Introduction
Peripheral intravenous catheters (PIVCs) are commonly placed in human and veterinary patients to facilitate the administration of IV fluids and medications.1,2 Although PIVCs play a vital role in the treatment of hospitalized patients, PIVC complications may occur. PIVC complication rates in humans have been reported to be as high as 67%,3 while the noninfectious PIVC complication rate in hospitalized dogs has been reported to be 19.9% to 43%,2,4,5 with phlebitis and line breakage being the most frequently reported complications.4,5 In both human and veterinary medicine, PIVC complications are classified as extravasation, phlebitis, dislodgment, and occlusion.3–9 In veterinary medicine, line breakage, defined as breakage of the standard T-port extension set via separation of the line from the male or female adaptor port, and self-removal have also been reported as complications.8 Regardless of the cause, PIVC complications may result in dire consequences for the patient, including failure to receive vital treatments.
Several risk factors for PIVC complications have been identified in the human literature, including the administration of antibiotics, longer PIVC dwell time, use of 22- or 24-gauge PIVCs, placement in the hand/wrist or forearm, type and cleanliness of the dressing, experience level of personnel, increasing age, and female sex.3,6,7,9,10 In veterinary medicine, 1 study identified longer length of hospitalization (LOH) and higher body weight as risk factors for mechanical PIVC complications in dogs4; however, risk factors for PIVC complications in cats were not identified in a separate study.8 One study2 reported that a PIVC dwell time ≥ 36 hours was correlated with increased visual infusion phlebitis (VIP) scores in dogs, and male sex and failure to use sedation correlated with increased VIP scores in cats. Other veterinary studies11,12 have evaluated infectious complications and identified dextrose supplementation, administration of immunosuppressive medications, immunosuppressive diseases, and experience of person placing the PIVC as risk factors for bacterial colonization of PIVCs in dogs. Identifying risk factors for PIVC complications in veterinary patients will allow for identification of at-risk patients and allow for adjustments to PIVC placement and management protocols to reduce overall PIVC complication rates. The objective of our study was to identify risk factors associated with PIVC complications in dogs hospitalized within the critical care unit (CCU). We hypothesized that longer PIVC dwell time, longer LOH, higher body weights, smaller-gauge PIVCs, and insertion site would be risk factors for PIVC complications.
Methods
Patient population
This was a prospective, observational trial performed at the Colorado State University Veterinary Teaching Hospital from October 2022 to March 2023. The protocol was approved by the Clinical Review Board at Colorado State University. Dogs that were expected to be hospitalized in the CCU for at least 24 hours were evaluated for enrollment. Colorado State University Veterinary Teaching Hospital technicians and veterinarians in the urgent care unit and CCU were trained by a single investigator on the PIVC placement protocol and were considered trained personnel. All PIVCs enrolled in the study were placed by trained personnel or students under direct supervision of trained personnel. Dogs were excluded if they were not hospitalized with a PIVC in place for at least 24 hours or if the PIVC was not placed according to the study’s PIVC placement protocol.
PIVC placement protocol
PIVCs included 18-gauge, 44-mm catheters; 18-gauge, 32-mm catheters; 20-gauge, 32-mm catheters, and 22-gauge, 25-mm catheters (Insyte; Becton Dickinson Infusion Therapy Systems Inc). The study protocol required that trained personnel wear examination gloves during the entire procedure. The hair was clipped circumferentially around the limb at the anticipated insertion site with clippers only used for catheter placement. The skin was aseptically prepared over the vessel, alternating between woven cotton gauze soaked with 4% chlorhexidine scrub and woven cotton gauze soaked with 70% isopropyl alcohol for 3 cycles. Once the PIVC was placed, it was secured to the patient with medical tape (Curad; Medline Industries) around the hub of the PIVC and circumferentially around the limb. In an opposing circumferential direction, an additional piece of tape was placed underneath the hub of the PIVC and wrapped around the limb to secure the hub of the PIVC. Next, a transparent dressing (Tegaderm transparent film bandage; 3M) was placed to cover the insertion site, and a piece of medical tape in a crisscross pattern was used to secure the hub of the catheter to the transparent dressing. An additional piece of tape was wrapped circumferentially at the most proximal edge of the transparent dressing. A layer of cast padding (BSN Medical) was placed starting underneath the hub of the catheter and wrapped proximally in a single layer. This layer was covered by a self-adherent bandage (Vetra; 3M) starting distally and moving proximally. A standard t-port extension set (Vedco Inc) was attached to the catheter, and the T-port extension set was secured to the patient with medical tape wrapped circumferentially around the dog’s limb. If placement occurred in an emergent setting (ie, active seizure), then trained personnel were allowed to aseptically prepare the skin over the vessel with a Prevantics (Professional Disposables International Inc; chlorhexidine gluconate 3.15%, isopropyl alcohol 70%) swab stick.
