Safety of peripheral intravenous catheters in children.

Care of Peripheral Venous Catheter Sites: Advantages of Transparent Film Dressings Over Tape and Gauze

US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. This is an update of a review first published in 2010. To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re-siting the catheter routinely. For this update the Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Vascular Specialised Register (March 2015) and CENTRAL (2015, Issue 3). We also searched clinical trials registries (April 2015). Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions. Two review authors independently assessed trial quality and extracted data. Seven trials with a total of 4895 patients were included in the review. The quality of the evidence was high for most outcomes but was downgraded to moderate for the outcome catheter-related bloodstream infection (CRBSI). The downgrade was due to wide confidence intervals, which created a high level of uncertainty around the effect estimate. CRBSI was assessed in five trials (4806 patients). There was no significant between group difference in the CRBSI rate (clinically-indicated 1/2365; routine change 2/2441). The risk ratio (RR) was 0.61 (95% CI 0.08 to 4.68; P = 0.64). No difference in phlebitis rates was found whether catheters were changed according to clinical indications or routinely (clinically-indicated 186/2365; 3-day change 166/2441; RR 1.14, 95% CI 0.93 to 1.39). This result was unaffected by whether infusion through the catheter was continuous or intermittent. We also analysed the data by number of device days and again no differences between groups were observed (RR 1.03, 95% CI 0.84 to 1.27; P = 0.75). One trial assessed all-cause bloodstream infection. There was no difference in this outcome between the two groups (clinically-indicated 4/1593 (0.02%); routine change 9/1690 (0.05%); P = 0.21). Cannulation costs were lower by approximately AUD 7.00 in the clinically-indicated group (mean difference (MD) -6.96, 95% CI -9.05 to -4.86; P ≤ 0.00001). The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present.

Protecting the Vessels- Options for the Cystic Fibrosis Patient

Peripheral Vascular Catheter Research: A Scoping Review

Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit

Aim: Existing literature reports that incorrect and repeated interventions during peripheral intravenous catheterization (PIVC) can cause complications such as pain, phlebitis, and hematoma. This study was conducted to systematically examine the current evidence for the prevention of such complications encountered during PIVC procedures. Method: In this study, we evaluated the most recent data found in relevant research papers retrieved from the databases Medline, Scopus, Cochrane, and CINAHL. This study includes manuscripts that (1) focused on the prevention of complications during PIVC procedures based on randomized clinical trials; (2) were published in the English language within the last 10 years; and (2) had accessible full text. Thirteen papers conforming to these inclusion criteria were evaluated. The keywords used for scanning the databases were “peripheral venous catheters,” “pain,” “phlebitis,” “ecchymosis,” “hematoma,” “peripheral venous catheters guideline,” and “nursing care.” Results: An evaluation of these studies shows that the administration of local anesthetic sprays, creams, saline solutions, and lidocaine is effective in pain relief (n=5). Further investigation focused on prolonging the placement of the PIVC and decreasing the symptoms and findings related to pain, phlebitis, and hematoma; the investigation also revealed that these were experimental randomized controlled studies, which evaluated the catheter material (n=1), catheter type and insertion site (n=2), type of dressing used for the fixation (n = 2), and the length of stay of the PIVC (n=3). These studies emphasized that large veins are preferred because they do not restrict the mobility of the patient when using vialon catheters. They recommend that catheters always be selected on the basis of their suitability for the patient and the treatment (Size: 18G–22G). Catheters with transparent dressings should be examined for the signs and symptoms of phlebitis. Furthermore, it was stated that catheters might stay in place for 96 hours if no complications are encountered during the examinations performed every eight hours after the PIVC procedure. Routine catheter replacement is not recommended due to repetitive exposure to pain, increased cost, and larger workload for the caregiver staff. Conclusion: To sum up, our study presents evidence to determine the current best approach toward the prevention of complications during PIVC procedures, and that our findings will guide nurses in the implementation of positive results

The purpose of this study was to investigate the safety of clinically indicated peripheral intravenous catheters (PIVC) replacement intervals. Peripheral intravenous catheters are used internationally, including in China where PIVCs are routinely replaced every 72 to 96hours. Despite some recent international evidence showing such routine replacement is unnecessary, developing countries such as China have no supporting data. This cluster-randomized trial was conducted between December 2 and December 31, 2013, in 10 internal medicine wards and 10 surgery wards at a tertiary referral teaching hospital in Xiamen, China. Patients were randomly divided into an experimental group (PIVCs were replaced only when clinical indications appeared) and a control group (PIVCs were routinely changed every 72-96hours). Per-protocol analysis and intention-to-treat analysis were used to analyse the data. Primary end point was the incidence of phlebitis. This study analysed the data of 1198 patients (553 patients in the experimental group and 645 patients in the control group). There were no catheter-related bloodstream infections or local infections in the 2 groups. The 2 groups showed no statistically significant differences in the incidence of phlebitis, catheter occlusion, infiltration, and accidental removal. Clinically indicated PIVC replacement is feasible, and it may reduce nursing staff workload and patient discomfort.

