Routine PVC Replacement May Protect Against Bloodstream Infections

By Reuters Staff

September 27, 2021

NEW YORK (Reuters Health) - Replacing peripheral intravenous catheters (PVCs) only when clinically required may increase the risk of PVC-related bloodstream infections (BSIs) compared with routine PVC replacement, according to data from a large observational study from Switzerland.

Whether PVCs should be replaced routinely or only when clinically indicated remains an open question, Dr. Niccolo Buetti and colleagues with the Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, note in JAMA Internal Medicine.

They assessed the incidence of PVC-BSIs after a change in policy at the University of Geneva Hospitals from routine PVC replacement every 96 hours to clinically indicated replacement.

The analysis covered more than 412,000 PVCs used in 164,331 patients, including 241,432 PVCs used during the routine replacement (baseline) period, 130,779 used during the clinically indicated replacement (intervention) period and 40,420 used during the routine replacement (reversion) period. PVCs were routinely replaced every 96 hours.

During the baseline period, 11 PVC-BSIs were recorded, 46 during the clinically indicated intervention period and four during the reversion period to routine replacement.

The number of monthly inserted PVCs was lower during the intervention period, despite the fact that the monthly number of PVC-days remained steady across all study periods.

When compared with the baseline and reversion periods, the number of PVCs still in place after four or seven days was higher during the intervention period.

There was a significantly higher incidence of PVC-BSIs during the intervention than at baseline (incidence-rate ratio, 7.20; P<0.001), but no significant rise during the reversion period (IRR, 1.35; P=0.69).

PVCs are the most frequently used indwelling devices in hospitals around the world. PVC-BSIs are "rare, but severe and preventable, adverse events," Dr. Buetti and colleagues note in their paper.

"In this study, clinically indicated replacement of PVCs was associated with an increased risk of PVC-BSI compared with routine replacement, which only could have been identified by analyzing a sufficiently large, prospective surveillance database. Even if PVC-associated BSI is a rare event, the use of PVCs in most patients makes this outcome relevant," they conclude.

The study was presented September 17 at the 6th International Conference on Prevention and Infection Control (ICPIC 2021) in Geneva, Switzerland.

SOURCE: https://bit.ly/3zxEnvQ JAMA Internal Medicine, online September 17, 2021.

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