Risk factors for site complications of intravenous therapy in children and adolescents with cancer

Santos, Luciano Marques dos; Silva, Cleonara Sousa Gomes e; Machado, Elis Souza; Almeida, André Henrique do Vale; Silva, Carlos Alberto Lima da; Silva, Bianka Sousa Martins; Avelar, Ariane Ferreira Machado

doi:10.1590/0034-7167-2019-0471

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0471 copy

Risk factors for site complications of intravenous therapy in children and adolescents with cancer

Factores de riesgo para complicaciones locales de la terapia intravenosa en niños y adolescentes con cáncer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze predictive factors for the incidence of complications related to peripheral venous catheters in children and adolescents with cancer.

Methods:

a longitudinal follow-up study, conducted at a pediatric oncology clinic unit of a hospital in Bahia, with 333 peripheral venous catheters inserted in 77 children and 26 adolescents. Data collection took place between April 2015 and December 2016 through direct observation of peripheral intravenous catheter insertion, medical record data collection and daily observation of the puncture site.

Results:

the incidence of complications was 18.6%. The modeling of the variables confirmed that the risk factors for complications in children/adolescents with cancer were: prolonged peripheral intravenous therapy (p=0.002), history of complications (p=0.000), non-irritating/vesicant medications (p=0.003) and vesicant solutions (p=0.000).

Conclusions:

the goal has been achieved. Results can contribute to the theoretical, practical and social context.

Descriptors:
Pediatric Nursing; Child Hospitalization; Catheterizations, Peripheral; Infusion, Intravenous; Adverse Effects

Variáveis	Oncology Clinic
Variáveis	N	%
Occurrence of complication (n=333)	62	18.6
Type of complication (n=62)
Phlebitis	15	24.2
Extravasation	26	41.9
Infiltration	12	19.4
Obstruction	9	14.5
Complication Rate (n=333)
Phlebitis	15	4.50
Extravasation	26	7.80
Infiltration	12	3.60
Obstruction	9	2.70
Phlebitis degree (n=14)^* * 1 child/adolescent from the oncology clinic the Phlebitis Degree could not be analyzed;
Degree 1	7	50.0
Degree 2	5	35.7
Degree 3	2	14.3
Degree of infiltration (n=9)^** * 3 children/adolescents from the oncology clinic the Infiltration Degree could not be analyzed;
Degree 1	5	55.6
Degree 2	4	44.4
Age in months (n=39)
Up to 35mo (infant)	6	15.4
From 36mo to 83mo (Preschool)	16	41.0
From 84mo toa 131mo (School)	6	15.4
≥132mo (Adolescent)	11	28.2
Gender (n=39)
Female	21	53.8
Male	18	46.2
Race/color (n=39)
White	12	30.8
Non-white^* ***** This category includes black and brown.	27	69.2
Nutritional status (n=39)
Eutrophic	33	84.6
Malnourished	6	15.4
Prematurity (n=39)	4	10.3
Edema (n=39)	2	5.1
Agitation (n=39)	9	23.1
Length of hospitalization (n=39)
Up to 7 days	31	79.5
≥ 8 days	8	20.5

