Risk factors for infiltration in children and adolescents with peripheral intravenous catheters

Santos, Luciano Marques dos; Figueredo, Irlane Batista; Silva, Cleonara Sousa Gomes e; Catapano, Uliana Oliveira; Silva, Bianka Sousa Martins; Avelar, Ariane Ferreira Machado

doi:10.1590/0034-7167-2021-0176

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (04) • 2022 • https://doi.org/10.1590/0034-7167-2021-0176 copy

Risk factors for infiltration in children and adolescents with peripheral intravenous catheters

Factores de riesgo para infiltración en niños y adolescentes con catéteres intravenosos periféricos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to estimate the incidence of infiltration and the factors associated with its occurrence in children and adolescents in the operative period and with peripheral intravenous catheters.

Methods:

a longitudinal and prospective study with children and adolescents using peripheral intravenous catheters, conducted at the surgical clinic unit of a pediatric hospital in Feira de Santana, State of Bahia, from April 2015 to December 2016. The study used Pearson’s chi-square and Fisher’s exact test for the analysis. It also applied multiple analyses using Poisson regression with robust variance.

Results:

the incidence of infiltration was 31.2% and was associated with female sex (RR=0.53; CI=[0.30-0.96]), non-eutrophic children (RR=2.27; CI=[1.25-4.20]), who used non-irritating and non-vesicant drugs (RR=1.72; CI=[1.03-2.87]), vesicant drugs (RR=1.84; CI=[1.05-3.22]) and irritating/vesicant electrolytes (RR=2.35; CI=[1.38-3.97]).

Conclusions:

the study suggests the development of strategies that will help in the prevention of this adverse event through the knowledge of the associated factors.

Descriptors:
Pediatric Nursing; Child Hospitalization; Catheterizations; Peripheral; Infusion; Intravenous; Adverse Effects

	n	%
Infiltration	34	31.2
Age in months (n = 97)
Up to 35 (infant)	14	14.4
From 36 to 83 (preschool)	25	25.8
From 84 to 131 (school)	20	20.6
≥ 132 (adolescent)	38	39.2
Sex (n = 97)
Female	42	43.3
Male	55	56.7
Race/color (n = 97)
White	10	10.3
Not white^* * In this category, black and brown are included.	87	89.7
History of prematurity (n = 97)	8	8.2
Nutritional condition (n = 97)
Eutrophic	86	88.7
Malnourished	10	10.3
Obese	1	1
Hospitalization length (n = 97)
Up to 7 days	76	78.4
≥ 8 days	21	21.6

Variables	Yes (n = 34) n (%)	No (n = 75) n (%)	p value	RR^§ § Relative Risk;	CI (95%)^‡ ‡ 95% confidence interval.
Age			0.072^* * Chi-Pearson’s square;	1.76	0.95-2.89
Up to 6 years (up to 83 months)	18 (40.9%)	26 (59.1%)
≥ 7 years (84 months or more)	16 (24.6%)	49 (75.4%)
Sex			0.038^* * Chi-Pearson’s square;	0.53	0.28-0.99
Female	10 (20.8%)	38 (79.2%)
Male	24 (39.3%)	37 (60.7%)
Race / color			1.000^ Fisher’s exact test;	0.86	0.31-2.36
White / red	03 (27.3%)	08 (72.7%)
Black / brown	31 (31.6%)	67 (68.4%)
History of prematurity			1.000^ Fisher’s exact test;	0.79	0.23-2.7
Yes	02 (25%)	06 (75%)
No	32 (31.7%)	69 (68.3%)
Nutritional condition			0.033^ Fisher’s exact test;	2.09	1.19-3.65
Non-eutrophic	8 (51.1%)	6 (42.9%)
Eutrophic	26 (27.4%)	69 (72.6%)
Hospitalization length (days)			0.172^* * Chi-Pearson’s square;	1.47	0.85-2.56
8 days or more	15 (39.5%)	23 (60.5%)
Up to 7 days	19 (26.8%)	52 (73.2%)

