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Mimoz O, Debonne A, Glanard A, Keita Perse O, Lucet JC. Best practice in the use of peripheral venous catheters: A consensus from French experts. Infect Dis Now 2024; 54:104923. [PMID: 38759732 DOI: 10.1016/j.idnow.2024.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical devices in healthcare. While they are often perceived as innocuous because they are common, this perception does not match their risk factors. In France, 16% of intravenous device-associated bacteremia are due to PIVCs. This consensus document reports the French experience in PIVC management, issues arising from their complications, and a proposed path toward improved PIVC care. METHODS A panel of five French experts discussed this topic based on evidence and personal experience. A consensus process was applied to highlight the issues in need of increased awareness and to suggest possible improvements. PIVC topics were organized as General Statements, Indication, Preparation, Insertion, Maintenance, and Removal. An electronic survey was used to record agreement or disagreement; to expand the dataset, five additional French experts also answered the questions. RESULTS Out of 67 statements, 62 reached a consensus (the 80% agreement threshold was exceeded). Experts are increasingly aware that PIVCs are a significant source of complications, including local and bloodstream infections. Practices need to progress to improve patient outcomes, which will require better education for all personnel involved with the insertion and maintenance of PIVCs. CONCLUSIONS Current practice around PIVCs does not always comply with the recommendations issued. A new surveillance network targeting catheter-related healthcare-associated infections is now in place in France. Simplified, standardized, bundled solutions are needed to reduce avoidable harm from PIVCs. Healthcare practice has changed over time and new educational tools are needed to adapt to increased workload and time constraints.
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Affiliation(s)
- Olivier Mimoz
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
| | - Anne Debonne
- Centre Hospitalier d'Argenteuil, Argenteuil, France.
| | | | | | - Jean-Christophe Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, F-75018 Paris, France; Université Paris Cité, Inserm, IAME, F-75018 Paris, France.
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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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Li HM, Wan LL, Jin CX, Zhang GY, Yang H, Zhang XY. Risk factors of peripheral venous catheter-related complication and infection in children with bronchopneumonia. BMC Infect Dis 2023; 23:603. [PMID: 37715150 PMCID: PMC10503115 DOI: 10.1186/s12879-023-08540-1] [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: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To investigate the risk factors associated with the peripheral venous catheter-related complication and infection in children with bronchopneumonia. METHODS A total of 185 patients were divided into case group (n = 114) and control group (n = 71) according to the presence of catheter-related infection and complications related to indwelling needle. We performed a multivariate logistic regression analysis to explore the risk factors associated with the infection. RESULTS Age was divided into 4 categories (0 < age ≤ 1, 1 < age ≤ 3, 3 < age ≤ 6, age > 6). The case group had a higher percentage of patients with 0 < age ≤ 1 than the control group (21% vs. 9.7%) and the age distribution was significant different between the two groups (P = 0.045). The case group had a longer retention time than the control group (≥ 3 days: 56% vs. 35%, P < 0.001). The results of binary logistics regression analysis revealed that the indwelling time and indwelling site were the factors that influenced the complications or bacterial infection. Among the three indwelling sites, the hand is more prone to infection and indwelling needle-related complications than the head (OR: 2.541, 95% CI 1.032 to 6.254, P = 0.042). The longer the indwelling time, the more likely the infection and indwelling needle related complications (OR: 2.646, 95% CI 1.759 to 3.979, P< 0.001). CONCLUSION Indwelling time and indwelling site are the influencing factors of complications or bacterial infection, which should be paid more attention to prevent the catheter-related infection in children with bronchophenumonia.
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Affiliation(s)
- Hong-Mei Li
- Department of General Services, Nanjing Hospital of Integrated Traditional Chinese and Western Medicine, No. 179 of Xiaolingwei Street, Xuanwu District, Nanjing, 210014, China
| | - Li-Li Wan
- Department of Paediatrics, Nanjing Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, 210014, China
| | - Cai-Xiang Jin
- Department of General Services, Nanjing Hospital of Integrated Traditional Chinese and Western Medicine, No. 179 of Xiaolingwei Street, Xuanwu District, Nanjing, 210014, China.