Data collection
Data collection began when patients were admitted to either the urgent care unit or CCU and a PIVC was placed. Four self-designed data collection forms (DCFs) were used to collect patient and PIVC-related data, PIVC monitoring data, PIVC removal data, and PIVC complication data. Patient-related data attained for each PIVC at admission included medical record number; age; sex; breed; weight; reason for hospitalization; whether the PIVC was placed in an emergent setting or not; trained personnel classification as veterinarian, technician, or student; the acute patient physiologic and laboratory evaluation (APPLE)FULL and APPLEFAST score13; patient mobility status; whether a PIVC was placed within the last 30 days; and number of PIVCs placed at admission. If more than 1 PIVC was placed at admission, only 1 PIVC was enrolled in the study. Patient mobility status was categorized as needing assistance for ambulation (eg, sling-assisted), self-ambulatory, and nonambulatory (eg, tetraplegic) for statistical analysis. Trained personnel were classified as either student, technician, or veterinarian.
The reasons for hospitalization were categorized as either cardiovascular (congestive heart failure, ventricular and supraventricular arrhythmias, etc), endocrine, gastrointestinal/hepatobiliary (gastrointestinal foreign bodies, acute hemorrhagic diarrhea syndrome, hepatopathies, etc), hematologic (immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, leukopenia, etc), musculoskeletal (fractures, myopathies, etc), neurologic (myelopathies, seizures, etc), neoplasia related, renal/urogenital (acute kidney injuries, urinary obstructions, pyometras, etc), respiratory (aspiration pneumonia, pulmonary hypertension, etc), toxic, and ophthalmic. This categorization was based on the primary reason for the dog’s current hospitalization without accounting for previously diagnosed underlying diseases.
When all APPLEFULL and APPLEFAST variables were available at the time of PIVC placement, APPLEFULL and APPLEFAST scores were calculated. APPLEFULL scores utilize a 10-variable model and contain creatinine, WBC count, albumin, oxygen saturation (SpO2), total bilirubin, mentation score, respiratory rate, age, lactate, and presence of free fluid in a body cavity. APPLEFAST scores utilize a 5-variable model and contain glucose, albumin, mentation score, platelet count, and lactate.13
PIVC-related data collected included gauge, insertion site, administration of irritant and anticoagulant medications, PIVC dwell time, and whether the PIVC was placed in an emergent setting. A previously reported list of irritant medications8 (Table 1) was used to assign patients to either having received or having not received an IV irritant medication during their hospitalization. The anticoagulant medications reported in the present study included clopidogrel, apixaban, and enoxaparin. Dwell time was calculated as the time interval between insertion and removal of the PIVC, rounded to the nearest quarter hour. PIVC dwell time was also categorized into 3 timeframes: 24 to 48 hours, 48 to 72 hours, and > 72 hours.