346 Ultra Long Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasound-Guided Catheter Survival

Peripheral intravenous catheters (PIVCs) are common devices used across many healthcare settings. This quality improvement project aims to proactively remove PIVCs as soon as possible by empowering nurses and providers to clinically evaluate the necessity of every PIVC on a daily basis on a general hospital medical unit. Specific criteria were established to assess PIVC necessity. Cases of PIVCs not meeting established criteria are escalated to providers for a decision point. The PIVC removal times documented within the electronic medical record were analyzed to compare precriteria PIVC dwell times to postcriteria dwell times. The time between removal of a patient's last PIVC and patient discharge was analyzed to determine if more PIVCs are being removed sooner after becoming clinically unnecessary. Significantly fewer PIVCs (decrease of 14.4%) are being removed on the day of discharge in the postintervention time frame, whereas more PIVCs are being removed one (increase of 5.5%) or two (increase of 4.0%) days before the day of discharge. A strategic project to critically evaluate PIVCs on a daily basis and remove PIVCs not meeting criteria for use was successful in proactively removing PIVCs. Hospitals should evaluate PIVC practice, monitor daily usage, and strategically intervene to remove unneeded PIVCs.

China introduced a “volume-based procurement (VoBP)” policy for medical products to contain healthcare costs and improve patient access to cost-effective products recently. The VoBP of peripheral intravenous catheters (PIVCs) was piloted in Jiangsu, Shandong and Jiangxi provinces in late 2019. The bidding of PIVCs mainly focused on their prices, while the evaluation standard on clinical performance of PIVCs was less emphasized. In this study, we aim to understand the clinical impacts associated with the utilization of different PIVCs influenced by the implementation of VoBP policy in China. Semi-structured interviews were conducted with nurses in Nanjing and Linyi, the pilot cities implementing VoBP. A total of 27 nurses who used a leading multinational corporation’s (MNC’s) PIVCs before VoBP and changed to China local brands’ PIVCs after VoBP were included as informants. In the first 15 interviews, all domains (PIVC placement, complications, product issues, and training) and corresponding concepts listed in conceptual framework were mentioned, indicating that sample size was sufficient. After the change from the MNC’s PIVCs to local brands, PIVCs used per patient increased from 2.0 to 3.5 and the average indwelling time decreased from 3.7 days to 2.1 days. Compared with the MNC’s PIVCs, those from local brands were associated with a 0.9-minute increase in PIVC insertion time and a 9% relative decrease in first stick success rate. Furthermore, increased complication rate, quality issues and hard catheter materials, and reduced product training after PIVC change were also mentioned by nurses. This study discloses that PIVC product change following the implementation of VoBP may result in unexpected issues. Therefore, establishing quality evaluation criteria and strengthening product monitoring mechanism are recommended for VoBP policy optimization on medical consumables.

Objective To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters (PIVCs) in old adults. Methods Total of 1 627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited. Patients were randomly divided into an experimental group (817 cases) and control group (810 cases) by random digits tale method. PIVCs in the experiment were replaced only when clinical indications appeared, while PIVCs in the control group were routinely changed every 72-96 hours. Indwelling time, complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters. Results PIVC indwelling time was (3.43±1.36) days in the experimental group, and (3.18±1.16) days in the control group ,there was significant difference between two groups (t value was 4.07, P 0.05). The severity of phlebitis in the experiment group was higher than that in the control group, and there was significant difference between two groups (χ2 value was 20.99, P<0.05). Nurse compliance achieved in the experimental group 100.00% (817/817) was higher than that in the control group 87.65% (710/810), which showed statistically difference (χ2 value was 107.47, P<0.05). Conclusion Indwelling time in the clinically- indicated replacement group was longer than that of the routine replacement group. Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications. Key words: Aged; Peripheral intravenous catheters; Clinically- indicated replacement

