34. Why are peripheral intravenous catheters removed in practice? A secondary analysis of a multi-site cluster randomised controlled trial

Abstract

Introduction: Peripheral intravenous catheters (PIVCs) should be removed when no longer needed, with guidelines recommending either removal and replacement routinely at 72 hours (adults only) or as clinically indicated (adults/paediatrics). This study described and explored reasons for PIVC removal, or lack thereof, in practice. Methods: A secondary analysis of a stepped-wedge cluster trial was conducted. Participants with a successfully inserted PIVC were included from three tertiary hospitals and 12 wards (general and specialty medical/surgical, emergency/trauma, oncology/haematology, coronary care, intensive care). Adult and paediatric analyses were performed with logistic regression (binary/multinomial) to identify associations between PIVC removal and patient/PIVC characteristics. Results: PIVCs (adult n=1137/paediatric n=701) were removed as treatment complete without (62.0%/55.8%) or with complications (4.6%/14.6%), treatment incomplete with complications (20.0%/27.2%), or for routine resite (9.0%/0.9%). Some dwelled 73-82 hours (8.4%/12.6%) and >92 hours (17.8%/25.1%). Daily checks during dwell identified ≥1 complication in 19.6% adult and 21.7% paediatric PIVCs, but over 50% of these remained in-situ for >24-hours. Over 20% of PIVCs were left idle, with idle-associated factors including PIVC insertion-site location, and for adults only, specialty. Factors associated with reasons for removal (treatment in/complete with/out complications, routine resite) in both cohorts were specialty, difficult intravenous access, insertion-site location and idle status, and for adults only, insertion complications and dwell-time. Conclusion: The results suggest most PIVCs are removed based on clinical indication. However, many are left in place with a complication or when no longer needed. Education and surveillance of PIVC care processes, including removal, should support optimal practices.