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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:ciae195. [PMID: 38593192 DOI: 10.1093/cid/ciae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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 January 1, 1980-March 16, 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with three 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 eight research questions.Based on findings of low to high COE, wearing gloves reduced the risk for overall adverse events related to insertion compared to no gloves (one non-randomised controlled trial [RCT]; adjusted risk ratio [RR]: 0.52, 95% confidence interval 0.33-0.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR: 0.74, 95% credible interval 0.49-1.01) compared to clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared to non-chlorhexidine-containing disinfection (one RCT; 0.14 versus 0.68, p = 0.003). 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.
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Affiliation(s)
- Andreea Dobrescu
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila," Dionisie Lupu 37, 030167 Bucharest, Romania
| | - Larisa Pinte
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila," Dionisie Lupu 37, 030167 Bucharest, Romania
| | - Andrea Chapman
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Rokietnicka 7, 60806, Poznan, Poland
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Robert Emprechtinger
- Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit, Department of Integrated Health Services, WHO, Avenue Appia, 1211 Geneva 27, 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, WHO, Avenue Appia, 1211 Geneva 27, 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, WHO, Avenue Appia, 1211 Geneva 27, Switzerland
- High Impact Epidemics, WHO Health Emergencies Programme, WHO, Avenue Appia, 1211 Geneva 27, Switzerland
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Center for Public Health Methods, RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194. USA
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
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Zhou M, Dong S, Zhang J, Liu Y, Zhang L, Xu J, Yang Y, He Y, Wu K, Yuan Y, Lin W, Bian W, Li J, Chen C, Xue Y, Tao T, Kang Y, Sun L, Yuan L, Xu C. Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial. Int J Nurs Stud 2024; 151:104676. [PMID: 38241817 DOI: 10.1016/j.ijnurstu.2023.104676] [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: 08/02/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. OBJECTIVE To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DESIGN This was a prospective, randomized, controlled, open-label trial. SETTING Patients were recruited from 14 medical institutions in China between February and June 2023. PARTICIPANTS In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. METHODS Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. RESULTS After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). CONCLUSION The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.
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Affiliation(s)
- Mian Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shan Dong
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuping Liu
- The Affiliated Hospital of Xuzhou Medical University, China
| | - Liuliu Zhang
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, China
| | - Junxia Xu
- The First Affiliated Hospital of USTC, China
| | - Ying Yang
- Huai'an First People's Hospital, China
| | - Yulan He
- Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), China
| | | | - Yuan Yuan
- Affiliated Hospital of Yangzhou University, China
| | - Wenqin Lin
- Yizheng Hospital of Nanjing Drum Tower Hospital Group, China
| | - Wenxia Bian
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, China
| | - Juan Li
- Huai'an Second People's Hospital, China
| | - Chunli Chen
- The Second People's Hospital of Hefei, China
| | - Youhua Xue
- Department of Interventional and Vascular Surgery, Zhongda Hospital affiliated to Southeast University, China
| | - Tingting Tao
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yubiao Kang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China
| | - Lulu Sun
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ling Yuan
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China..
| | - Cuirong Xu
- Department of Nursing, Zhongda Hospital Southeast University, Nanjing, China.
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Indarwati F, Munday J, Keogh S. Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study. J Pediatr Nurs 2023; 73:106-112. [PMID: 37659338 DOI: 10.1016/j.pedn.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE This study aimed to assess peripheral intravenous catheter use, maintenance practices, and outcomes of paediatric patients in a developing country setting. DESIGN AND METHODS A point prevalence survey using validated checklist was conducted between March and April 2022 in ten hospitals in Indonesia. A total number of 478 participants were approached during the audit. Data were obtained from site observation and medical records. RESULTS Of the 386 patients surveyed, >90% (362) had one catheter in-situ. The catheters were mostly inserted by nurses (331, 86%), primarily in the dorsum of the hand (207, 54%) with the purpose of delivering intravenous infusions and medications (367, 95%). Simple transparent dressings (176, 46%) with splint and bandage (295, 76%) were predominantly used for securement methods. Insertion sites were not visible for 182 (47%) patients, and 151 (40%) of daily care practices were poorly documented. Complications were documented in the medical record for 166 (43%) catheters. Adjusted analysis indicated that patient diagnosis, ward, catheter size, location, dressings, infusate, and flushing administration were significantly associated with complications. CONCLUSIONS Findings indicate that issues related to paediatric intravenous catheter complications in Indonesia are comparable to developed country settings. Ongoing surveillance is important to evaluate the management practices to benchmark against guidelines, optimise patient safety, and improve outcomes. PRACTICE IMPLICATIONS Results demonstrate low and middle-income countries face similar challenges with catheter insertion and care. The study indicates the importance of applying vascular access needs assessments, providing training for inserters, identifying optimum dressing methods, and optimising documentation.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
| | - Judy Munday
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Nursing Sciences, University of Agder, Grimstad, Norway.
| | - Samantha Keogh
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
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