Marsh Nicole, Webster Joan, Larson Emily, Cooke Marle, Mihala Gabor, Rickard Claire M
1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
J Hosp Med. 2018 Feb 1;13(2):83-89. doi: 10.12788/jhm.2867. Epub 2017 Oct 18.
Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy.
To identify risk factors associated with PIV failure.
A single center, prospective, cohort study.
Medical and surgical wards of a tertiary hospital located in Queensland, Australia.
Adult patients requiring a PIV.
Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal.
We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06).Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)-(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% C-0.46)-(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement.
Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
近70%的住院患者需要外周静脉导管（PIV），然而高达69%的PIV在治疗完成前失败。
确定与PIV失败相关的风险因素。
单中心前瞻性队列研究。
位于澳大利亚昆士兰州的一家三级医院的内科和外科病房。
需要PIV的成年患者。
收集人口统计学、临床和潜在的PIV风险因素。如果导管在拔除时有并发症则判定为失败。
我们招募了1000名患者。1578根PIV中有512根（32%）发生导管失败。堵塞/渗漏的风险因素包括静脉输注氟氯西林（风险比[HR]，1.98；95%置信区间[CI]，1.19 - 3.31）、22号PIV（HR，1.43；95% CI，1.02 - 2.00）以及女性患者（HR，1.48；95% CI，1.10 - 2.00）。静脉炎与女性患者（HR，1.81；95% CI，1.40 - 2.35）、穿刺部位瘀青（HR，2.16；95% CI，1.26 - 3.71）、静脉输注氟氯西林（HR，2.01；95% CI，1.26 - 3.21）以及优势侧穿刺（HR，1.39；95% CI，1.09 - 1.77）有关。脱出风险是由护理人员穿刺（HR，1.78；95% CI，1.03 - 3.06）。每日PIV穿刺平均次数每增加1次，与堵塞/渗漏、静脉炎和脱出相关（HR 1.11，95% CI 1.03 - 1.20） - （HR 1.14，95% CI 1.08 - 1.21）。额外的固定产品与较少的堵塞/渗漏、静脉炎和脱出相关（HR 0.32，95% CI 【此处原文似乎有误，推测可能是0.46 - 0.63】） - （HR 0.63，95% CI 0.48 - 0.82）。
可改变的风险因素应指导教育和穿刺者技能培养，以降低目前PIV的高失败率。
