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Dobrescu A, Constantin AM, Pinte L, Chapman A, Ratajczak P, Klerings I, Emprechtinger R, Allegranzi B, Zingg W, Grayson ML, Toledo J, Gartlehner G, Nussbaumer-Streit B. Effectiveness and Safety of Measures to Prevent Infections and Other Complications Associated With Peripheral Intravenous Catheters: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:1640-1655. [PMID: 38593192 DOI: 10.1093/cid/ciae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. METHODS We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980-16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. RESULTS 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33-.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49-1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non-chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. CONCLUSIONS Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. CLINICAL TRIALS REGISTRATION The protocol was registered in the Open Science Framework (https://osf.io/exdb4).
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Affiliation(s)
- Andreea Dobrescu
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Larisa Pinte
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Andrea Chapman
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Robert Emprechtinger
- Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - M Lindsay Grayson
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Infectious Diseases Department, Austin Health, Melbourne, Australia
| | - Joao Toledo
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- High Impact Epidemics, WHO Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
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Kaphan K, Auypornsakul S, Somno J, Wongwattananan W, Jamsittikul K, Baicha W, Somsri S, Sawatrak T. The Prevalence and Associated Factors of Peripheral Intravenous Complications in a Thai Hospital. JOURNAL OF INFUSION NURSING 2024; 47:120-131. [PMID: 38422405 PMCID: PMC10916754 DOI: 10.1097/nan.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Complications of peripheral intravenous catheters (PIVCs) remain a major contributor to health care costs and are a patient safety problem. The objective of this cross-sectional descriptive study was to examine the prevalence of complications and factors associated with complications from peripheral intravenous fluid administration. The study was conducted at a tertiary care hospital in Thailand. The instruments were developed from the literature review. Data were analyzed using SPSS statistics, version 22. The study examined 441 patients with a total of 497 PIVC sites. Phlebitis (level 1 and 2 only) occurred at 2.41% of all sites; infiltration (level 1 and 2 only) occurred at 1.01% of all sites, and extravasation (mild and moderate only) occurred at 0.60% of all sites. Factors associated with the occurrence of infiltration complications included receiving intravenous (IV) crystalloids (P = .03) and receiving IV analgesic drugs (P = .001). Age was statistically significantly related to extravasation complications (P = .001). Nurses should be aware of possible complications from peripheral intravenous fluid administration, especially in older patients and those receiving IV crystalloids or analgesic drugs.
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Affiliation(s)
- Kraiwan Kaphan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Siriporn Auypornsakul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Jenjira Somno
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Watsaporn Wongwattananan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Kamonthip Jamsittikul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Wilaiporn Baicha
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Saowanuch Somsri
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Thanyanan Sawatrak
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
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Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
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Fan XW, Xu L, Wei WS, Chen YM, Yang YQ. Relationship between indwelling site and peripheral venous catheter-related complications in adult hospitalized patients: A systematic review and meta-analysis. J Clin Nurs 2023; 32:1014-1024. [PMID: 35229381 DOI: 10.1111/jocn.16241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/13/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES This systematic review and meta-analysis aimed to compare the incidence of PVC-related complications between catheterisation in the forearm and back of the hand in adult patients. BACKGROUND A peripheral intravenous catheter (PVC) is often inserted as part of care during patients' hospitalisation. The catheter is typically inserted in the forearm or at the back of the hand in usual practice. Studies have not yet reached a consensus on the optimal insertion site in any clinical setting. DESIGN We performed a systematic review and meta-analysis based on PRISMA guidelines. METHODS We searched the following electronic databases: PubMed, Cochrane Library, Embase, and CINAHL. Randomised controlled trials, cohort studies, case-control studies and cross-sectional studies from inception to July 2021 reporting the incidence of PVC-related complications at the forearm and back of the hand were included. Fixed-effects models and random-effects models were used to derive the pooled risk ratios. RESULTS Twenty-four studies involving 16562 PVCs met our inclusion criteria. The meta-analysis showed that compared with PVC placement in the back of the hand, placement in the forearm was associated with a higher incidence of total complications and infiltration/extravasation. However, the differences between the PVC indwelling sites were not significant (total complications: P = 0.43; phlebitis: P = 0.35; infiltration/extravasation: P = 0.51). Both incidence of total complications and infiltration/extravasation analyses showed high heterogeneity (total complications: I2 = 60%; infiltration/extravasation: I2 = 58%). CONCLUSION Available evidence suggests that there is no significant difference between PVC placement in the forearm and at the back of the hand in terms of the incidence of complications, thus making both approaches suitable. RELEVANCE TO CLINICAL PRACTICE For patients who need indwelling PVC, medical staff can choose the best indwelling site, and both forearm and back of the hand are suitable.
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Affiliation(s)
- Xiao-Wen Fan
- School of nursing, Soochow University, Suzhou, China
| | - Lei Xu
- Department of emergency, School of nursing, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Wen-Shi Wei
- Department of emergency, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya-Mei Chen
- Department of emergency, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Qun Yang
- Nursing Department, Dushu Lake Hospital Affiliated to Soochow University, the First Affiliated Hospital of Soochow University, Suzhou, China
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Yilmaz DU, Yilmaz D, Karaman D. Clinical nurses' knowledge and practices on routine care related to the prevention of complications of peripheral intravenous therapy: A cross-sectional study. J Vasc Access 2023; 24:277-283. [PMID: 34278851 DOI: 10.1177/11297298211033380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM The aim of this descriptive and cross-sectional study was to determine the knowledge and practices of nurses related to the prevention of peripheral intravenous therapy (PIT) complications, and to identify the influencing factors. METHODS The study adopted a cross-sectional and descriptive design and was conducted between April and August of 2018 with a total of 214 clinical nurses. The data collection tools employed were a 12-item sociodemographic questionnaire and a 16-item questionnaire on knowledge and practices related to the prevention of peripheral intravenous therapy complications. RESULTS The mean knowledge scores of the nurses were found to be 81.54 ± 12.06 (min: 50, max: 100). No statistically significant difference was found to exist between the scores, and the variables of the nurses' gender, length of employment in the health profession, type of work, training received related to PIT complications, and self-competence level in PIT complications. CONCLUSION The nurses were found to have high knowledge levels; however, their practices for preventing PIT complications differed. Standardized practice procedures and workplace training are needed in order to transform nurses' knowledge into practice with regard to the prevention of PIT complications.
