Increased Clinical and Economic Burden Associated With Peripheral Intravenous Catheter–Related Complications: Analysis of a US Hospital Discharge Database

Abstract

The burden of complications associated with peripheral intravenous use is underevaluated, in part, due to the broad use, inconsistent coding, and lack of mandatory reporting of these devices. This study aimed to analyze the clinical and economic impact of peripheral intravenous–related complications on hospitalized patients. This analysis of Premier Perspective® Database US hospital discharge records included admissions occurring between July 1, 2013 and June 30, 2015 for pneumonia, chronic obstructive pulmonary disease, myocardial infarction, congestive heart failure, chronic kidney disease, diabetes with complications, and major trauma (hip, spinal, cranial fractures). Admissions were assumed to include a peripheral intravenous. Admissions involving surgery, dialysis, or central venous lines were excluded. Multivariable analyses compared inpatient length of stay, cost, admission to intensive care unit, and discharge status of patients with versus without peripheral intravenous–related complications (bloodstream infection, cellulitis, thrombophlebitis, other infection, or extravasation). Models were conducted separately for congestive heart failure, chronic obstructive pulmonary disease, diabetes with complications, and overall (all 7 diagnoses) and adjusted for demographics, comorbidities, and hospital characteristics. We identified 588 375 qualifying admissions: mean (SD), age 66.1 (20.6) years; 52.4% female; and 95.2% urgent/emergent admissions. Overall, 1.76% of patients (n = 10 354) had peripheral intravenous–related complications. In adjusted analyses between patients with versus without peripheral intravenous complications, the mean (95% confidence interval) inpatient length of stay was 5.9 (5.8-6.0) days versus 3.9 (3.9-3.9) days; mean hospitalization cost was $10 895 ($10 738-$11 052) versus $7009 ($6988-$7031). Patients with complications were less likely to be discharged home versus those without (62.4% [58.6%-66.1%] vs 77.6% [74.6%-80.5%]) and were more likely to have died (3.6% [2.9%-4.2%] vs 0.7% [0.6%-0.9%]). Models restricted to single admitting diagnosis were consistent with overall results. Patients with peripheral intravenous–related complications have longer length of stay, higher costs, and greater risk of death than patients without such complications; this is true across diagnosis groups of interest. Future research should focus on reducing these complications to improve clinical and economic outcomes.

Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

“…Early recognition of impending PIVC failure has enormous tangible benefits, particularly with respect to reducing treatment delays and decreasing hospital length of stay. One study noted that PIVC related complications led to a significantly increased hospital length of stay (5.9 days vs. 3.9 days) compared to patients without PIVC complications [ 16 ]. Early identification of an impending failure before it is clinically apparent allows the treatment team to take a proactive and organized approach and plan for ongoing vascular access needs, potentially avoiding an interruption or delay in therapy.…”

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

“…Each shift, the nurse should assess for device complications, prompting early identification and correction of issues, and if necessary, removal and insertion of a new device. Unfortunately, device-associated complications are common; up to two-thirds of PIVCs (Marsh et al, 2021;Marsh et al, 2018) and one-fourth of CVADs (Takashima et al, 2018) cease to function before treatment is complete, resulting in painful and time-consuming additional insertion procedures, which also increases hospital costs (Lim et al, 2019).…”

Investigation of Nosocomial Cluster Infections of Peripheral Venous Catheter-Related Bloodstream Infection

“…In the nosocomial cluster infections, it was first considered whether the source of infections was due to insufficient air cleanliness, equipment contamination, or improper operation. The burden of complications associated with peripheral intravenous use is underestimated, due to the broad use, inconsistent coding, and lack of mandatory reporting of PIVCs [4], we failed to consider the cluster infections caused by PIVCs in time. In these cases, the patients all experienced shivers during the indwelling of PIVCs, body temperatures were greater than 38°C, which was consistent with the clinical symptoms of catheter-related bloodstream infection.…”

“…Due to the large number of PIVCs used, the absolute infection rate of PIVCs is close to the absolute infection rate of other catheters [2]. Once a bloodstream infection occurs, it will increase the patients' discomfort, mortality, hospitalization time, and cost [3,4]. Therefore, PIVC-BSI has received more attention in recent years.…”