Medications classified as irritant medications.
| Antibiotic medications | Vesicant medications | Hypertonic medications | Other medications |
|---|---|---|---|
| Amikacin | Calcium gluconate | KCl > 20 mEq/L | Diltiazem |
| Ampicillin | Chemotherapeutics | Dextrose > 7% | Dobutamine |
| Azithromycin | Diazepam | Hypertonic saline | Dolasetron |
| Cephalosporins | Dopamine | Mannitol | Flumazenil |
| Enrofloxacin | Doxapram | PPN | Hydromorphone |
| Erythromycin | Esmolol | TPN | IVIG |
| Imipenem | Methocarbamol | Sodium bicarbonate | Maropitant |
| Meropenem | Midazolam | — | Metoclopramide |
| Metronidazole | Nitroprusside | — | Ondansetron |
| Sulbactam | Norepinephrine | — | Propofol |
| Sulfamethoxazole | Phenobarbital | — | — |
| Ticarcillin | Phenylephrine | — | — |
IVIG = Intravenous immunoglobulin. PPN = Partial parenteral nutrition. TPN = Total parenteral nutrition.
(Adapted from Reminga CL, Silverstein DC, Drobatz KJ, Clarke DL. Evaluation of the placement and maintenance of central venous jugular catheters in critically ill dogs and cats. J Vet Emerg Crit Care (San Antonio). 2018;28[3]:232–243. doi:10.1111/vec.12714. Reprinted with permission.)
Twice-daily monitoring was performed by a single investigator (KLG), which included documentation of the catheter wrap integrity, a visual assessment of limb swelling above or below the insertion site, and manual palpation from the distal to the proximal joint. The PIVC insertion site was visually inspected after removing cast padding and self-adherent bandage, and signs of inflammation (palpable heat, swelling, pain, redness) or blood at the insertion site were noted. A maximum of 3 mL of 0.9% heparinized saline was used to assess for pain associated with catheter flushing.
When a PIVC complication occurred, data were recorded on a PIVC complication–specific DCF and included classification of the complication as either extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal, as previously defined.4 In addition, patient demeanor, phlebitis score (if applicable),14 and PIVC dwell time were recorded. If a PIVC complication occurred outside the twice-daily monitoring times, trained personnel completed the DCF. Phlebitis was graded via the previously published VIP scale,14 which scores phlebitis on a scale of 0 to 5 (Table 2). If PIVC removal was required due to a complication, a new PIVC was placed in a different vessel if further treatment was needed. A PIVC complication was regarded as the primary end point, and PIVCs were followed until removal.
Visual infusion phlebitis scoring system defined.
| Score | Definition |
|---|---|
| 1 | Either of the following signs are present at the insertion site: |
| Slight pain | |
| Redness | |
| 2 | Two of the following signs are present: |
| Pain at the insertion site | |
| Redness | |
| Swelling | |
| 3 | All of the following signs are present: |
| Pain at the insertion site | |
| Redness | |
| Swelling | |
| 4 | All of the following signs are present: |
| Pain at the insertion site | |
| Redness | |
| Swelling | |
| Palpable venous cord | |
| 5 | All of the following signs are present: |
| Pain at the insertion site | |
| Redness | |
| Swelling | |
| Palpable venous cord | |
| Fever |
(Adapted from Gallant P, Schultz AA. Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 2006;29[6]:338–345. doi:10.1097/00129804-200611000-00004. Reprinted with permission.)
Statistics
Continuous data were evaluated for assumption of normality and described as either mean and SD if normally distributed or median and range if data were not normally distributed. If normality was met, the data was compared via a t test. If normality was not met, the data were analyzed via a Wilcoxon 2-sample test. Categorical data were described with counts and percentages. The data was analyzed by means of a logistic regression analysis to calculate the likelihood of complications in presence of the factor. A multivariable logistic regression analysis was performed to explore the association between complications and potential predictor variables that met the criteria of P < .25 for initial selection. Incorporating a stepwise backward elimination approach, the final multivariable logistic regression model used a P < .05 for statistical significance. Model fitness was evaluated using the Akaike information criterion value. SAS, version 9.4 (SAS Institute Inc), was used for all statistical analyses.
