Risk factors for peripheral intravenous catheter failure in the care of patients with cancer: How can we improve care?
Recorded On: 12/16/2020
Background and Objective:
Peripheral intravenous catheters (PIVCs) are regularly used to administer intravenous infusates, including blood, chemotherapy, fluids, and supportive care drugs, in the treatment of cancer.
The purpose of this presentation will be to share results of a prospective observational study and a cancer-specific sub-analysis of a large international cross—sectional study, to explore both modifiable and non-modifiable risk factors for PIVC failure among hematology and oncology patients.
During the observational study, two hundred adult patients requiring a PIVC upon admission to a tertiary hospital in Queensland, Australia, were prospectively followed from admission through discharge. Each PIVC the patient received was followed and documented to understand how risk factors, both modifiable (e.g. PIVC gauge) and nonmodifiable (e.g. patient age), impacted upon all-cause PIVC failure. Following this, an oncology/hematology sub-analysis of a large international cross-sectional study was conducted, including n=1807 adult participants from 24 countries. During this study, participants were assessed once for PIVC characteristics and the presence of complications.
The cross-sectional survey identified several modifiable risk factors for complications, including insertion by medical physicians (compared with nurse and vascular access teams), insertion in emergency settings, poor PIVC dressing integrity, and dwell time ≥49 hours. Treatment risk factors included administration of intravenous colloids/blood products and antiemetics. The observational cohort study identified a single protective factor against PIVC dislodgement – the use of non-sterile tape (external to the primary dressing).
The rate of all-cause PIVC failure in cancer settings remains high. It is important that clinicians and researchers understand both modifiable and non-modifiable risk factors in order to inform quality improvement and future large interventional research studies.
1. Recognize what modifiable risk factors are associated with PIVC failure in Oncology and Hematology settings, and ways to mitigate them.
2. Describe the impact of non-modifiable (inherent) risk factors (such as age and gender) upon PIVC failure, and how this should influence device, vein, location, and dressing selection.
3. Understand how PIVC characteristics vary internationally and consider how to place these results in the context of your own clinical setting.
Research Fellow, Vascular Access
Emily Larsen is a Research Fellow, Vascular Access, with positions at the Royal Brisbane and Women’s Hospital and Griffith University in Australia. In her various roles with the Alliance for Vascular Access Teaching and Research (AVATAR), Ms. Larsen has coordinated over 30 single and multi-centre clinical trials, cohort studies and qualitative inquiries over the last 8 years. Her interests and expertise include patient experience of IV access and vascular access devices in oncology and hematology, as well as the classification and prevention of catheter-associated bloodstream infections.
CRNI® RUs: This session has been approved for 1 CRNI® recertification unit and meets the non INS Meeting criteria.
Contact Hours: This session has been approved for 1 contact hour
Expiration date for receipt of contact hours: December 16, 2023
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The Infusion Nurses Society is approved as a provider of continuing nursing education by the California Board of Registered Nursing, provider #CEP14209. The certificate must be retained by the attendee for a period of 4 years.