Nomogram for Predicting the Risk of Complications in Hospitalized Children With Peripheral Intravenous Catheters

OBJECTIVE

The aim of the study is to identify the hospitalized children at risk of peripheral intravenous catheter (PIVC) complications by severity prediction.

METHODS

The study included the data of 301 hospitalized children with PIVC complications in 2 tertiary teaching hospitals. A researcher-designed tool was used to collect risk factors associated with PIVC complications. Predictors of PIVC complications at univariate analysis and multivariable logistic regression analysis by backward stepwise. A nomogram was constructed based on the results of the final multivariable model, making it possible to estimate the probability of developing complications.

RESULTS

A total of 182 participants (60.5%) had a moderate injury from PIVC complications. Multivariable logistic regression analysis indicated that the vascular condition, limb immobilization, needle adjustment in venipuncture, infusion length, infusion speed, and insertion site were independent predictors. The nomogram for assessing the severity of PIVC complications indicated good predictive accuracy (area under the curve = 0.79) and good discrimination (concordance index = 0.779). Decision curve analysis demonstrated that the nomogram was a good clinical value with a wide range of threshold probabilities (4%-100%).

CONCLUSIONS

The risk prediction model has good predictive performance, and the nomogram provides an easy-to-use visualization to identify the severity of PIVC complications and guide timely nursing care management.

The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study

PURPOSE

The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications.

METHOD

This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed.

RESULTS

The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication.

CONCLUSIONS

The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population.

CLINICALTRIALS

GOV IDENTIFIER

NCT05769452.

Optimal dose of normal saline for confirming correct peripheral venous access with precordial Doppler ultrasonography in children

Precordial Doppler ultrasound technology can be utilized to confirm correct peripheral intravenous vascular (PIV) access in children during surgery. This study aimed to determine the minimally required dose of normal saline (NS) for confirming correct PIV access. Healthy children were randomly allocated to receive a 0.1 mL/kg, 0.3 mL/kg, or 0.5 mL/kg dose of NS injected via PIV access. Two independent raters judged the change in the recorded precordial Doppler sound test (S-test) before and after NS injection. Typically, rapid injection of NS increased the pitch of the heartbeat as the injection volume increased. Changes in blood flow velocity test (V-test) results were evaluated using a cut-off value of 1 cm/s. Both in the S- and V-tests, the detection rate of correct PIV access was lower with 0.1 mL/kg NS than with 0.3 mL/kg or 0.5 mL/kg. Logistic regression analysis showed that the positive results in both the S- and V-tests were significantly decreased with a 0.1 mL/kg NS; no significant difference was observed with a 0.3 mL/kg NS (reference dose: 0.5 mL/kg). These results suggest 0.3 mL/kg is the minimally required dose of NS for confirming correct PIV access. This study is registered with the University Hospital Medical Information Network (UMIN000041330).

Sensing Technologies for Extravasation Detection: A Review

Peripheral intravenous catheters are administered for various purposes, such as blood sampling or the infusion of contrast agents and drugs. Extravasation happens when the catheter is unintentionally directed outside of the vein due to movement of the intravascular catheter, enhanced vascular permeability, or occlusion of the upstream vein. In this article, extravasation and its mechanism are discussed. Subsequently, the sensorized devices (e.g., single sensor and multimodal detection) to identify the extravasation phenomena are highlighted. In this review article, we have shed light on both physiological and engineering points of view of extravasation and its detection approaches. This review provides an overview on the most recent and relevant technologies that can help in the early detection of extravasation.

Ultrasound assessment of peripheral intravenous catheters by nurses in the pediatric intensive care unit

OBJECTIVE

Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA.

DESIGN

Prospective observational cohort study.

SETTING

PICU within a children's hospital.

PATIENTS

PICU patients with a PIV.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0-13.8) and median weight was 15.0 kg (IQR 9.6-59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28-0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p < 0.0001). In 106 PIVs with a UA that indicated the PIV was intravascular (i.e. negative UA), the median survival was 50.0 h (IQR 21.8-100.3).

CONCLUSIONS

Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.