Results
Population demographics
There were 107 PIVCs enrolled. There were 59 male (55.1%; 10 intact, 49 neutered) and 48 female (44.9%; 9 intact, 39 spayed) dogs. Commonly represented breeds included mixed-breed dog (16.8% [18/107]), Labrador Retriever (12.1% [13/107]), Golden Retriever (8.4% [9/107]), German Shepherd Dogs (4.7% [5/107]), and Border Collies (3.7% [4/107]). The most common illness categories for reasons for hospitalization included gastrointestinal/hepatobiliary (26.2% [28/107]), respiratory disease (12.1% [13/107]), neurologic diseases (11.2% [12/107]), and cardiovascular diseases (11.2% [12/107]).
Risk factors for PIVC complication analyses
Overall PIVC complication rate was 12.1% (13/107), with phlebitis (4/107 [3.7%]) and extravasation (4/107 [3.7%]) being the most frequently recorded complications. Of those with phlebitis, the assigned VIP scores were either a 2 (3/4 [75%]) or 4 (1/4 [25%]). Patient and PIVC characteristics are reported (Table 3).
Patient and PIVC characteristics (n = 107) and complications (n = 13) reported as numbers and percentages.
| Variable | Total No. of PIVCs | Total No. of complications |
|---|---|---|
| Sex | ||
| Female | 48 (44.85) | 8 (7.47) |
| Male | 59 (55.15) | 5 (4.67) |
| PIVC placed within the last 30 d | ||
| Yes | 24 (22.43) | 3 (2.80) |
| No | 83 (77.57) | 10 (9.34) |
| Placement in an emergent setting | ||
| Yes | 7 (6.54) | 2 (1.86) |
| No | 100 (93.45) | 11 (10.28) |
| Personnel classification | ||
| Student | 2 (1.86) | 0 (0) |
| Technician | 105 (98.13) | 13 (12.15) |
| Veterinarian | 0 (0) | 0 (0) |
| Mobility status | ||
| Assisted ambulation needed | 11 (10.28) | 1 (0.93) |
| Nonambulatory | 9 (8.41) | 2 (1.86) |
| Self-ambulating | 87 (81.3) | 10 (9.34) |
| Insertion site | ||
| Cephalic | 99 (92.5) | 11 (10.28) |
| Saphenous | 8 (7.5) | 2 (1.86) |
| PIVC gauge | ||
| 18 | 88 (82.24) | 9 (8.41) |
| 20 | 19 (17.76) | 4 (3.73) |
| APPLEFULL scores | ||
| < 35 | 32 (42.1)* | 3 (3.9)* |
| > 35 | 44 (57.9)* | 10 (13.15)* |
| No. of catheters placed at admission | ||
| 1 | 99 (92.5) | 9 (8.41) |
| 2 | 8 (7.5) | 4 (3.73) |
| Dwell time | ||
| 24–48 h | 55 (51.4) | 7 (6.54) |
| 48–72 h | 33 (30.84) | 2 (1.86) |
| > 72 h | 19 (17.76) | 4 (3.73) |
| Irritant medications received | ||
| Yes | 82 (76.64) | 13 (12.15) |
| No | 25 (23.36) | 0 (0) |
| Anticoagulant medications received | ||
| Yes | 9 (8.41) | 2 (1.86) |
| No | 98 (91.6) | 11 (10.28) |
| PIVC complications | ||
| Extravasation | — | 4 (3.7) |
| Dislodgement | — | 1 (0.93) |
| Occlusion | — | 3 (2.8) |
| Line breakage | — | 1 (0.93) |
| Removed by patient | — | 0 (0) |
| Phlebitis | — | 4 (3.7) |
| VIP score 1** | — | 0 (0)** |
| VIP score 2** | — | 3 (75)** |
| VIP score 3** | — | 0 (0)** |
| VIP score 4** | — | 1 (25)** |
— = Not applicable. APPLE = Acute patient physiologic and laboratory evaluation. PIVC = Peripheral intravenous catheter. VIP = Visual infusion phlebitis.
