Clinical-epidemiological predictors of phlebitis associated with peripheral intravenous catheters in Spanish hospitals: results of a national cohort study

Abstract

Background: Peripheral intravenous catheters (PIVC) are essential medical devices, yet they frequently lead to complications such as phlebitis, infiltration, and occlusion. Identifying risk factors is key to reducing these complications.

Objectives: To estimate the incidence of PIVC‑associated phlebitis in Spanish hospitals and identify clinical and epidemiological risk factors.

Methods: We performed a prospective cohort study in 80 Spanish hospitals from 1 to 28 February 2023. Adult inpatients (≥18 years) receiving PIVCs in non‑ICU, non‑emergency, non‑pediatric wards were eligible. A total of 13,812 PIVCs in 9387 patients were followed daily by trained nurses until catheter removal, phlebitis onset (Maddox grade ≥ 2), or 15 days. We calculated cumulative incidence and incidence density per 100 catheter‑days. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for predictors-sex, age group, number of infused medications, hospital size, and dwell time.

Results: Phlebitis occurred in 1302 PIVCs (cumulative incidence 9.43 %; incidence density 0.14 per 100 person‑hours). Independent risk factors were female sex (HR 1.32, 95 % CI 1.21-1.45), age 65-79 years (HR 1.25, 95 % CI 1.12-1.40), administration of ≥ 2 medications (HR 1.50, 95 % CI 1.35-1.67), and hospital size ≥ 1000 beds (HR 1.30, 95 % CI 1.12-1.52). Phlebitis risk peaked 48-96 h post‑insertion.

Conclusions: Phlebitis incidence remains above recommended levels. Multivariable analysis identified female sex, a higher number of infused medications, older patient age, larger hospital size, and longer PIVC dwell time as the main independent predictors of phlebitis. Registration: Not registered.

Keywords: Catheter-related infections; Hospitalization; Peripheral intravenous catheters; Phlebitis; Risk factors; Survival analysis; Venous catheterization.

Fig. 1

Probability of remaining phlebitis-free over the 15-day follow-up period, overall and stratified by sex, the presence or absence of diabetes, and the presence or absence of hypertension.

Fig. 2

Probability of remaining phlebitis-free over the 15-day follow-up period, stratified by the presence or absence of obesity, the presence or absence of cancer, categorised age, and catheter gauge.

Fig. 3

Probability of remaining phlebitis-free over the 15-day follow-up period, stratified by the accessories used, the anatomical insertion site of the PIVC, and the number of medications administered through the PIVC.

Fig. 4

Probability of remaining phlebitis-free over the 15-day follow-up period, stratified by dressing type, the placement of securing strips relative to the PIVC insertion site, and the number of hospital beds.