Recent infections call into question our PIVC process

In February 2022, Asante implemented the new Institute for Safe Medication Practices recommendations to allow for longer dwell times of peripheral intravenous catheters.

As we have investigated recent infections related to central lines, some trends regarding prolonged dwell times for PIVCs have come to light. These trends include bloodstream infections, phlebitis and leaking catheters.

Millions of PIVCs are used annually in the United States and evidence has shown they were the contributing factor in over 100,000 bloodstream infections annually.

A 2023 study in the Journal of Hospital Infection concluded, “[T]he risk of developing PVC-related BSI in patient admitted to the medical wards may seem low, complications of PVC-related BSI are severe, and associated mortality remains high.”

At Asante we noted the following trends prior to the first positive blood culture within our patients who had a central line infection:

• The average dwell time for a PIVC was seven days, with a maximum number of days with a PICV at 44.
• Forty-nine percent of patients with a PIVC had it removed due to an issue, such as phlebitis, leaking or accidental removal.
• The average number of lines (PIVC, central line, art line etc.) per-patient during a hospital stay was seven, with a minimum of two and a maximum of 15.

In October, the device rep for our PIVCs will conduct an assessment. The goal is to round on departments, understand our documentation practices and get feedback from frontline staff to make a recommendation on best practices moving forward.

Current feedback includes:

• A provider order is required to remove a PIVC, which can create barriers to getting an order to remove the PIVC.
• When the PIVC looks good at 72 and 94 hours, it is challenging to explain to patients why we would change the PIVC.
• There is a discomfort in patients being without a PIVC, even when they do not need it.

While we work through policy changes here are some key tenets to keep in mind:

• Assess the PIVC site per policy and document any changes.
• Consider using a Curos cap to keep the integrity of the hub clean.
• Discuss with the provider the need for the PIVC (e.g., the patient is only getting saline flushes).
• Remember, all IVs placed outside of Asante should be replaced within 24 hours.

Look for more on this in future articles. In the meantime, thank you for being diligent in helping to prevent hospital-acquired infections.