Peripheral Vasoactive Administration in Critically Ill Children With Shock: A Single-Center Retrospective Cohort Study

OBJECTIVES

Management of fluid refractory pediatric shock requires prompt administration of vasoactive agents. Although delivery of vasoactive therapy is generally provided via a central venous catheter, their placement can delay drug administration and is associated with complications. We characterize peripheral vasoactive administration in a cohort of critically ill children with shock, evaluate progression to central venous catheter placement, and describe complications associated with extravasation.

DESIGN

Retrospective cohort study.

SETTING

Single-center, quaternary PICU (January 2010 to December 2015).

PATIENTS

Children (31 d to 18 yr) who received epinephrine, norepinephrine, or dopamine.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We compared patients based on the initial site of vasoactive infusion: peripheral venous access (PVA) or central venous access (CVA) and, within the PVA group, compared patients based on subsequent placement of a central catheter for vasoactive infusion. We also characterized peripheral extravasations. We evaluated 756 patients: 231 (30.6%) PVA and 525 (69.4%) CVA patients. PVA patients were older, had lower illness severity, and more frequently had vasoactive therapy initiated at night compared with CVA patients. In PVA patients, 124 (53.7%) had a central catheter placed after a median of 140 minutes (interquartile range, 65-247 min) of peripheral treatment. Patients who avoided central catheter placement had lower illness severity. Of the 93 patients with septic shock, 44 (47.3%) did not have a central catheter placed. Extravasations occurred in four of 231 (1.7% [95% CI, 0.03-3.4]) PVA patients, exclusively in the hand. Three patients received pharmacologic intervention, and none had long-term disabilities.

CONCLUSIONS

In our experience, peripheral venous catheters can be used for vasoactive administration. In our series, the upper limit of the 95% CI for extravasation is approximately 1-in-30, meaning that this route may be an appropriate option while evaluating the need for central access, particularly in patients with low illness severity.

Nurses' knowledge and experiences of peripheral intravenous catheter insertion at a tertiary paediatric health centre

AIM

The aim of the study was to determine paediatric nurses' knowledge and experiences of PIVC insertion.

METHOD

In this cross-sectional study, nurses working in a paediatric hospital in Izmir, Türkiye, between May and September 2019 were included (225; 67.4%). A PIVC knowledge and experience form, and a sociodemographic characteristics questionnaire were used to collect data.

RESULTS

Nurses most often inserted the PIVC on the dorsum of the hand (83.1%). Their choice of vein was influenced by the condition of the patient's veins (91.1%), medications (72%) and the patient's activity status (70.2%). The most preferred PIVC size was 24 gauge (98.2%), and the most frequently used cannula was a short peripheral cannula (96.9%). To clean the insertion site of the cannula, 93.8% of the nurses used 70% alcohol. Distractions used while inserting the PIVC were: letting the child play with a toy (51.1%), having the child sit on the mother's lap (45.8%), letting the child watch cartoons (45.3%), and administering oral sucrose (43.6%). Of the nurses, 69.3% attached a split septum/vein valve to the PIVC insertion site, and 82.2% cleaned the split septum/vein valve with 70% alcohol and waited until it dried before administering the medication. Some 79.6% secured the cannula with a hypoallergenic nonwoven adhesive fixation tape bandage. Some 94.7% performed catheter flushing for control after inserting PIVCs, 93.8% performed catheter flushing before IV fluid treatment, 89.8% flushed the catheter before drug administration through the bolus method, 53.3% flushed the PIVC catheter with a slow technique and 42.2% flushed it with an intermittent technique.

CONCLUSION

The nurses generally acted in accordance with Infusion Nurses Society (2016) guidance. It would be helpful if the hospital developed algorithms that include standards to prevent and manage PIVC insertions and complications.

Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children

AIM

This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis.

METHOD

The study was conducted in the largest children's hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal.

RESULTS

The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P<0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P<0.001).

CONCLUSION

Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.

Comparing ivWatch biosensor to standard care to identify extravasation injuries in the paediatric intensive care: a protocol for a randomised controlled trial

INTRODUCTION

Peripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries.

METHODS AND ANALYSIS

A single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children's Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals.

ETHICS AND DISSEMINATION

This study received approval from the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12620000317998.

