Fig. 1.
Multivariable analysis with marginal Cox regression analysis for the occurrence of phlebitis stratified by cannula material
| Variable | Multivariable analysis | |
|---|---|---|
| HR (95% CI) | p-value | |
| Cannula material | ||
| Polyurethane | ||
| Specified polyurethane | ||
| PEU-Vialon® | 1.45 (0.75–2.8) | 0.21 |
| SuperCath® | 2.60 (1.35–5.00) | < 0.01 |
| Other polyurethanes | Ref | - |
| Non-polyurethane | ||
| Ethylene tetrafluoroethylene | 2.29 (1.19–4.42) | 0.01 |
| Others | 2.20 (0.46–10.59) | 0.32 |
Comparison of the characteristics of short peripheral cannulas
| Variable | Cannula material | Non-polyurethane | ||||
|---|---|---|---|---|---|---|
| Specified polyurethane | Other polyurethanes n=276 (8.5%) | Ethylene tetrafluoroethylene n=1,292 (39.8%) | Others n=72 (2.2%) | p-value | ||
| PEU-Vialon® n=1,087 (33.5%) | SuperCath® n=702 (21.6%) | |||||
| Phlebitis | 83 (7.7) | 92 (13.1) | 17 (6.2) | 111 (8.6) | 10 (13.8) | < 0.01 |
| Age (years) | 67.4 [15.6] | 69.0 [14.2] | 67.3 [15.0] | 68.2 [15.4] | 64.3 [14.1] | 0.03 |
| Male sex | 685 (63) | 415 (59.1) | 157 (56.9) | 823 (63.7) | 42 (58.3) | 0.09 |
| Body heightA (cm) | 161.1 [9.9] | 160.7 [9.3] | 160.0 [10.2] | 160.6 [9.5] | 162.2 [9.7] | 0.25 |
| Body weightB (kg) | 60.0 [13.4] | 62.0 [19.5] | 59.2 [17.4] | 59.1 [13.3] | 63.6 [16.9] | < 0.01 |
| BMIB | 22.8 [4.1] | 23.7 [5.78] | 22.87 [4.68] | 22.8 [4.21] | 24.0 [4.87] | < 0.01 |
| APACHE II scoreC | 17.8 [7.6] | 20.2 [8.7] | 15.3 [6.0] | 20.7 [8.6] | 16.2 [7.4] | < 0.01 |
| SAPS II scoreC | 41.1 [18.3] | 47.1 [19.5] | 34.5 [15.5] | 47.4 [19.7] | 37.2 [18.6] | < 0.01 |
| SOFA score C | 6.9 [4.0] | 6.7 [3.5] | 5.3 [3.2] | 7.0 [3.5] | 5.8 [3.7] | < 0.01 |
| Charlson Comorbidity Index | 4.4 [2.74] | 4.1 [2.5] | 3.7 [2.1] | 4.2 [2.5] | 3.6 [2.5] | < 0.01 |
| ICU admission from | ||||||
| Operating room | 531 (48.6) | 211 (30.1) | 183 (66.3) | 381 (29.5) | 42 (58.3) | < 0.01 |
| Emergency room | 307 (28.2) | 347 (49.4) | 65 (23.6) | 630 (48.8) | 20 (27.8) | |
| General ward | 223 (20.6) | 45 (6.4) | 28 (10.1) | 201 (15.6) | 8 (11.1) | |
| Outpatients | 8 (0.7) | 1 (0.1) | 0 (0) | 11 (0.9) | 0 (0) | |
| Transfer from other hospital | 18 (1.7) | 98 (14.0) | 0 (0) | 69 (5.3) | 2 (2.8) | |
| Type of admission to ICU | ||||||
| Elective surgical | 345 (31.7) | 26 (3.7) | 111 (40.2) | 187 (14.5) | 23 (31.9) | < 0.01 |
