Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters
- PMID: 31648879
- DOI: 10.1016/j.pedn.2019.09.023
Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters
Abstract
Purpose: To describe worldwide characteristics, performance and risk factors of peripheral intravenous catheters (PIVCs), in pediatrics.
Design: A secondary, subgroup analysis of pediatric (<18 years) data was undertaken, using a global, cross-sectional 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: >2 years age (odds ratio [OR] > 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 > 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.
Keywords: Catheterization; Evidence-based practice; Infection control; Pediatrics; Peripheral.
Copyright © 2018 Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of competing interest Griffith University has received investigator-initiated grants and unrestricted donations from vascular access product manufacturers (3M, Adhezion, Angiodynamics, Becton Dickinson [BD]-Bard, BBraun, Centurion Medical Products-Medline), to support research led by AJU, unrelated to the current project. Griffith University has received investigator initiated research grants from vascular access product manufacturers (Adhezion, Angiodynamics, Becton Dickinson, Centurion Medical Products), to support research led by TK, unrelated to the current project. MT has no financial disclosures. Griffith University has received on GRB's behalf unrestricted investigator-initiated research grants (3M, Becton Dickinson, Smiths Medical) and consultancy payments (3M, Becton Dickinson, Medline, ResQDevices). Western Sydney and Griffith University has received on EA's behald unrestricted investigator-initiated research grants (from 3M, Becton Dickinson, BBraun, Cook Medical and Flo Medical). Griffith University has received investigator-initiated grants, or consultancy payments on behalf of CMR from vascular access product manufacturers (3M, Adhezion, Angiodynamics, BD-Bard, Baxter; BBraun, Centurion Medical Products, Medtronic, Smiths Medical unrelated to the current project.
