title: Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial.
abstract: OBJECTIVE
  To identify risk factors for infusion-related phlebitis with peripheral intravenous catheters.
  
  
  METHODS
  A randomized trial of two catheter materials, with consideration of 21 potential risk factors.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Hospitalized adults without granulocytopenia who received a peripheral intravenous catheter.
  
  
  METHODS
  House officers or ward nurses inserted the catheters, and each insertion was randomized to a catheter made of tetrafluoroethylene-hexafluoropropylene (FEP-Teflon) or a novel polyetherurethane without leachable additives (PEU-Vialon).
  
  
  METHODS
  Research nurses scored insertion sites each day for inflammation and cultured catheters at removal.
  
  
  RESULTS
  The Kaplan-Meier risk for phlebitis exceeded 50% by day 4 after catheterization. intravenous antibiotics (relative risk, 2.00), female sex (relative risk, 1.88), prolonged (greater than 48 hours) catheterization (relative risk, 1.79), and catheter material (PEU-Vialon: FEP-Teflon) (relative risk, 0.73) strongly predicted phlebitis in a Cox proportional hazards model (each, P less than 0.003). The best-fit model for severe phlebitis identified the same predictors plus catheter-related infection (relative risk, 6.19), phlebitis with a previous catheter (relative risk, 1.54), and anatomic site (hand: forearm, relative risk, 0.71; wrist:forearm, relative risk, 0.60). The low incidence of local catheter-related infection was comparable with the two catheter materials (5.4% [95% CI, 3.8% to 7.6%] and 6.9% [CI, 4.9% to 9.6%]); none of the 1054 catheters prospectively studied caused bacteremia.
  
  
  CONCLUSIONS
  Multiple factors, including the infusate and the duration of cannulation, contribute to the development of infusion-related phlebitis. The use of peripheral intravenous catheters made of PEU-Vialon appears to pose the same risk for catheter-related infection as the use of catheters made of FEP-Teflon, and PEU-Vialon can permit longer cannulation with less risk for phlebitis. The risk for catheter-related bacteremia with FEP-Teflon and PEU-Vialon catheters is sufficiently low that it no longer seems justifiable to recommend the use of small steel needles for most peripheral intravenous therapy.
authors.affiliation: University of Wisconsin Medical School, Madison.
authors.forename: D G
authors.initials: DG
authors.lastname: Maki
authors.forename: M
authors.initials: M
authors.lastname: Ringer
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation; D004866:Equipment Contamination; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D007239:Infections / Q000209:etiology; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011140:Polyurethanes; D016016:Proportional Hazards Models; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013223:Statistics as Topic; D013924:Thrombophlebitis / Q000209:etiology*
chemical_list: D011140:Polyurethanes; C048129:Vialon; C115016:polyetherurethane; D011138:Polytetrafluoroethylene