Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review

Abstract

Background: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods: In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000eDecember 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results: Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2e7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings

“…15 Although a systematic review was published in 2019 by the Alliance for Vascular Access Teaching and Research (AVATAR) group on PVCR-BSI rates, the studies included did not report PVC days as denominators of PVCR-BSIs rates, and for that reason such data were not comparable with our study. 24 This systematic review by AVATAR included studies in which PVCR-BSI rates were presented as follows 24 : Australia (0.39 PVCR-BSI per 10,000 occupied bed days), 25 Germany (3.04 PVCR-BSI per 1,000 patient days), 26 Spain (1.17 PIVC-BSI per 10,000 patient days 27 and 0.05 PIVC per 1,000 patient days 28 ), and the United States (0.0150 PVCR-BSI per 100 patient days 29 and 0.57 PIVCR-BSI per 1,000 patient days 30 ). In different studies, the risk of acquiring BSI was not as high if PVCs were used instead of central lines.…”

“…37 The implementation of PVC insertion and maintenance bundles to decrease PVCR-BSI rates is common in industrialized countries. 24,27 To reduce the hospitalized patient's risk of infection, PVCR-BSI surveillance by number of device days is essential because it effectively characterizes the threatening situation created by PVCR-BSIs. This method must be followed by the implementation of multifaceted and surveillance programs aimed at PVCR-BSI prevention and control.…”

The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation

“…Improved assessment could prompt removal of idle catheters and early detection of complications 6. To date, efforts to improve PIVC outcomes using phlebitis tools, care plans, maintenance bundles, electronic records and journey boards have achieved varied results 7 8. Supporting evidence for phlebitis tools is not robust, as they fail to consider complications such as dislodgement, occlusion or infiltration, and do not prompt assessment of device need, function, dressing integrity, securement and infection prevention strategies 7 9.…”

Avaliação da incidência de potenciais eventos adversos em Unidade de Terapia Intensiva de hospital geral: relevância para a Sistematização da Assistência de Enfermagem

“…Em continuidade ao tema, encontrou-se estudo que relaciona o tempo médio de permanência em CTI com a ocorrência de EA, onde foi identificado um aumento do tempo médio de permanência em 19 dias, dado este inferior ao resultado de Forster et al (2008) (superior a 31 dias na internação hospitalar) e superior ao do estudo de Martins et al (2018) ao analisarem os fatores associados aos EA relacionados à medicação, não encontraram uma relação estatisticamente significante entre os EA com medicações com as variáveis idade e sexo (gênero) do paciente em nenhuma das duas formas de coletas dos dados. Quitério et al (2016), ao analisarem uma UTI de um hospital público, encontraram uma média de idade de 52,7 anos, com predominância de pacientes do sexo masculino (51%) e tempo médio de internação na terapia intensiva de dez dias.…”

“…Ahmed et al (2015) (2,4 dias de permanência na terapia intensiva) (ROQUE; TONINI; MELO, 2016).A fim de ilustrar,Forster et al (2008), em estudo prospectivo realizado em UTI, apontam que o percentual de mortalidade e tempo médio de permanência, 25% e 15 dias, respectivamente, são potencializados pelos EA, aumentando, em média, seis dias de permanência e o risco absoluto de morte (SILVA, 2013).Um dos danos evitáveis mais presentes nas organizações de saúde são as infecções relacionadas à assistência à saúde, que representam a maior ameaça à segurança do paciente. Nesse sentido, Sinésio et al(2018) apontaram que um dos fatores relacionados que contribuem para a presença da infecção relacionada à assistência à saúde é a idade.…”