Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications.

BACKGROUND: Although intravenous therapy is one of the most commonly performed procedures in hospitalized patients, it remains susceptible to infectious and non-infectious complications. Previous studies investigated peripheral intravenous catheter (PIVC) complications mainly in pediatrics, but apparently none were investigated among Saudi adult populations. The aim of this study was to assess the pattern and complications of PIVCs at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.

METHODS: An observational prospective cohort study investigated PIVCs pattern and complications among adults with PIVCs, admitted to various wards at KAMC. PIVCs-related clinical outcomes (pain, phlebitis, leaking, and others) were recorded in 12-hour intervals, using the Visual Inspection Phlebitis scale. Density incidence (DI) and cumulative incidence (CI) of complications and their relative risks (RRs) were calculated. Regression analyses were applied and significance limits were set at P<0.05.

RESULTS: During the study period, 359 adults were included, mounting to 842 PIVCs and 2,505 catheter days. The majority of patients, 276 (76.9%), had medical, chief admission complaints, whereas 83 (23.1%) were trauma/surgical and infectious cases. Complicated catheters were found in 141 (39.3%) patients, with 273 complications (32.4/100 catheters), in 190 complicated catheters (CI =22.56/100 catheters and DI =75.84/1,000 catheter days). Phlebitis ranked first among complications, 148 (CI =17.6%), followed by pain 64 (CI =7.6%), leaking 33 (CI =3.9%), dislodgement 20 (CI =2.4%), and extravasations and occlusion 4 (CI=0.5% each). Phlebitis was predicted with female sex (P<0.001), insertion in fore/upper arm (P=0.024), and infusion of medication (P=0.02). Removal time for PIVCs insertion was not a significant predictor of phlebitis (RR =1.46, P=0.08).

CONCLUSION: Incidence of complications in this study was significantly higher than rates in previous studies. Better insertion techniques may be sought to lower the incidences of PIVC complications, thus extending their onset beyond day 3. Changing catheters is recommended when clinically indicated rather than routinely post-72 hours.

Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Abolfotouh MA, Salam M, Bani-Mustafa A, White D, Balkhy HH. Ther Clin Risk Manag. 2014 Dec , vol 8, no 10, p993-1001

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Prevention of Colonization and Infection by Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae in Long Term Acute Care Hospitals.

Background. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) are an increasing threat to healthcare institutions. Long-term acute care hospitals (LTACHs) have especially high prevalence of KPC. Methods. Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPCpositive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare worker education and adherence monitoring) would reduce colonization and infection due to KPC in four LTACHs with high endemic KPC prevalence. The study was conducted between February 1, 2010-June 30, 2013; 3,894 patients were enrolled during pre-intervention (16-29 months) and 2,951 patients were enrolled during intervention (12-19 months).

RESULTS: KPC colonization prevalence was stable during pre-intervention (average, 45.8%; 95% CI 42.1-49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI 32.4%-36.2%; p<0.001 for exponential decline). During intervention, KPC admission prevalence remained high (average, 20.6%, 95% CI 19.1%-22.3%). The incidence-rate of KPC colonization fell during intervention from 4 to 2 acquisitions/100 patient-weeks (p=0.004 for linear decline). Compared to pre-intervention, average rates of clinical outcomes declined during intervention: KPC in any clinical culture (3.7 to 2.5/1000 patient-days, p=0.001), KPC bacteremia (0.9 to 0.4/1000 patient-days, p=0.008), all-cause bacteremia (11.2 to 7.6/1000 patient-days, p=0.006) and blood culture contamination (4.9 to 2.3/1000 patient-days, p=0.03).

CONCLUSIONS: A bundled intervention was associated with clinically important and statistically significant reductions in KPC colonization, KPC infection, all-cause bacteremia and blood culture contamination in a high-risk LTACH population.

Prevention of Colonization and Infection by Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae in Long Term Acute Care Hospitals. Hayden MK, Lin MY, Lolans K, et al Clin Infect Dis. 2014 Dec 23. pii: ciu1173. [Epub ahead of print]