Flushing of peripheral intravenous catheters: A pilot, factorial, randomised controlled trial of high versus low frequency and volume in paediatrics

Abstract

Aim: To test the feasibility of an efficacy trial comparing different flushing frequencies and volumes to reduce peripheral intravenous cannula (PIVC) failure in paediatric inpatients. Methods: Pilot, 2 × 2 factorial, randomised controlled trial comparing PIVC flushing techniques in intervention pairs: (i) low volume (3 mL) versus high volume (10 mL); and (ii) low frequency (24 hourly) versus high frequency (6 hourly). Patients were excluded if: fluids were restricted, weight < 5 kg, PIVC already in situ for >24 h or continuous infusion. The primary end-point was feasibility (eligibility, recruitment, retention, protocol adherence, missing data and sample size estimates) of a large trial. Secondary end-points were PIVC failure (composite and individual), bloodstream infection and mortality. Results: A total of 919 children were screened from April to November 2015, with 55 enrolled. Screening feasibility criteria were not met, mainly due to continuous infusions and PIVCs in situ >24 h or planned for imminent removal. However, 80% of eligible participants consented, 2% withdrew, protocol adherence was 100%, and there was no missing primary end-point data. PIVC failure was significantly higher (hazard ratio = 2.90, 95% confidence interval: 1.11-7.54) in the 3 mL compared to the 10 mL group. There was no difference in failure between frequency groups (hazard ratio = 0.91, 95% confidence interval: 0.36-2.33). There was no interaction effect (P = 0.22). Conclusion: Trial feasibility proved challenging due to eligibility criteria, which could be improved with additional recruiting staff. Firm conclusions cannot be made based on this small sample, but flush volume may impact PIVC failure.

Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic Review and Meta‐Analysis

“…Variation in PIVC flush. Heparinized saline compared with 0.9% sodium chloride flush 29 did not reduce infiltration (RR, 0.31; 95% CI, 0.03-2.84), occlusion (RR, 1.88; 30,31 (253 participants) compared PIVC flush frequency (daily compared with more frequent flush regimes). There was no reduction in overall PIVC failure, extravasation/ infiltration, phlebitis, or occlusion during dwell (Appendix Fig-ure 4.1-4.4).…”

“…There was no reduction in overall PIVC failure, extravasation/ infiltration, phlebitis, or occlusion during dwell (Appendix Fig-ure 4.1-4.4). Additionally, no effect was demonstrated when a single study 31 investigated volume of flush on extravasation/ infiltration, dislodgement, phlebitis, or occlusion.…”

“…In the included studies, 139 patients did not receive a PIVC owing to failed insertion. Ten studies examined techniques (needle-tip positioning, 27 vein choice for PIVC insertion, 28 flushing regimen, [29][30][31] nonpharmacological 32,33 dressing and securement, 34,35 and pharmacological comfort measures 36 ), and 11 studies examined technologies (vessel visualization including ultrasound, 4,[37][38][39][40] near-infrared [image of vein projected onto the skin], 37,[41][42][43][44] transillumination [transmission of light through the skin], 45 and catheter design 46 ). Table 1 outlines characteristics of included studies.…”

“…Table 1 outlines characteristics of included studies. Most trials were single center and conducted in an acute inpatient pediatric-specific setting 4,[27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46] or dedicated pediatric unit in a large public hospital 35,43,44 ; one study was a multicenter trial. 36 All trials described evidence of ethical review board approval and participant consent for trial participation.…”

The Efficacy, Safety, and Convenience of a New Device for Flushing Intravenous Catheters (Baro Flush™): A Prospective Study

“…According to the Centers for Disease Control and Prevention (CDC), it is important to flush the catheter under positive pressure to reduce IV-catheter-related complications, maintain patency, and prevent the mixing of incompatible medications [4,[7][8][9]. Although there is no consensus on the optimal frequency of catheter flushing [7], the Royal College of Nursing recommends flushing more than two times a day [10] to prevent peripheral IV-catheter-related complications [4,9,11,12]. Because each flushing procedure has to be done using aseptic techniques, IV-catheter flushing is a burden on registered nurses (RNs) and is also time consuming and expensive [11,13,14].…”