Abstract:
Introduction: Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase PVC failure, risk profiles for many are unclear.
Objective: To synthesise data from prospective PVC studies conducted between 2013-2019, to determine associations between common antimicrobials and PVC failure.
Methods: A secondary analysis of 7 randomised controlled trials and 2 prospective cohort studies, from 3 quaternary hospitals (2 adult; 1 paediatric) in Australia between 2013-2019. The primary outcome was PVC failure from: (1) vessel injury (occlusion, infiltration, or extravasation); or (2) irritation (pain or phlebitis). Associations between antimicrobial use and failure were explored using multivariable Cox regression.
Results: In total, 5,252 PVCs (4,478 patients) were analysed; vessel injury occurred in 19% of all PVCs, and irritation in 11%. Vessel injury was significantly associated with cefepime hydrochloride (hazard ratio [HR] 2.50; [95% confidence interval, 1.44-4.34]), ceftazidime pentahydrate (HR 1.91 [1.11-3.31]), flucloxacillin sodium (HR 1.84 [1.45-2.33]), lincomycin hydrochloride (HR 1.67 [1.10-2.52]), and vancomycin hydrochloride (HR 1.73 [1.25-2.40]). Flucloxacillin sodium was significantly associated with irritation (HR 1.58 [1.96-3.40]).
Conclusions: This study identified several antimicrobials associated with increased PVC failure, including some previously known for this association, and some hitherto unidentified. Research is urgently needed to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure.
Reference:Larsen EN, Marsh N, Mihala G, King M, Zunk M, Ullman AJ, Keogh S, Kleidon TM, Rickard CM. Intravenous antimicrobial administration though peripheral venous catheters – establishing risk profiles from an analysis of 5252 devices. Int J Antimicrob Agents. 2022 Feb 17:106552. doi: 10.1016/j.ijantimicag.2022.106552. Epub ahead of print. PMID: 35183678.