Variables	Yes (n = 34) n (%)	No (n = 75) n (%)	p value	RR^§ § Relative Risk;	CI (95%)^‡ ‡ 95% confidence interval;
Difficulty history for PIVC^£ £ peripheral intravenous catheterization;			0.003^* * Chi-Pearson’s square;	2.44	1.29-4.61
Yes	24 (44.4%)	30 (55.6%)
No	10 (18.2%)	45 (81.8%)
Prolonged peripheral intravenous therapy			0.172^* * Chi-Pearson’s square;	1.47	0.85-2.56
Yes	15 (39.5%)	23 (60.5%)
No	19 (26.8%)	52 (73.2%)
History of complications^† † In two children/adolescents, it was not possible to collect this information;			0.027^* * Chi-Pearson’s square;	2.25	1.02-4.95
Yes	27 (37.5%)	45 (62.5%)
No	06 (17.1%)	30 (82.9%)
History of phlebitis			0.803^* * Chi-Pearson’s square;	0.92	0.49-1.72
Yes	10 (35.7%)	18 (64.3%)
No	17 (38.6%)	27 (61.4%)
History of infiltration			0.945^* * Chi-Pearson’s square;	1.02	0.52-2.03
Yes	20 (37.7%)	33 (62.3%)
No	07 (18.9%)	12 (63.2%)
History of extravasation			0.161^ Fisher’s exact test;	1.77	0.96-3.27
Yes	06 (60%)	04 (40%)
No	21 (33.9%)	41 (66.1%)
History of obstruction			0.430^* * Chi-Pearson’s square;	0.73	0.33-1.64
Yes	05 (29.4%)	12 (70.6%)
No	22 (40%)	33 (60%)
Location of PIVC^£ £ peripheral intravenous catheterization;			1.000^ Fisher’s exact test;	0.96	0.34-2.58
MMII^± ± Lower limbs;λUpper members;	03 (30%)	07(70%)
MMSS^λ	31 (31.3%)	68 (68.7%)
Vein visibility			0.436^* * Chi-Pearson’s square;	1.25	0.71-2.21
Not visible	13 (36.1%)	23 (63.9%)
Visible	21 (28.8%)	52 (71.2%)
Palpability of the vein			0.930^* * Chi-Pearson’s square;	0.96	0.32-2.59
Not palpable	07 (30.4%)	16 (63.9%)
Palpable	27 (31.4%)	59 (71.2%)
Catheter gauge			0.6948^ Fisher’s exact test;	1.49	0.59-3.75
20 G^δ δ Gauge.	03 (42.9%)	04 (57.1%)	> 0.99^ Fisher’s exact test;	1.18	0.43-3.26
24 G^δ δ Gauge.	08 (36.4%)	14 (63.6%)
22 G^δ δ Gauge.	23 (28.8%)	57 (71.3%)
Catheter Material			0.360^* * Chi-Pearson’s square;	0.76	0.43-1.35
Teflon	22 (28.6)	55 (71.4%)
Polyurethane	12 (37.5%)	20 (62.5%)
Puncture method			0.145^ Fisher’s exact test;	2.04	0.700-9.60
Direct	31 (34.1%)	60 (65.9%)
Indirect	03 (16.7%)	15 (83.3%)
Catheter stabilization			0.440^* * Chi-Pearson’s square;	1.31	0.68-2.54
No	7 (38.9%)	11 (61.1%)
Yes	27 (39.7%)	64 (70.3%)

Variables	Yes (n = 34) n (%)	No (n = 75) n (%)	p value	RR^§ § Relative Risk;	CI (95%)^‡ ‡ 95% confidence interval;
Use of irritating drugs^§ § Relative Risk;			0.678^* * Chi-Pearson’s square;	0.88	0.48-1.60
Yes	22 (39.3%)	53 (70.7%)
No	11 (33.3%)	22 (66.7%)
Use of vesicant drugs^§ § Relative Risk;			0.135^* * Chi-Pearson’s square;	1.58	0.89-2.80
Yes	11 (42.3%)	15 (57.7%)
No	22 (26.8%)	60 (73.2%)
Use of non-irritating and non-vesicant medicinal product			0.060^* * Chi-Pearson’s square;	0.57	0.31-1.04
Yes	12 (22.2%)	42 (77.8%)
No	21 (38.9%)	33 (61.1%)
Use of irritant / vesicant electrolyte^§ § Relative Risk;			0.010^* * Chi-Pearson’s square;	2.26	1.32-3.84
Yes	09 (60%)	06 (40%)
No	25 (26.6%)	69 (73.4%)
PIVC^£ usage time^‡ ‡ 95% confidence interval; (hour)			0.215^ Fisher’s exact test;	0.61	0.26-1.41
Greater than or equal to 72	05 (20.8%)	19 (79.2%)
Less than 72	29 (34.1%)	56 (65.9%)

Variables	Occurrence of infiltration
Variables	p value	RR^§ § Relative Risk;	CI (95%)^‡ ‡ 95% confidence interval.
Sex	0.038	0.53	0.30-0.96
Female
Male
Nutritional condition	0.008	2.27	1.25-4.20
Malnourished
Eutrophic
Use of vesicant medicines	0.039	1.72	1.03-2.87
Yes
No
Use of non-irritating/non-vesicant medicinal products	0.034	1.84	1.05-3.22
Yes
No
Use of irritating/vesicant electrolytes	0.002	2.35	1.38-3.97
Yes
No

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[1] Corresponding author: Luciano Marques dos Santos, E-mail: lucmarxenfo@yahoo.com.br