Peripheral venous catheters: an under-evaluated problem
Introduction
Peripheral venous catheters (PVC) are the most frequently used invasive device in hospitals. It is estimated that 30ā80% of patients receive a peripheral line during their hospital stay [1, 2, 3, 4, 5, 6]. Despite the frequent use of this routine device, randomized studies investigating PVC-associated catheter-related bloodstream infections (PVC-BSI) are rare and focus on phlebitis, catheter colonization and catheter patency [7, 8, 9, 10]. Although there is abundant literature on catheter-associated bloodstream infection, it concerns mostly central-line devices. Indeed, data on this potentially serious complication can only be obtained from small studies, notably the exemplary report by Maki et al. [11]. We reviewed the literature to determine if complications arising from PVC use are under-evaluated and, in particular, whether the peer-reviewed literature appropriately reflects the wide use of this device, whether potentially harmful complications are well addressed, and the type of prevention and intervention measures proposed.
Section snippets
Epidemiology
A total of 150 million PVCs are used annually in the USA, and extrapolated catheter days reach 450 million, which is 15 times higher than the cumulative dwell time of central venous lines. At present there are no Europe-wide epidemiological data on PVC use. In 2006, the Swedish Council on Technology Assessment in Health Care conducted a country-wide review of annual PVC use and reported 5 million PVCs. PVC use is a routine procedure, but various studies estimate that 4ā28% of the PVCs are not
Thrombophlebitis
The best described, most frequent PVC complication is phlebitis, or thrombophlebitis when phlebitis is combined with thrombus formation. PVC-associated thrombophlebitis rates range from 2 to 80% [4, 5, 16, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37]. This remarkable variation results from distinct study settings and the use of individual rather than universally valid definitions of thrombophlebitis. While all definitions are based on clinical findings such as
Scheduled catheter change
There are many reports on scheduled catheter change for thrombophlebitis prevention. Based on early results the CDC suggested that PVCs should be replaced after 48ā72 h [5, 19]. The threshold of 3 days was subsequently challenged by various studies in which catheters were in place for 96 h or longer without detecting an increase in thrombophlebitis [17, 18, 26, 70, 71, 72, 73, 74]. Although the studies extending the dwell time to 96 h produced satisfying results, those suggesting that scheduled
Precautionary measures
Only a few studies have investigated clinical intervention strategies, and those that have done sowere mainly focuse donthrom-bophlebitis as the primary outcome parameter. Performance feedback reduced phlebitis rates from 8.5% to 5.4% in a before-after study among 37 surgical wards in the UK [20]. Feedback is a well-established intervention method in medicine, particularly in infection control [76, 77]. It has repeatedly been shown that performance feedback can be effective in improving
Conclusion
PVCs are the most frequently used, but at the same time abused, invasive devices in hospitals. The risks and benefits of PVCs are largely underevaluated in clinical medicine, and this is particularly true for PVC-BSI. Given that PVC-BSI is the most serious complication of catheterization in general, such a lack of information is regrettable. Compared with central venous lines, where many studies describe every single detail as well as the overall epidemiological picture, it is not known whether
References (77)
- et al.
Prospective surveillance of phlebitis associated with peripheral intravenous catheters
Am J Infect Control
(2006) - et al.
Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital
J Hosp Infect
(2007) - et al.
The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies
Mayo Clin Proc
(2006) - et al.
Relevance and complications of intravenous infusion at the emergency unit at Nice University Hospital
J Infect
(2003) - et al.
Effect of a long-term quality improvement program on the risk of infection related to peripheral venous catheters [in French]
Presse Med
(2009) - et al.
Multi-centre research surveillance project to reduce infections/phlebitis associated with peripheral vascular catheters
J Hosp Infect
(2000) Daily change of an antiseptic dressing does not prevent infusion phlebitis: a controlled trial
Am J Infect Control
(1989)- et al.
A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition
Clin Nutr
(1991) - et al.
Infusion thrombophlebitis
Br J Anaesth
(1985) - et al.
The epidemiology of peripheral vein infusion thrombophlebitis: a critical review
Am J Med
(2002)