| Emergency surgical | 186 (17.1) | 185 (26.4) | 72 (26.1) | 194 (15.0) | 19 (26.4) | |
| Medical | 556 (51.1) | 491 (69.9) | 93 (33.7) | 911 (70.5) | 30 (41.7) | |
| Sepsis at ICU admission | ||||||
| Sepsis | 60 (5.5) | 46 (6.6) | 7 (2.5) | 156 (12.1) | 0 (0) | < 0.01 |
| Septic shock | 173 (15.9) | 63 (9.0) | 12 (4.4) | 177 (13.7) | 10 (13.9) | |
| Medical staff inserting the cannulaa | ||||||
| Doctor | 85 (10.2) | 28 (5.0) | 11 (6.5) | 160 (14.7) | 3 (15.0) | < 0.01 |
| Nurse | 749 (89.8) | 536 (95.0) | 160 (93.0) | 931 (85.3) | 17 (85.0) | |
| Medical technologist | 0 (0) | 0 (0) | 1 (0.6) | 0 (0) | 0 (0) | |
| Provision of standardized drug administration measures in the ICU | 1,067 (98.2) | 702 (100.0) | 276 (100.0) | 1264 (97.8) | 72(100.0) | < 0.01 |
| Insertion siteb | ||||||
| Forearm | 633 (58.8) | 381 (54.7) | 133 (48.2) | 659 (51.2) | 43 (66.2) | < 0.01 |
| Upper arm | 104 (9.7) | 81 (11.6) | 16 (5.8) | 151 (11.7) | 4 (6.2) | |
| Elbow | 55 (5.1) | 44 (6.3) | 6 (2.2) | 56 (4.4) | 2 (3.1) | |
| Wrist | 52 (4.8) | 44 (6.3) | 19 (6.9) | 46 (3.6) | 1 (1.5) | |
| Hand | 134 (12.5) | 82 (11.8) | 91 (33.0) | 190 (14.8) | 10 (15.4) | |
| Lower leg | 51 (4.7) | 42 (6.0) | 4 (1.5) | 124 (9.6) | 4 (6.2) | |
| Dorsal foot | 46 (4.3) | 22 (3.2) | 7 (2.5) | 61 (4.7) | 1 (1.5) | |
| Cannula gaugec | ||||||
| 14G | 0 (0) | 0 (0) | 0 (0) | 1 (0.1) | 0 (0) | < 0.01 |
| 16G | 10 (2.0) | 1 (1.2) | 35 (12.7) | 26 (2.0) | 2 (3.4) | |
| 18G | 19 (1.8) | 10 (1.5) | 30 (10.9) | 29 (2.3) | 1 (1.7) | |
| 20G | 354 (33.3) | 171 (24.6) | 38 (13.8) | 308 (24.1) | 17 (28.8) | |
| 22G | 644 (60.5) | 509 (73.3) | 167 (60.7) | 895 (70.1) | 39 (66.1) | |
| 24G | 37 (3.5) | 3 (0.4) | 5 (1.8) | 17 (1.3) | 0 (0) | |
| Antiseptic solution before cannulizationd | ||||||
| None | 1 (0.1) | 1 (0.2) | 1 (0.6) | 5 (0.5) | 0 (0) | |
| Alcohol | 800 (96.5) | 559 (99.1) | 171 (98.8) | 1049 (97/2) | 20 (100) | |
| 0.2% chlorhexidine alcohol | 6 (0.7) | 3 (0.5) | 0 (0) | 12 (1.1) | 0 (0) | < 0.01 |
| 0.5% chlorhexidine alcohol | 3 (0.4) | 0 (0) | 0 (0) | 12 (1.1) | 0 (0) | |
| 1.0% chlorhexidine alcohol | 15 (1.8) | 1 (0.2) | 1 (0.6) | 0 (0) | 0 (0) | |
| 10% povidone iodine | 1 (0.1) | 0 (0) | 0 (0) | 1 (0.1) | 0 (0) | |
| Other | 3 (0.1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Use of ultrasonographye | 35 (4.3) | 5 (0.9) | 4 (2.3) | 14 (1.3) | 0 (0) | < 0.01 |
