Tripathi Sandeep, Gladfelter Taylor
Pediatric Critical Care, OSF Saint Francis Medical Centre Peoria, IL, USA.
Healthcare Analytics, OSF Saint Francis Medical Centre, Peoria, IL, USA.
J Vasc Access. 2022 Jul;23(4):581-588. doi: 10.1177/11297298211000874. Epub 2021 Mar 30.
Despite being the most common hospital procedure, limited information is available on the peripheral intravenous (PIV) catheter insertion practices. This study was designed to evaluate the contemporary PIV insertion practice (all age groups), and to identify the patient and device-related factors influencing the dwell times (<18 years).
Single Center Retrospective study. Patients of all age groups admitted to the hospital for >4 midnights, from 01/2015 to 12/2019. Data extracted by automated EMR audits. Variables included patient demographics, number of PIVs inserted, PIV size, location, dwell time, and length of stay. Standard comparative analysis, including multivariable linear regression for dwell time performed for patients <18 years.
A total of 44,198 (39,341 (89%) adults and 4857 (11%) children) PIVs on unique patients met study criteria, with mean duration of 2.8 ± 2.4 days in children and 2.6 ± 1.3 days in adults ( < 0.001). Pediatric PIV had more dwell time variation, with a higher proportion lasting <1-day and also >2 SD of the age-specific mean, compared to adults. Adults had significantly higher number of PIVs placed/week compared to children. The failure rate for PIV was 56% in children and 76% in adults ( < 0.001). 1 out of 5 adults required >5 PIV/admission. Forty-five percent of children requiring only one PIV versus 21.8% of seniors. Discharge department, body part, and PIV size were independently associated with the dwell duration in children. No PIV size, however, had an independent increase in dwell duration over the reference of the 24 Ga cannula in children. PIVs placed in ante cubital vein and upper arm had dwell duration 26% and 20% longer than PIVs placed in the hand.
The failure rate of PIV is high, and patients are subjected to multiple insertions during hospitalization. Hospital unit, body part, and PIV size are associated with the dwell duration in children.
尽管外周静脉（PIV）导管插入术是最常见的医院操作，但关于其操作实践的信息有限。本研究旨在评估当代PIV插入实践（所有年龄组），并确定影响留置时间（<18岁）的患者和设备相关因素。
单中心回顾性研究。2015年1月至2019年12月期间入院超过4个午夜的所有年龄组患者。通过自动电子病历审计提取数据。变量包括患者人口统计学、插入的PIV数量、PIV尺寸、位置、留置时间和住院时间。进行标准比较分析，包括对<18岁患者的留置时间进行多变量线性回归分析。
共有44198例（39341例（89%）成人和4857例（11%）儿童）在独特患者身上的PIV符合研究标准，儿童的平均持续时间为2.8±2.4天，成人的平均持续时间为2.6±1.3天（<0.001）。与成人相比，儿科PIV的留置时间变化更大，持续时间<1天以及超过特定年龄平均值2个标准差的比例更高。与儿童相比，成人每周放置的PIV数量明显更多。儿童PIV的失败率为56%，成人为76%（<0.001）。五分之一的成人每次入院需要>5个PIV。45%的儿童仅需要1个PIV，而老年人为21.8%。出院科室、身体部位和PIV尺寸与儿童的留置持续时间独立相关。然而，在儿童中，没有任何PIV尺寸相对于24G套管的参考值能使留置持续时间独立增加。置于肘前静脉和上臂的PIV的留置持续时间比置于手部的PIV长26%和20%。
PIV的失败率很高且患者在住院期间会接受多次插入。医院科室、身体部位和PIV尺寸与儿童的留置持续时间相关。
