Full title: peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study

Abstract

BackgroundPeripheral venous catheterization (PVC) is frequently used in children. This procedure is not free from potential complications. Our purpose was to identify the types and incidences of PVC complications in children and their predisposing factors in a developing country.MethodsWe conducted a prospective observational multicenter study in five pediatric and pediatric surgery departments over a period of 2 months. Two hundred fifteen PVC procedures were conducted in 98 children. The times of insertion and removal and the reasons for termination were noted, and the lifespan was calculated. Descriptive data were expressed as percentages, means, standard deviations, medians and interquartile ranges. The Chi2 test or the Fisher test, with hazard ratios and 95% confidence intervals (CI95%), as well as Student’s t test or the Mann-Whitney U test were used to compare categorical and quantitative variables, respectively, in groups with and without complications. The Spearman test was used to determine correlations between the lifespan and the quantitative variables. The Kruskal Wallis test was used to test for differences in the median lifespan within 3 or more subgroups of a variable. Linear regression and logistic binary regression were used for multivariate analysis. A p-value <0.05 was considered significant.ResultsThe mean lifespan was 68.82 ± 35.71 h. A local complication occurred in 111 PIVC (51.9%) cases. The risk factors identified were a small catheter gauge (24-gauge) (p = 0.023), the use of a volume-controlled burette (p = 0.036), a longer duration of intravenous therapy (p < 0.001), a medical diagnosis of respiratory or infectious disease (p = 0.047), the use of antibiotics (p = 0.005), including cefotaxime (p = 0.024) and vancomycin (p = 0.031), and the use of proton pump inhibitors (p = 0.004).The lifespan of the catheters was reduced with the occurrence of a complication (p < 0.001), including the use of 24-gauge catheters (p = 0.001), the use of an electronic pump or syringe(p = 0.036) and a higher rank of the intravenous device in each patient (p = 0.010).ConclusionsPVC complications were frequent in our pediatric departments and are often associated with misuse of the device. These results could engender awareness among both doctors and nurses regarding the need for rationalization of the use of PVC and better adherence to the recommendations for the use of each drug and each administration method.

Application of a modified electrocardiogram‐guided technique for umbilical venous catheterisation in neonates: A retrospective trial

“…However，it is difficult to perform a vein puncture and maintain a venous route because of the tiny peripheral blood vessels of premature infants. Also, repeated punctures can increase the risks of intracranial haemorrhage and infection . Umbilical vein, as a natural venous access, is easy to maintain for long‐time catheterisation.…”

Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters

“…Harm associated with inappropriate PIVC insertion and management is an under-recognised patient safety issue. Local and national studies have demonstrated, after successful insertion, pediatric PIVCs are associated with high rates of local and systemic complications, including infiltration/extravasation, occlusion and dislodgment (Ben Abdelaziz et al, 2017;Malyon et al, 2014). Bloodstream infections associated with PIVCs are rare but can be fatal (Webster, Osborne, Rickard, & Marsh, 2019); and the volume of PIVCs used entails a significant associated burden on the healthcare system.…”

Effectiveness of dry heat application on ease of venepuncture in children with difficult intravenous access: A randomized controlled trial

“…It is estimated that more than 70% of hospitalized children are subjected to peripheral IV puncture (Negri, Avelar, Andreoni, & Pedreira, ) Over the years, many methods have been developed to assist in inserting and securing peripheral IV lines more effectively. These include visualization devices, venous distension devices, transillumination methods and ultrasound‐guided techniques which help in identifying an appropriate vein (Ben Abdelaziz et al, ; Mbamalu & Banerjee, ). Bedside methods like gently tapping on the vein, tourniquet application, asking patients to clench and relax their hands, and hanging the arm down are known to improve venous visibility (Kaur, Kaur, & Patel, ).…”