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Affiliation(s)
- Derya Uzelli Yilmaz
- Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Yilmaz
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Dilek Karaman
- Department of Health Care Services, Ahmet Erdogan Health Services Vocational School, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Karaoğlan N, Sarı HY, Devrim İ. Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S23. [PMID: 35439080 DOI: 10.12968/bjon.2022.31.8.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. METHOD The study was conducted in the largest children's hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. RESULTS The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P<0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P<0.001). CONCLUSION Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.
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Affiliation(s)
- Nalan Karaoğlan
- Nurse, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Hatice Yıldırım Sarı
- Professor, Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - İlker Devrim
- Professor, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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Reducing Peripheral Intravenous Catheter Extravasation in Neonates: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2021; 48:31-38. [PMID: 33427807 DOI: 10.1097/won.0000000000000728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to reduce total and severe peripheral intravenous extravasation (PIVE) incidence by 40% in our neonatal intensive care unit. SETTING/APPROACH This quality improvement initiative was performed at an academic, free-standing suburban children's hospital, in a level 4 neonatal intensive care unit from June 2017 to April 2018. Baseline extravasation data for a period of 6 months prior to the initiative were reviewed, along with a nursing knowledge questionnaire and random audits of catheter stabilization techniques. A Pareto chart and a key driver diagram were created to identify the most common causes of extravasations and lead to a series of process changes. We implemented 4 Plan-Do-Study-Act (PDSA) cycles: (1) dressing protocol for peripheral intravenous vascular (PIV) catheter securement that instituted standardized securement and safer equipment; (2) education on PIV assessment and maintenance, concentrating on hourly evaluation and documentation; (3) guidance algorithm for PIVE identification and treatment; and (4) escalation policy, limiting the number of placement attempts and increased use of a "superuser" team. OUTCOMES The overall prevalence of extravasations decreased by 54%, from 73 preintervention to 40 at postintervention. At baseline, 52% (38/73) extravasations were severe; however, those in the severe category decreased by 35% (14/40) postintervention. The overall rate of adherence to the PIV catheter management algorithm approached 95%; whereas adherence to the securement guideline fluctuated between 80% and 98%. IMPLICATION FOR PRACTICE The implementation of these new practice recommendations along with the education has resulted in a decreased rate and severity of extravasation. Frequent audits and reinforcements are integral to sustainment and to ensure accountability for the implemented procedures.
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Abstract
Hospitalized adult patients often require more than 1 short peripheral catheter (SPC) to complete the prescribed intravenous (IV) therapy attributed to catheter failure and the practice of routinely replacing SPCs. The purpose of this quality improvement project was to increase the number of SPCs that dwell for the complete duration of the IV therapy in hospitalized adult patients using a bundled approach. Implementation of an engineered securement device (ESD), education pertaining to modifiable risk factors, and changing the practice to removal on clinical indication were methods used to reduce the number of SPC insertions and catheter failures. This study was conducted at a rural Midwestern hospital using a convenience sample (N = 405) and an observational, descriptive cohort design in 6 phases between September 2019 and March 2020. After the practice changes, there was a reduction of SPC replacement (24%), catheter failures (24% to 13%), SPCs per patient (M = 2.9-2.2; P = .045), SPC insertions (4000 per year), and catheter-related bloodstream infections (0.26 per 1000 catheter days to 0.0), as well as a significant increase of SPCs remaining in situ (M = 2.6-3.8 days; P < .001), resulting in an estimated cost savings of at least $285,000. The results demonstrated that the risk of failure significantly increased when SPCs were inserted in the wrist (P = .007) and upper arm (P = .026) and significantly reduced when inserted in the forearm (P = .39). Study findings suggest that using an ESD, promoting SPC insertion in the forearm, avoiding the wrist and upper arm, and changing practice to removal when clinically indicated reduced the number of SPC insertions and rate of catheter failures.
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Marsh N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, Rickard CM. Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis. J Adv Nurs 2020; 76:3346-3362. [DOI: 10.1111/jan.14565] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Joan Webster
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Amanda J. Ullman
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Medicine Griffith University Brisbane Queensland Australia
- Centre for Applied Health Economics Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Division of Hospital Medicine Department of Medicine University of Michigan Ann Arbor Michigan USA
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
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Ryan D, Miller J, Campbell J. Cannula complications using elastomeric infusers in Hospital in the Home. JAC Antimicrob Resist 2020; 2:dlaa033. [PMID: 34223000 PMCID: PMC8210130 DOI: 10.1093/jacamr/dlaa033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Comparison of the short peripheral cannula (SPC) complication rate of patients with cellulitis receiving IV cefazolin via an elastomeric infuser with those receiving twice-daily bolus treatment (control group) in the Hospital in the Home service. Methods A randomized controlled study using elastomeric infuser versus bolus delivery of IV cefazolin via an SPC of patients referred to the Hospital in the Home service in the Northern Illawarra for treatment of cellulitis. A total of 104 patients were enrolled during the time period of May 2018 to January 2019. Primary outcome measures were SPC complications including phlebitis with a secondary outcome of patient satisfaction. Results A total of 104 patients enrolled. After randomization there were 60 in the infuser group and 44 in the bolus group. Patient characteristics of age, gender, weight and mobility were similar for the two groups. There was no statistically significant difference between the groups for the endpoint of cannula complication rates. Patient satisfaction scores showed patient acceptance of both forms of treatment. Conclusions This study suggests that using elastomeric infusers to deliver cefazolin via a short peripheral IV catheter has similar complication rates to traditional bolus delivery. Patients surveyed showed high levels of satisfaction with both forms of antibiotic delivery.
