Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi-center prospective study.

Introduction: Millions of patients worldwide use peripheral venous catheters (PVCs), which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration, and the appropriate time for catheter removal. This multicentric prospective field study evaluated potential predictors of phlebitis including PVC site. Methods: From January to June 2012, the clinical course of each patients who received a new PVC, for any cause, in five Italian hospitals, was followed up by trained nurses until catheter removal. The presence of phlebitis was assessed every 24h using Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression. Results: The final sample consisted of 1498 patients (mean age 60.8±20.7y; 41.2% males). The average time for catheters in-situ was 65.6±34.5h, and 23.6% of the catheters was in place beyond 96h. Overall phlebitis incidence was 15.4%, 94.4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96h. As compared to subjects with catheter placed in the dorsum of the hand (22.8% of the sample), those with the catheter located in the antecubital fossa (34.1%) or forearm were less likely to have a phlebitis of any grade (Adjusted Odds Ratios 0.66 and 0.52, respectively; both p<0.05). Conclusions: Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support CDC recommendation to replace catheters in adults no later than 96h. A relevant proportion of healthcare personnel did not adhere to such guidelines: more attention to this issue is required.