Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project)

Abstract

IntroductionPeripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors.MethodsA prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE.ResultsData were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors.ConclusionLimitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings.

Catheter dwell time and risk of catheter failure in adult patients with peripheral venous catheters

“…However, they treated the dwell time as an ordinal variable, which may lead to ignoring potential inflection points of the risk of phlebitis over dwell time. Additionally, findings from Katiuska and colleagues showed that dwell time >4 days was associated with a lower risk of PVC failure (Miliani et al, ), which concurs with our findings. We think that this may be the result of the counterwork between the ability of one's physiological resilience and the ability of invasion of foreign elements.…”

“…Peripheral venous catheter failure occurred in 57.8% of the patients, making it the main reason for PVC removal. This result is similar to the results of a study in France (Miliani et al, ). While some studies have explored the risk factors for PVC failure, this is the largest study, to our knowledge, to assess the relationship between dwell time and PVC failure.…”

“…The sample size was calculated using the formula by Chow (Chow, Shao, & Wang, 2008) for tests concerning whether a proportion is equal to a reference value. We referred to the incidence rate of PIVC failure (52.3%) reported by Miliani et al (2017), with the estimated incidence of catheter-related complications in our research as 57.3%, with type I error α at 0.05 and 95% power (1−β); thus, 1,269 participants were the calculated sample size. When considering 10% nonresponse rate, the final sample was determined as 1,410.…”

“…When replacing PVCs according to clinical indication, the rate of PVC failure may increase. A study conducted in France showed that PVC failure reached 50% when PVCs were removed based on clinical indication (Miliani et al, ), and in China, a study showed that the corresponding failure rate was >60% (Zhu, Wang, & Wen, ). The relationship between dwell time and PVC failure is worthy of clinical attention.…”

Tecnovigilância no Brasil: panorama das notificações de eventos adversos e queixas técnicas de cateteres vasculares

“…In another study, of 815 CVCs in 573 patients, phlebitis was the most common AE, with 38% 39 . Two types of catheter presented the highest levels of AE: the PICC with40% of total notifications, and the PVC with 35%.…”