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Vascular Access/IV

Vascular access care in patients with multimorbidity

22 April 2021

Association for Vascular Access

02 April 2021

Volume 30 · Issue 8

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Background:

More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups.

Methods:

A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ², Student's t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA.

Results:

We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596.

Conclusions:

Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts.

Highly complex patients require an integrated care approach (case management) due the coexistence of multiple health problems, advanced age, greater functional impairment, higher risk of mortality, and greater use of health care resources.^1,2,3 The frequent hospital admissions in this patient population imply multiple intravenous therapies⁴ and higher risk of complications,⁵ including infiltration, phlebitis, thrombosis, and bacteraemia.^6,7,8,9,10 The increased requirement of intravenous therapy and population aging are important contributors to the emergence of difficult venous access (DIVA).^11,12,13

DIVA has been defined as the lack of visible or palpable veins or history of difficulty with catheter placement.^{14,15,16,17,18,19,20} This difficulty leads to an increase in the number of unsuccessful attempts at catheter placement, the use of inappropriate catheter insertion sites,^9,11 delays in administration of medication, and loss of medication through leakage. Further, patients are more likely to need central venous catheters, which are associated with a greater risk of serious complications.¹¹

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Comorbidity

Fluid therapy

Inpatients

Peripheral catheterization

Vascular access devices