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Affiliation(s)
- Damian Ryan
- Hospital in the Home, Wollongong Hospital, Illawarra Shoalhaven Local Hospital District, Wollongong, NSW, Australia
| | - Jennifer Miller
- Ambulatory Care Centre, Wollongong Hospital, Illawarra Shoalhaven Local Hospital District, Wollongong, NSW, Australia
| | - Joanne Campbell
- Ambulatory Care Centre, Wollongong Hospital, Illawarra Shoalhaven Local Hospital District, Wollongong, NSW, Australia
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Dat M, Jc DLTM, Ac N, Reis RK, Mh B, Sem T. Prevalence of and factors associated with difficult peripheral venipuncture in adult surgical patients. J Vasc Access 2020; 22:404-410. [PMID: 32720556 DOI: 10.1177/1129729820939335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the prevalence of difficult venous access in adult patients admitted to a surgical unit. METHOD This observational prospective cohort study included 235 patients from a Brazilian hospital. Clinical data were collected by direct observation and analyzed by descriptive, inferential statistics, and multiple binomial logistic regressions. Odds ratios were also calculated. RESULTS Most of the patients (66.4%) were men and self-reported as white (59.2%). The prevalence of difficult intravenous access was 32.8%. Predictors of peripheral intravenous cannula insertion failure were history of difficult intravenous access and nonvisibility of the vein. CONCLUSION History of difficult intravenous access and a nonvisible venous network were significant predictors of peripheral cannula insertion failure in adults undergoing clinical surgery. The prevalence of difficult intravenous access was 32.8%.
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Affiliation(s)
- Monteiro Dat
- Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Nicolussi Ac
- Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - R K Reis
- University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Barbosa Mh
- Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Toffano Sem
- Federal University of Triângulo Mineiro, Uberaba, Brazil
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13
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Heng SY, Yap RTJ, Tie J, McGrouther DA. Peripheral Vein Thrombophlebitis in the Upper Extremity: A Systematic Review of a Frequent and Important Problem. Am J Med 2020; 133:473-484.e3. [PMID: 31606488 DOI: 10.1016/j.amjmed.2019.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The acceptable incidence of thrombophlebitis following intravenous cannulation is 5%, as recommended by the Intravenous Nurses Society guidelines, but publications have reported startling figures of 20% to 80%. Given the frequency of intravenous lines, this presents a potential clinical problem. We aimed to determine the predisposing patient, catheter, and health care-related factors of peripheral vein thrombophlebitis in the upper extremity. METHODS In this systematic review, we used a comprehensive search strategy to identify risk factors of thrombophlebitis from inception to May 20, 2019. Studies reporting risk factors of peripheral vein thrombophlebitis of adult patients admitted to the hospital and receiving an intravenous cannulation were included. The Quality of Prognostic Studies tool was used in the assessment for risk of bias to determine the study quality. RESULTS Of the 6910 studies initially identified, 25 were eligible for inclusion. Qualitative syntheses revealed that patient-related factors that confer a higher risk included intercurrent illness, immunocompromised state, comorbidities such as diabetes mellitus, malignancy, previous thrombophlebitis, burns, and higher hemoglobin levels. Catheter-related risk factors included catheter size, duration, and site of insertion. Intravenous antibiotics and potassium chloride predisposed to thrombophlebitis. Cannulation by an intravenous therapy team and more nursing care were associated with a decreased risk. A P-value < .5 was considered to be statistically significant. CONCLUSION Recognition of the predisposing factors would allow for targeted strategies to aid in the prevention of this iatrogenic infection, which may include closer monitoring of patients who are identified to be vulnerable. Based on this systematic review, we developed an algorithm to guide clinical management. Further research is warranted to validate this algorithm.
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Affiliation(s)
- Shu Yun Heng
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Robert Tze-Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Joyce Tie
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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King A, Byrne BA, Chigerwe M. Prevalence of and risk factors for intravenous catheter infection in hospitalized cattle, goats, and sheep. J Vet Intern Med 2020; 34:330-338. [PMID: 31859417 PMCID: PMC6979082 DOI: 10.1111/jvim.15684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intravenous catheter (IVC) use in hospitalized ruminants is a common procedure. Limited information is available describing complications associated with IVCs. HYPOTHESES Prevalence of IVC infections in hospitalized ruminants is >50%. Intravenous catheters maintained for >5 days are more likely to be infected than those maintained for <5 days. Intravenous catheters placed non-aseptically have a higher risk for infection than those placed aseptically. ANIMALS Thirty-four cattle, 39 goats, and 33 sheep were hospitalized in a university teaching hospital. METHODS Prospective observational study. The IVCs from cattle, goats, and sheep admitted for medical and surgical procedures were randomly selected and submitted for bacteriological culture and susceptibility testing. RESULTS Prevalence values (95% confidence interval) of infected catheters were 61.8 (45.5, 78.1), 51.3 (35.3, 66.7), and 42.4% (25.2, 58.8) in cattle, goats, and sheep, respectively. Coagulase-negative Staphylococcus spp was the most frequently isolated bacterium. Catheter type/placement technique was a significant (P = .03) predictor of IVC infection in goats but not in cattle (P = .65) and sheep (P = .47). Antibiotic use and reason for catheter placement were not significant predictors of IVC infection in all species. Catheters maintained for >4 days had a higher likelihood of being infected than those maintained for <4 days in all species. CONCLUSIONS AND CLINICAL IMPORTANCE Clinicians should consider replacing catheters maintained for >4 days to reduce IVC infection.
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Affiliation(s)
- Ailbhe King
- William Pritchard Veterinary Medical Teaching HospitalDavisCalifornia
| | - Barbara A. Byrne
- Department of Pathology, Microbiology and ImmunologyUniversity of California DavisDavisCalifornia
| | - Munashe Chigerwe
- Department of Veterinary of Medicine and EpidemiologyUniversity of California DavisDavisCalifornia
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Cost-Effectiveness Analysis of Low-Cost, Domestic Short Peripheral Catheters Versus Higher-Priced, Imported Short Peripheral Catheters. JOURNAL OF INFUSION NURSING 2019; 42:209-214. [PMID: 31283664 DOI: 10.1097/nan.0000000000000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This prospective study has been designed with the hypothesis that low unit price does not necessarily mean cost-effectiveness. Low-cost, domestic short peripheral catheters (SPCs) and higher-priced, imported SPCs were compared in 2 different time periods. With the use of the higher-priced, imported SPCs, the rate of successful insertion on first attempt was increased (P < .001), and the development of complications was reduced (P < .001). The study revealed that $345 was saved per 1000 catheters when the catheter with the higher unit price was chosen. Although the domestic SPCs had a low unit price, their use resulted in greater health care expenses.
