The risks of peripheral IV catheters

For several years Asante has successfully prevented catheter-associated urinary tract (CAUTI) and central-line-associated bloodstream (CLABSI) infections  through diligence and care bundles.

But peripheral IVs carry an equal if not greater risk of infection. Consider a recent case at Asante Rogue Regional. A patient was admitted on May 7 with a right antecubital peripheral IV that had been placed in the ED. The patient’s chart indicated old dried bloody drainage as the site description and that the dressing was reinforced on May 9. The IV was left in place until May 11 when the patient was discharged.

Just before discharge, the patient’s temperature spiked. Blood cultures came back positive for methicillin-resistant staphylococcus aureus (MRSA). The patient was readmitted with evidence of thrombophlebitis at the site of the removed IV. The patient required hospitalization for an additional eight days.

Nationwide, epidemiological studies of methicillin-resistant staphylococcus aureus became available in 2004 when the CDC added surveillance for this organism as part of its Emerging Infections Program. Ten years later, the CDC added surveillance and reporting of CLABSIs as a requirement for acute care reporting and discovered that many cases were attributed to staph. Additional studies confirmed that peripheral intravenous catheters had a 50% failure rate, and likely cause more bloodstream infections than central venous catheters.

There continues to be many opportunities to reduce the incidence of S. aureus  — specifically, MRSA — in the clinical setting. While efforts historically have concentrated on reducing CLABSIs, a new area of focus has emerged that examines the role of peripheral intravenous lines in staph and MRSA bloodstream infections.

Asante is required to report cases of hospital-onset MRSA bacteremia to CMS and state agencies. A hospital-onset case is defined as a positive blood culture on day four or longer. In recent cases reviewed with unit leadership responsible for these infections, it is evident that our system has opportunities to better manage peripheral IVs.