Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units
Abstract Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involv...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
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SpringerOpen
2022-04-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-022-01009-5 |
| _version_ | 1819210429133488128 |
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| author | Hideto Yasuda Claire M. Rickard Nicole Marsh Ryohei Yamamoto Yuki Kotani Yuki Kishihara Natsuki Kondo Kosuke Sekine Nobuaki Shime Keita Morikane Takayuki Abe the AMOR-NUS study group |
| author_facet | Hideto Yasuda Claire M. Rickard Nicole Marsh Ryohei Yamamoto Yuki Kotani Yuki Kishihara Natsuki Kondo Kosuke Sekine Nobuaki Shime Keita Morikane Takayuki Abe the AMOR-NUS study group |
| author_sort | Hideto Yasuda |
| collection | DOAJ |
| description | Abstract Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017). |
| first_indexed | 2024-12-23T06:11:02Z |
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| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-23T06:11:02Z |
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| series | Annals of Intensive Care |
| spelling | doaj.art-1c04c6e8f3b84436b43b0d0c33bff64a2022-12-21T17:57:26ZengSpringerOpenAnnals of Intensive Care2110-58202022-04-0112111310.1186/s13613-022-01009-5Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care unitsHideto Yasuda0Claire M. Rickard1Nicole Marsh2Ryohei Yamamoto3Yuki Kotani4Yuki Kishihara5Natsuki Kondo6Kosuke Sekine7Nobuaki Shime8Keita Morikane9Takayuki Abe10the AMOR-NUS study groupDepartment of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical CenterSchool of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of QueenslandSchool of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of QueenslandDepartment of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto UniversityDepartment of Intensive Care Medicine, Kameda Medical CenterDepartment of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical CenterDepartment of Intensive Care Medicine, Chiba Emergency Medical CenterDepartment of Medical Engineer, Kameda Medical CenterDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDivision of Clinical Laboratory and Infection Control, Yamagata University HospitalBiostatistics, Clinical and Translational Research Center, Keio University School of MedicineAbstract Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).https://doi.org/10.1186/s13613-022-01009-5CatheterCatheter-related infectionsCritically ill patientRisk factorsIntensive care unitCatheterization |
| spellingShingle | Hideto Yasuda Claire M. Rickard Nicole Marsh Ryohei Yamamoto Yuki Kotani Yuki Kishihara Natsuki Kondo Kosuke Sekine Nobuaki Shime Keita Morikane Takayuki Abe the AMOR-NUS study group Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units Annals of Intensive Care Catheter Catheter-related infections Critically ill patient Risk factors Intensive care unit Catheterization |
| title | Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units |
| title_full | Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units |
| title_fullStr | Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units |
| title_full_unstemmed | Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units |
| title_short | Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units |
| title_sort | risk factors for peripheral intravascular catheter related phlebitis in critically ill patients analysis of 3429 catheters from 23 japanese intensive care units |
| topic | Catheter Catheter-related infections Critically ill patient Risk factors Intensive care unit Catheterization |
| url | https://doi.org/10.1186/s13613-022-01009-5 |
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