Highlights

  • Catheter failure is a serious matter challenging the delivery of high-quality care for pediatric patients.

  • Insertion modality, patient race, and an intensive care unit or emergency department setting are predictive of catheter failure and removal.

  • Peripheral intravenous catheter insertion under ultrasound guidance had an estimated dwell time of 6.5 days compared to 4.0 days when transillumination was used.

Abstract
Background:

Peripheral intravenous catheter (PIVC) insertion is one of the most common medical procedures experienced by pediatric patients. A high incidence of catheter failure (CF) and associated sequelae are widely documented.

Methods:

This single-center retrospective study was conducted at a freestanding pediatric academic center. Electronic health records were reviewed to identify variables predictive of PIVC dwell time. PIVCs inserted by the vascular access team using either ultrasound guidance (USG) or transillumination during an inpatient admission in October–December 2019 were analyzed.

Results:

The sample included 743 PIVCs. Survival time, or dwell time, was estimated with the Kaplan-Meier survival curve. PIVCs inserted with USG demonstrated an estimated median dwell time of 6.5 days (95% CI: 5.8, 8.0); those inserted with transillumination had an estimated median dwell time of 4.0 days (95% CI: 3.1, 5.2). Factors predictive of dwell time were insertion modality, race, and patient care setting. Catheter removal associated with failure is 1.87 (95% CI = [1.24, 2.8], P = 0.003) times more likely when the PIVC insertion modality is transillumination compared to USG. Odds of CF are 1.76 (95% CI = [1.19, 2.6], P = 0.004) times more likely in a Black/African American patient than a White patient. Odds of patients in an intensive care unit or emergency department setting are 1.34 (95% CI = [1.03, 1.7], P = 0.029) times more likely to have catheter removal due to failure than in a floor/nonemergency unit.

Conclusions:

Understanding factors contributing to CF gives clinicians the knowledge to improve practice and mitigate harm in pediatric patients.

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