Variables	Oncology Clinic				p value
Variables	Yes (n=62) N (%)	No (n=271) N (%)	RR	CI	p value
Age
Up to 6 years (up to 83 months)	34 (17.3%)	163 (82.7%)	0.84	0.535 – 1.315	0.443^* * Pearson’s chi-square;
≥ to 7 years (84 months or more)	28 (20.6%)	108 (79.4%)
Gender
Female	34 (20%)	136 (80%)	1.16	0.741 – 1.829	0.508^* * Pearson’s chi-square;
Male	28 (17.2%)	135 (82.8%)
Race/color
Whites	19 (18.8%)	82 (81.2%)	1.01	0.624 – 1.651	0.952^* * Pearson’s chi-square;
Non-whites	43 (18.5%)	189 (81.5%)
Nutritional status
Malnourished	10 (33.3%)	20 (66.7%)	1.90	1.081 – 3.332	0.036^* * Pearson’s chi-square;
Eutrophic	52 (17.6%)	244 (82.4%)
Prematurity
Yes	9 (28.1%)	23 (71.9%)	1.60	0.872 – 2.926	0.146^* * Pearson’s chi-square;
No	53 (17.6%)	248 (82.4%)
Edema
Yes	4 (44.4%)	5 (55.6%)	2.48	1.153 – 5.345	0.066^ Fisher’s exact test.
No	58 (17.9%)	266 (82.1%)
Child hyperactivity
Yes	14 (15.9%)	74 (84.1%)	0.81	0.472 – 1.398	0.446^* * Pearson’s chi-square;
No	48 (19.6%)	197 (80.4%)
Length of hospitalization (days)
Greater than or equal to 7 days	14 (73.7%)	5 (26.3%)	4.82	3.316 – 7.007	<0.001^ Fisher’s exact test.
Less than 7 days	48 (15.3%)	266 (84.7%)

Variables	Oncology Clinic				p value
Variables	Yes (n=62)N (%)	No (n=271) N (%)	RR	CI	p value
Peripheral Intravenous Catheter site
Lower limbs	1 (33.3%)	2 (66.7%)	1.80	0.357 – 9.051	0.463^ Fisher’s exact test.
Upper limbs	61 (18.5%)	268 (81.5%)
Vein Visibility
Non-visible	16 (33.3%)	32 (66.7%)	2.06	1.278 – 3.336	0.005^* * Pearson’s chi-square;
Visible	46 (16.1%)	239 (83.9%)
Vein palpability
Not palpable	18 (26.5%)	50 (73.5%)	1.60	0.987 – 2.575	0.062^* * Pearson’s chi-square;
Palpable	44 (16.6%)	221 (83.4%)
Vein path
Tortuous	20 (21.3%)	74 (78.7%)	1.21	0.752 – 1.949	0.435^* * Pearson’s chi-square;
Rectilinear	42 (17.6%)	197 (82.4%)
Vein mobility
Mobile	15 (16.9%)	74 (83.1%)	0.87	0.516 – 1.484	0.617^* * Pearson’s chi-square;
Fixed	47 (19.3%)	197 (80.7%)
Catheter gauge
20 G	3 (42.9%)	4 (57.1%)	1.93	0.779 – 4.808	0.403^ Fisher’s exact test.
24 G	28 (15.1%)	158 (84.9%)	0.68	0.428 – 1.079	0.100^* * Pearson’s chi-square;
22 G	31 (22.1%)	109 (77.9%)
Catheter type
Teflon^®	25 (16.1%)	130 (83.9%)	0.78	0.490 – 1.228	0.276^* * Pearson’s chi-square;
Polyurethane	37 (20.8%)	141 (79.2%)
Puncture method
Direct	58 (19.7%)	237 (80.3%)	1.87	0.719 – 4.855	0.173^ Fisher’s exact test.
Indirect	4 (10.5%)	34 (89.5%)
Catheter stabilization
No	10 (19.6%)	41 (80.4%)	1.07	0.579 – 1.952	0.844^* * Pearson’s chi-square;
Yes	52 (18.4%)	230 (81.6%)
Use of irritating medications
Yes	53 (22.6%)	182 (77.4%)	2.45	1.261 – 4.781	0.004^* * Pearson’s chi-square;
No	9 (9.2%)	89 (90.8%)
Use of non-irritating/vesicant medication
Yes	41 (26.6%)	113 (73.4%)	2.27	1.404 – 3.667	0.001^* * Pearson’s chi-square;
No	21 (11.7%)	158 (88.3%)
Use of vesicant solution
Yes	36 (35%)	67 (65%)	3.09	1.976 – 4.838	0.000^* * Pearson’s chi-square;
No	26 (11.3%)	204 (88.7%)
Use of non-irritating/vesicant solution
Yes	49 (23.4%)	160 (76.6%)	2.24	1.265 – 3.953	0.003^* * Pearson’s chi-square;
No	13 (10.5%)	111 (89.5%)

