Understanding Pediatric Peripheral IV Injury Prevalence and Reporting

Peripheral intravenous (PIV) therapy is used widely in hospitalized patients. Based on data from 2019 to 2021, Lucile Packard Children’s Hospital (LPCH) places about 9,500 Neo/Ped PIVs in pediatric patients annually. While it is known that injuries associated with fluids leaking into the tissue surrounding the IV (infiltrations and extravasations) are fairly common for pediatric patients, the prevalence of these injuries at LPCH is currently not well understood. These injuries can range in severity from minor swelling to serious tissue damage, sometimes requiring surgery or otherwise increasing length of stay.

Our high level objective was to use data on PIV placements and reported PIV injuries to understand current practice and recommend changes to institutional practice in order to reduce the prevalence and severity of pediatric PIV injuries.

Specific Aims:

1. Process, clean, and visualize current iCare and EPIC data on PIV placements and injuries to understand PIV injury prevalence and other risk factors like length of stay and PIV duration
2. Develop and distribute a survey to nurses to understand current practice around PIV access and injuries
3. Connect PIV placement and injury data to hospital patient demographics data to understand demographic risk factors for PIV injury

Key conclusions:

Based on injuries reported in the iCare system, the pediatric PIV injury occurrence rate across all patients at LPCH appears to be about 2%. In particular, patients under the age of 10 are at a higher risk of PIV injury according to iCare data. Patients with a primary language other than English, Spanish, or Mandarin also seem to have higher PIV injury occurrence.

Using the iCare report summaries, we also determined what actions were taken by providers after discovering a PIV injury. For over 90% of cases, the IV infusion was stopped and the IV removed. However, an antidote was only given in about 12% of cases.

Patients with a PIV injury also had a median stay length of 11 days, over twice the median stay length of all pediatric patients with a PIV. However, the duration of a PIV was similar for both populations, with a 46 hour median PIV duration for patients with a PIV injury compared to 43.7 hour median PIV duration for all pediatric patients with a PIV.

We also developed a nurse survey with our sponsors, with questions about current practice for PIV insertion as well as reporting and treating injuries. Our survey has over 190 responses currently, and will close towards the end of the quarter for response analysis.

Next steps:

1. Analyze nurse survey data to better understand current practice around PIV access and injuries
2. Develop a series of recommendations to improve current access and injury reporting practices in order to reduce PIV injury prevalence and severity
3. Collaborate with IS and sponsors to develop a dashboard for PIV injury prevalence
4. Build a predictive model to identify patients at high risk for PIV injuries in order and to predict how long a line should remain in a patient