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Comparison of Routine Replacement With Clinically Indicated Replacement of Peripheral Intravenous Catheters

Educational Objective
To investigate the incidence of peripheral intravenous catheter bloodstream infections (PVC-BSIs) after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement.
1 Credit CME
Key Points

Question  Is clinically indicated replacement of peripheral intravenous catheters (PVCs) compared with routine replacement every 96 hours associated with increased risk of peripheral intravenous catheter bloodstream infections (PVC-BSIs)?

Findings  In this cohort study of 412 631 PVCs, there was a significantly increased incidence rate ratio of PVC-BSIs after switching from routine replacement to clinically indicated replacement of PVCs. After a routine replacement strategy was reestablished, a reduction of PVC-BSI incidence was observed.

Meaning  These findings suggest that clinically indicated replacement of PVCs is associated with an increased risk of PVC-BSIs compared with routine replacement.

Abstract

Importance  Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events.

Objective  To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement.

Design, Setting, and Participants  This institution-wide, observational cohort study evaluated all patients hospitalized at a large university-affiliated hospital with 10 sites in Western Switzerland with a PVC insertion between January 1, 2016, and February 29, 2020.

Exposures  Peripheral intravenous catheters were routinely replaced every 96 hours until March 31, 2018 (baseline period). Between April 1, 2018, and October 15, 2019, PVCs were replaced if clinically indicated (intervention period). From October 16, 2019, PVCs were again routinely replaced every 96 hours (reversion period).

Main Outcomes and Measures  The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period.

Results  A total of 412 631 PVCs with documented catheter duration were included (164 331 patients; median [interquartile range] patient age, 51 [33-72] years; 88 928 [54.1%] female): 241 432 PVCs at baseline, 130 779 at intervention, and 40 420 at reversion. Eleven PVC-BSIs were observed during the baseline period, 46 during the intervention, and 4 during the reversion period. Although the monthly number of PVC-days remained stable during all study periods, the number of monthly inserted PVCs decreased during the intervention period. The number of PVCs still in place more than 4 or more than 7 days was higher during the intervention period compared with the baseline and reversion periods. A significantly increased IRR of PVC-BSIs was observed for the intervention period (IRR, 7.20; 95% CI, 3.65-14.22; P < .001) compared with baseline, whereas during the reversion period there was no significant increase (IRR, 1.35; 95% CI, 0.30 6.17; P = .69).

Conclusions and Relevance  The results of this cohort study using a large, prospective surveillance database suggest that replacement of PVCs only when clinically indicated may be associated with an increased risk of PVC-BSI compared with routine replacement. Even if PVC-associated BSI is a rare event, the use of PVCs in most patients makes this outcome relevant.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 1, 2021.

Published Online: September 17, 2021. doi:10.1001/jamainternmed.2021.5345

Corresponding Author: Niccolò Buetti, MD, MSc, Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland (niccolo.buetti@hcuge.ch and niccolo.buetti@gmail.com).

Author Contributions: Dr Buetti had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Buetti and Abbas contributed equally to this work.

Concept and design: Buetti, Abbas, Pittet, Zingg.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Buetti, Abbas, Pittet, Teixeira, Zingg.

Critical revision of the manuscript for important intellectual content: Buetti, Abbas, Pittet, de Kraker, Chraiti, Sauvan, Sauser, Harbarth, Zingg.

Statistical analysis: Buetti, Abbas, de Kraker, Teixeira, Sauser, Zingg.

Obtained funding: Buetti.

Administrative, technical, or material support: Buetti, Abbas, Teixeira, Chraiti, Sauvan, Zingg.

Supervision: Pittet, Harbarth, Zingg.

Conflict of Interest Disclosures: Dr Buetti reported receiving grants from the Swiss National Science Foundation during the conduct of the study. Dr de Kraker reported receiving grants from Innovative Medicines Initiative Joint Undertaking (Combatting Bacterial Resistance in Europe projects), resources that are composed of financial contribution from the European Union’s Seventh Framework Programme and the European Federation of Pharmaceutical Industries and Associations companies’ in-kind contribution outside the submitted work. Dr Zingg reported receiving grants from the Swiss National Foundation, European Commission, and Horizon 2020 and personal fees from 3M outside the submitted work. No other disclosures were reported.

Meeting Presentation: This article was presented at the 6th International Conference on Prevention & Infection Control (ICPIC 2021); September 17, 2021; Geneva, Switzerland.

Additional Contributions: Anne Iten, MD, SPCI, University of Geneva Hospitals, provided data on hand hygiene adherence during the review process. She was not compensated for her work. The Routine Bacteriology Laboratory was responsible for providing laboratory test results. The Infection Prevention and Control team performed prospective bloodstream infection surveillance. The Groupe Accès Vasculaires at University of Geneva Hospitals issued institutional recommendations and policies on the use of intravascular medical devices.

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