Lifespan and associated factors of peripheral intravenous Cannula among infants admitted in public hospitals of Mekelle City, Tigray, Ethiopia, 2016

Intravenous (IV) therapy relates to the administration of therapeutic solutions directly into a vein. Compared with other approaches such as intramuscular injection, intravenous (IV) therapy is the fastest and most reliable way to deliver fluids or medications [1]. With more than 90% of hospitalized patients requiring IV therapy, the proportion of patients requiring infusion devices has increased significantly over the past 30 years. IV therapy, which has multiple indications, can maintain the fluid and electrolyte balance of the body, infuse medications, transfuse blood or blood components and provide some nutritional support such as total parenteral nutrition [2].

The lifespan of a peripheral intravenous cannula is an important issue, and its survival depends on many variables, including the size, frequency of usage, methods of administration of medications and fluids, and others. It is noticed that when certain drugs are administered, the peripheral intravenous cannula is infiltrated faster. Factors affecting the life span of peripheral intravenous cannula have been studied in newborns and infants [3, 4]. Heparin and limb splinting have been used in an attempt to prolong duration of the peripheral intravenous cannula [5, 6].

Although peripheral intravenous cannulas are routinely used in hospital admitted infants, the risk of complications remains high. Non-elective removal of a peripheral intravenous cannula as a result of complications occurs in up to 78% of insertions and can lead to untimely removal of up to 95% of the devices [7]. It is difficult to ascertain precise complication rates due to a lack of consistent definition for complications, significant variation in reporting among different facilities, and studies focused on specific complications. Routine replacement of peripheral intravenous cannulas is not recommended in neonates given challenges associated with their small, fragile veins and limited vascular access [8, 9]. Peripheral intravenous cannulas that are left in situ when they are no longer required may predispose the patient to intravascular infection. There is also emerging evidence that the regular refitting of peripheral intravenous cannulas as a strategy to reduce intravascular infection provides no protective benefit, and if removed when clinically indicated, can avoid millions of cannula insertions which can substantially reduce health care costs and improve patient satisfaction [10].

The average lifespan of peripheral intravenous cannulas in neonates and infants reported in the literature ranges from 15 to 54 h and 12 to 274 h respectively. Cannulas can be safely maintained with adequate monitoring for up to 144 h in critically ill children [11, 12]. Accessing the vascular system necessitates penetration of the skin and stabilization of the cannula in situ. The lifespan of peripheral intravenous cannula and its survival depends on many factors, including the size cannula, frequency of usage, methods of administration of medications, increased number of attempts at placement of intravenous cannulas, fluids and others [3, 4].

Insertion of peripheral intravenous cannulas is a painful procedure for infants, therefore, identifying which factors affect the lifespan of a peripheral intravenous cannula will help reduce complications and increase duration of cannula patency. Additional issues that must be considered include the potential for prolonged hospital stay as a result of cannula-associated complications, delays in therapy, and the impact on patient/family satisfaction. Thus, reducing complications will lead to a reduction in downstream activity, as well as the time associated with the reassessment of a failed peripheral intravenous cannula, reducing additional supplies for the peripheral intravenous cannula replacement, and reducing the risk of needle stick injury.

This study evaluates the lifespan of peripheral intravenous cannulas in infants and identifies factors which affect the lifespan of peripheral intravenous cannula that contribute to the current knowledge regarding intravenous practices in infants.

The study was conducted in Mekelle, Ethiopia, an area with two governmental hospitals and three private hospitals. Ayder Hospital, a major referral and teaching hospital in the Tigray region, opened in 2007 with 500 beds, serving 32,000 patients. The second, Mekelle Hospital, a regional referral and teaching hospital, was established in 1962 with 162 beds and a total annual flow of 4276 patients. The study period spanned from October, 2015 to May, 2016. The study design was an institutional based cross-sectional study design.

In this study, ninety-four (52.8%) of the infants were with a short cannula lifespan (<30 h), and 37.6% of cannulas failed within 24 h. This is lower than the study finding of Rio de Janeiro and California which was 50 and 45.8% respectively [13, 14]. This difference may be related to smaller sample size, different study setup and background of the patients. A majority (168) of cannulas failed within 72 h. This is inline with the study conducted in Gold Coast Hospital, Australia [15].

In this study, the median lifespan of cannulas was 30 h, comparable with the studies conducted previously in the United States in which lifespan was 33 h [4], but less comparable with the study conducted in India which was 40 and 51 h respectively [3, 16]. Smaller sample size might influence the result along with health service related factors and study design.

Pediatric units showed significant association with the lifespan of peripheral intravenous cannula. Infants admitted to a pediatric intensive care unit had a shorter cannula lifespan compared to those who were admitted in the pediatric ward. Similar findings were also observed in an earlier study conducted in the southwestern United States [17]. This might be due to the reason that infants admitted to pediatric intensive care units were critically ill and were more likely to concurrently require more medications.

The lifespan of the peripheral intravenous cannula was significantly reduced by dislodgement and complication. This finding may be supported due to the reason that as the cannula is foreign to the human body, the presence of a foreign body in the vein stimulates an inflammatory response which disposes the development of thrombus and complication.

The survival time of peripheral intravenous cannula was prolonged with the administration of medication as compared to the survival time of peripheral intravenous cannula in those not receiving medication. Specifically, the administration of corticosteroids was found to prolong the cannula lifespan, possibly due to the corticosteroid associated broad anti-inflammatory effect.

This study showed that the site of peripheral intravenous cannula placement in the arm, in comparison to the scalp, significantly increased the longevity of peripheral intravenous cannula. This is consistent with the study conducted previously in West Coast City, United States (best to match the previous reference by naming a region such as Northeast or Southwest as earlier in the document) and Australia [7, 18]. This may be partly a result of the size of the vein into which it is placed, as also demonstrated in this study.

The lifespan of the peripheral intravenous cannula was also prolonged with the transfusion of blood. Similar findings were observed in earlier studies conducted in India and the Southwestern United States [16, 17]. It was hypothesized that the acidic solutions being infused in the peripheral intravenous cannula may be buffered by the pH of the blood.

In this study, the clinical experience of a nurse who insert the cannula was shown to have a significant effect on the lifespan of peripheral intravenous cannula. Cannulas secured by more experienced nurses stayed secure longer as compared to less experienced nurses.

In conclusion, untimely removal of peripheral intravenous cannulas was higher in infants. This study also found that the pediatric intensive care unit, clinical experience (35 years), insertion site (arm), reason for removal (dislodge and complication), medications, corticosteroids and blood transfusion were identified as variables that showed a statistical significant association with the lifespan of a peripheral intravenous cannula.