title: Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: an observational cohort study.
abstract: OBJECTIVE
  To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement.
  
  
  METHODS
  All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed.
  
  
  RESULTS
  Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1.
  
  
  CONCLUSIONS
  PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters.
authors.affiliation: Nosocomial Infection Control Unit, Delfos Medical Center, Barcelona, Spain. mestre.ucin@centromedicodelfos.es
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mestre Roca
authors.forename: Cristina
authors.initials: C
authors.lastname: Berbel Bertolo
authors.forename: Purificación
authors.initials: P
authors.lastname: Tortajada Lopez
authors.forename: Gema
authors.initials: G
authors.lastname: Gallemi Samaranch
authors.forename: Mari Carmen
authors.initials: MC
authors.lastname: Aguilar Ramirez
authors.forename: Joan
authors.initials: J
authors.lastname: Caylà Buqueras
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Martinez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult