Factores de riesgo de dificultad en la canalización venosa periférica en atención hospitalaria. Estudio caso-control multicéntrico

Zusammenfassung

Introduction. Peripheral venous catheters are the most widely used invasive devices in hospital care, with millions of catheters placed every year in our country. In some situations, the cannulation technique can be complex, resulting in multiple punctures that generate pain, degradation of the vascular tree, and other undesired effects that may imply a high impact on health care. Identifying the risk factors for difficult cannulation will be useful in predicting and avoiding these effects and their consequences on patient health. Objective. The main objective of this thesis is to identify, analyze and model the risk factors associated with the occurrence of peripheral venous cannulation difficulty in adults in hospital care. Methods. A project was designed with 2 phases: (1) a systematic review of the scientific literature to identify and analyze the risk factors proposed by previous studies and (2) an analytical observational multicenter case-control study, in which different risk factors were studied together in a population of adult inpatients. Results. In the systematic review, 7 international studies were selected, through which more than 50 potential risk factors were identified. This analysis was used to establish a definition of the study problem, define the variables that were hypothesized as risk factors in the primary study, and identify other elements with possible influence, such as the context of care and the variables of the professional. In the case-control study, a sample of 2,662 patients was obtained, of whom 221 (8.3%) presented difficulty in canalization. A previous history of difficult cannulation, the presence of non-palpable veins, acute alterations in the upper limbs, and the selection of the antecubital fossa as the puncture site were independent risk factors for difficulty in peripheral venous cannulation. Patients with difficulty required a greater number of punctures (3.3 ± 1.1 vs. 1.1 ± 0.3) and presented higher pain levels associated with the technique (3.0 vs. 1.8 on the visual scale). ABSTRACT Factores de riesgo de dificultad en la canalización venosa periférica en atención hospitalaria 20 Conclusions. In this study, we identified 4 independent risk factors for suffering difficulty in peripheral venous cannulation, with the previous history of difficulty being the most important factor. In addition, measurable and reproducible variables were identified that can be contrasted in future studies, and an operational definition of the concept of difficulty in peripheral venous cannulation was proposed. We found that the context in which health care occurs influences difficult peripheral venous cannulation, but we found no association with the variables related to the professional performing the technique.