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Clinical Features of Bloodstream Infections Associated with Peripheral Versus Central Venous Catheters. Infect Dis Ther 2019; 8:343-352. [PMID: 31368046 PMCID: PMC6702512 DOI: 10.1007/s40121-019-00257-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction This study aimed to compare the clinical characteristics and prognoses of central venous catheter-associated bloodstream infections (CVC-BSIs) with peripheral venous catheter-associated BSIs (PVC-BSIs). Methods This retrospective observational study was conducted between April 2011 and March 2013 at a teaching hospital in Tokyo, Japan. Adult patients who developed CVC-BSIs and PVC-BSIs more than 2 days after admission were included. Patients with both CVC-BSIs and PVC-BSIs were excluded. Clinical characteristics of patients with CVC-BSIs and PVC-BSIs were obtained from medical records, and 30-day all-cause mortality was measured as the clinical outcome. Results We enrolled 124 PVC-BSI cases and 110 CVC-BSI cases. Median age, age-adjusted Charlson score, Sequential Organ Failure Assessment score, sex, and ward type at BSI onset did not differ significantly between the two groups. The median duration of catheter indwelling was significantly shorter in the PVC-BSI group than in the CVC-BSI group. Staphylococcus aureus and Gram-negative bacilli infections were more frequent and coagulase-negative staphylococci (CNS) and Candida spp. infections were less frequent in the PVC-BSI group than in the CVC-BSI group. The prevalence of oxacillin resistance among causative S. aureus and CNS, 30-day all-cause mortality, and appropriateness of empirical and definitive antimicrobial therapies did not differ significantly between the two groups. Conclusion The pathogen species distribution varies between PVC-BSIs and CVC-BSIs. However, all-cause mortality does not differ between the two groups. PVCs are not safer than CVCs with respect to BSIs; therefore, it is necessary to use similar precautions relevant to CVC use in order to avoid unnecessary use of PVCs.
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Blanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control 2019; 8:124. [PMID: 31367345 PMCID: PMC6647274 DOI: 10.1186/s13756-019-0581-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices among inpatients. Catheter-related bloodstream infections (CRBSI) are serious yet preventable events for patients. Although the contribution of PIVCs towards these infections is gradually being recognised, its role in the Spanish setting is yet to be determined. We aimed to estimate the rate and incidence of PIVC failure at Manacor hospital (Spain) as baseline within a wider quality improvement initiative. Methods Tips from all PIVC removed during December 2017 and January 2018 in hospital wards were cultured semiquantitatively. The study population included all PIVCs inserted in adult patients admitted to any of three medical and one surgical wards, emergency department, critical care unit and operating rooms. Clinical, microbiological and ward information was collected by clinical researchers for each PIVC from insertion to removal on the study sites. CRBSI was defined per international guidelines (i.e., Centers for Disease Control and Prevention, USA). Data was analysed descriptively. Results Seven hundred and eleven tips were cultured, with 41.8% (297/711) reported as PIVC failure. The PIVC failure rate density-adjusted incidence for hospital length of stay (HLOS) was 226.2 PIVC failure/1000 HLOS. 5.8% (41/711) tips yielded positive isolates, with most frequent microorganisms Staphylococcus spp (S. epidermidis 29/41, 70.7%, S. aureus 2/41, 4.9%, S. hominis 2/41, 4.9%), and Acinetobacter baumannii (1/41, 2.4%). One S. aureus isolate was methicillin-resistant. 53.6% (22/41) positive cultures were obtained from patients with local signs and symptoms compatible with catheter-related infection (CRI), 2.4% (1/41) were compatible with CRBSI type 2 and that clinical signs improve within 48 h of catheter removal (density-adjusted incidence for hospital stays of 16.7 PIVC-CRI/1000 hospital-stays and 0.76 PVC-BSI/1000 hospital-stays respectively) and no patients were diagnosed CRBSI type 3 with a bacterial growth concordant in tip and blood cultures. Most cases responded favourably to catheter removal and management. Conclusions Our findings show that almost 42% PIVCs resulted in unplanned removal, amplifying the importance in terms of morbidity, mortality and patient safety. A high number of positive tip cultures without clinical signs and symptoms was observed. We underpin the importance to remove unnecessary PIVCs for the prevention of CRBSI.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- 2Servei de Salut de les Illes Balears, Palma, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Joan de Pedro-Gómez
- 3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | | | - Ismael Fernández-Fernández
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain
| | - Enrique Castro-Sánchez
- 6NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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Simonetti V, Comparcini D, Miniscalco D, Tirabassi R, Di Giovanni P, Cicolini G. Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study. NURSE EDUCATION TODAY 2019; 73:77-82. [PMID: 30544076 DOI: 10.1016/j.nedt.2018.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/22/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement. OBJECTIVE To determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence. DESIGN Cross-sectional. SETTINGS The study was carried out (March-September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna). PARTICIPANTS A convenience sample of NSs (n = 1056) was involved. METHODS We collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample. RESULTS Most participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%). In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores. "Infusionset removal after 24 h when lipids or blood products are administered" (75.4%). CONCLUSIONS NSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.
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Affiliation(s)
| | - Dania Comparcini
- UNIVPM University, Italy; ASUR Marche, AV5 Ascoli Piceno Hospital, Italy; AO Ospedali Riuniti di Ancona Hospital, Italy.
| | | | | | | | - Giancarlo Cicolini
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy; ASL 02 Abruzzo, Chieti, Italy.
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Abstract
Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.
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Baqaei R, Khalkhali H, Rezaeifar P. Effect of Structured Nursing Education Programs in Prevention of Admitted Patients’ Phlebitis. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis 2018; 65:1757-1762. [PMID: 29020252 DOI: 10.1093/cid/cix562] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/20/2017] [Indexed: 01/01/2023] Open
Abstract
Short-term peripheral venous catheters (PVCs) are commonly used in healthcare settings. To determine the magnitude of bloodstream infections (BSIs) related to their use, PubMed, article bibliographies, and the authors' library were searched for pertinent articles. The incidence of PVC-related BSIs was 0.18% among 85063 PVCs. Short-term PVCs accounted for a mean of 6.3% and 23% of nosocomial BSIs and nosocomial catheter-related BSIs, respectively. Prolonged dwell time and catheter insertion under emergent conditions increased risk of PVC-related bloodstream infection (PVCR-BSI). If approximately 200 million PVCs are successfully inserted into adult patients each year in the United States, there may be many PVCR-BSIs occurring yearly. Clinicians should obtain blood cultures in patients with evidence of PVC infection and systemic symptomatology such as fever, carefully inspect the PVC insertion site in bacteremic or fungemic patients, and remove PVCs associated with localized infection with or without associated BSI.
