Reducing complications and extending the lifespan of peripheral intravenous catheters in newborns-simple and feasible methods.

Peripheral intravenous catheters (PIVCs) are the most common invasive medical devices used in hospitalized patients. They provide access to the bloodstream for administering fluids, medications, nutritional supplements, and blood transfusions and are integral to medical treatment. However, inserting and maintaining PIVCs can be challenging, particularly in neonates and infants. According to a recent study, establishing a PIVC in infants has the highest failure rate (18.4%) compared to other pediatric age groups1Chu C.H. Liu C.C. Lai C.Y. Chen Y.C. Tien C.H. Hsieh K.H. et al.New dimension on potential factors of successful pediatric peripheral intravenous catheterization.Pediatr Neonatol. 2023; 64: 19-25Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar In a secondary analysis of 11,830 PIVCs (8,200 participants) in 12 prospective studies conducted between 2008 and 2020, 4,263 (36%) PIVCs failed due to complications, most commonly infiltration/occlusion (n = 2767, 23%), followed by phlebitis (n = 1421, 12%) and dislodgement of the catheter (n = 779, 7%).2Marsh N. Larsen E.N. Takashima M. Kleidon T. Keogh S. Ullman A.J. et al.Peripheral intravenous catheter failure: a secondary analysis of risks from 11,830 catheters.Int J Nurs Stud. 2021; 124104095Crossref PubMed Scopus (21) Google Scholar However, in a study of 12,978 neonates who required PIVCs for intravenous therapy, unplanned removal occurred in 7,627 (59%) neonates. The most common cause of PIVC failure was intravasation/extravasation (n = 5,159, 40%), followed by phlebitis (n = 1,590, 12%), occlusion (n = 527, 4%), dislodgment (n = 286, 2%), and swelling/discoloration (n = 65, 1%).3van Rens M.F.P.T. Hugill K. Mahmah M.A. Bayoumi M. Francia A.L.V. Garcia K.L.P. et al.Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study.BMJ Open. 2021; 11e047788Crossref Scopus (8) Google Scholar Several strategies can be employed to prevent PIVC complications. One strategy is to select the appropriate catheter size and material for each patient. The catheter size should be based on the patient's age, vein size, and the type and duration of therapy.4Helm R.E. Klausner J.D. Klemperer J.D. Flint L.M. Huang E. Accepted but unacceptable: peripheral IV catheter failure.J Infus Nurs. 2019; 42: 151-164Crossref PubMed Scopus (26) Google Scholar Using a smaller catheter (26-gauge) in neonates results in a 49% risk of complications, while using a larger catheter (22-gauge) results increases the risk to 77%.3van Rens M.F.P.T. Hugill K. Mahmah M.A. Bayoumi M. Francia A.L.V. Garcia K.L.P. et al.Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study.BMJ Open. 2021; 11e047788Crossref Scopus (8) Google Scholar The catheter material should also be considered, as some materials have lower rates of phlebitis than others. For example, polyurethane or silicone catheters are less irritating to the vein wall than other materials.4Helm R.E. Klausner J.D. Klemperer J.D. Flint L.M. Huang E. Accepted but unacceptable: peripheral IV catheter failure.J Infus Nurs. 2019; 42: 151-164Crossref PubMed Scopus (26) Google Scholar Another strategy to prevent PIVC complications is to use the proper insertion technique. The insertion site should be cleaned and disinfected with an antiseptic solution that has proven efficacy against skin flora, such as chlorhexidine or povidone-iodine. The catheter should be inserted using sterile technique, and the number of insertion attempts should be minimized to reduce the risk of trauma and infection. The catheter hub and injection ports should be handled aseptically to prevent contamination and infection.5O'Grady N.P. Alexander M. Burns L.A. Dellinger E.P. Garland J. Heard S.O. et al.Guidelines for the prevention of intravascular catheter-related infections.Clin Infect Dis. 2011; 52: e162-e193Crossref PubMed Scopus (1443) Google Scholar The third strategy to prevent PIVC complications is to provide appropriate catheter care and maintenance. The PIVC site should be inspected regularly for signs of infection, infiltration, phlebitis, or occlusion. The catheter dressing should be changed every 3–7 days or sooner if it becomes soiled, wet, or loose.6Gorski L.A. Hadaway L. Hagle M.E. Broadhurst D. Clare S. Kleidon T. et al.Infusion therapy standards of practice, 8th edition.J Infus Nurs. 2021; 44: S1-S224Crossref PubMed Scopus (345) Google Scholar However, despite these strategies, the failure rate of PIVCs remains high.4Helm R.E. Klausner J.D. Klemperer J.D. Flint L.M. Huang E. Accepted but unacceptable: peripheral IV catheter failure.J Infus Nurs. 2019; 42: 151-164Crossref PubMed Scopus (26) Google Scholar Improving catheter care and preventing complications associated with PIVCs are areas for improvement, and understanding the risk factors for a failed PIVC would enhance clinical care. In this volume of the Journal, Tseng et al. analyzed 315 PIVCs in neonates and infants aged less than 4 months. In that study, the mean indwelling time of PIVCs was 33.8 ± 21.5 h, and the rate of complications was 82.2%. The most common complications were infiltration (55.9%) and extravasation (22.2%). Interestingly, intermittent flushing may be superior to continuous intravenous drip (CIVD) for maintaining the patency of a PIVC. CIVD with a hypertonic solution, CIVD with higher infusion rates, or administration of ampicillin at high concentrations (>50 mg/mL) significantly reduces PIVC patency and increases the rate of complications.7Tseng J.H. Elaine Chen Y.F. Chang S.P. Wang H.C. Kuo Y.T. Factors affecting the patency and complications of peripheral intravenous catheters in newborns.Pediatr Neonatol. 2023; 64: 239-246Abstract Full Text Full Text PDF Scopus (2) Google Scholar Their study provided some simple and feasible methods to prevent complications and extend the lifespan of PIVCs. In conclusion, PIVCs are widely used in clinical practice but can cause serious complications. Healthcare professionals can reduce complication rates and improve the safety of PIVCs in neonates and infants by following evidence-based guidelines and protocols. The author declares no conflicts of interest.