Intravenous Infiltration Risk by Catheter Dwell Time Among Hospitalized Children

Abstract

Purpose: This study was aimed to examine the cumulative risk for infiltration over IV catheter dwell time by general or catheterization-specific characteristics of pediatric patients with IV therapy. Design and methods: This secondary data analysis was done with the data of 1596 children who received peripheral IV therapy at least once during their hospital stay between August 1st and October 30th, 2011 and in June, 2013 in an academic medical center, Yangsan, Republic of Korea. The survival functions of infiltration were determined by using the Kaplan-Meier analysis. Result: The cumulative risk for infiltration had rapidly increased from 1.5% after 24 hours of catheter dwell time to 17.3% after 96 hours. The survival functions were significantly different in the medical than in the surgical department (p = .005), lower extremities than upper ones (p = .001), and use of 10% dextrose (p = .001), ampicillin/sulbactam (p < .001), vancomycin (p = .024), high-concentration electrolytes (p = .001), and phenytoin (p < .001). Conclusion: When catheter dwell times are similar, the cumulative risk for infiltration was higher in cases wherein the patient had a risk factor. The cumulative risk for infiltration has rapidly increased after 24 hours in patients who have 10% dextrose, high-concentration electrolytes, and phenytoin. Practice implications: The results suggest that nurses are required to assess the IV site every hour after 24 hours of catheter dwell time for the infusion of irritants for a safer practice of IV therapy. However, this monitoring time may be modified by the age of child, previous IV complications, and/or hemodynamic issues which may impact IV integrity. (C) 2017 Elsevier Inc. All rights reserved.