title: Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients.
abstract: Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices.
  
  
  
  This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis.
  
  
  
  PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3-3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0-2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1-1.4], p < 0.01) significantly predicted PIVC failure.
  
  
  
  Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required.
  
  
  
  Australian and New Zealand Clinical Trials Registry: ACTRN12615000025538 . Registered on 19 January 2015.
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Health Sciences Building N48 170 Kessels Road, Nathan, Brisbane, Queensland, 4011, Australia. s.keogh@griffith.edu.au.|Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia. s.keogh@griffith.edu.au.
authors.forename: Samantha
authors.initials: S
authors.lastname: Keogh
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Health Sciences Building N48 170 Kessels Road, Nathan, Brisbane, Queensland, 4011, Australia.|Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Flynn
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Health Sciences Building N48 170 Kessels Road, Nathan, Brisbane, Queensland, 4011, Australia.|Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Marsh
authors.affiliation: School of Medicine, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Gabor
authors.initials: G
authors.lastname: Mihala
authors.affiliation: Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, St Lucia, Brisbane, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Davies
authors.affiliation: NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Health Sciences Building N48 170 Kessels Road, Nathan, Brisbane, Queensland, 4011, Australia.|Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Rickard
mesh_terms: D000293:Adolescent; D000328:Adult; D061807:Catheter Obstruction / Q000209:etiology*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011793:Queensland; D012307:Risk Factors; D012737:Sex Factors; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D062606:Tertiary Care Centers; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D055815:Young Adult
chemical_list: D012965:Sodium Chloride
keywords: 0.9 % sodium chloride; Catheter obstruction; Flushing; Peripheral; Phlebitis; Randomised controlled trial; Vascular access devices