Pharmacological burden and chemical phlebitis associated with peripheral venous catheters: A nested case-control study. Results of the national Flebitis Zero project.

BACKGROUND

Chemical phlebitis is a common preventable complication of peripheral venous catheters (PIVCs), yet multicenter evidence on intravenous product-related risk factors remains scarce.

OBJECTIVE

To analyze the relationship between specific intravenous products, pharmacological burden, and the risk of chemical phlebitis.

METHODS

An exploratory nested case-control study was conducted within a prospective cohort across 93 Spanish hospitals (February 2023), including patients aged ≥18 years receiving intravenous therapy through a PIVC. Phlebitis was assessed using the Visual Infusion Phlebitis scale. Baseline balance between cases and controls was assessed using standardised mean differences (SMD). Multivariable logistic regression identified independent risk factors, adjusting for age and catheter gauge.

RESULTS

The study included 9409 patients and 13,820 PIVCs. Groups were well-balanced across baseline characteristics. The highest independent risks for phlebitis were associated with caspofungin (aOR=10.81; CI95%: 2.89-40.49), ganciclovir (aOR=8.14; CI95%: 1.63-40.55), amiodarone (aOR=4.14; CI95%: 2.40-7.16), tobramycin (aOR=3.71; CI95%: 1.42-9.67), and parenteral nutrition (aOR=2.93; CI95%: 1.63-5.25). A gradient of increasing risk was observed across pharmacological burden categories: compared to patients receiving no products, risk more than doubled with two simultaneous products (aOR=2.19; CI95%: 1.82-2.65).

CONCLUSIONS

High-risk irritants such as caspofungin, ganciclovir, and amiodarone were independently associated with the highest phlebitis risk. The use of any intravenous irritant product was associated with an increased risk of phlebitis; additional products did not produce a consistent further increase. These findings support incorporating pharmacological risk assessment into vascular access decision algorithms to prioritize central or midline routes for high-risk therapies.