| | - Guo-Ying Zhang
- Department of Infection Management, Nanjing Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, 210014, China
| | - Hui Yang
- Department of Clinical laboratory, Nanjing University of Traditional Chinese Medicine, Nanjing, 210014, China
| | - Xiao-Yu Zhang
- Department of Paediatrics, Nanjing University of Traditional Chinese Medicine, Nanjing, 210014, China
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Zingg W, Barton A, Bitmead J, Eggimann P, Pujol M, Simon A, Tatzel J. Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. Infect Prev Pract 2023; 5:100271. [PMID: 36910422 PMCID: PMC9995289 DOI: 10.1016/j.infpip.2023.100271] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device in health care with an overall failure rate of 35-50%. Most complications are non-infectious, but local site and bloodstream infections can also occur. Even if PIVC-related infections are rare, the total number of affected patients and the preponderance of Staphylococcus aureus as related pathogen due to the frequent use of these devices are relevant arguments to implement preventive strategies. The aim of this document is to raise awareness that infections caused by PIVCs are a relevant problem that can be reduced by practice change. Methods A panel of experts discussed this topic based on evidence and proposed practice points by consensus. Discussion Despite published evidence-based guidelines, current practice concerning aseptic techniques during insertion and care of PIVCs often are substandard. These devices have become commonplace and tend to be perceived as safe. An overall lack of awareness about the true risks associated with the use of PIVCs results in limited surveillance and prevention efforts. Conclusion Successful insertion and maintenance bundles in central venous lines are a blueprint to the implementation of adapted bundle strategies in the prevention of PIVC-associated infections. There is a need for studies to specifically investigate infection prevention in PIVCs and to agree on effective and implementable bundles.
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Affiliation(s)
- Walter Zingg
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrew Barton
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - James Bitmead
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Miquel Pujol
- University Hospital de Bellvitge, Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Arne Simon
- Saarland University Clinic, Homburg, Germany
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Ray-Barruel G, Alexander M. CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. Am J Nurs 2023; 123:32-37. [PMID: 37718967 DOI: 10.1097/01.naj.0000905568.37179.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.
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Affiliation(s)
- Gillian Ray-Barruel
- Gillian Ray-Barruel is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health. Mary Alexander is chief executive officer of the Infusion Nurses Society in Norwood, MA. Contact author: Gillian Ray-Barruel, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Prat M, Guenezan J, Drugeon B, Burucoa C, Mimoz O, Pichon M. Impact of Skin Disinfection on Cutaneous Microbiota, before and after Peripheral Venous Catheter Insertion. Antibiotics (Basel) 2022; 11:antibiotics11091209. [PMID: 36139988 PMCID: PMC9495181 DOI: 10.3390/antibiotics11091209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. Patients with invasive medical devices are at high risk for infection. Skin colonization is the initial stage of these infections, leading to the recommendation of practices requiring disinfection using antiseptics. Microbial communities playing a major role in skin health could be impacted by antiseptic procedures. Aim. To characterize and compare the bacterial communities of skin samples from patients before an antisepsis procedure, and after removal of the medical device itself, according to the nature of the antiseptic molecule (povidone iodine or chlorhexidine). Methods. The study focused on alterations in bacterial communities depending on the nature of the antiseptic procedure and type of intravascular device. After amplification of 16S rDNA, libraries (n = 498 samples) were sequenced using MiSeq platform. Results. Using an in-house pipeline (QIIME2 modules), while no alteration in skin microbiota diversity was associated with antiseptic procedure or PVC type, according to culture results (p < 0.05), alterations were at times associated with restricted diversity and higher dissimilarity (p < 0.05). Antiseptic procedures and PVC types were associated with the modification of specific bacterial representations with modulation of the Bacillota/Bacteroidota (Firmicutes/Bacteroidetes) ratio (modulation of C. acnes, Prevotella, Lagierella, and Actinomyces spp.) (p < 0.05). At baseline, the microbiota shows certain bacteria that are significantly associated with future PVC colonization and/or bacteremia (p < 0.05). All of these modulations were associated with altered expression of metabolic pathways (p < 0.05). Discussion. Finally, this work highlights the need to optimize the management of patients requiring intravascular devices, possibly by modulating the skin microbiota.
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Affiliation(s)
- Manon Prat
- CHU Poitiers, Bacteriology Laboratory, Infectious Agents Department, 86021 Poitiers, France
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Jeremy Guenezan
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
| | - Bertrand Drugeon
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Christophe Burucoa
- CHU Poitiers, Bacteriology Laboratory, Infectious Agents Department, 86021 Poitiers, France
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Olivier Mimoz
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
| | - Maxime Pichon
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-(0)5-4944-4143
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Patel A, Spychalski P, Kobiela J. For and Against Routine Removal of Peripheral Intravenous Catheters. JAMA Intern Med 2022; 182:457. [PMID: 35156994 DOI: 10.1001/jamainternmed.2021.8307] [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)
- Agastya Patel
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Spychalski
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarek Kobiela
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
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Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z, Zhang F, Lyu Y, Lin F. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. J Clin Nurs 2021; 31:2959-2970. [PMID: 34779070 DOI: 10.1111/jocn.16129] [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] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. BACKGROUND Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. DESIGN A multisite randomised controlled trial. METHODS The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. RESULTS The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients' first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. CONCLUSIONS In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. RELEVANCE TO CLINICAL PRACTICE In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.
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Affiliation(s)
- Jing Li
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Peking University School of Nursing, Beijing, China
| | - Peiying Zhang
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, China.,Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | | | - Yang Lyu
- Beijing Chao-Yang Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia.,School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
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