Clinical-epidemiological predictors of phlebitis associated with peripheral intravenous catheters in Spanish hospitals: results of a national cohort study

Background

Peripheral intravenous catheters (PIVC) are essential medical devices, yet they frequently lead to complications such as phlebitis, infiltration, and occlusion. Identifying risk factors is key to reducing these complications.

Objectives

To estimate the incidence of PIVC‑associated phlebitis in Spanish hospitals and identify clinical and epidemiological risk factors.

Methods

We performed a prospective cohort study in 80 Spanish hospitals from 1 to 28 February 2023. Adult inpatients (≥18 years) receiving PIVCs in non‑ICU, non‑emergency, non‑pediatric wards were eligible. A total of 13,812 PIVCs in 9387 patients were followed daily by trained nurses until catheter removal, phlebitis onset (Maddox grade ≥ 2), or 15 days. We calculated cumulative incidence and incidence density per 100 catheter‑days. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for predictors—sex, age group, number of infused medications, hospital size, and dwell time.

Results

Phlebitis occurred in 1302 PIVCs (cumulative incidence 9.43 %; incidence density 0.14 per 100 person‑hours). Independent risk factors were female sex (HR 1.32, 95 % CI 1.21–1.45), age 65–79 years (HR 1.25, 95 % CI 1.12–1.40), administration of ≥ 2 medications (HR 1.50, 95 % CI 1.35–1.67), and hospital size ≥ 1000 beds (HR 1.30, 95 % CI 1.12–1.52). Phlebitis risk peaked 48–96 h post‑insertion.

Conclusions

Phlebitis incidence remains above recommended levels. Multivariable analysis identified female sex, a higher number of infused medications, older patient age, larger hospital size, and longer PIVC dwell time as the main independent predictors of phlebitis. Registration: Not registered.