Skin complications associated with vascular access devices: A secondary analysis of 13 studies involving 10,859 devices

Abstract

Background: Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives: To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design: Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. Settings: Six hospitals (metropolitan and regional) in Queensland, Australia. Participants: The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7,669 participants with 10,859 devices were included, involving peripheral venous (n=9,933), peripheral arterial (n=341), and central venous access (n=585) devices. Analysis: Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p<0.01 to reduce the effect of multiple comparisons. Results: Over 12% of devices were associated with skin complication, at 46.2 per 1,000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1-50.7), and 22.5 per 1,000 catheter days for central devices (95% CI 16.5-306). The most common skin complications were bruising (peripheral n=134, 3.7%; central n= 33, 6.8%), and swelling due to infiltration for peripheral devices (n=296; 2.9%), and dermatitis for central devices (n=13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches.

Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study

“…Participant characteristics: Upon enrolment, the ReN collected baseline data including: age; gender; height; weight; skin integrity (good, fair, poor) [17]; dominant hand; number of co-morbidities (0, 1, 2, 3, >3); primary admitting diagnosis and treatment duration; presence and type of current infections or wounds; blood type; and history of PIV and/or CVAD insertion.…”

Development of central venous access device‐associated skin impairment assessment instrument

“…During long-term CVAD placement, the skin integrity surrounding catheter sites is a substantial challenge, as the skin is repeatedly in contact with disinfectants, dressings, etc. (Mimoz et al, 2015;Ullman et al, 2019). In 2017, a study provided practical references for clinical researchers and health workers to identify, prevent and treat CVAD-related skin lesions (Broadhurst et al, 2017).…”

“…It is estimated that approximately 8% of hospitalized patients require CVADs during hospitalization, and more than 5 million central venous punctures are performed per year in the United States (Duwadi et al., 2019 ). Although catheter placement into the central vein is a common procedure performed in many clinical settings, severe insertion and retention complications associated with CVADs, such as bloodstream infections, skin lesions, phlebitis and thrombosis, are still prevalent (Jiang et al., 2020 ; Mimoz et al., 2015 ; Pu et al., 2020 ; Ullman et al., 2019 ).…”

Investigation and Analysis of Catheter-Associated Skin Impairment in PICC’s Patients in Jingzhou City

“…Among them, local infection accounted for the largest proportion in CASI type, and mechanical injury was relatively rare. Ullman et al [4] reported that in CASI with 10,859 vascular pathways (PICC, CVC, Port, etc. ), local infection or mechanical injury was relatively rare.…”