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Affiliation(s)
- Leonard A Mermel
- Department of Medicine, Alpert Medical School of Brown University.,Division of Infectious Diseases and Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence
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Xu L, Hu Y, Huang X, Fu J, Zhang J. Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults: A nonblinded, cluster-randomized trial in China. Int J Nurs Pract 2017; 23. [PMID: 28990241 DOI: 10.1111/ijn.12595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Lichun Xu
- School of Nursing; Fudan University; Shanghai China
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Yan Hu
- School of Nursing; Fudan University; Shanghai China
| | - Xiaojin Huang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jianguo Fu
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jinhui Zhang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
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A prospective clinical trial to assess peripheral venous catheter-related phlebitis using needleless connectors in a surgery department. Am J Infect Control 2017; 45:1139-1142. [PMID: 28964346 DOI: 10.1016/j.ajic.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of intravascular catheters is often complicated by phlebitis, which is associated with increased morbidity and extended duration of hospitalization. We conducted a study to investigate the impact of needleless intravenous access devices on the rate of phlebitis in peripheral venous catheters (PVCs). METHODS We prospectively recruited patients in 2 phases. The first group was treated with a regular cap, and the second group was treated with a needleless connector. The incidence of catheter-related phlebitis (CRP) was recorded as the primary end point. RESULTS A total of 620 PVCs using regular caps were inserted into 340 patients and CRP rates were recorded. In the second phase of the study, 169 PVCs using needleless connectors were inserted into 135 patients. In the group treated with the regular cap, the CRP rate was 60% compared with 7% in the group treated with the needleless cap (P <.001). Consequently, the number of catheter replacements was decreased from 1.9 on average to 1.3 (P <.001). In both phases, patients who developed phlebitis had a statistically significant longer mean hospitalization period (P <.001), as were patients in the regular cap group (P <.01). CONCLUSIONS The use of needleless connectors was found to be associated with a significant reduction of CRP in peripheral veins in a surgery department setting. The decreased morbidity resulted in a lower number of catheter replacements and duration of hospitalization.
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Peripheral Venous Catheter-Related Adverse Events in a Tropical Country. Infect Control Hosp Epidemiol 2017; 38:1258-1259. [PMID: 28793936 DOI: 10.1017/ice.2017.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, Bouza E. Nationwide study on peripheral-venous-catheter-associated-bloodstream infections in internal medicine departments. J Hosp Infect 2017; 97:260-266. [PMID: 28716670 DOI: 10.1016/j.jhin.2017.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/04/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of peripheral venous catheters (PVCs) has increased outside intensive care units, as has the rate of PVC-associated-bloodstream infection (PVC-BSI). PVCs are widely used in internal medicine departments (IMDs), but data on the incidence of PVC-BSI and its characteristics in IMDs are scarce. AIM To assess the incidence of PVC-BSI episodes detected in IMDs in Spain. METHODS A one-year multi-centre prospective observational cohort study in 14 Spanish IMDs was undertaken. Adult patients admitted with at least one PVC and bacteraemia were included in the study. Demographic and clinical data were provided by local coordinators. FINDINGS Seventy episodes of PVC-BSI were recorded, representing an overall rate of 1.64 PVC-BSI episodes/1000 IMD admissions. The mean age of patients was 67.44 (standard deviation 16.72) years. It was estimated that 25.7% of PVCs were no longer necessary. Staphylococcus aureus was the most frequently isolated micro-organism (41.7%). Phlebitis was clinically evident in 44 (62.9%) episodes, and proved to be an independent predictor of catheter insertion in emergency departments (odds ratio 5.44). The crude and attributable mortality rates were 12.9% and 5.7%, respectively. CONCLUSIONS PVCs carry a significant risk for bacteraemia in Spanish IMDs. Phlebitis is not always clinically evident in patients with bacteraemia in this population. The study findings support the need for educational and interventional preventive measures in both IMDs and emergency departments to reduce the rate of PVC-BSI and associated comorbidities, and costs.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J A Capdevila
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - J Barberán
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain
| | - B Pinilla
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, HGU Gregorio Marañón, Madrid, Spain
| | - P Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain
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Capdevila-Reniu A, Capdevila JA. Peripheral venous catheter, a dangerous weapon. Key points to improve its use. Rev Clin Esp 2017; 217:464-467. [PMID: 28576382 DOI: 10.1016/j.rce.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022]
Abstract
Catheter-related bacteremia is one of the most important causes of nosocomial infection. Is associated to high rates of morbidity and mortality, including an economic burden. Peripheral venous catheter bacteremia is a leading cause of nosocomial infection in internal medicine departments. In this article, we review some important key points to improve its use and avoid infections.
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Affiliation(s)
| | - J A Capdevila
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Spain.
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Arias-Fernández L, Suérez-Mier B, Martínez-Ortega MDC, Lana A. Incidencia y factores de riesgo de flebitis asociadas a catéteres venosos periféricos. ENFERMERIA CLINICA 2017; 27:79-86. [DOI: 10.1016/j.enfcli.2016.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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Enes SMS, Opitz SP, Faro ARMDCD, Pedreira MDLG. Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon. Rev Esc Enferm USP 2017; 50:263-71. [PMID: 27384206 DOI: 10.1590/s0080-623420160000200012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. OBJETIVO Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.
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Miliani K, Taravella R, Thillard D, Chauvin V, Martin E, Edouard S, Astagneau P. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project). PLoS One 2017; 12:e0168637. [PMID: 28045921 PMCID: PMC5207628 DOI: 10.1371/journal.pone.0168637] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. Methods A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Results Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Conclusion Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings.