Risk factors for infiltration in children and adolescents with peripheral intravenous catheters

ABSTRACT Objectives: to estimate the incidence of infiltration and the factors associated with its occurrence in children and adolescents in the operative period and with peripheral intravenous catheters. Methods: a longitudinal and prospective study with children and adolescents using peripheral intravenous catheters, conducted at the surgical clinic unit of a pediatric hospital in Feira de Santana, State of Bahia, from April 2015 to December 2016. The study used Pearson’s chi-square and Fisher’s exact test for the analysis. It also applied multiple analyses using Poisson regression with robust variance. Results: the incidence of infiltration was 31.2% and was associated with female sex (RR=0.53; CI=[0.30-0.96]), non-eutrophic children (RR=2.27; CI=[1.25-4.20]), who used non-irritating and non-vesicant drugs (RR=1.72; CI=[1.03-2.87]), vesicant drugs (RR=1.84; CI=[1.05-3.22]) and irritating/vesicant electrolytes (RR=2.35; CI=[1.38-3.97]). Conclusions: the study suggests the development of strategies that will help in the prevention of this adverse event through the knowledge of the associated factors.

Effect of Intravenous Infiltration Management Program on Peripheral Intravenous Catheter Success and Infiltration in Hospitalized Infants

BACKGROUND

Peripheral intravenous catheter (PIVC) insertion is the most frequently used method for intravenous (IV) treatment in pediatric patients.

PURPOSE

The aim of this study was to determine the effect of the Intravenous Infiltration Management Program on the success of PIVC insertion and infiltration in infants.

METHODS

The study was carried out using a quasi-experimental design with pretest-posttest control groups and included 750 PIVC procedures for 218 infants between 28 days and 12 months of age.

RESULTS

The program decreased the number of PIVC insertions per patient, although it was not statistically significant (P = .076) and had an impact on the success of the PIVC attempt (P < .001), first PIVC attempt (P < .001), PIVC dwell time, and early detection of infiltration (P < .001).

CONCLUSION

The program is effective in the success of the PIVC insertion process and early detection of infiltration.

Extravasation Injuries of the Limbs in Neonates and Children-Development of a Treatment Algorithm

BACKGROUND

Hospitalized children and neonates very often receive intravenous treatment. There has not yet been any systematic study of the incidence of extravasation injuries in this age group. In a few studies of neonates in intensive care receiving intravenous treatment, incidence figures in the range of 18-46% have been reported; 2.4-4% sustain serious complications, such as necrosis and ulceration, that can lead over the long term to contractures, deformities, and impaired limb function due to unfavorable scarring. No guidelines currently exist for the care of pediatric extravasation injuries.

METHODS

This review is based on pertinent publications (from 1979 to June 2020) retrieved by a selective search in PubMed, as well as on experience from the authors' own institution.

RESULTS

In the absence of randomized controlled trials on the care of pediatric extravasation injuries, the available evidence is limited to small-scale comparative studies and case series. Conservative, medical, or surgical treatment can be used, depending on the volume of the extravasate, the nature of the substrate, and individual patient-related factors. It should first be determined whether the extravasated substance has no primary toxic properties or is a tissue irritant or a necrosis-inducing substance (vesicant). The skin and subcutaneous tissue should be examined for injury, coloration, swelling, capillary refill time, and pulses distal to the injury. Depending on the volume of the extravasate, the substrate, and the degree of tissue damage, the injury can be treated conservatively; medically, with the administration of an antidote, hyaluronidase, or a vasodilator such as phentolamine; or surgically, with multiple puncture procedures, washouts, or liposuction.

CONCLUSION

As there is no clear evidence that one form of treatment is superior to any other, the treatment of pediatric extravasation injuries remains an individual decision, with the known attendant risks of off-label treatment.

Measuring the Validity and Reliability of the Vascular Access Complication Staging and Treatment Instrument in a Pediatric Population

A multiphase study designed with Delphi and observational components was conducted to establish the preliminary validity and reliability of the 2018 Vascular Access Complication Staging and Treatment Instrument in pediatric and neonatal populations from a single, free-standing academic children's hospital. The instrument uses objective measurement criterion to determine the severity of swelling and tissue damage to inform treatment decisions. The results of the study provided preliminary empirical evidence to support a pediatric and neonatal intravenous complication staging instrument to assess degree of swelling and severity of tissue injury. The study also offered preliminary evidence that the instrument was perceived by the nurses who participated in the study to be efficient and easy to use.

