 children in a pediatric ward of a university hospital after approval of the ethics committee. The Wald Chi-squared, Prevalence Ratio (PR) and backward procedure (p≤0.05) tests were applied. Success of peripheral intravenous puncture was obtained in 300 (89.5%) children and failure in 35 (10.4%). The failure rates were significantly influenced by: presence of clinical history of difficult venous access, malnourishment, previous use of peripherally inserted central venous catheter, previous use of central venous catheter, and history of phlebitis or infiltration. In the multivariate model, being malnourished and having previously been submitted to central venous catheterization were the predisposing factors for the failure. The failure rate of 10.4% is similar to that identified in analogous studies and was influenced by characteristics of the children and intravenous therapy. In association with this, malnutrition and previous use of a central venous catheter were the most important variables influencing increase in peripheral intravenous puncture failure.

Highlights

Obtaining peripheral intravenous access is the most-commonly carried out invasive procedure in health institutions
It is estimated that more than 70% of hospitalized patients are subjected to peripheral intravenous puncture (PIP), with the catheters remaining in place for a considerable part of the time that the patients remain hospitalized[1,2]
Evidence was provided for the success of PIP in 330 (89.6%) of the 335 children studied, and failure in 35 (10.4%)

Summary

Introduction

Obtaining peripheral intravenous access is the most-commonly carried out invasive procedure in health institutions. On this issue, with 592 children and 1135 attempts at puncture carried out by 143 nurses, observed a rate of failure of 10%, around 50% of the first attempts failed. Each child was submitted to 2.1 attempts at obtaining intravenous access[3]. In analyzing this intervention in children, one may observe specific issues related to the anatomical, physiological and cognitive characteristics inherent to the age range, which may influence the intervention’s success. Studies undertaken with children have shown failure rates for the procedure varying from 9 to 36%(4-7). The factors which determine the outcome, are not well explained in the literature in the area

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Discussion

Conclusion