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Affiliation(s)
- Katiuska Miliani
- Coordinating Centre for control of healthcare-associated infections (CClin), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Raphaël Taravella
- Coordinating Centre for control of healthcare-associated infections (CClin), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Denis Thillard
- Coordinating Centre for control of healthcare-associated infections (CClin), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Valérie Chauvin
- Infection Control Department, Lariboisière/F. Widal University Teaching Hospital, Paris, France
| | - Emmanuelle Martin
- Infection Control Department, Elbeuf-Louviers-Val de Reuil Intercommunal Hospital, Elbeuf, France
| | | | - Pascal Astagneau
- Coordinating Centre for control of healthcare-associated infections (CClin), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- * E-mail:
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Tan YHG, Tai WLS, Sim C, Ng HLI. Optimising peripheral venous catheter usage in the general inpatient ward: a prospective observational study. J Clin Nurs 2016; 26:133-139. [DOI: 10.1111/jocn.13451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Crystal Sim
- Nursing Service; Tan Tock Seng Hospital; Singapore City Singapore
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Abstract
Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.
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Fernández-García C, Mata-Peón E, Avanzas-Fernández S. Related factors with extravasation of non-cytostatic agents in peripheral vein catheters. ENFERMERIA CLINICA 2016; 27:71-78. [PMID: 27865648 DOI: 10.1016/j.enfcli.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To know the independent variables related to the occurrence of extravasation in patients with peripheral vein catheters (PVC). MATERIAL AND METHOD Retrospective study carried out in 6 longitudinal cuts between July 2013 an January 2014. A total of 1,442 PVC were reviewed, of which 730 met the inclusion criteria, and were divided into 2 groups: extravasation and not extravasation, with 365 cases each. The variables of age, gender, admission unit, catheter gauge, insertion site, previous insertion into the same limb, hospital unit where the insertion took place, communication difficulties, personal health history and analyzed parenterally drug administered were considered. RESULTS Risk factors to develop extravasation were: female gender, with previous insertion in the same limb, <72h PVC of insertion, communication difficulties, personal health history of neoplasia and KCl, gentamicin or beta lactam treatment. CONCLUSIONS Our study allows to know the variables that are related to the emergence of extravasations in patients with non-cancer treatments (gender, medical service of admission, catheter gauge, elapsed time since the insertion, patient communication difficulties, personal health history, and intravenous treatments), as well as the factors that may be considered protective.
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Affiliation(s)
- Cristina Fernández-García
- Comisión de Cuidados de Enfermería, Unidad de Psiquiatría, Fundación Hospital de Jove, Gijón, España.
| | - Esther Mata-Peón
- Comisión de Cuidados de Enfermería, Calidad, Fundación Hospital de Jove, Gijón, España
| | - Sara Avanzas-Fernández
- Comisión de Cuidados de Enfermaría, Unidad Medicina Interna, Fundación Hospital de Jove, Gijón, España
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodriguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Austin ED, Sullivan SB, Whittier S, Lowy FD, Uhlemann AC. Peripheral Intravenous Catheter Placement Is an Underrecognized Source of Staphylococcus aureus Bloodstream Infection. Open Forum Infect Dis 2016; 3:ofw072. [PMID: 27191005 PMCID: PMC4867656 DOI: 10.1093/ofid/ofw072] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/29/2016] [Indexed: 11/15/2022] Open
Abstract
Few studies have focused on the risks of peripheral intravenous catheters (PIVs) as sources for Staphylococcus aureus bacteremia (SAB), a life-threatening complication. We identified 34 PIV-related infections (7.6%) in a cohort of 445 patients with SAB. Peripheral intravenous catheter-related SAB was associated with significantly longer bacteremia duration and thrombophlebitis at old PIV sites rather than current PIVs.
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Affiliation(s)
| | | | - Susan Whittier
- Department of Pathology and Cell Biology, Clinical Microbiology Laboratory , Columbia University Medical Center , New York
| | - Franklin D Lowy
- Department of Medicine, Division of Infectious Diseases; Department of Pathology and Cell Biology, Clinical Microbiology Laboratory, Columbia University Medical Center, New York
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Carr PJ, Rippey JCR, Cooke ML, Bharat C, Murray K, Higgins NS, Foale A, Rickard CM. Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: the Vascular Access Decisions in the Emergency Room (VADER) study protocol. BMJ Open 2016; 6:e009196. [PMID: 26868942 PMCID: PMC4762116 DOI: 10.1136/bmjopen-2015-009196] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Peripheral intravenous cannula (PIVC) insertion is one of the most common clinical interventions performed in emergency care worldwide. However, factors associated with successful PIVC placement and maintenance are not well understood. This study seeks to determine the predictors of first time PIVC insertion success in emergency department (ED) and identify the rationale for removal of the ED inserted PIVC in patients admitted to the hospital ward. Reducing failed insertion attempts and improving peripheral intravenous cannulation practice could lead to better staff and patient experiences, as well as improving hospital efficiency. METHODS AND ANALYSIS We propose an observational cohort study of PIVC insertions in a patient population presenting to ED, with follow-up observation of the PIVC in subsequent admissions to the hospital ward. We will collect specific PIVC observational data such as; clinician factors, patient factors, device information and clinical practice variables. Trained researchers will gather ED PIVC insertion data to identify predictors of insertion success. In those admitted from the ED, we will determine the dwell time of the ED-inserted PIVC. Multivariate regression analyses will be used to identify factors associated with insertions success and PIVC failure and standard statistical validation techniques will be used to create and assess the effectiveness of a clinical predication rule. ETHICS AND DISSEMINATION The findings of our study will provide new evidence to improve insertion success rates in the ED setting and identify strategies to reduce premature device failure for patients admitted to hospital wards. Results will unravel a complexity of factors that contribute to unsuccessful PIVC attempts such as patient and clinician factors along with the products, technologies and infusates used. TRIAL REGISTRATION NUMBER ACTRN12615000588594; Pre-results.