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

OBJECTIVE

to elaborate and validate the content and appearance of an algorithm for treating infiltration and extravasation of non-chemotherapy drugs and solutions administered to children.

METHOD

a methodological study of the technology formulation and validation type. To elaborate the algorithm, a bibliographic review was carried out to list the scientific evidence on the treatment of infiltration and extravasation. Content and appearance validation was in charge of 14 specialists in pediatric nursing, using the Delphi technique, adopting a value equal to or greater than 0.80 as Content Validation Index.

RESULTS

the algorithm was validated in the third evaluation by the judges, reaching a Global Content Validation Index of 0.99, being composed by the perception of the occurrence of the complication; discontinuation of intravenous therapy infusion; verification of signs and symptoms; measurement of edema; application of an infiltration and extravasation assessment scale and conduits to be used according to the characteristics of the fluid administered and the type of complication.

CONCLUSION

the algorithm was validated and can be used in a practical and objective way by health professionals, in order to promote safety in the care of hospitalized children, with regard to reducing harms caused by infiltration and extravasation.

Recommendations for Management of Noncytotoxic Vesicant Extravasations

To prepare clinicians to treat extravasation of noncytotoxic vesicants with antidotes and thermal compresses, a literature review was performed to identify noncytotoxic vesicants and to create evidence and consensus-based recommendations. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. For osmolarity, pH, absorption refractory, and cytotoxic concentration-dependent vesicants, warm compresses and administration of hyaluronidase are recommended. Compared with potentially catastrophic costs of undertreatment, the cost of overtreatment is minimal.

The related factors of phlebitis among low birth weight infants in perinatology ward

Peripheral intravenous line placement might lead to some risks and complications in low birth weight (LBW) infants including phlebitis, which shows varying percentages. This study aimed to analyze the causative factors of phlebitis among LBW infants in a perinatology ward. A total of 106 LBW infants who selected using a consecutive sampling technique were analyzed with cross-sectional method. Data were collected when LBW infants started receiving infusions until the infusion was stopped under certain conditions, using the Infusion Nurses Society (INS) phlebitis scale and the Neonatal Infant Pain Scale (NIPS) as the instrument. The variables related to phlebitis under bivariate analysis included the clinical experience of intravenous insertion, infusion pumps, site of insertion, neonatal birth weight, and the administration of total parenteral nutrition. The most significant risk factor of phlebitis was the nurses' clinical experience of intravenous insertion (< 2 years). Therefore, the results of this study can be considered to improve the quality of nursing care in perinatology ward.

The Incidence of Peripheral Intravenous Catheter Phlebitis and Risk Factors among Pediatric Patients

BACKGROUND

Phlebitis is one of the most common complications of peripheral intravenous catheter (PIVC) that can lead to many complications, including higher medical costs and longer hospital stays.

OBJECTIVE

To identify the incidence of phlebitis associated with PIVC and determine its risk factors among hospitalized pediatric patients.

METHODS

An observational and cross-sectional design was used. Data such as patient's demographics, medical diagnosis, place of admission, and other PIVC characteristics were recorded. In addition, observations of PIVC sites over 12-hour intervals were conducted to measure PIVC complications using the Visual Infusion Phlebitis (VIP) scale.

SAMPLE AND SETTING

Over a period of six months, a sample consisting of 307 children from five governmental hospitals that are located in north and middle Jordan were targeted. The sample consists of patients under 12 years old with PIVCs who were hospitalized in pediatric departments.

RESULTS

PIVC catheterization has been associated with several complications such as phlebitis (N = 164; 53.4%), extravasation (N = 107, 34.9%), pain (N = 37; 12.1%), leakage (N = 37; 12.1%), and obstruction (N = 26; 8.5%). The main risk factors for phlebitis were: children admitted to wards, PIVC inserted by novice nurse, catheter inserted in the lower limbs, and catheter with contaminated dressing.

CONCLUSION

This study enriches knowledge of PIVC complications and risk factors of phlebitis to help nurses avoid complications and initiate prompt treatment, leading to decrease financial burden as well as patient pain and discomfort.