Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Unité Mixte de Recherche ( UMR ) 1137 , Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM, Université de Paris, Paris, France.
JAMA Intern Med. 2021 Nov 1;181(11):1471-1478. doi: 10.1001/jamainternmed.2021.5345.
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.
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.
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).
The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period.
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).
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.
外周静脉导管（PVC）是全球医院最常使用的留置装置。外周静脉导管相关性血流感染（PVC-BSI）虽罕见，但后果严重且可预防。
调查将每 96 小时常规更换 PVC 的政策改为临床指征更换后，PVC-BSI 的发生率。
设计、地点和参与者：这项全机构、观察性队列研究评估了 2016 年 1 月 1 日至 2020 年 2 月 29 日期间，瑞士西部 10 个地点的一家大型大学附属医院中所有接受 PVC 置入的患者。
在 2018 年 3 月 31 日之前（基线期），PVC 常规每 96 小时更换一次。在 2018 年 4 月 1 日至 2019 年 10 月 15 日期间，如果临床指征需要，PVC 则更换（干预期）。自 2019 年 10 月 16 日起，PVC 再次每 96 小时常规更换（回归期）。
各时期的 PVC-BSI 发生率和 PVC-BSI 发病率比值（IRR）。
共纳入 412631 份记录导管持续时间的 PVC（164331 名患者；中位[四分位间距]患者年龄为 51[33-72]岁；88928 名[54.1%]女性）：基线期 241432 份 PVC，干预期 130779 份，回归期 40420 份。在基线期观察到 11 例 PVC-BSI，干预期 46 例，回归期 4 例。尽管所有研究期间的 PVC 天数每月保持稳定，但每月插入的 PVC 数量在干预期间减少。与基线和回归期相比，干预期仍在使用超过 4 天或超过 7 天的 PVC 数量更高。与基线期相比，干预期 PVC-BSI 的 IRR 显著升高（IRR，7.20；95%CI，3.65-14.22；P<0.001），而回归期无显著升高（IRR，1.35；95%CI，0.30-6.17；P=0.69）。
这项使用大型前瞻性监测数据库的队列研究结果表明，与常规更换相比，仅在临床指征时更换 PVC 可能与 PVC-BSI 风险增加相关。即使 PVC 相关性 BSI 是一种罕见事件，但其在大多数患者中的应用仍使该结果具有相关性。