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Affiliation(s)
- Peter J Carr
- Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - James C R Rippey
- Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia
- Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, Perth, Western Australia, Australia
| | - Marie L Cooke
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Chrianna Bharat
- Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Niall S Higgins
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Aileen Foale
- Medical Student, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A. Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.62008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Di Nisio M, Peinemann F, Porreca E, Rutjes AWS. Treatment for superficial infusion thrombophlebitis of the upper extremity. Cochrane Database Syst Rev 2015; 2015:CD011015. [PMID: 26588711 PMCID: PMC6885032 DOI: 10.1002/14651858.cd011015.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although superficial thrombophlebitis of the upper extremity represents a frequent complication of intravenous catheters inserted into the peripheral veins of the forearm or hand, no consensus exists on the optimal management of this condition in clinical practice. OBJECTIVES To summarise the evidence from randomised clinical trials (RCTs) concerning the efficacy and safety of (topical, oral or parenteral) medical therapy of superficial thrombophlebitis of the upper extremity. SEARCH METHODS The Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (2015, Issue 3). Clinical trials registries were searched up to April 2015. SELECTION CRITERIA RCTs comparing any (topical, oral or parenteral) medical treatment to no intervention or placebo, or comparing two different medical interventions (e.g. a different variant scheme or regimen of the same intervention or a different pharmacological type of treatment). DATA COLLECTION AND ANALYSIS We extracted data on methodological quality, patient characteristics, interventions and outcomes, including improvement of signs and symptoms as the primary effectiveness outcome, and number of participants experiencing side effects of the study treatments as the primary safety outcome. MAIN RESULTS We identified 13 studies (917 participants). The evaluated treatment modalities consisted of a topical treatment (11 studies), an oral treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used a placebo or no intervention control group, whereas all others also or solely compared active treatment groups. No study evaluated the effects of ice or the application of cold or hot bandages. Overall, the risk of bias in individual trials was moderate to high, although poor reporting hampered a full appreciation of the risk in most studies. The overall quality of the evidence for each of the outcomes varied from low to moderate mainly due to risk of bias and imprecision, with only single trials contributing to most comparisons. Data on primary outcomes improvement of signs and symptoms and side effects attributed to the study treatment could not be statistically pooled because of the between-study differences in comparisons, outcomes and type of instruments to measure outcomes.An array of topical treatments, such as heparinoid or diclofenac gels, improved pain compared to placebo or no intervention. Compared to placebo, oral non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity. Safety issues were reported sparsely and were not available for some interventions, such as notoginseny creams, parenteral low-molecular-weight heparin or defibrotide. Although several trials reported on adverse events with topical heparinoid creams, Essaven gel or phlebolan versus control, the trials were underpowered to adequately measure any differences between treatment modalities. Where reported, adverse events with topical treatments consisted mainly of local allergic reactions. Only one study of 15 participants assessed thrombus extension and symptomatic venous thromboembolism with either oral non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it reported no cases of either. No study reported on the development of suppurative phlebitis, catheter-related bloodstream infections or quality of life. AUTHORS' CONCLUSIONS The evidence about the treatment of acute infusion superficial thrombophlebitis is limited and of low quality. Data appear too preliminary to assess the effectiveness and safety of topical treatments, systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Frank Peinemann
- University of CologneChildren's HospitalKerpener Str. 62CologneGermany50937
| | - Ettore Porreca
- "University G. D'Annunzio" FoundationDepartment of Medicine and Aging; Centre for Aging Sciences (Ce.S.I.), Internal Medicine Unit31 Via dei VestiniChietiItaly66100
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Weiss D, Gefen A, Einav S. Modelling catheter-vein biomechanical interactions during an intravenous procedure. Comput Methods Biomech Biomed Engin 2015; 19:330-339. [PMID: 25853223 DOI: 10.1080/10255842.2015.1024667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A reliable intravenous (IV) access into the upper extremity veins requires the insertion of a temporary short peripheral catheter (SPC). This so common procedure is, however, associated with a risk of developing short peripheral catheter thrombophlebitis (SPCT) which causes distress and potentially prolongs patient hospitalization. We have developed and studied a biomechanical SPC-vein computational model during an IV procedure, and explored the biomechanical effects of repeated IV episodes on onset and reoccurrences of SPCT. The model was used to determine the effects of different insertion techniques as well as inter-patient biological variability on the catheter-vein wall contact pressures and wall deformations. We found that the maximal pressure exerted upon the vein wall was inhomogeneously distributed, and that the bending region was exposed to significantly greater pressures and deformations. The maximal exerted contact pressure on the inner vein's wall was 2938 Pa. The maximal extent of the SPC penetration into the vein wall reached 3.6 μm, which corresponds to approximately 100% of the average height of the inner layer, suggesting local squashing of endothelial cells at the contact site. The modelling describes a potential biomechanical damage pathway that can explain the reoccurrence of SPCT.
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Affiliation(s)
- Dar Weiss
- a Department of Biomedical Engineering , Faculty of Engineering, Tel Aviv University , Tel Aviv 69978 , Israel
| | - Amit Gefen
- a Department of Biomedical Engineering , Faculty of Engineering, Tel Aviv University , Tel Aviv 69978 , Israel
| | - Shmuel Einav
- a Department of Biomedical Engineering , Faculty of Engineering, Tel Aviv University , Tel Aviv 69978 , Israel.,b Stony Brook University , Stony Brook , NY , USA
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Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini D, Capasso L, Di Baldassarre A, Eltaji Elfarouki G. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi-centre prospective study. J Adv Nurs 2014; 70:2539-49. [PMID: 24684163 DOI: 10.1111/jan.12403] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 09/18/2024]
Abstract
AIMS This multi-centre prospective field study evaluated whether peripheral venous catheter site of insertion influences the risk of catheter-related phlebitis. Potential predictors of phlebitis were also investigated. BACKGROUND Millions of patients worldwide use peripheral venous catheters, which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration and the appropriate time for catheter removal. DESIGN A prospective cohort design was carried out from January-June 2012. METHODS The clinical course of each patient who received a new peripheral venous catheter for any cause in five Italian hospitals was followed by trained nurses until catheter removal. The presence of phlebitis was assessed every 24 hours using the Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression. RESULTS The final sample consisted of 1498 patients. The average time for catheters in situ was 65·6 hours and 23·6% of the catheters were in place beyond 96 hours. Overall phlebitis incidence was 15·4%, 94·4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96 hours. Compared with patients with catheter placed in the dorsum of the hand (22·8% of the sample), those with the catheter located in the antecubital fossa (34·1%) or forearm were less likely to have a phlebitis of any grade. CONCLUSIONS Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support Centers for Disease Control and Prevention recommendations to replace catheters in adults no later than 96 hours. A relevant proportion of healthcare personnel did not adhere to such guidelines - more attention to this issue is required.
