Risk Factors for Peripheral Intravenous Catheter Failure: A Multivariate Analysis of Data from a Randomized Controlled Trial

OBJECTIVE: To assess the relative importance of independent risk factors for peripheral intravenous catheter (PIVC) failure. METHODS: Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal. SETTING: Three acute care hospitals in Queensland, Australia. PARTICIPANTS: The trial included 3,283 adult medical and surgical patients (5,907 catheters) with a PIVC with greater than 4 days of expected use. RESULTS: Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio HR, 1.47 95% confidence interval (CI), 1.28-1.68, 1.27 95% CI, 1.08-1.49, and 1.25 95% CI, 1.04-1.50, respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 95% CI, 1.08-2.03). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 95% CI, 0.67-0.94). Modifiable risks for accidental removal included hand or antecubital fossa insertion compared with forearm (HR, 2.45 95% CI, 1.93-3.10 and 1.65 95% CI, 1.23-2.22, respectively), clinical staff insertion compared with intravenous service (HR, 1.69 95% CI, 1.30-2.20); and smaller PIVC diameter (HR, 1.29 95% CI, 1.02-1.61). Female sex was a nonmodifiable factor associated with an increased risk of both phlebitis (HR, 1.64 95% CI, 1.28-2.09) and occlusion (HR, 1.44 95% CI, 1.30-1.61). CONCLUSIONS: PIVC survival is improved by preferential forearm insertion, selection of appropriate PIVC diameter, and insertion by intravenous teams and other specialists. TRIAL REGISTRATION: The original randomized controlled trial on which this secondary analysis is based is registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTRN12608000445370).