title: Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial.
abstract: OBJECTIVE
  To assess the relative importance of independent risk factors for peripheral intravenous catheter (PIVC) failure.
  
  
  METHODS
  Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal.
  
  
  METHODS
  Three acute care hospitals in Queensland, Australia.
  
  
  METHODS
  The trial included 3,283 adult medical and surgical patients (5,907 catheters) with a PIVC with greater than 4 days of expected use.
  
  
  RESULTS
  Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28-1.68], 1.27 [95% CI, 1.08-1.49], and 1.25 [95% CI, 1.04-1.50], respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08-2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 [95% CI, 0.67-0.94]). Modifiable risks for accidental removal included hand or antecubital fossa insertion compared with forearm (HR, 2.45 [95% CI, 1.93-3.10] and 1.65 [95% CI, 1.23-2.22], respectively), clinical staff insertion compared with intravenous service (HR, 1.69 [95% CI, 1.30-2.20]); and smaller PIVC diameter (HR, 1.29 [95% CI, 1.02-1.61]). Female sex was a nonmodifiable factor associated with an increased risk of both phlebitis (HR, 1.64 [95% CI, 1.28-2.09]) and occlusion (HR, 1.44 [95% CI, 1.30-1.61]).
  
  
  CONCLUSIONS
  PIVC survival is improved by preferential forearm insertion, selection of appropriate PIVC diameter, and insertion by intravenous teams and other specialists.
  
  
  BACKGROUND
  The original randomized controlled trial on which this secondary analysis is based is registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTRN12608000445370).
authors: School of Nursing and Midwifery, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
authors: Marianne C
authors: MC
authors: Wallis
authors: Matthew
authors: M
authors: McGrail
authors: Joan
authors: J
authors: Webster
authors: Nicole
authors: N
authors: Marsh
authors: John
authors: J
authors: Gowardman
authors: E Geoffrey
authors: EG
authors: Playford
authors: Claire M
authors: CM
authors: Rickard
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D058633:Antipyretics / Q000008:administration & dosage; D001132:Arm; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D005542:Forearm; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009873:Operating Rooms; D010689:Phlebitis / Q000209:etiology; D011872:Radiology Department, Hospital; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000900:Anti-Bacterial Agents; D058633:Antipyretics