Prehospital Peripheral Venous Catheters: A Prospective Study of Patient Complications

Abstract

Purpose

To investigate prehospital peripheral venous catheters (PVCs) in relation to the frequency of thrombophlebitis.

Method

Data in this prospective study were collected using three types of data source: a study-specific questionnaire, a PVC observation instrument (PVC assess), and electronic patient records. The questionnaire was distributed to ambulance crews who had inserted a PVC before bringing the patient to an emergency department at a level one trauma centre in Sweden during 10 weeks in 2008–2009. Patients admitted to hospital ward were followed-up daily by registered nurses using the PVC assess until the PVC was removed. Patient record data were collected by means of auditing.

Results

Of the 83 patients available for follow-up, 45 (54%) developed thrombophlebitis. Quick PVC removal was performed in 32 (71%) of these patients while 13 (29%) PVCs were left in situ for 1–8 days. No association was found between the occurrence of thrombophlebitis and potential risk factors.

Conclusions

Although thrombophlebitis frequently occurred in PVCs inserted in a prehospital setting, early removal of the device with complication was common. Further studies are warranted to identify the optimal in situ time for PVCs inserted by prehospital emergency teams.

Keywords

Catheterization Emergency department Emergency medical services Nursing Peripheral Phlebitis

Get full access to this article

View all access options for this article.

References

Idvall

, Gunningberg

Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: a systematic review.

J Adv Nurs 2006; 55: 715–22.

The Joanna Briggs Institute for Evidence Based Nursing. Management of peripheral intravascular devices. www.joannabriggs.edu.au. Accessed on Dec 17, 2009.

O'Grady

, Alexander

, Dellinger

, Gerberding

, Heard

, Maki

Guidelines for prevention of intravascular catheter-related infections.

Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002; 1–29.

The Cochrane Collaboration. Clinically-indicated replacement versus routine replacement of peripheral venous catheters (Review). www.thecochranelibrary.com. Accessed on Jun 1, 2010.

Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf. Accessed on Dec 21, 2009.

Maki

, Kluger

, Crnich

The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.

Mayo Clinic Proceedings 2006; 9: 1159–71.

Shreve

, Knotts

Quality improvement with prehospital-placed intravenous catheters in trauma patients.

J Emerg Nurs 1999; 4: 285–9.

Ezingeard

, Coudrot

, Guyomarc'h

. Evaluation of colonisation of peripheral venous catheters inserted by prehospital emergency service teams (SMUR) in France. J Hosp Infect 2009; 72: 169–75.

Kagel

, Rayan

Intravenous catheter complications in the hand and forearm.

Journal of Trauma 2004; 1: 123–7.

10.

Campbell

I.V.-related phlebitis, complications and lengths of hospital stay: 1.

Br J Nurs 1998; 7: 1304–6.

11.

Tagalakis

, Kahn

, Libman

, Blostein

The epidemiology of peripheral vein infusion thrombophlebitis: a critical review.

Am J Med 2002; 2: 146–51.

12.

Lawrence

, Lauro

Complications from IV therapy: Results from field-started and emergency department-started IVs compared.

Ann Emerg Med 1988; 4: 314–17.

13.

Zarate

, Mandleco

, Wilshaw

, Ravert

Peripheral intravenous catheters started in prehospital and emergency department settings.

Trauma Nurs 2008; 2: 47–52.

14.

Ahlqvist

, Berglund

, Wiren

, Klang

, Johansson

Accuracy in documentation - a study of peripheral venous catheters.

J Clin Nurs 2009; 13: 1945–52.

15.

Henderson

, Thomson

, Bahrs

, Norman

Unnecessary intravenous access in the emergency setting.

Prehosp Emerg Care 1998; 4: 312–16.

16.

Kuzma

, Sporer

, Michael

, Youngblood

When are prehospital intravenous catheters used for treatment?

J Emerg Med 2009; 4: 357–62.

17.

Minville

, Pianezza

, Asehnoune

, Cabardis

, Smail

Prehospital intravenous line placement assessment in the French emergency system: a prospective study.

Eur J Anaesthesiol 2006; 23: 594–7.

18.

Pace

, Fuller

, Dahlgren

Paramedic decisions with placement of out-of-hospital intravenous lines.

Am J Emerg Med 1999; 17: 544–7.

19.

Ahlqvist

, Berglund

B.G N.

, Klang

, Wiren

, Johansson

A new reliable tool (PVC Assess) for assessment of peripheral venous catheters.

J Eval Clin Pract 2009; in press.

20.

Cicchetti

The precision of reliability and validity estimates revisited: distinguishing between clinical and statistical significance of sample size requirements.

J Clin Exp Neuropsychol 2001; 5: 695–700.

21.

Maki

, Ringer

Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial.

Ann Intern Med 1991; 10: 845–54.

22.

Kaplan

, Meier

Nonparametric estimation from incomplete observations.

J Am Stat Assoc 1958; 457–81.

23.

Bregenzer

, Conen

, Sakmann

, Widmer

Is routine replacement of peripheral intravenous catheters necessary?

Arch Intern Med 1998; 2: 151–6.

24.

Webster

, Clarke

, Paterson

. Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ 2008; 19: 157–60.

25.

O'Grady

, Alexander

, Dellinger

. Guidelines for the prevention of intravascular catheter-related infections. 2002, Centers for Disease Control and Prevention. p. 1–29.

26.

Webster

, Osborne

, Rickard

, Hall

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Cochrane Database of Systematic Reviews 2010; 3.

27.

Göransson

, Johansson

Indication and usage of peripheral venous catheters inserted in adult patients during emergency care.

J Vasc Access 2011 Nov 3 [ePub ahead of print].