Variables	Oncology Clinic				p value
Variables	Yes (n=62)N (%)	No (n=271) N (%)	RR	CI	p value
Cinical history of difficult Peripheral Intravenous Catheter access^a a 3 children/adolescents with oncology did not use previous Intravenous Catheter;
Yes	31 (24.6%)	95 (75.4%)	1.62	1.037 – 2.528	0.034^* * Pearson’s chi-square;
No	31 (15.2%)	173 (84.8%)
Prolonged peripheral Intravenous Therapy
Yes	14 (70%)	6 (30%)	4.56	3.099 – 6.724	<0.001^ Fisher’s exact test;
No	48 (15.3%)	265 (84.7%)
Previous use of Intravenous Therapy
Yes	62 (18.8%)	268 (81.2%)	-	-	1.00^ Fisher’s exact test;
No	0 (0%)	3 (100%)
Type of catheter previously used^b b 1 child/adolescent had used Peripheral Intravenous Catheter + Central Venous Catheter + Peripherally Inserted Central Venous Catheter and 4 children/adolescents had used Peripheral Intravenous Catheter + Peripherally Inserted Central Venous Catheter;
Central Venous Catheter + Peripheral Intravenous Catheter	8 (16%)	42 (84%)	0.815	0.413 – 1.606	0.547^* * Pearson’s chi-square;
Central Venous Catheter	-	-
Peripheral Intravenous Catheter	54 (19.6%)	221 (80.4%)
Hystory of complications^c c 1 child/adolescent could not have data related to the history of complications collected.
Yes	56 (23.5%)	182 (76.5%)	3.69	1.644 – 8.264	0.003^* * Pearson’s chi-square;
No	6 (6.4%)	88 (93.6%)
Hystory of Phlebitis
Yes	24 (25.3%)	71 (74.7%)	1.13	0.712 – 1.791	0.607^* * Pearson’s chi-square;
No	32 (22.4%)	111 (77.6%)
Hystory of infiltration
Yes	49 (25.7%)	142 (74.3%)	1.72	0.835 – 3.556	0.119^* * Pearson’s chi-square;
No	7 (14.9%)	40 (85.1%)
Hystory of extravasation
Yes	4 (14.8%)	23 (85.2%)	0.60	0.236 – 1.531	0.257^* * Pearson’s chi-square;
No	52 (24.6%)	159 (76.5%)
Hystory of obstruction
Yes	28 (24.3%)	87 (75.7%)	1.07	0.677 – 1.691	0.773^* * Pearson’s chi-square;
No	28 (22.8%)	95 (77.2%)

Variables	Intravenous Therapy Complications
Variables	RR	CI	p-value
Prolonged peripheral Intravenous Therapy	3.44	1.58 – 7.50	0.002
Hystory of complications	4.22	2.84 – 6.26	<0.001
Use of non-irritating/vesicant medication	1.99	1.26 – 3.15	0.003
Use of vesicant solution	2.65	1.69 – 4.17	<00001

Variables	Complicações da Terapia Intravenosa		p value
Variables	RR	IC	p value
Terapia Intravenosa periférica prolongada	3.44	1.58 - 7.50	0.002
Antecedente de complicações	4.22	2.84 - 6.26	<0.001
Utilização de medicamentos não irritantes/vesicantes	1.99	1.26 - 3.15	0.003
Utilização de solução vesicante	2.65	1.69 - 4.17	<0.001

Variables	Intravenous Therapy Complications		p value
Variables	RR	CI	p value
Prolonged peripheral IVT	3.44	1.58 - 7.50	0.002
Hystory of complications	4.22	2.84 - 6.26	<0.001
Use of non-irritating/vesicant medication	1.99	1.26 - 3.15	0.003
Use of vesicant solution	2.65	1.69 - 4.17	<00001

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[1] Corresponding author: Luciano Marques dos Santos. E-mail: lucmarxenfo@yahoo.com.br