| Number of attempts for insertionf | 0.72 | |||||
| 1 | 642 (80.5) | 447 (79.5) | 138 (80.2) | 876 (82.0) | 16 (84.2) | |
| 2 | 96 (12.0) | 71 (12.6) | 23 (13.4) | 120 (11.2) | 3 (15.8) | |
| 3 | 33 (4.1) | 34 (6.1) | 9 (5.2) | 54 (5.1) | 0 (0) | |
| 4 | 14 (1.8) | 5 (0.9) | 2 (1.2) | 5 (0.5) | 0 (0) | |
| 5 | 6 (0.6) | 1 (0.4) | 0 (0) | 8 (0.8) | 0 (0) | |
| ≧ 6 | 7 (0.9) | 4 (0.7) | 0 (0) | 5 (0.5) | 0 (0) | |
| Difficulties with the insertionsg | ||||||
| Easy | 343 (44.1) | 254 (45.1) | 101 (58.7) | 527 (49.4) | 7 (43.8) | 0.05 |
| Slightly easy | 248 (32.0) | 186 (33.0) | 41 (23.8) | 294 (27.6) | 3 (18.8) | |
| Slightly difficult | 141 (18.2) | 96 (17.1) | 22 (12.8) | 192 (18.0) | 5 (31.3) | |
| Difficult | 45 (5.8) | 27 (4.8) | 8 (4.7) | 53 (5.0) | 1 (6.3) | |
| Gloveh | ||||||
| Sterile | 7 (0.9) | 5 (0.9) | 0 (0) | 6 (0.6) | 1 (5.3) | < 0.01 |
| Non-sterile | 743 (91.6) | 521 (93.5) | 170 (98.8) | 1044 (97.5) | 18 (94.7) | |
| None | 61 (7.5) | 31 (5.6) | 2 (1.2) | 21 (2.0) | 0 (0) | |
| Dressingi | ||||||
| Chlorhexidine-impregnated dressing | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | < 0.01 |
| Sterile dressing | 1037 (96.0) | 697 (99.4) | 271 (98.6) | 1270 (98.8) | 52 (94.6) | |
| Non-sterile dressing | 34 (3.2) | 4 (0.6) | 4 (1.5) | 15 (1.2) | 3 (5.5) | |
| Gauze dressing | 1 (0.1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Tape dressing | 8 (0.3) | 0 (0.3) | 0 (0.2) | 0 (0) | 0 (0) | |
| Any infection during cannula dwell | 225 (20.7) | 176 (25.1) | 25 (9.1) | 367 (28.4) | 10 (13.9) | < 0.01 |
| Duration of cannula dwell (hours) | 75.6[84.7] | 63.7 [48.8] | 54.3 [46.9] | 56.7 [62.3] | 65.6 [65.7] | < 0.01 |
| Administered drug | ||||||
| Ampicillin/sulbactam | 44 (4.1) | 57 (8.1) | 8 (2.9) | 88(6.8) | 2(2.8) | < 0.01 |
| Dexmedetomidine | 83 (7.6) | 74 (10.5) | 27 (9.8) | 97(7.5) | 11(15.3) | 0.024 |
| Lipid emulsion | 78 (7.2) | 63 (9.0) | 21 (7.6) | 138(10.7) | 8(11.1) | 0.042 |
| Fentanyl | 100 (9.2) | 72 (10.3) | 44 (15.9) | 236(18.3) | 11(15.3) | < 0.01 |
| Heparin | 154 (14.2) | 46 (6.6) | 39 (14.1) | 77(6.0) | 18(25.0) | < 0.01 |
| Midazolam | 5 (0.5) | 13 (1.9) | 3 (1.1) | 35(2.7) | 4(5.6) | < 0.01 |
| Nicardipine | 82 (7.5) | 113 (16.1) | 37 (13.4) | 68(5.3) | 7(9.7) | < 0.01 |
| Noradrenaline | 28 (2.6) | 17 (2.4) | 4 (1.4) | 40(3.1) | 2(2.8) | -** |