Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study

Zoe Clarke; Clayton Lam; Amy L Sweeny; Peter J Snelling

doi:10.1111/jpc.16675

Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study

J Paediatr Child Health. 2024 Sep 25. doi: 10.1111/jpc.16675. Online ahead of print.

Authors

Zoe Clarke¹, Clayton Lam^{2

3}, Amy L Sweeny^{2

3

4}, Peter J Snelling^{2

3

5

6}

Affiliations

¹ Paediatric Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
² School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
³ Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
⁴ Faculty of Medicine and Dentistry, Bond University, Gold Coast, Queensland, Australia.
⁵ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
⁶ Sonography Innovation and Research (Sonar) Group, Gold Coast, Queensland, Australia.

PMID: 39319500
DOI: 10.1111/jpc.16675

Abstract

Aim: Children and their families have reported peripheral intravenous catheter (PIVC) insertion as the most stressful part of their emergency department (ED) encounter, with some enduring multiple attempts without a successful insertion. The purpose of this study was to identify factors associated with abandonment of paediatric PIVC insertion.

Methods: A retrospective cohort study was conducted at the Gold Coast University Hospital. All patients 16 years of age and younger, presented in 2019 with a PIVC insertion attempted in the ED were eligible. The electronic medical records were screened by two reviewers to identify those who required a PIVC insertion. Logistic regression analysis was performed to assess variables associated with PIVC insertion abandonment.

Results: Of 6394 records screened, 2401 (8.3%) had a PIVC insertion attempted, with 99 (4.1%) being abandoned. Age <12 months was the strongest predictor of PIVC abandonment at a rate of 11.3% (38/336), with a >10-fold increased risk for infants less than 3 months old and 3-12 months old; adjusted odds ratio (95% confidence interval) 12.4 (5.1-30.2) and 14.8 (5.8-37.4), respectively. Indications of 'infection' or 'rehydration' were associated with a decreased likelihood of abandonment when compared to 'investigation only' in multivariate modelling (odds ratio (95% confidence interval): 0.181 (0.099-0.332) and 0.262 (0.100-0.686), respectively).

Conclusions: This study suggests the rate of PIVC insertion abandonment in children is relatively infrequent. However, more than one in 10 children aged <12 months had PIVC attempts without successful insertion. PIVC abandonment was less likely when there was an indication that necessitated PIVC insertion, such as a serious bacterial infection.

Keywords: children; difficult intravenous access; emergency department; peripheral intravenous catheter; ultrasound.

© 2024 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).