*Percent is the result of total numbers of APPLEfull scores available (n = 76).
**Percent is the result of total numbers of phlebitis (n = 4).
Complete sets of variables for 76 PIVCs were available for calculation of both APPLEFULL and APPLEFAST scores. If all diagnostics to attain complete APPLEFULL or APPLEFAST scores were not performed by the admitting clinician, then those scores were deemed incomplete and excluded from analysis.
Univariable logistic regression analysis identified having an APPLEFULL score > 35 (OR, 5.9; 95% CI, 1.51 to 22.85; P = .011) and having 2 PIVCs placed at admission (OR, 10; 95% CI, 2.13 to 46.93; P = .004) as risk factors for PIVC complication. Other continuous data including age, weight, dwell time, and LOH were not statistically significant in the univariable analysis (Table 4). Sex, PIVC placement within the last 30 days, placement in an emergent setting, mobility status, insertion site, gauge, dwell time (24 to 48 hours, 48 to 72 hours, > 72 hours), and administration of anticoagulant medications were not statistically significant in univariable analysis (Table 5).
Continuous data represented as either mean ± SD and their respective t test (if normality was met) or median (range) and their respective Wilcoxon 2-sample test (if normality was not met).
| Variable | Mean ± SD | Median (range) | Z value | T value | P value |
|---|---|---|---|---|---|
| Age (y) | — | 8.00 (0.5–16.2) | 1.32 | — | .19 |
| Weight (kg) | — | 25.40 (2.5–67) | 0.03 | — | .98 |
| Dwell time (h) | — | 46.50 (24.25–159.25) | 0.23 | — | .82 |
| LOH (d) | — | 2.00 (1–16) | 1.38 | — | .17 |
| APPLEFULL scores* | 37.86 ± 12 | — | — | –2.25 | .028 |
| APPLEFAST scores* | 19.75 ± 5.85 | — | — | –1.49 | .14 |
Results of univariable logistic regression model (n = 107).
| Variable | OR | 95% CI | P value |
|---|---|---|---|
| Sex | 2.16 | 0.66–7.10 | .20 |
| PIVC placed within the last 30 d | 1.04 | 4.14–0.26 | .95 |
| Placement in an emergent setting | 3.24 | 0.56–18.72 | .19 |
| Mobility status | |||
| Assisted ambulation needed vs nonambulatory | 0.35 | 0.03–4.65 | .43 |
| Assisted ambulation needed vs self-ambulating | 0.77 | 0.09–6.67 | .81 |
| Nonambulatory vs self-ambulating | 2.20 | 0.40–12.09 | .37 |
| Insertion site | 0.38 | 0.07–2.09 | .26 |
| PIVC gauge | 0.43 | 0.12–1.57 | .20 |
| No. of catheters placed at admission | 10.00 | 2.13–46.93 | .004 |
| Dwell time | |||
| 24–48 h vs 48–72 h | 2.26 | 0.44–11.60 | .33 |
| 24–48 h vs > 72 h | 0.55 | 0.14–2.13 | .38 |
| 48–72 h vs > 72 h | 0.24 | 0.04–1.47 | .12 |
| APPLEFULL scores | |||
| > 35 vs < 35 | 5.88 | 1.51–22.85 | .011 |
| Anticoagulant medications received | 2.26 | 0.42–12.27 | .35 |
See Table 3 for key.
A multivariable logistic regression analysis was performed on the 76 PIVCs with complete sets of APPLEFULL and APPLEFAST scores. The selected variables that met the criteria of P < .25 to enter multivariable logistic regression analysis were age, placement in an emergent setting, LOH, number of PIVCs placed at admission, APPLEFULL scores, APPLEFAST scores, sex, PIVC gauge, and PIVC dwell time. The final model revealed that for each day increase in the LOH (OR, 1.43; 95% CI, 1.04 to 1.97; P = .029), there were increased odds of PIVC complication. In addition, having 2 PIVCs placed at admission (OR, 10.92; 95% CI, 1.96 to 60.73; P = .006) and having an APPLEFULL score > 35 (OR, 4.66; 95% CI, 1.09 to 19.90; P = .038) were associated with increased odds of PIVC complication. The final multivariable model with LOH, number of catheters placed at admission, and APPLEFULL score had an Akaike information criterion value of 67.66.
