Variability in Vascular Access Device Use, Dwell Time and Failure: Insights From Routine Nursing Documentation in a Multicentre Cohort Study.

Abstract

Aims: To describe and compare institutional patterns of vascular access device use, dwell time, and failure, and to explore their implications for nursing practice.

Design: Retrospective multicentre observational cohort study.

Methods: Routinely collected nursing records of vascular access device insertion and removal were analysed from seven public hospitals over a one-year period. All devices inserted in hospitalised adults were included, with each device treated as an independent episode. Device failure was defined as removal due to any complication. Device use, dwell time, and failure were summarised by device type and institution. Time-to-event analyses were used to describe complication-free device survival.

Results: More than 200,000 vascular access device episodes were identified, of which ~85,000 had complete data for dwell time and removal reason. Short peripheral intravenous catheters accounted for the majority of devices and reportedly had the shortest dwell time and highest proportion of failure. Medium and long duration devices remained in situ for longer periods and had lower rates of failure, although their use varied substantially between hospitals. Marked inter-institutional variability was observed in device mix, reported dwell time, complications, and data completeness, with substantial missingness in key variables across hospitals.

Conclusions: Substantial variability exists in vascular access device use, duration, and failure across hospitals. The use of short peripheral intravenous catheters dominates clinical practice despite early failure and limited alignment with expected treatment duration. These findings highlight opportunities to improve device selection and support more consistent, evidence-based nursing practice, but also underline the need to strengthen institutional data infrastructure and standardise vascular access documentation to enable reliable benchmarking and quality improvement.

Implications for the profession and/or patient care: Optimising vascular access device selection according to anticipated treatment duration may reduce repeated insertions, improve patient comfort, and decrease nursing workload associated with device failure.

Impact: What problem did the study address? ○ Inconsistent use, duration, and documentation of vascular access devices in routine hospital nursing practice. What were the main findings? ○ Short peripheral intravenous catheters were widely used and failed early, while longer-duration devices were used less frequently despite lower failure rates. Important gaps in data completeness were also identified across hospitals, particularly for dwell time and removal outcomes. Where and whom will the research have an impact? ○ The findings are relevant to nurses, nurse leaders, and healthcare organisations involved in vascular access decision-making and quality improvement.

Reporting method: This study is reported in accordance with the STROBE guidelines for observational studies.

Patient or public contribution: No patient or public contribution.