Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients

Article


Keogh, Samantha, Flynn, Julie, Marsh, Nicole, Mihala, Gabor, Davies, Karen and Rickard, Claire. 2016. "Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients." Trials. 17 (1), pp. 1-10. https://doi.org/10.1186/s13063-016-1470-6
Article Title

Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised
controlled trial in adult medical-surgical hospital patients

ERA Journal ID35155
Article CategoryArticle
AuthorsKeogh, Samantha (Author), Flynn, Julie (Author), Marsh, Nicole (Author), Mihala, Gabor (Author), Davies, Karen (Author) and Rickard, Claire (Author)
Journal TitleTrials
Journal Citation17 (1), pp. 1-10
Article Number348
Number of Pages10
Year2016
Place of PublicationUnited Kingdom
ISSN1745-6215
Digital Object Identifier (DOI)https://doi.org/10.1186/s13063-016-1470-6
Web Address (URL)https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1470-6
Abstract

Background: Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices. Methods: This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis. Results: PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3-3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0-2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1-1.4], p < 0.01) significantly predicted PIVC failure. Conclusion: Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required.

Keywords0.9 % sodium chloride; Catheter obstruction; Flushing; Peripheral; Phlebitis; Randomised controlled trial; Vascular access devices
ANZSRC Field of Research 2020420506. Sub-acute care
420501. Acute care
420599. Nursing not elsewhere classified
Byline AffiliationsGriffith University
Department of Health, Queensland
Institution of OriginUniversity of Southern Queensland
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