Due to the small numbers of dogs that did not receive irritant medications (n = 25), small numbers of dogs in multiple hospitalization categories (endocrine = 3, ophthalmic = 2, neoplasia = 4, musculoskeletal = 4), and insufficient numbers of PIVCs placed by students (2) and veterinarians (0), statistical analysis for administration of irritant medications, reasons for hospitalization, and personnel classifications could not be assessed as risk factors.
Discussion
The PIVC complication rate was lower in our study (12.1%) compared to previous veterinary studies (19.9% to 43%).2,4,5,8 Our placement protocol included circumferential clipping of fur, cleaning with a standardized cleaning agent, securement of the PIVC by the hub of the catheter, and use of a sterile transparent dressing over the insertion site. In humans, the reinforcement of transparent occlusive dressings secured with nonsterile tape resulted in significantly reduced PIVC complications, especially occlusions.15 The PIVC insertion site is an iatrogenically produced wound; therefore, the insertion site should be covered using sterile products to prevent microorganism colonization of the wound. Moreover, human PIVC guidelines state that use of a transparent, semipermeable polyurethane dressing permits continuous visual inspection of the catheter site and requires less frequent changes than do standard gauze and tape dressings.16 This was further supported in a recent integrative review where it was found that nonsterile tape directly over the PIVC insertion site and poor securement were associated with higher incidences of PIVC failure.17 The lower complication rate in this study may be due to the PIVC placement/securement protocol and the use of a sterile transparent dressing. However, veterinary medicine has yet to extensively explore PIVC placement protocols that deliberately compare multiproduct dressings and securement bundles. Therefore, further investigation in this area could yield additional insights.
In our study, extravasation and phlebitis accounted for the highest percentage of reported PIVC complications (3.7% each), which is comparable to other reported complication rates in the veterinary literature.2,4,5 In humans, extravasation may be due to mechanical (poor vein condition, catheter-vein size mismatch, patient activity, catheter malfunction), physiologic (clot formation, thrombin or fibrin sleeve at catheter tip, lymphedema), or pharmacologic (drug pH, osmolarity, cytotoxicity, vasoconstrictive properties) factors.18 The causes of extravasation in veterinary patients have not been thoroughly evaluated, so further research may help limit this complication.
Contrary to previous veterinary literature, body weight was not identified as a risk factor for PIVC complication in the present study.4 In human literature, the lower the weight of the newborn on the puncture day, the greater the complication risk.19 In veterinary patients, breed, body condition score, and body conformations may also influence body weight and risk for PIVC complication. Additional studies evaluating the interactions of these factors are needed.
In veterinary medicine, there are hospitals that routinely replace PIVCs up to every 72 hours, regardless of the PIVC or insertion site condition. However, there are several human and veterinary studies8,20–22 that suggest that routine replacement of PIVCs has no added benefit. The CDC’s guidelines16 to prevent catheter-related infections recommend PIVC replacement on an “as clinically indicated” basis for children. In the present study, dwell time was not associated with increased odds of PIVC complication. This may support the notion that routine replacement of PIVCs in veterinary patients is unnecessary. In addition to reducing the replacement of PIVCs unnecessarily, replacement on an as clinically indicated basis is less costly to the client and reduces unnecessary procedures.
