The burden of peripheral intravenous catheters (PIVCs) in older hospital in-patients: A National Cross-Sectional Study (Part of the One Million Global [OMG] PIVC Collaboration)

Abstract

Aims: We investigated the burden of PIVCs in older in-patients.

Methods: In a cross-sectional study of patients aged ≥65 across 65 Australian hospitals, we assessed PIVC characteristics and complications.

Results: In 2179 individual PIVCs across 2041 patients (mean age 77.6 years, 44.9% female, 57.7% NSW), 43% were inserted by doctors, 24% by nurses. Most were inserted on the ward (40.2%) or in ED (25.6%). Antecubital fossa was the commonest site (28.9%), followed by hand and forearm (both 27%). Eighty percent were 20-22 gauge, and 74.2% were used that day. The commonest indications for PIVC were IV medications (57.7%) and fluids (22%).

Overall, 18% (393/2179) of patients had PIVC-related signs/symptoms, most commonly tenderness (4.1%; 90/2179) and local redness (1.8%); other symptoms (tracking erythema, palpable vein, swelling) were rare. Dressing (98% transparent type) was clean and dry in 70.9%, but only timed/dated in 36.8%.

Highest age quartile (≥84 years) was associated with reduced likelihood of phlebitis symptoms (OR 0.60, P = 0.03), and increased ‘ideal’ (forearm/upper arm) placement (aOR 1.24, P = 0.05).

Among 1565 patients (76.7%) who rated their catheter experience (Likert scale 0-10, 10 = ‘best possible’), median score was 8 (IQR 6-10). Highest age quartile was associated with lower likelihood of a high (>8) experience score (both univariate and adjusted for presence of clinical signs; aOR 0.71, P = 0.02).

Conclusions: Despite a potentially vulnerable population, clinical signs and patient dissatisfaction were uncommon, although the oldest old were less likely to rate the experience very highly. Further research should focus on minimising harm and improving patient experiences.