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Rickard CM, Larsen E, Walker RM, Mihala G, Byrnes J, Saiyed M, Cooke M, Finucane J, Carr PJ, Marsh N. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med 2023; 18:21-32. [PMID: 36372995 PMCID: PMC10099685 DOI: 10.1002/jhm.12995] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Emily Larsen
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Rachel M Walker
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Masnoon Saiyed
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro South Hospitals and Health Service, Queen Elizabeth II Hospital, Nathan, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Santos-Costa P, Paiva-Santos F, Sousa LB, Bernardes RA, Ventura F, Salgueiro-Oliveira A, Parreira P, Vieira M, Graveto J. Evidence-Informed Development of a Bundle for Peripheral Intravenous Catheterization in Portugal: A Delphi Consensus Study. NURSING REPORTS 2022; 12:498-509. [PMID: 35894037 PMCID: PMC9326523 DOI: 10.3390/nursrep12030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/25/2022] Open
Abstract
Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses' clinical decision-making in this scope. METHODS Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward's nurses. RESULTS After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter's functionality and performance at each shift. CONCLUSION The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.
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Affiliation(s)
- Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Filipe Paiva-Santos
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Liliana B. Sousa
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Rafael A. Bernardes
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Anabela Salgueiro-Oliveira
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Pedro Parreira
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Margarida Vieira
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João Graveto
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
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Keeping Patients Safer: Reviewing Predictors of Success and Failure of Short Peripheral Intravenous Catheters. JOURNAL OF INFUSION NURSING 2022; 45:210-219. [PMID: 35820126 DOI: 10.1097/nan.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2014, a large urban community hospital adopted protected clinical indication practices as a quality improvement project. It then undertook a research study to examine bedside practices with short peripheral catheters, which included direct observation at the bedside once weekly for 6 months. A total of 4305 catheters were observed and remained in place for a total of 23 423 days. Fifty six percent of devices remained in place beyond 96 hours. The overall rate of peripheral bloodstream infection in patients enrolled in the study was 0.12/1000 peripheral intravenous days. Significant differences were noted based on which department placed the catheter, as well as which department cared for the patient during hospitalization. Patients admitted to step-down critical care units had the highest completion of therapy rates; however, those being cared for in medical/surgical units had the best outcomes. Devices placed in the emergency department had a higher successful dwell rate than those placed in critical care units. Twenty-gauge catheters were found to have the highest successful dwell rate, as well as insertion sites that were observed to be within normal limits during the weekly observation. Dressings that were noted to be clean, dry, and intact had a stronger association with completion of therapy than those that were not fully intact. Emphasis was placed on ensuring consistent practices with insertion, care, and maintenance, which contributed to more consistent outcomes between settings that insert, care for, and maintain devices. Nonmodifiable risk factors may remain.
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Rickard CM, Paterson DL, Chopra V. For and Against Routine Removal of Peripheral Intravenous Catheters. JAMA Intern Med 2022; 182:456-457. [PMID: 35157008 DOI: 10.1001/jamainternmed.2021.8304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Claire M Rickard
- Herston Infectious Diseases Institute, Metro North Health, School of Nursing, Midwifery, and Social Work, University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - David L Paterson
- Herston Infectious Diseases Institute, Metro North Health, School of Nursing, Midwifery, and Social Work, University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
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