Indwell times, complications and costs of safety peripheral intravenous catheters

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#IVTEAM #Intravenous literature: González López, J.L., Arribi Vilela, A., Fernández Del Palacio, E., Olivares Corral, J., Benedicto Martí, C. and Herrera Portal, P. (2013) Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study. The Journal of Hospital Infection. December 1st. [epub ahead of print].

Abstract:

BACKGROUND: Catheter-related infections (CRIs) caused by peripheral intravenous catheters (PIVCs) are an increasingly common iatrogenic complication. To prevent this, recommended timelines for routine replacement of PIVCs have increased from 48h to 72h and subsequently to 96h, despite a lack of supporting scientific evidence.

AIM: To compare closed-system (COS) PIVCs with open-system (MOS) PIVCs.

METHODS: This prospective, randomized controlled trial compared the indwell time of COS PIVCs without complications with that of MOS PIVCs, removed only by clinical indication. In total, 1199 PIVCs (642 inpatients) were randomized and 283 PIVCs were cultured. Sixteen catheters (11 patients) were lost to the study after randomization.

FINDINGS: In total, 104,469 catheter-hours (54,173h in 584 COS and 50,296h in 599 MOS) were recorded. The median dwell time was 137.1h for COS PIVCs and 96h for MOS PIVCs (P = 0.001). Among PIVCs in place for ≥24h, the median dwell time was 144.5h for COS PIVCs [95% confidence interval (CI) 123.4-165.6] and 99h for MOS PIVCs (95% CI 87.2-110.8). Use of COS PIVCs reduced phlebitis rates by 29% (31 vs 45 cases/1000 catheter-days; P = 0.004). The probability that a MOS PIVC would last for 96h was 79.9%, and the probability that a COS PIVC would last for 144h was 80.4%. There were no significant differences in rates of bacterial colonization per 1000 catheter-days (51.1 COS vs 54.1 MOS) or CRI (5.76 COS vs 6.65 MOS). Nevertheless, there was a 20% relative risk reduction in CRI.

CONCLUSION: Use of COS PIVCs reduced episodes of phlebitis and risk of infection at a cost of only €0.09/day. When PIVCs are replaced based on clinical indication, COS PIVCs last for up to 144h and MOS PIVCs last for up to 96h without increased risk and with significant cost savings (€786,257/year/1000 beds).

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