PEDIATRICS Vol. 89 No. 6 June 1992, pp. 1145-1150
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Peripheral Intravenous Catheter Complications in Critically Ill Children: A Prospective Study

Jeffery S. Garland MD1, Peter Havens MD, MS1, W. Michael Dunne Jr PhD2, Mary Hintermeyer RN3, Mary Anne Bozzette RN3, Jeni Wincek RN, MSN3, Tina Bromberger RN3, and Michelle Seavers RN3

1 From the Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee
2 Department of Pathology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee
3 From the Department of Nursing, Children's Hospital of Wisconsin, Milwaukee

Six hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit patients were examined to determine complication rates and associated risk factors. Phlebitis, extravasation, and bacterial colonization occurred at rates of 13%, 28%, and 11%, respectively. Logistic regression of factors that increased phlebitis risk revealed infusion of hyperalimentation (odds ratio 2.9) or lorazepam (odds ratio 2.2) and catheter location (odds ratio 2.9) as the most important determinants of phlebitis risk. Age (le1 year, odds ratio 2.0), catheter time in situ (le72 hours, odds ratio 2.1), and infusion of antiepileptics (odds ratio 2.1) were the most important determinants of extravasation. Catheters were colonized most frequently with coagulase-negative Staphylococcus (51/54). Sepsis attributable to catheter colonization occurred in 1 patient. Duration of catheter placement (ge144 hours, odds ratio 5.8) was an important determinant of catheter colonization. Colonization risk increased from 11% in catheters that were in situ for 48 to 144 hours to 34% for catheters that were in for longer than 144 hours. Infusion of diazepam (odds ratio 11.0) or lipid emulsions (odds ratio 2.5) and age (le1 year, odds ratio 2.2) were also important determinants of colonization risk. Replacing catheters in critically ill children every 72 hours would not decrease phlebitis, bacterial colonization, or catheter-induced sepsis and could increase extravasation risk. Catheters can be safely maintained with adequate monitoring for up to 144 hours in critically ill children.

Key Words: intravenous catheters • catheter complications • pediatric intensive care • phlebitis • catheter colonization • extravasation

Submitted on August 22, 1991
Accepted on November 12, 1991


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