Catheter failure in the administration of hyperosmotic drugs through a peripheral vein and vascular selection: A retrospective cohort study

Abstract

peripheral intravenous catheter, ultrasonography, blood flow, complication, adverse events This study aimed to determine whether the placement of a peripheral intravenous catheter (PIVC) in the cephalic vein of the forearm could prevent PIVC failure in patients receiving hyperosmotic drugs through the peripheral vein. This retrospective cohort study included patients aged ≥ 20 years who had received infusion therapy via a PIVC in our institution between July and November 2017. Patients were divided into groups according to PIVC insertion into the cephalic, basilic, and medial veins. PIVCs used to administer drugs with osmotic pressure ratios > 2.0 were included. The primary outcome was survival time to catheter failure. Catheter failure was defined as accidental and unplanned catheter removal. We set the cephalic vein and other veins, including the medial and basilic veins, in the forearm as cohort groups. We used the Kaplan-Meier survival curves to compare the time until catheter failure in the cohort groups. The Cox proportional hazard models were fitted, and the hazard ratios were calculated. A total of 46 catheters with hyperosmotic agents were included in the analysis. Catheter failure was observed in 25 (54.3%) cases. Time to catheter failure in patients receiving high-dose drugs via the cephalic vein was significantly longer than that in the other two groups (p < 0.01). Thus, the cephalic vein, which has a high blood flow, is the ideal site of PIVC insertion in patients receiving high drug concentrations to prevent catheter failure.

Investigative study of hemodilution ratio: 4Vs for vein diameter, valve, velocity, and volumetric blood flow as factors for optimal forearm vein selection for intravenous infusion

“…Valve location establishes an additional factor for con sideration in optimal positioning of a PIVC. 8,[15][16][17][18] Placement of a PIVC at a distance away from valves avoids contact allowing optimal function of the valve and movement of fluid through the vessel. The vascular system in adults cir culates blood at a remarkable volume of 5-6 L/min.…”

“…The physical laws of fluid mechanics under score the impact of vein diameter on local blood flow, Velocity of Blood, and the corresponding amount of blood volume and hemodilution. [1][2][3][4][5][6][7][8][15][16][17][18][19][20] Application of the Hemodilution Ratio, which translates the 4Vs and rate of infusion into practical comparative parameters, may allow clinicians to effectively anticipate a patient response to treatment infusions based on the vein used and position of the catheter. 2,15 The cephalic vein in the forearm extends from the wrist to the antecubital fossa and may represent the best location with longer dwell for PIVCs.…”

“…2,15 The cephalic vein in the forearm extends from the wrist to the antecubital fossa and may represent the best location with longer dwell for PIVCs. 17 Blood flow velocity within this vein is variable based on vein diameter and valve function. For example, Patient #8′s upper cephalic vein diameter measured 0.24 cm.…”