Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

• Published in: Journal of advanced nursing Vol. 76; no. 12; pp. 3346 - 3362
• Main Authors: Marsh, Nicole, Webster, Joan, Ullman, Amanda J., Mihala, Gabor, Cooke, Marie, Chopra, Vineet, Rickard, Claire M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2020
• Subjects: Adult; Analysis; catheter obstruction; Catheterization; Catheterization, Peripheral - adverse effects; Catheters; Catheters - adverse effects; Clinical research; Clinical trials; Cohort analysis; Comparative studies; Complications; Emergency services; Epidemiology; extravasation; Health care expenditures; Health services; Humans; Indwelling; infiltration; Infusions, Intravenous; MESH: Catheters; Meta-analysis; nurse; Nurses; nursing; Observational studies; Pain; Phlebitis; Phlebitis - etiology; Quality assessment; Systematic review; thrombophlebitis; Transformation; MESH: Catheters; extravasation; catheter obstruction; Indwelling; nurse; catheterization; nursing; phlebitis; infiltration; thrombophlebitis
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14565

Aims The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications. Design This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies. Data sources The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019. Review Methods Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models. Results Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies. Conclusion Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. Impact Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters. 摘要 目的 本系统评价和荟萃分析旨在概述和量化外周静脉导管相关并发症。 设计 本系统评价是通过随机对照试验用Cochrane程序和队列研究用荟萃分析流行病观察研究来报告的。 数据来源 2000年至2019年4月期间,检索了Cochrane对照试验中央缓存器、PubMed、CINAHL和EMBASE数据库、ClinicalTrials.gov等临床试验缓存器和纳入研究的参考文献清单。 审查方法 两位作者使用专门设计的数据提取工具,独立确定了全面审查、数据提取和质量评估方面的研究。在Freeman‐Tukey双重反正弦转化后,使用随机效应荟萃分析对二元结果进行汇总;异质性的估计是基于逆方差固定效应模型。 结果 纳入了70项观察性研究和33项随机对照试验(76977例导管)。外周静脉导管相关并发症如下:静脉炎(有定义)19.3%、静脉炎(无定义)4.5%、浸润/外渗13.7%、闭塞8%,渗漏7.3%、疼痛6.4%和移位6.0%。亚组分析发现,急诊科插入的导管的浸润/外渗明显高于其他科室插入的导管的浸润/外渗(25.2%;p=.022),发展中经济体国家的疼痛明显高于发达经济体国家(p <.001)。 结论 外周静脉导管并发症在全球范围内是不可接受的常见病症。本项审查表明,需要做出大量的多专业工作来解决与并发症相关的后遗症问题。减少并发症将对患者和医疗服务产生巨大的潜在益处。 影响 外周静脉并发症使得重要治疗中断,这可能会给患者带来痛苦,并导致住院时间延长,医疗费用增加。本项审查发现静脉炎和浸润是导管失败的最主要原因。这些结果为护士制定有效的实践干预措施提供了有力的证据基础,这对预防外周静脉导管患者的预后不良至关重要。