Background Peripheral intravenous catheters (PIVC) are among the most common medical intervention for hospitalized patients. While PIVC can provide life-saving treatments, PIVC are also a major source of complications such as infiltration, occlusion, leaking, pain, dislodgement, and bacteremia, particularly due to Staphylococcus aureus. Both the Infusion Nurses Society (INS) and the Centers for Disease Control and Prevention state that PIVC that are no longer in use should be removed, with INS specifically stating that a catheter that has not used for more than 24 hours should be removed. Despite the guidance to remove PIVC that are unused, prevalence studies demonstrate that approximately 14% of all PIVC have not been used in the prior 24 hours. These “idle PIVC” contribute to avoidable morbidity and mortality. The goal of this study is to assess the opportunity for harm reduction at our institution by evaluating the prevalence of idle PIVC and the incidence of S. aureus bacteremia attributed to PIVC.Figure 1.Peripheral intravenous catheter days in hospitalized patients, 2024 Methods This is a retrospective cohort study at a 500-bed academic safety net hospital in Denver, CO. The study dates are 1/1/24 through 12/31/24. All hospitalized patients were eligible for inclusion. PIVC were considered idle if they had not been used for at least 24 hours. Hospital onset S. aureus bacteremia was defined as those presenting on hospital day 4 or greater, with the day of admission being hospital day 1. A hospital-onset S. aureus bacteremia case was considered secondary to PVC if there was erythema, induration, or purulent drainage at the site of a PIVC that was currently in place or had been removed in the prior 7 days. Results During the study period, there was a mean of 18,071 total PIVC days per month. The proportion of idle PIVC days ranged from 11.3% to 13.2% with a mean of 12.2% (Figure 1). There were 7 cases of hospital onset S. aureus bacteremia (5 MSSA, 2 MRSA) attributed to PIVC during the study period. The rate of PIVC-related S. aureus bacteremia was 0.4 cases per 1000 PIVC days. Conclusion Idle PIVC are prevalent in our institution. There is substantial opportunity to decrease the prevalence of idle PIVC. A reduction in idle PIVC could lead to fewer hospital onset S. aureus bacteremia cases. Disclosures All Authors: No reported disclosures

BackgroundUnused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment.MethodsThis was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.ResultsA total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3).ConclusionOne-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. Observational point prevalence study. Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.

British Journal of NursingVol. 23, No. Sup8 Research and GuidelinesThe One Million Global Catheters PIVC worldwide prevalence studyEvan AlexandrouEvan AlexandrouSearch for more papers by this authorEvan AlexandrouPublished Online:6 May 2014https://doi.org/10.12968/bjon.2014.23.Sup8.S16AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ahlqvist M, Berglund B, Nordstrom G, Klang B, Wirén M, Johansson E (2010) A new reliable tool (PVC assess) for assessment of peripheral venous catheters. J Eval Clin Pract 16(6): 1108–15. doi: https://doi.org/10.1111/j.1365-2753.2009.01278.x Crossref, Medline, Google ScholarKagel EM, Rayan GM (2004) Intravenous catheter complications in the hand and forearm. J Trauma 56(1): 123–7. doi: https://doi.org/10.1097/01.TA.0000058126.72962.74 Crossref, Medline, Google ScholarMaki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81(9): 1159–71. http://bit.ly/R9JTjG Google ScholarWebster J, Clarke S, Paterson Det al. (2008) Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ 337: a339. doi: https://doi.org/http://dx.doi.org/10.1136/bmj.a339 Crossref, Medline, Google ScholarZingg W, Pittet D (2009) Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 34(Suppl 4): S38–42. doi: https://doi.org/10.1016/S0924-8579(09)70565-5 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byThe effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis20 January 2023 | European Journal of Emergency Medicine, Vol. 30, No. 2Ultraschallgesteuerte periphere Venenpunktion bei schlechtem Venenstatus8 February 2023 | Die Anaesthesiologie, Vol. 23The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study30 May 2022 | The Journal of Vascular Access, Vol. 24Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access27 September 2021 | Journal of Patient Safety, Vol. 18, No. 3The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial2 February 2021 | The Journal of Vascular Access, Vol. 23, No. 2Development of a Three-Dimensionally Printed Ultrasound-Guided Peripheral Intravenous Catheter PhantomCureus, Vol. 23The Role of Ultrasound in the Ambulatory Setting9 March 2021Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department19 August 2020 | Journal of the American College of Emergency Physicians Open, Vol. 1, No. 6Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews24 August 2020 | PLOS ONE, Vol. 15, No. 8Nurse-Performed Ultrasound-Guided Technique for Difficult Peripheral Intravenous Access in Critically Ill Patients: A Randomized Controlled Trial3 April 2020 | Journal of the Association for Vascular Access, Vol. 25, No. 2Better With UltrasoundChest, Vol. 157, No. 2Accès veineux central en radiologie interventionnelleLa Presse Médicale, Vol. 48, No. 10Vessel health and preservation: An integrative review14 November 2018 | Journal of Clinical Nursing, Vol. 28, No. 7-8Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care6 October 2016 | Journal of Paediatrics and Child Health, Vol. 53, No. 2Indications for Peripheral, Midline, and Central Catheters: Summary of the Michigan Appropriateness Guide for Intravenous Catheters RecommendationsJournal of the Association for Vascular Access, Vol. 21, No. 3Ultrasonography Versus Landmark for Peripheral Intravenous Cannulation: A Randomized Controlled TrialAnnals of Emergency Medicine, Vol. 68, No. 1Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborativeJournal of Infection Prevention, Vol. 17, No. 2Effectiveness of a training program in compliance with recommendations for venous lines care30 July 2015 | BMC Infectious Diseases, Vol. 15, No. 1 23 April 2014Volume 23Issue Sup8ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 6 May 2014 Published in print 23 April 2014 Information© MA Healthcare LimitedPDF download