Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms

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.

Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines

“…These results provide insight into the various mechanisms that lead to PIVC failure, reflecting a poor adherence to recommendations with associated iatrogenic harms to patients [35]. PIVC failure triggers the need for a new PIVC insertion with its potential adverse events, increasing the risk of CRBSIs [4], as well as imposing a significant demand on healthcare resources [36,37]. We observed suboptimal performance between different hospital environments and types regarding the clinical outcomes from CPG recommendations for care of PIVC.…”

“…In our study, we observed that approximately 45% of PIVC insertion sites were not visible, a disappointing scenario considering the impact that inspection of the PIVC insertion site per shift would have to prevent and mitigate adverse events [ 31 ]. Removal of the PIVC should occur if phlebitis, inflammation or obstruction are present, or intravenous therapy has completed in the previous 24 hours, or the PIVC is no longer needed [ 4 , 23 , 34 ]. However, 9% of total PIVCs were unnecessarily maintained, with no differences between these outcomes and the hospital environment.…”

“…It is estimated that physicians and nurses insert more than 330 million PIVCs annually in the United States [1,3]. However, up to 42% of these catheters are prematurely removed during intravenous therapy due to PIVC failure [4], which is defined as the unplanned removal of the device due to mechanical complications (i.e., phlebitis, occlusion, infiltration) or infection before the completion of scheduled intravenous therapy [5,6]. These complications are concerning in their own right, as catheter-related bloodstream infections (CRBSIs) are one of the most severe adverse events [7,8], which can prolong hospital stay, resulting in attributable mortality rates of up to 25% [9,10], and leading to unnecessary costs of approximately $45,000 per infection [5,7].…”

Care of Peripheral Intravenous Catheters in Three Hospitals in Spain: Mapping Clinical Outcomes and Implementation of Clinical Practice Guidelines

“…PIVC failure triggers the need for a new PIVC insertion with its potential adverse events, increasing the risk of CRBSIs [4], as well as imposing a significant demand on healthcare resources [36,37]. We observed suboptimal performance between different hospital environments and types regarding the clinical outcomes from CPG recommendations for care of PIVC.…”

Reducing Risks and Improving Vascular Access Outcomes

“… 13 Current SPC practice has seen a shift from routine replacement every 72 hours to replacement when clinically indicated. 14 The reported incidence rate of complications in patients undergoing catheter insertion is up to 42%. 15 The most common complications include phlebitis, occlusion, infiltration and extravasation, and catheter-related bloodstream infection (CR-BSI).…”