Niall Higgins, RN, GDipeH, PhD

Peripheral intravenous catheters (PIVCs) are ubiquitous devices that can have serious complications including bloodstream infections.[1] The annual use of PIVCs in North America has been reported to be in excess of 330 million. The estimated number of PIVCs used across greater Europe or other regions of the world is largely unknown, although estimates from global device sales have been reported to be approximately 1.2 billion.[1, 2]

Robust data on the prevalence of PIVCs and their associated management and infection prevention practices remain poor in Western countries; even more concerning is that PIVC data in developing nations remain relatively unknown.[3] Healthcare‐associated infection rates are significantly higher in developing nations, where the lack of resources and staff training can contribute to poor PIVC insertion and management.[4, 5]

There are currently scant data on PIVC management practices across different regions of the world. Localized complication rates such as phlebitis and infiltration are an under‐reported problem, yet are known to be a contributing factor for PIVC failure that leads to premature cessation of intravenous (IV) therapy, device removal, and the requirement for resiting of a new PIVC. Such failure can lead to delays in IV therapy, increased length of hospital stay, and cost.[6] Importantly, it can also lead to patient‐reported anxiety and pain. This lack of information has made it difficult to identify contributing factors for PIVC failure that may include inserter characteristics, patient‐related factors, and anatomical placement as well as healthcare facility adherence to international best practice and infection prevention guidelines.[6, 7]

The aim of this study was to undertake a multicenter, international study to assess the prevalence of PIVCs across different countries, to review population and PIVC characteristics from different regions of the world, and ascertain whether a larger study would provide beneficial data. The data of interest for this study included: (1) prevalence of PIVC use, (2) patient and PIVC characteristics, (3) prevalence of localized symptoms such as phlebitis, and (4) PIVC securement and dressing practices.

MATERIALS AND METHODS

RESULTS

DISCUSSION

This study has shown variation in the prevalence, characteristics, and management practices of PIVCs across sites from different regions of the world. Estimates for global PIVC prevalence in hospitalized patients vary widely from 30% to 80%.[8, 9, 10] The overall prevalence of PIVCs in this pilot study at 59% lay in the midrange of those reported in recent literature,[11] yet we found disproportionate PIVC prevalence between sites and regions. This heterogeneity could be explained by a number of factors including cohort acuity, clinician preference, and hospital guidelines. The generalizability of results from participating hospitals to their country is limited, because in most countries only a single institution participated.

Insertion of PIVCs was mainly by nurses, except in the Oceania region, where specialist teams and medical staff were the primary inserters. Of concern was the disparity in training provided by sites, with medical staff being less likely to receive instruction in how to prevent infection during this important procedure. A larger study would be needed to understand the effect on patient and infection outcomes of different inserter models and training provided.

A small proportion of patients from a site in Western Europe were observed to have gauze and tape as the PIVC dressing. The preference for gauze and tape is not common in developed nations, although recommended in clinical practice guidelines as an acceptable option.[12] There is currently no strong evidence to suggest that any 1 dressing or securement device to secure PIVCs is more effective than any other.[13] Nearly a quarter of PIVCs were loose or lifting from the Oceania region, this is of concern as interrupted dressings have been shown to increase the risk of catheter failure and catheter‐related bloodstream infection.[14]

We found that 17% of PIVCs overall had no IV order for fluids or medication. This proportion of redundant catheters increases the burden of preventable intravascular infection.[15] The prevalence of unnecessary PIVCs was lowest in Asia and greatest in the Oceania region, where 43% had no documented IV orders.

We reported PIVC prevalence from only a small number of nonrepresentative international sites for the purpose of considering a larger prevalence study. Observed differences in PIVC care and management cannot be generalized to entire regions. We asked sites to focus on medicalsurgical wards, and as such some PIVCs in higher acuity areas were likely not included. A larger study will help to assess PIVC outcomes and contributing factors for any differences, and improve external validity.

Operational challenges also may have affected sample selection and size. This was an unfunded study undertaken by hospital investigators, with competing workload demands. Poor or slow internet connection at the bedside was reported by every participating site, and may have contributed to the small numbers of patients screened at some sites.

CONCLUSION

More than half of hospitalized patients screened internationally had a PIVC, and 1 in 4 patients had no VAD, with wide variability from country to country both in prevalence and practice. The data gained have provided valuable initial insights into the global variation in PIVC use and care, and confirm that a larger international study with multiple sites is warranted. In particular, it remains important to understand variations in PIVC use and whether country or regional trends increase the risk of infection.

Disclosures

All authors have made substantial contributions to the study conception and design, acquisition of the data, and analysis and interpretation of the data. Each author has contributed to drafting and editing the manuscript and approved the final version for publishing as per the International Committee of Medical Journal Editors convention. The authors wish to declare they have received unrestricted investigator‐initiated research grants from Becton Dickinson (BD) and 3M. The investigators also received professional translation services for most languages that were funded by B. Braun. All funds have been made payable to Griffith University and not to researchers themselves. These funders played no role in the conception, design, execution, analysis or reporting of the study. BD, 3M, CareFusion, Smiths Medical, B Braun, Vygon, and Teleflex assisted in disseminating study information and assisting with translation of data forms where necessary. No commercial entity had any involvement in the design, execution and analysis, or reporting of the study. Evan Alexandrou has provided education services for CareFusion, Teleflex, Cook Medical, and 3M. Peter Carr is undertaking a PhD, which is partly funded by BD. He has received payment for educational lectures from CareFusion. Claire Rickard's department (Griffith University) has received investigator‐initiated, unrestricted research/educational grants from suppliers of vascular access device products including: 3M, BD, CareFusion, and Centurion. Claire Rickard has undertaken contract research or educational lectures for Bard, BBraun, BD, CareFusion, and Teleflex. Sheila Inwood is an employee of CareFusion. Leonard Mermel has received research funding from Theravance, Astellas Pharma, Marvao Medical, and CareFusion, and he has been a consultant for 3M, CareFusion, Catheter Connections, Fresenius Medical, Marvao Medical, Bard Access, and ICU Medical.

