Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters

Abstract

To describe worldwide characteristics, performance and risk factors of peripheral intravenous catheters (PIVCs), in pediatrics. Design: A secondary, subgroup analysis of pediatric (b18 years) data was undertaken, using a global, crosssectional study of PIVCs. Practice characteristics included: demographic, diagnostic, utility, management, performance and resources. Multivariate regression identified complication risks factors. Results: Data from 4206 children in 278 hospitals across 47 countries. Most PIVCs (outside of Australia, New Zealand) were inserted by nurses (71%; n = 2950), with dedicated teams only common in North America (23.2%; n = 85). Large gauges (≤18G) were mostly used in South America, Europe and Africa. Regions predominantly placed 24G (49%; n = 2060) except in Australia and New Zealand, who more commonly placed 22G (38.7%; n = 192). The most common placement was the hand (51%; n = 2143), however North America, Australia and New Zealand frequently utilised the antecubital fossa (24.5%, n = 90; 21.4%; n = 106). Polyurethane dressings were most used (67.1%; 2822), and many were not clean, dry and intact (17.1%; n = 715). Over 8% of PIVCs were idle, with the highest rates in North America (21.2%; n = 78). PIVC local complication risk factors included: N2 years age (odds ratio [OR] N 1.58; 1.2-2.1); ambulance/emergency insertion (OR 1.65; 1.2-2.3); upper arm/antecubital placement (OR 1.44; 1.1-2.0); poor dressing integrity (OR 5.4; 4.2-6.9); and 24-72 h dwell (OR N 1.9; 1.3-2.6). Conclusions: There is global inconsistency in pediatric PIVC practice, which may be causing harm. Clinical implications: Improvements in pediatric PIVC placement, dressings, and gauge selection are needed.

Improving Peripheral Intravenous Catheter Care for Children with Cancer Receiving Chemotherapy in Malawi

“…Peripheral intravenous catheter (PIVC) insertion is one of the most common procedures in hospitalized children (Ben Abdelaziz et al, 2017;Marsh, Webster, Mihala, & Rickard, 2015;Ullman et al, 2020). PIVC insertion is frequently challenging in children and insertion attempts requiring 10 or more attempts are reported (Cooke et al, 2018;Kleidon et al, 2017;Ullman et al, 2020). A cross-sectional study conducted in 25 countries evaluated PIVC placements in children.…”

“…An international study evaluating use of PIVCs (n = 40,620) in 51 countries found catheter placement in non-recommended sites (66%), idle PIVCs (14%), pain on assessment (10%), symptoms of phlebitis (10%) and suboptimal dressings (21%) (Alexandrou et al, 2018). A study evaluating global pediatric PIVC practices in 47 countries (including Africa) found numerous inconsistencies in PIVC care (Ullman et al, 2020). This secondary data analysis of 4206 PIVCs revealed the need for improved catheter placement, consistent PIVC observation and assessment, removal of idol PIVCs, and focus on dressing integrity.…”

“…This secondary data analysis of 4206 PIVCs revealed the need for improved catheter placement, consistent PIVC observation and assessment, removal of idol PIVCs, and focus on dressing integrity. Previous studies evaluating PIVC care emphasize the harm associated with inappropriate insertion and care and stressed the importance of standardized PIVC procedures (Alexandrou et al, 2018;O' Grady et al, 2011;Ullman et al, 2020).…”

An international survey of pediatric and neonatal clinicians' vascular access practice: PediSIG assessment of vascular access, education, and support (PAVES) catheter selection

“…Less than half of the respondents reported having 24/7 coverage for vascular access coverage, with a recent global study identifying pediatric vascular access specialist teams being most common in the US. 11 For those who answered that they did not have a vascular access team, vascular access is provided by the bedside RN in most of the responses.…”

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children

“…An international research study ( 3 ) conducted with children from 278 hospitals in 47 countries in Africa, Asia, Australia/New Zealand, Europe, the Middle East, North America, South America and the South Pacific, demonstrated that, in 11.4% of the catheter insertion sites, signs of some complication were observed, while the incidence of these events was estimated at 18.6% in a prospective longitudinal study carried out in Bahia, Brazil ( 4 ) .…”