Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Keogh, Samantha; Flynn, Julie; Marsh, Nicole; Mihala, Gabor; Davies, Karen; Rickard, Claire
• Is Part Of: Trials. Volume 17:Issue 1(2016)
• Page Start: 1
• Page End: 10
• Publication Date: 2016-12
• Subjects: Flushing -- 0.9 % sodium chloride -- Peripheral -- Randomised controlled trial -- Catheter obstruction -- Vascular access devices -- Phlebitis; Group-randomized trials -- Periodicals; Randomized Controlled Trials -- Periodicals; 615.0727
• DOI: 10.1186/s13063-016-1470-6
• Languages: English
• ISSNs: 1745-6215

Abstract

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. Trial registration Australian and New Zealand Clinical Trials Registry:ACTRN12615000025538 . Registered on 19 January 2015.