Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients.

Samantha Keogh,Nicole Marsh,Karen Davies,Gabor Mihala,Claire Rickard,Julie Flynn

doi:10.1186/s13063-016-1470-6

Abstract

BackgroundResearch has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices.MethodsThis is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis.ResultsPIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3–3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0–2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1–1.4], p < 0.01) significantly predicted PIVC failure.ConclusionNeither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required.Trial registrationAustralian and New Zealand Clinical Trials Registry: ACTRN12615000025538. Registered on 19 January 2015.

Highlights

Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices
Research Nurse (RN) spent an average of 4 hours a day (Monday to Friday) recruiting and data collecting for the trial
Initial group comparisons suggested that higher frequency and higher volume flushing were associated with increased PIVC failure

Summary

Introduction

Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices. Failure prior to completion of therapy occurs in up to 69 % of patients [4,5,6,7,8,9,10,11,12]. This may be due to a range of complications, which can be mechanical, vascular or infectious. Mechanical complications include occlusion, infiltration and dislodgement. Infectious complications may be bacterial or fungal, and local or systemic bloodstream infections. Bloodstream infections prolong hospitalisation and increase treatment costs and mortality [14, 15]

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