Hiding in Plain Sight: Peripheral Intravenous Catheter Infections

2020 ◽  
Vol 40 (5) ◽  
pp. 57-66
Author(s):  
Barb Nickel
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
Current Evidence ◽  
Evidence Based ◽  
Intravenous Catheter ◽  
Central Venous ◽  
Peripheral Venous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Catheter Infections ◽  
Intravenous Catheters

Topic This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. Clinical Relevance Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter–related bloodstream infections is likely as high as and may surpass the number of central venous catheter–related bloodstream infections, with significant associated morbidity and mortality. Purpose of Paper Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. Content Covered This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.

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

2014 ◽  
Vol 19 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Stéphanie F. Bernatchez
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Venous ◽  
Term Care ◽  
Peripheral Venous Catheter ◽  
Care Facilities ◽  
Review Current ◽  
Peripheral Venous Line

AbstractPeripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.

scholarly journals Routine Replacement versus Clinical Monitoring of Peripheral Intravenous Catheters in a Regional Hospital in the Home Program A Randomized Controlled Trial

2009 ◽  
Vol 30 (9) ◽  
pp. 915-917 ◽  
Author(s):  
Patricia Van Donk ◽  
Claire M. Rickard ◽  
Matthew R. McGrail ◽  
Glenn Doolan
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Bloodstream Infections ◽  
Clinical Indication ◽  
Intravenous Catheter ◽  
Home Setting ◽  
Home Program ◽  
Randomized Controlled ◽  
Peripheral Intravenous Catheter ◽  
Intravenous Catheters

This randomized, controlled trial involving 316 patients in the home setting found no difference in the rate of phlebitis and/or occlusion among patients for whom a peripheral intravenous catheter was routinely resited at 72-96 hours and those for whom it was replaced only on clinical indication (76.8 events per 1,000 device-days vs 87.3 events per 1,000 device-days; P = .71). There were no bloodstream infections.

Early Onset versus Late Onset Peripherally Inserted Central Venous Catheter Infections: An Analysis of Risk Factors and Microbiology

2013 ◽  
Vol 34 (9) ◽  
pp. 980-983 ◽  
Author(s):  
Paul Chittick ◽  
Sobia Azhar ◽  
Kalyani Movva ◽  
Paula Keller ◽  
Judith A. Boura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Early Onset ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Infections ◽  
Central Catheters

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

2009 ◽  
Vol 30 (7) ◽  
pp. 645-651 ◽  
Author(s):  
Howard E. Jeffries ◽  
Wilbert Mason ◽  
Melanie Brewer ◽  
Katie L. Oakes ◽  
Esther I. Mufioz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Evidence Based ◽  
Central Venous ◽  
Improvement Project ◽  
Team Members ◽  
Prevention Interventions

Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

scholarly journals TO COMPARE CENTRAL VENOUS CATHETER AND PERIPHERAL INTRAVENOUS CATHETER IN PATIENTS OF LAPAROTOMY: AN OBSERVATIONAL COMPARATIVE STUDY

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Ketan. P. Prajapati ◽  
Rajan B Somani ◽  
Soham V. Shah
Keyword(s):  
Central Venous Catheter ◽  
Life Span ◽  
Complication Rate ◽  
Venous Catheter ◽  
Intravenous Catheter ◽  
Central Venous ◽  
Peripheral Intravenous Catheter ◽  
Group A ◽  
The Mean ◽  
Group B

Background: The laparotomy is one of the major surgery require ample amount of intravenous fluids administration, blood transfusion ,and sometime parental nutrition, repeated blood sampling to monitor patients condition. These all things fulfilled by either use of peripheral intravenous catheter or central venous catheter. Both of these intravenous catheters are compared on basis of their life span, hospital stay of the patient, and their complications to evaluate the efficacy of both in patients undergoing laparotomy. Methods: An observational comparative study was conducted among 50 patients of laparotomy in the department of general surgery, sir t hospital Bhavnagar. All patients were randomly assigned to two groups A and B. Patients of group A were subjected to central venous catheter and patients of group b were subjected to peripheral intravenous catheter. Results: The mean of hospital stay of patients in group a was 20.4 (± 4.9) and group b was 15.4 (± 6.12) . The mean life span of catheter was 18.8 ± 4.25 days in group A and 6.04 ± 1.947 days in group B. Rate of major complication in group A was 12% as compare to group B having 40% complication rate. Rate of intermediate complication in group A was 20% as compare to group B having 72% complication rate. . Rate of minor complication in group A was 8% as compare to group B having 56% complication rate. Rate of overall complication in group A was 28% as compare to group B having 72% complication rate. Conclusion: Life span of central venous catheter is greater as compare to the peripheral intravenous catheter and rate of complications is more in patients with peripheral intravenous catheter. Keywords:  Central Venous Catheter, Peripheral Intravenous Catheter, Laparotomy