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Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy; ASL, 02 Abruzzo, Italy
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Laudenbach N, Braun CA, Klaverkamp L, Hedman-Dennis S. Peripheral i.v. stabilization and the rate of complications in children: an exploratory study. J Pediatr Nurs 2014; 29:348-53. [PMID: 24613130 DOI: 10.1016/j.pedn.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Abstract
Peripheral intravascular catheter insertion is the most common invasive procedure performed on the hospitalized child with a significant potential for complications. This study compared complication rates between a standard aseptic taping technique and a commercially-available adhesive anchoring device in 80 hospitalized children ages 2-17 years. Eighteen (18) participants (22.5%) experienced a complication with occlusion being the most common (n=8) followed by infiltration (n=4), leaking (n=3), and dislodgement (n=2). There were no differences in complication rates or types between the two groups. This study provides evidence that a stabilization device may not be necessary in short-duration PIVs in children.
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Affiliation(s)
| | - Carie A Braun
- Department of Nursing, College of St. Benedict/St. John's University, St. Joseph, MN.
| | | | - Sigrid Hedman-Dennis
- Department of Nursing, College of St. Benedict/St. John's University, St. Joseph, MN
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Di Nisio M, Peinemann F, Porreca E, Rutjes AWS. Treatment for superficial infusion thrombophlebitis of the upper extremity. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Verification of intravenous catheter placement by auscultation--a simple, noninvasive technique. J Vasc Access 2014; 15:189-92. [PMID: 24474520 DOI: 10.5301/jva.5000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Verification of proper placement of an intravenous catheter may not always be simple. We evaluated the auscultation technique for this purpose. METHODS Twenty healthy volunteers were randomized for 18G catheter inserted intravenously either in the right (12) or left arm (8), and subcutaneously in the opposite arm. A standard stethoscope was placed over an area approximately 3 cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a 0-6 scale the murmur heard by rapidly injecting 2 mL of NaCl 0.9% solution. The auscultation was evaluated by a blinded staff anesthesiologist. RESULTS All 20 intravenous injection were evaluated as flow murmurs, and were graded an average 5.65 (±0.98), whereas all 20 subcutaneous injections were evaluated as either crackles or no sound, and were graded an average 2.00 (±1.38), without negative results. Sensitivity was calculated as 95%. Specificity and Kappa could not be calculated due to an empty false-positive group. CONCLUSIONS Being simple, handy and noninvasive, we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position. Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting.
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Fakih MG, Jones K, Rey JE, Takla R, Szpunar S, Brown K, Boelstler A, Saravolatz L. Peripheral venous catheter care in the emergency department: education and feedback lead to marked improvements. Am J Infect Control 2013; 41:531-6. [PMID: 23219672 DOI: 10.1016/j.ajic.2012.07.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/11/2012] [Accepted: 07/11/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral venous catheters (PVCs) can be associated with serious complications. We evaluated the effect of education and feedback on processes related to PVC placement. METHODS We implemented an educational intervention in a 72-bed Emergency Department (ED) over 12 months (4 periods, each a quarter). During preimplementation period, we evaluated PVC placement, condition, accurate documentation, and demonstration of aseptic steps for medication infusion. With implementation, ED nurses had formal education, with direct observations and feedback. For postimplementation periods 1 and 2, we continued direct observations and feedback, reducing the number of audits per week. RESULTS Of 2,568 PVCs evaluated in the ED, accurate documentation on dressing improved from 83 of 803 (10.3%) preimplementation to 300 of 476 (63%) at the end of the study (P < .0001). Correct documentation in ED records improved from 498 of 803 (62%) preimplementation to 409 of 476 (85.9%) at the end of study (P < .0001). We observed 273 attempts to place PVC; of them, 220 (80.6%) were completed. The overall compliance with the procedure steps was very poor preimplementation (n = 3/63, 4.8%) and improved in implementation (n = 17/55, 30.9%) and postimplementation periods 1 (n = 19/60, 31.7%) and 2 (n = 14/42, 33.3%, P < .0001). ED health care workers showed significant improvement in knowledge with education. CONCLUSION Education and real-time feedback to ED health care workers are associated with an increased and sustained compliance with processes to reduce the risk of infection from PVCs.
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Affiliation(s)
- Mohamad G Fakih
- Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, MI, USA.
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Molecular investigation of bacterial communities on the inner and outer surfaces of peripheral venous catheters. Eur J Clin Microbiol Infect Dis 2013; 32:1083-90. [DOI: 10.1007/s10096-013-1854-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/27/2013] [Indexed: 01/17/2023]
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Palese A, Cescon F. Effectiveness of 10% povidone-iodine drying time before peripheral intravascular catheter insertion: preliminary results from an explorative quasi-experimental study. Rev Lat Am Enfermagem 2013; 21 Spec No:47-51. [PMID: 23459890 DOI: 10.1590/s0104-11692013000700007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/01/2012] [Indexed: 11/21/2022] Open
Abstract
AIM to investigate the effectiveness of 10% povidone-iodine after a 30-second or 2-minute drying time on microbial count reduction at the point of a Peripheral Intravascular Catheter (PIC) insertion. A quasi-experimental design was adopted. In total, 53 patients were enrolled, 25 were exposed to a 2-m drying time and 28 to a 30-s drying time. From the preliminary results of this study, no differences in the occurrence of contamination have emerged between patients receiving 30-s and 2-m drying time for 10% povidone-iodine solutions.
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Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District, Westmead, NSW 2145, Australia.
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Rickard CM, Webster J, Wallis MC, Marsh N, McGrail MR, French V, Foster L, Gallagher P, Gowardman JR, Zhang L, McClymont A, Whitby M. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet 2012; 380:1066-74. [PMID: 22998716 DOI: 10.1016/s0140-6736(12)61082-4] [Citation(s) in RCA: 271] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement. METHODS This multicentre, randomised, non-blinded equivalence trial recruited adults (≥18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370. FINDINGS All 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI -1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred. INTERPRETATION Peripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Claire M Rickard
- Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, QLD, Australia.
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Retirada sistemática de los catéteres venosos periféricos: ¿salva vidas o incrementa costes? Med Clin (Barc) 2012; 139:203-5. [DOI: 10.1016/j.medcli.2012.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/23/2022]
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