Ms Nicole Marsh1,2, Professor Joan Webster1,2, Dr Amanda Ullman1,2, Mr Gabor Mihala2, Professor Marie Cooke2, Professor Claire Rickard1,2
1Royal Brisbane And Women’s Hospital, Herston, Australia
2Griffith University, Nathan, Australia
Introduction: Peripheral intravenous catheters are essential to modern healthcare and the most frequently used vascular access device, but system-wide understanding of complications is lacking. The aim of this systematic review was to summarize and quantify peripheral intravenous catheter failure and individual catheter-related complications, including local and catheter-related bloodstream infections.
Methods: Data sources including The Cochrane Register of Controlled Trials, PubMed, CINAHL, and EMBASE (2000 to October 2017) were searched. Observational studies and randomised controlled trials in English reporting outcomes were eligible for inclusion. Two investigators independently selected studies, extracted characteristics and results, assessed quality and risk of bias.
Results: Sixty-four observational studies and 28 randomised controlled trials were included (73,853 participants). Catheter related blood stream infection occurred in <0·1% (<0·1-<0·1%) or <0.1 per 1000 catheter days (0.0-0·2); local infection occurred in 0·7% (<0·1- 1·9%). While incidence of infection was low, overall catheter failure occurred in 35·8% catheters (95% confidence interval [CI] 31·6- 40·1%) or 114 failures per 1000 catheter days. More commonly reported individual complications included: phlebitis 16·4% (95% CI 13·4- 19·5%); infiltration 13·4% (10·7- 16·4%); occlusion 7·6% (5·4- 10·1%); leakage 7·3% (4·7%- 10·4%); pain 7·0% (5·2- 9·1%); and dislodgement 5·7% (4·5- 7·0%).
Conclusions: This large review shows that catheter failure is a significant world-wide problem, affecting one in three PVCs, and is rarely due to infection. New, substantial, and multi-specialty efforts are needed to address catheter failure and its sequelae of treatment disruption, increased health costs and poor patient experiences and outcomes.
Nicole Marsh is currently working as a research fellow in vascular access with the Royal Brisbane and Women’s Hospital, and Griffith University. The research she will be presenting today forms an element of her PhD, which focused on risk factors of peripheral venous access failure, and possible interventions to improve patient outcomes.