Risk of bloodstream infections with indwelling peripheral catheters increase after 3 days

1. The risk of bloodstream infections (BSIs) in individuals with indwelling peripheral intravenous catheters (PIVCs) is significantly increased after 3 days of dwell time. 

Evidence Rating Level: 2 (Good)

Study Rundown: PIVCs are common among hospitalized patients, with frequently reported adverse events associated with PIVCs being phlebitis and hematoma. Thus far, there have been limited attempts to characterize the association between BSIs and PIVCs. Indeed, the impact of dwell time on the risk of BSIs in patients with PIVCs has not been well characterized. This cohort study therefore sought to investigate the association between dwell time and the risk of BSIs in patients with PIVCs.

371,061 PIVCs were included from Geneva University Hospitals (HUG) in Switzerland. The primary outcome of interest was BSI with PIVC as defined by the European Centre for Disease Prevention and Control. 38% of patients had a dwell time of 1 to 2 days, 32% of patients had a dwell time of 3 to 4 days, and 30% had a dwell time greater than 4 days. A significantly increased risk of BSI with PIVCs was observed after 3 days of dwell time and remained increased for every day onwards. The highest number of BSI with PIVCs occurred when PIVCs were removed after 5 days. 

Overall, this study found that among patients with PIVCs, the risk of BSIs was significantly increased after 3 days of dwell time. 

Click to read the study in JAMA Network

Relevant Reading: Comparison of Routine Replacement With Clinically Indicated Replacement of Peripheral Intravenous Catheters

In-Depth [prospective cohort study]: More than half of hospitalized patients will have at least 1 PIVC in situ. Complications associated with PIVC that are often reported include phlebitis and hematoma. BSIs are an important, yet underestimated complication of PIVC associated with increased mortality. However, the impact of dwell time on the risk of BSIs in patients with PIVCs has not been well characterized. Indeed, there remains conflicting evidence surrounding the optimal replacement strategy of PIVCs to minimize BSIs. This cohort study therefore sought to investigate the association between dwell time and the risk of BSIs in patients with PIVCs.

371,061 pediatric and hospitalized patients with at least 1 PIVC between January 2016 and February 2020 (median patient age, 63 years [IQR, 41-79 years]; 51% female) were included from Geneva University Hospitals (HUG) in Switzerland. The primary outcome of interest was BSI with PIVC as defined by the European Centre for Disease Prevention and Control. Per patient stay, the mean (SD) number of PIVCs was 1.7 (1.6). 38% of patients had a dwell time of 1 to 2 days, 32% of patients had a dwell time of 3 to 4 days, and 30% had a dwell time greater than 4 days. In total, 61 BSIs were observed throughout the study period with the highest number of BSIs with PIVCs occuring when PIVCs were removed after 5 days. A significantly increased risk of BSI with PIVCs was observed after 3 days of dwell time versus less than 3 days (adjusted OR [AOR], 13.55; 95% CI, 5.44-34.00; P < .001), and remained increased for every day after (after 4 days versus less than 4, AOR, 8.53 [95% CI, 4.47-16.28]; after 5 days versus less than 5, AOR, 5.38 [95% CI, 3.23-8.96]; after 6 days versus less than 6, AOR, 7.63 [95% CI, 4.57-12.74; P < .001]).

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