scholarly journals Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

2020 ◽  
Vol 8 ◽  
pp. 205031212091212
Author(s):  
Efrain Riveros-Perez ◽  
Camila Albo ◽  
Eduardo Guzzo ◽  
Maria Gabriela Sanchez ◽  
Nianlan Yang ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Venous Catheter ◽  
Free Flow ◽  
Surgical Patients ◽  
Intravenous Catheter ◽  
Catheter Position ◽  
Color Flow ◽  
Old Patients ◽  
Peripheral Venous Catheter ◽  
Peripheral Intravenous Catheter

Objective: To evaluate color flow Doppler flow ultrasound compared to standard clinical techniques, to detect the intravascular position of peripheral intravenous catheters in adult surgical patients. Methods: A prospective study was conducted in adult (>18 years old) patients scheduled to undergo elective surgery. Peripheral intravenous catheter position was evaluated with standard clinical techniques (free flow of fluid from a hanging bag, easy saline injection, and aspiration of blood), and with color flow Doppler ultrasound proximal to the insertion site to identify intravascular catheter position. Comparative test performance was carried out. Results: In total, 174 patients were enrolled. The venous catheter was deemed to be intravascular in 92.53% ( n = 161) and 90.23% ( n = 157) based on clinical evaluation and color flow Doppler, respectively ( p = 0.206). Moderate to substantial agreement between the two approaches was found. Cohen’s kappa was 0.64 (95% CI 0.43–0.83). Specificity of clinical judgment to detect catheter extravascular position was only 58.82%, when the color flow Doppler technique was set as the gold standard. Free flow from a hanging bag method showed the best agreement with color flow Doppler to determine intravascular position of a catheter ( p = 0.3173, kappa = 0.68), with sensitivity of 98.09% and specificity of 64.71%. Conclusion: Color flow Doppler is a specific tool complementary to sensitive clinical indicators to detect peripheral venous catheter infiltration. The ability of color flow Doppler to accurately determine the position of a peripheral venous catheter depends on experience and familiarity with the tool by providers, who can master the technique with education and training.

The Role of Biofilm in Central Venous Catheter Related Bloodstream Infections: Evidence-based Nursing and Review of the Literature

2020 ◽  
Vol 15 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Nicola Ielapi ◽  
Emanuela Nicoletti ◽  
Carmela Lorè ◽  
Giorgio Guasticchi ◽  
Tiziana Avenoso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Evidence Based ◽  
Central Venous ◽  
Device Management ◽  
Bibliographic Search ◽  
Materials Used ◽  
Evidence Based Nursing

Background: Biofilm is a fundamental component in the pathogenesis of infections related to the use of the central venous catheter (CVC,) which can represent an important health issue in everyday practice of nursing and medical staff. Objective: The objective of the following review is to analyze the components of biofilm and their role in catheter-related infection determinism in an evidencebased nursing perspective in such a way as to give health professionals useful suggestions in the prevention and management of these complications. Methods: The following databases were consulted for the bibliographic search: Medline, Scopus, Science Direct. Biofilm can be the cause of CVC extraction and can lead to serious haematogenic infectious complications that can increase the morbidity and mortality of affected patients. Results: Updated pathophysiologic knowledge of biofilm formation and appropriate diagnostic methodology are pivotal in understanding and detecting CVC-related infections. Lock therapy appears to be a useful, preventive, and therapeutic aid in the management of CVCrelated infections. New therapies attempting to stop bacterial adhesion on the materials used could represent new frontiers for the prevention of CVC-related infections. Conclusion: The correct evidence-based nursing methods, based on the use of guidelines, provides the opportunity to minimize the risks of infection through the implementation of a series of preventive measures both during the CVC positioning phase and in the subsequent phase, for example, during device management which is performed by medical and nursing staff.

