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Patient safety and risk management
PS-026 Peripheral infusions in neonatal and paediatric intensive care: extravasation rate and risk factors
  1. C Fonzo-Christe1,
  2. A Parron2,
  3. C Combescure3,
  4. R Pfister4,
  5. P Rimensberger4,
  6. P Bonnabry2
  1. 1Geneva University Hospitals, Pharmacy, Geneva, Switzerland
  2. 2Geneva University Hospitals, Pharmacy – School of Pharmaceutical Sciences, Geneva, Switzerland
  3. 3Geneva University Hospitals, Research Center and Division of Clinical Epidemiology, Geneva, Switzerland
  4. 4Geneva University Hospitals, Neonatology and Pediatric Intensive Care Unit, Geneva, Switzerland

Abstract

Background Intravenous infusions of highly concentrated drugs and hyperosmolar parenteral nutrition are frequent in our neonatology (NEONAT) and paediatric intensive care (ICU) units, by central or peripheral venous catheters (PVCs). Extravasation may have severe consequences (necrosis, skin graft).

Purpose To determine the extravasation rate of peripheral infusions in two care units (NEONAT/ICU) and associated risk factors.

Material and methods Retrospective study (Jan–Dec 2013, electronic patient data) of all patients hospitalised in NEONAT or ICU and with at least one PVC.

Global PVC (location, duration in situ (days), patient’s age (days) at PVC removal) and patient analyses (sex, age at admission (year), gestational age (GA, week)). ‘Extravasation group’ if PVC was removed or insertion site documented as ‘diffusion’ and if the patient had at least one extravasated PVC.

Comparison of ‘extravasation’ and ‘no extravasation’ groups (median value [IQR25–75]) and multivariate subgroup (NEONAT/ICU) analysis of associated factors.

Results A total of 1,300 PVCs in 695 patients were analysed. An extravasation rate of 11.7% (152/1,300) of PVCs and 17.6% (122/695) of patients was determined. In NEONAT and ICU, a rate of 28.3% (51/180) PVCs and 30.1% (44/146) patients, and 9.1% (101/1,115) PVCs and 14.3% (78/547) patients respectively was observed. In the extravasation group, the PVC remained in situ for longer (1.8d [1.0; 3.1] vs. 1.5d [0.8; 2.7], p = 0.01) and age at PVC removal (131.8d [1.2; 966.3] vs. 984.4d [154.2; 5,146.0], p < 0.0001), age at admission (0.3y [0.0; 2.5] vs. 1.7y [0.1; 9.2], p < 0.0001) and GA (33.4 w [32.0; 37.0] vs. 36.3 w [33.6; 39.4], p = 0.002)) were lower. No differences were observed in terms of sex or location. In subgroup analysis, low GA (NEONAT < 32 week), low age at PVC removal (NEONAT/ICU) and in situ duration >3 days (ICU) were independent risk factors.

Conclusion We observed a global extravasation rate of 11.7% (PVC) and 17.6% (patients). Prematurity (NEONAT), low age and PVC remaining in situ >3 days were associated risk factors. Implementation of PVC management guidelines and of an assessment scale are planned in the next future.

References and/or acknowledgements No conflict of interest.

https://doi.org/10.1136/ejhpharm-2015-000639.352

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