Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study

Abstract

BackgroundPeripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs.MethodsIn 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement.ResultsA total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8–72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant.ConclusionGiven the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.

Cumplimiento De Practicas Clinicas Basadas en Evidencia Para La Instalacion Y Mantencion De Cateteres Venosos Perifericos en Personas Hospitalizadas

“…Walker et al (19) objetivaron que en 9.620 CVP evaluados, el 59% del total de catéteres se instaló en servicios medico quirúrgicos, seguido de un 24% en salas de emergencia y 76% de éxito al primer intento en enfermeras, similar a nuestro estudio en donde el 60% correspondió a servicios medico quirúrgicos adultospediátricos, seguido de 20% en urgencias. La tasa de éxito al primer intento de los dispositivos con registro del número de intentos correspondió a 77,7% para el bloque adultos y 78,5% al bloque pediátrico, no obstante, el 69,7% de los CVP instalados no tenían registro del número de intentos, esta brecha puede tener relación al reciente enfoque implementado de evaluación de usuarios de difícil acceso venoso (DIVA), en donde el número de intentos para el éxito de la instalación del dispositivo toma absoluta relevancia al momento de elegir el tipo de catéter venoso periférico.…”

“…Al igual que en el estudio realizado por Chen et al (7) las causas más frecuentes de fracaso estuvieron relacionado a flebitis, infiltración y extravasación. A nivel de Latinoamérica y de acuerdo con "The Vascular Study" publicado en 2023, se logró cuantificar que, del total de dispositivos, el 14% se encontraba con fijación no estaban limpios, secos e intactos, un 6% con sangre en el tubo o conexiones y 3% sangre seca alrededor del sitio del catéter (19). Por otra parte, un estudio observacional realizado en personas mayores hospitalizadas de medicina interna evidenció tasas de complicaciones asociadas a 21,5 x 1.000 días para retiro accidental, 16,2 x 1.000 días para infiltración /obstrucción y 15 x 1.000 días para flebitis (33).…”

“…La instalación del dispositivo en sitios anatómicos no recomendados correspondió al 52% de los catéteres. Dentro de las complicaciones de la mantención de los catéteres periféricos correspondió a 6% con sangre en la conexión, 6% dolor a la palpación, 3% sangre seca alrededor del catéter, 2% hiperemia >1cm desde el sitio de inserción y el 1% con edema > 1cm desde la inserción del dispositivo (19).…”

Striving for vessel health preservation through standardized assessment: a Letter to the Editor

“…Furthermore, a study that demonstrated the insertion and maintenance processes of peripheral intravenous catheters in 132 hospitals in five Latin American countries (Argentina, Brazil, Chile, Colombia and Mexico), covering 9620 peripheral intravenous catheters, identified results indicating the 3 de LETTER TO THE EDITOR need for advances in evidence-based clinical practice to promote better indicators, since there are more than 25% failure in the first puncture, 29% of the catheters are inserted in the veins of the hand, 19% stabilized with non-sterile tapes, 18% of the observed catheters had signs of adverse events, reaching a an average length of stay of one day (3) .…”

“…Still, one in every four patients is subjected to consecutive puncture attempts by clinicians, leading to vessel health harm and depletion over time, with significant impact on patients (e.g., pain, distrust, delays in treatment), healthcare professionals (e.g., anxiety, increased care volume and complexity) and health organizations (e.g., longer admission periods, increased care costs) (1)(2) . Thus, implementing formal assessment of venous assessment with standardized instruments will likely increase the identification of patients at higher risk of difficult intravenous access (DIVA) and the adoption of differentiated techniques (e.g., ultrasound-guided PIVC), leading to better patient outcomes and care experience (1,3) .…”