The APPLE score provides an objective illness severity stratification system independent of the primary illness or diagnosis. The APPLEFULL score utilizes 10 variables and has been reported to optimize predictive accuracy. However, if clinical information or time is more limited, the 5-variable model, APPLEFAST score, can be used instead.13 Both models have been utilized in several patient populations and, given their calculation independent of the patient’s diagnosis, have been deemed useful scoring systems to determine the patient’s severity of illness and mortality risk.23,24 When all data were available, both the APPLEFULL and APPLEFAST scores were calculated. It has been previously reported that an APPLEFULL score > 30 has an 81.2% sensitivity and 89.4% specificity for the prediction of mortality and that an APPLEFULL score > 40 has a 40.9% sensitivity and 98.3% specificity.13 In an effort to maintain both the sensitivity and specificity of the illness stratification system, a cutoff score of 35 was used to evaluate the APPLEFULL score as a risk factor. In this study, an APPLEFULL score > 35 was associated with increased odds of PIVC complication, likely representing a more severely ill population of hospitalized dogs. In contrast, APPLEFAST scores were not associated with increased odds of PIVC complication in this study. This may suggest that 1 or more of the variables utilized in the APPLEFULL score, but not in the APPLEFAST score, contributed to the risk of PIVC complication. Most of those values, including WBC count, total bilirubin, presence of fluid in a body cavity, creatinine, and respiratory rate, were not evaluated as independent risk factors in our study.
In this study, there were increased odds of PIVC complication for each additional day of hospitalization. LOH may be related to severity of illness, with more critically ill dogs requiring longer LOH. While LOH was identified as a risk factor for PIVC complication, PIVC dwell time was not. This was unexpected, as patients that are in the hospital have a PIVC in place, so if they are in the hospital longer, we would expect them to have PIVCs in place longer. While the reason for this is not clear, a type II error cannot be excluded, as only 13 catheter complications were included in the analysis. Having 2 PIVCs placed at admission was also associated with increased odds of PIVC complication. In our hospital, 2 PIVCs may be placed at admission when large volumes of IV fluids are required for resuscitation, when the patient requires multiple continuous rate infusions during hospitalization, when the patient will be administrated medications that may be incompatible, or when the patient requires a transfusion. Although LOH, APPLEFULL score, and having 2 PIVCs placed at admission are independent risk factors and may be found in dogs that are not severely ill, the combination of these factors may represent a population of more severely ill dogs. Based on the results from this study, more severely ill dogs may be at higher risk of PIVC complication and represent a population that requires more aggressive PIVC monitoring and care.
There are a few limitations to our study. There is inevitably some variability in individual technique (eg, tightness of tape) in placing PIVCs. A standardized protocol was used for PIVC placement, so this is likely not a significant limitation. Additionally, patient’s behavior and the use of sedation were not reported or controlled for in this study. In cats, fractious behavior and lack of sedation have been associated with increased VIP scores.2 While we suspect that this limitation does not significantly impact the validity of the results, this may be an area of interest for future studies. Human error may have resulted in failure to document or to correctly classify the PIVC complication, which could have affected the overall complication rate or the breakdown of complications. Finally, our study was conducted at a single veterinary hospital using a single PIVC placement protocol and therefore may not reflect risk factors in a broader population of dogs in other hospitals.
Increasing LOH, APPLEFULL scores > 35, and having 2 PIVCs placed at admission were identified as risk factors for PIVC complications in dogs hospitalized in the CCU. Although these are independent risk factors for PIVC complications that may be found in dogs that are not severely ill, the combination of increasing LOH, an APPLEFULL score > 35, and having 2 PIVCs placed at admission may represent a more severely ill population, which draws attention to this vulnerable group of patients at risk for PIVC complications. Age, weight, sex, PIVC dwell time, PIVC placement within the last 30 days, PIVC placement in an emergent setting, mobility status, insertion site, PIVC gauge, and administration of anticoagulant medications were not identified as risk factors for PIVC complications in this study.
Acknowledgments
The authors would like to thank Dr. Sangeeta Rao for performing the statistical analysis for this study.
Disclosures
The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.
Funding
The authors would like to acknowledge the Jorgensen Fund for their financial contributions to the study.
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