Clinically indicated versus routine replacement of peripheral intravenous cannulas in elderly patients: Secondary analysis of a multi-center randomized controlled trial in mainland China.

BACKGROUND

Peripheral Intravenous Cannulas (PIVCs) are extensively used for infusion therapy. Although current evidence suggests that adult patients may have PIVCs removed based on clinical indications, the indication in elderly patients remains unclear.

OBJECTIVE

To compare the differences and odds ratio (OR) for all-cause PIVCs failure (a composite outcome of phlebitis, occlusion, and infiltration), suspected infection, and catheter dwell time between the Clinically Indicated group (CIG) and the Routine Replacement group (RRG) in elderly patients.

DESIGN

This study was a secondary analysis of data from a randomized, unblinded, controlled pilot study evaluating PIVCs replacement based on clinical indication or every 96 hours.

SETTING

Multi-center trial conducted in 12 hospitals from 6 provinces.

PARTICIPANTS

Patients with age≥60 years were selected from the dataset of the multi-center randomized controlled study. And the final sample size reached 1805 cases which were utilized in the following analysis.

METHODS

Patients in the CIG had their PIVCs removed either at the completion of therapy or upon the occurrence of complications (phlebitis, infiltration, occlusion, dislodgement, accidental removal, or suspected infection). For the RRG, an additional removal criterion was applied: routine replacement every 96 hours. The primary outcome was all-cause PIVCs failure. Secondary outcomes included phlebitis, occlusion, infiltration, and suspected infection.

RESULTS

This study enrolled 1805 patients (CIG: n = 910; RRG: n = 895). The baseline andtreatment characteristics were well-balanced between the two groups. Compared with the RRG, the CIG demonstrated a significantly longer PIVCs dwell time (p < 0.01). Analysis of the overall data revealed significant differences between the groups in the incidence of all-cause PIVCs failure (OR 2.273, p < 0.01), phlebitis (OR 1.882, p < 0.01), occlusion (OR 1.935, p < 0.01), and infiltration (OR 1.653, p < 0.01). No significant difference was observed in the incidence of suspected infection (p > 0.05). When focusing on outcomes within the first 96 hours, only the incidence of all-cause PIVCs failure and occlusion were significantly higher in the CIG compared to the RRG (p < 0.01). Multivariable analysis identified the following as independent risk factors for PIVCs failure: admission to a surgical department, insertion in the left limb, ≥2 puncture attempts, poor vein quality, and the infusion of potassium-containing solutions or nutritional fluids. Conversely, the infusion of vasoactive drugs was identified as a protective factor (HR 0.558). The Kaplan-Meier survival curves suggested similar cumulative survival probabilities between the two groups (p = 0.345).

CONCLUSION

In elderly patients, clinically indicated PIVCs removal was associated with significantly prolonged catheter dwell time but an increased risk of all-cause PIVCs failure. Vigilant monitoring for occlusion is particularly recommended during the first 96 hours of catheter retention in this population.

TRIAL REGISTRATION: Registered with https://www.chictr.org.cn/ (ChiCTR1900022006).