Effectiveness of transparent film dressing for peripheral intravenous catheter

2020 ◽  
pp. 112972982092723
Author(s):  
Selma Atay ◽  
Fatma Yilmaz Kurt
Keyword(s):  
Dwell Time ◽  
Venous Catheter ◽  
University Hospital ◽  
Control Group ◽  
Transparent Film ◽  
Patient Identification ◽  
Intravenous Catheter ◽  
Chi Square ◽  
Peripheral Venous Catheter ◽  
Peripheral Intravenous Catheter

Background: The intravenous applications are the most common type of such interventions. It is underlined that in cases where the peripheral intravenous catheter is not properly secured in place, even a minor movement inside the vein would result in injury of vein. Objective: The insertion of peripheral intravenous catheter is a common practice. This is a randomized controlled prospective study aiming at investigating the effectiveness of use of transparent film dressing for peripheral intravenous catheter. Methods: The universe of this study included inpatients in the Internal Diseases clinic of a University Hospital, and the sample included a total of 110 peripheral intravenous catheters that were calculated by power analysis. The patient identification form, the peripheral venous catheter and treatment information form, and the visual infusion phlebitis identification scale were used to collect data. The forms were completed by the investigators on the basis of daily observations. The data were assessed by the percentage, chi-square test, and logistic regression analysis via the software SPSS 20.00. Results: The individuals in the study group and the control group included in the sample are comparable in terms of gender, having/not having a chronic disease, the site of peripheral intravenous catheter, use of antibiotics, intravenous fluid therapy, and mean age. There were no statistically significant differences between the groups. There was a significant relationship between the dwell time for the catheter and development of any complications and the groups. Conclusion: The use of transparent film dressing for insertion of peripheral intravenous catheter can be recommended as it increases the dwell time for the catheter and reduces incidence of complications.

scholarly journals Long peripheral catheters: Is it time to address the confusion?

2018 ◽  
Vol 20 (5) ◽  
pp. 457-460 ◽  
Author(s):  
Kirby R Qin ◽  
Ramesh M Nataraja ◽  
Maurizio Pacilli
Keyword(s):  
Venous Catheter ◽  
Seldinger Technique ◽  
Ultrasound Guided ◽  
Intravenous Catheter ◽  
Upper Arm ◽  
Peripheral Venous Catheter ◽  
Long Line ◽  
Peripheral Catheter ◽  
Peripheral Intravenous Catheter ◽  
Polyurethane Catheter

Long peripheral catheters are 6–15 cm peripheral dwelling catheters that are inserted via a catheter-over-needle or direct Seldinger (catheter-over-guidewire) technique. When inserted in the upper extremity, the distal tip terminates before reaching the axilla, typically no further than the mid-upper arm. This is distinct from a midline catheter, which is inserted via a modified Seldinger technique and terminates at the axilla. The nomenclature of this catheter is confusing and inconsistent. We have identified over a dozen labels in the literature, all describing the same device. These include ‘15 cm catheter’, ‘catheter inserted with a Seldinger method’, ‘extended dwell/midline peripheral catheter’, ‘Leaderflex line’, ‘long catheter’, ‘long IV catheter’, ‘long peripheral cannula’, ‘long peripheral catheter’, ‘long peripheral venous catheter’, ‘long polyurethane catheter’, ‘midline cannula’, ‘mini-midline’, ‘peripheral intravenous catheter’, ‘Seldinger catheter’, ‘short midline catheter’, ‘short long line’ and ‘ultrasound-guided peripheral intravenous catheter’. The purpose of this editorial is to achieve some level of standardisation in the nomenclature of this device. Is it time to address the confusion? We suggest adopting ‘long peripheral catheter’. However, we encourage discussion and debate in reaching a consensus.

Preventing Peripheral Intravenous Line Infections: Recommendations for Healthcare Facilities

2009 ◽  
Vol 14 (4) ◽  
pp. 187-190 ◽  
Author(s):  
Nancy Moureau
Keyword(s):  
United States ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Line ◽  
Intravenous Catheter ◽  
Central Lines ◽  
Healthcare Facilities ◽  
Peripheral Intravenous Catheter ◽  
Intravascular Devices

Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000–500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%–25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented prevalence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 catheter days. Though the frequency of peripheral intravenous catheter-associated infections is lower than with other intravascular devices, absolute numbers of patients affected can be significant with more than 330 million peripheral catheters sold each year in the United States (Millennium Research Group, 2006). Some doctors are stressing the need to use a peripheral line versus early placement of a central line with the rationale to reduce infection rates. Multiple national and international guidelines advocate a number of simple, yet highly effective procedures to reduce risk of central venous catheter infections. Some of these same guidelines should be applied as standards for peripheral catheters. By standardizing protocols across all types of catheter insertions, safety is ensured in reducing infections and ultimately improving patient care.

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