Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study

(2023) 22:11 Baye et al. BMC Nursing https://doi.org/10.1186/s12912-022-01164-x BMC Nursing Open Access RESEARCH Incidence, time to occurrence and predictors of peripheral intravenous cannula‑related complications among neonates and infants in Northwest Ethiopia: an institutional‑based prospective study Nega Dagnew Baye1*, Assefa Agegnehu Teshome1, Atalo Agimas Ayenew1, Tadeg Jemere Amare1, Anmut Tilahun Mulu1, Endeshaw Chekol Abebe1, Gebrehiwot Ayalew Tiruneh2, Teklie Mengie Ayele3, Zelalem Tilahun Muche1, Awgichew Behaile Teklemariam1, Biruk Demissie Melese4, Melaku Mekonnen Agidew1 and Mohammed Abdu Seid1 Abstract Background Peripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia. Methods and setting An institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed. Results The incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63–6.27), admission unit (AHR = 1.88, 95%CI: 1.07–4.02), sickness (AHR = 0.24, 95% CI: 1.31–4.66), medication type (AHR = 2.04, 95%CI: 1.13–3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02–0.99), clinical experience (AHR = 0.52, CI:0.26–0.84), and flushing (AHR = 0.71, 95%CI: 0.34–0.98) were potential predictors of PIVC complication. Conclusion Knowing the predictor factors helps clinicians to provide effective care and to detect complications early. *Correspondence: Nega Dagnew Baye Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Baye et al. BMC Nursing (2023) 22:11 Page 2 of 7 Keywords Peripheral intravenous cannula, Peripheral intravenous cannula complications, Incidence, Infants, Infiltration, Phlebitis Background A peripheral intravenous cannula (PIVC) is a short catheter inserted into the vein in the peripheral areas of the patient [1]. PIVC insertion is one of the most frequently performed invasive procedures in hospitalized neonates and infants. It is estimated that 30% to 80% of admitted patients undergo this procedure during hospitalization [2]. It provides venous access for the administration of intravenous fluids, drugs, blood products, parenteral nutrition, and sampling of blood [3]. Despite its benefits and frequent use, intravenous cannulation has complications that can seriously threaten patient safety such as clotting, occlusion, leakage, infiltration, extravasation, phlebitis, and infection [4]. Furthermore, it is the main source of procedurerelated pain in hospitalized patients [5]. In neonates and infants, PIVC complications are associated with increased morbidity [6]. PIVC failure due to complications and reinsertion attempts are painful and anxiety-provoking for neonates and infants and their parents. It interferes with the most important intravenous therapy, resulting in longer hospital stays and higher additional medical care costs, including the expense of PIVC and nursing time [7, 8]. Ill neonates and infants are at an increased risk of PIVC-related complications. The risk of a PIVC-related complication in neonates and infants is reported as up to 75%, of which extravasation/infiltration rate was high, having an incidence of around 65% [4, 9–11]. Occlusion is also a common cause of premature loss of catheter function [12]. This can be attributed to their immature skin structure, immature immune system, flexible subcutaneous tissue, and smaller, fragile veins [9, 13]. Globally, most peripheral intravenous cannulas are inserted into the hand [8]. In neonatal intensive care units (NICU), local complications occur in up to 97% of PIVCs, and the cannulas have a median lifespan of 23 to 40 h [4, 10, 14]. For instance, in Jordan, the average life span of PIVCs was 18.45 h and the incidence of phlebitis started increasing, from 3.7% to 21.2%, after 24 h and reached 27.5% after 48 h [15]. Many factors, including infant age, weight, corticosteroid use, flushing, cannula size, anatomical site of insertion, type of infusion, and infection, influenced the development of PIVC complications [9, 10, 16, 17]. The incidence of PIVC complications is still higher and remains an issue of public health concern. There is certainly a pressing need for credible research and forwarding suggestions in this area. To the best of our knowledge, there is no published scientific research describing the incidence and time to complication of PIVC and its predictors among neonates and infants in Ethiopia. Therefore, this study was primarily aimed to assess the incidence, types, and time to occurrence of PIVC complications and to identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia. Our findings could provide directions for the prevention of PIVC complications, improvement of patient outcomes, and reduction of medical care costs. Methods Study design and setting This was an institutional-based prospective cohort study (...truncated)