Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units

Abstract

Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

A study of the risk factors for phlebitis in patients stratified using the acute physiology and chronic health evaluation II score and admitted to the intensive care unit: A post hoc analysis of the AMOR-VENUS study

“…Therefore, a more severe disease indicated lower blood pressure (i.e., nicardipine could not be administered; hence, noradrenaline was used); thus, there may be differences in the use of nicardipine and noradrenaline in each group. On the other hand, fat administration was used least frequently in group 1; however, it was not a statistically significant risk factor for phlebitis in a previous study (6). Therefore, since drugs administered at different frequencies in each group are not necessarily significant risk factors, there might be different risk factors for phlebitis regarding administered drugs due to severity of the illness.…”

Risk factors for peripheral venous catheter-related phlebitis stratified by body mass index in critically ill patients: A post-hoc analysis of the AMOR-VENUS study

“…No data were missing. More than 300 drugs were administered to the patients in the AMOR-VENUS study, and 26 were administered to at least 5% of patients, with a phlebitis frequency of ≥1% ( 7 ). Fentanyl was the most administered drug (13.5%), followed by heparin (9.8%), fat emulsion (9.0%), and nicardipine (9.0%).…”

“…This study was a post-hoc analysis using the database of the Incidence And risk factors of phlebitis and coMplicatiOns due to peRipheral VENoUS catheters in critically ill patients (AMOR-VENUS) study. The AMOR-VENUS study was a prospective, multicenter, observational study conducted at 22 institutions and 23 ICUs in Japan between January and March 2018 ( 3 , 7 ). The AMOR-VENUS study was registered at the University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000028019) and approved by the institutional review board or medical ethics committee of each participating institution.…”

“…Previous studies have identified risk factors for phlebitis in patients admitted to the ICU, including patient body mass index (BMI), ICU characteristics, the medical staff inserting a catheter, catheter insertion site, and medication type ( 7 ). In particular, the BMI of patients had a U-shaped relationship with the occurrence of phlebitis.…”

Mapping progress in intravascular catheter quality surveillance: An Australian case study of electronic medical record data linkage

“…Within the last decade, complications associated with intravascular (IV) catheters have increased in focus as new evidence reveals the burden of catheter failure in hospitalized patients ( 1 , 2 ). Globally, IV catheters are the most prevalent invasive medical device used in healthcare ( 3 , 4 ).…”