Construction Of The Risk Assessment Model For Peripheral Venous Catheter-related Complications In ICU Patients

ObjectiveTo develop the risk assessment scale of peripheral venous catheter(PVC)related complications in patients with ICU,construct the risk assessment model of PVC related complications in patients with ICU,and verify the model.Methods1.The literature review method was used to form the initial index items of PVC-related complications in patients with ICU.And through two rounds of Delphi correspondence method to form the risk assessment form of PVC-related complications in ICU patients.2.The convenience sampling method was used to select 330 patients from a ICU in a level 3 general hospital in Shandong Province from July to November 2021.The risk assessment form of PVC-related complications in ICU patients was used to collect relevant information,and the data were input into SPSS23.0 for statistical analysis.Univariate analysis and Logistic step regression analysis were used to analyze the influencing factors of PVC-related complications in ICU patients,and a risk prediction model and line graph were constructed to predict the risk of PVC in patients.The prediction model was evaluated by receiver operating characteristic curve(ROC)Result1.An assessment scale with four dimensions and 26 items were constructed.The four dimensions were patient basic information,patient catheter-related factors,patient treatment-related factors and PVC puncture factors.The Cronbach’s α of the scale was0.887,the S-CVI value of the total consistency was 0.963,the I-CVI value of each factor was in the range of 0.9-1.0,and the CVI value of each item was in the range of 0.71-1.0.The scale has good reliability and validity.2.The results of univariate analysis showed that: Age,complication,infection,immune deficiency,patient compliance,cause problems for the damaged vasculature change or cycle,skin integrity,albumin levels,neutropenia,quality of the medical history of complications,the patients’ blood vessels,PVC indwelling position,PVC type,PVC indwelling time,the length of the catheter in intravascular,puncture times,sealing tube method,methods of infusion,total volume of infusion,infusion speed,infusion time,use of anticoagulants,special drugs(blood products),proficiency in venipecture operation,whether received theoretical training related to peripheral venous catheter in recent one year,and frequency differences were statistically significant(P <0.05).3.Multivariate logistic regression analysis3.1 Independent risk factors for phlebitis were age(OR=1.13;95% CI: 1.03-1.45;P< 0.05);Complications(OR=2.60;95% CI: 1.47-8.55;P < 0.05);Patient compliance(OR=0.73;95% CI: 0.21-0.91;P < 0.05);Skin integrity(OR=3.75;95% CI: 1.02-13.87;P < 0.05);Albumin level(OR=0.43;95% CI: 0.11-0.98;P < 0.05);Number of punctures(OR=7.66;95% CI: 1.83-32.18;P < 0.05);Infusion rate(OR=1.87;95% CI: 1.20-7.02;P< 0.05);Whether OR not you have received theoretical training on peripheral venous catheterization within the last year and the number of times(OR=7.72;95% CI: 1.07-55.93;P < 0.05).3.2 Independent risk factors for venous infiltration were age(OR=1.13;95% CI:1.07-1.57;P < 0.05);Diseases causing vasculature changes OR impaired circulation(OR=2.50;95% CI: 1.47-8.55;P < 0.05);Skin integrity(OR=2.39;95% CI: 1.02-5.79;P< 0.05);Albumin level(OR=0.32;95% CI: 0.13-0.74;P < 0.05);Number of punctures(OR=3.83;95% CI: 1.43-10.22;P < 0.05);Infusion rate(OR=1.73;95% CI: 1.02-7.02;P< 0.05).3.3 Independent risk factors for catheter blockage were age(OR=1.17;95% CI: 1.01-1.35;P < 0.05);Complications(OR=2.47;95% CI: 1.25-8.54;P < 0.05);Albumin level(OR=0.68;95% CI: 0.13-0.96;P < 0.05);History of PVC-induced complications(OR=3.84;95% CI: 1.36-9.44;P < 0.05);Input mode(OR=2.79;95% CI: 1.11-12.46;P< 0.05);Whether OR not you have received theoretical training on peripheral venous catheterization within the past year and the number of times(OR=1.38;95% CI: 1.02-16.14;P < 0.05).4.Validation of risk assessment model for PVC-related complications in ICU patients4.1 Evaluation and verification of the rot-line model of phlebitis occurrence:C-index value was 0.959,AUC was 0.960,95% confidence interval was 0.9326-0.9865,P<0.001,specificity was 0.933,sensitivity was 0.983,and Yorden index was 0.916,suggesting that the line graph model had good accuracy and differentiation in predicting the occurrence of PVC-associated phlebitis in ICU patients.4.2 Evaluation and verification of the lipopograph model of venous infiltration:C-index value was 0.906,AUC was 0.906,95% confidence interval was 0.8705-0.9422,P<0.001,specificity was 0.880,sensitivity was 0.899,Yorden index was 0.779,These results suggest that the linear model has good accuracy and distinction in predicting PVC-associated venous infiltration in ICU patients.4.3 Evaluation and verification of the rosette model of catheter blockage: C-index value was 0.944,AUC was 0.939,95% confidence interval was 0.98992-0.9778,P<0.001,specificity was 0.892,sensitivity was 0.880,Yorden index was 0.772,These results suggest that the line-map model has good accuracy and distinction in predicting PVC-associated vein occlusion in ICU patients.Conclusions1.The Delphi expert letter consultation method was used to develop the risk factor assessment table of PVC-related complications in ICU patients,with good reliability and validity.2.The risk assessment model of PVC-related complications in ICU patients showed that the independent risk factors for phlebitis were age,complications,patient compliance,skin integrity,albumin level,puncture times,infusion speed,and whether the patients had received peripheral venous catheter related theoretical training and times in the past year.Risk factors for venous infiltration are age,disease causing vasculature changes or impaired circulation,skin integrity,albumin levels,number of punctures,and infusion speedThe risk factors for catheter blockage were age,comorbidities,albumin level,previous history of PVC-induced complications,mode of input,and whether and how many times peripheral venous catheter theory training had been received in the past year.3.In this study,the risk assessment model of PVC-related complications in ICU patients was constructed and the prediction model had good calibration ability.