Peripheral intravenous catheters (PIVCs) are ubiquitous devices that can have serious complications including bloodstream infections.[1] The annual use of PIVCs in North America has been reported to be in excess of 330 million. The estimated number of PIVCs used across greater Europe or other regions of the world is largely unknown, although estimates from global device sales have been reported to be approximately 1.2 billion.[1, 2]

Robust data on the prevalence of PIVCs and their associated management and infection prevention practices remain poor in Western countries; even more concerning is that PIVC data in developing nations remain relatively unknown.[3] Healthcare‐associated infection rates are significantly higher in developing nations, where the lack of resources and staff training can contribute to poor PIVC insertion and management.[4, 5]

There are currently scant data on PIVC management practices across different regions of the world. Localized complication rates such as phlebitis and infiltration are an under‐reported problem, yet are known to be a contributing factor for PIVC failure that leads to premature cessation of intravenous (IV) therapy, device removal, and the requirement for resiting of a new PIVC. Such failure can lead to delays in IV therapy, increased length of hospital stay, and cost.[6] Importantly, it can also lead to patient‐reported anxiety and pain. This lack of information has made it difficult to identify contributing factors for PIVC failure that may include inserter characteristics, patient‐related factors, and anatomical placement as well as healthcare facility adherence to international best practice and infection prevention guidelines.[6, 7]

The aim of this study was to undertake a multicenter, international study to assess the prevalence of PIVCs across different countries, to review population and PIVC characteristics from different regions of the world, and ascertain whether a larger study would provide beneficial data. The data of interest for this study included: (1) prevalence of PIVC use, (2) patient and PIVC characteristics, (3) prevalence of localized symptoms such as phlebitis, and (4) PIVC securement and dressing practices.

MATERIALS AND METHODS

RESULTS

DISCUSSION

This study has shown variation in the prevalence, characteristics, and management practices of PIVCs across sites from different regions of the world. Estimates for global PIVC prevalence in hospitalized patients vary widely from 30% to 80%.[8, 9, 10] The overall prevalence of PIVCs in this pilot study at 59% lay in the midrange of those reported in recent literature,[11] yet we found disproportionate PIVC prevalence between sites and regions. This heterogeneity could be explained by a number of factors including cohort acuity, clinician preference, and hospital guidelines. The generalizability of results from participating hospitals to their country is limited, because in most countries only a single institution participated.

Insertion of PIVCs was mainly by nurses, except in the Oceania region, where specialist teams and medical staff were the primary inserters. Of concern was the disparity in training provided by sites, with medical staff being less likely to receive instruction in how to prevent infection during this important procedure. A larger study would be needed to understand the effect on patient and infection outcomes of different inserter models and training provided.

A small proportion of patients from a site in Western Europe were observed to have gauze and tape as the PIVC dressing. The preference for gauze and tape is not common in developed nations, although recommended in clinical practice guidelines as an acceptable option.[12] There is currently no strong evidence to suggest that any 1 dressing or securement device to secure PIVCs is more effective than any other.[13] Nearly a quarter of PIVCs were loose or lifting from the Oceania region, this is of concern as interrupted dressings have been shown to increase the risk of catheter failure and catheter‐related bloodstream infection.[14]

We found that 17% of PIVCs overall had no IV order for fluids or medication. This proportion of redundant catheters increases the burden of preventable intravascular infection.[15] The prevalence of unnecessary PIVCs was lowest in Asia and greatest in the Oceania region, where 43% had no documented IV orders.

We reported PIVC prevalence from only a small number of nonrepresentative international sites for the purpose of considering a larger prevalence study. Observed differences in PIVC care and management cannot be generalized to entire regions. We asked sites to focus on medicalsurgical wards, and as such some PIVCs in higher acuity areas were likely not included. A larger study will help to assess PIVC outcomes and contributing factors for any differences, and improve external validity.

Operational challenges also may have affected sample selection and size. This was an unfunded study undertaken by hospital investigators, with competing workload demands. Poor or slow internet connection at the bedside was reported by every participating site, and may have contributed to the small numbers of patients screened at some sites.

CONCLUSION

More than half of hospitalized patients screened internationally had a PIVC, and 1 in 4 patients had no VAD, with wide variability from country to country both in prevalence and practice. The data gained have provided valuable initial insights into the global variation in PIVC use and care, and confirm that a larger international study with multiple sites is warranted. In particular, it remains important to understand variations in PIVC use and whether country or regional trends increase the risk of infection.

Disclosures

All authors have made substantial contributions to the study conception and design, acquisition of the data, and analysis and interpretation of the data. Each author has contributed to drafting and editing the manuscript and approved the final version for publishing as per the International Committee of Medical Journal Editors convention. The authors wish to declare they have received unrestricted investigator‐initiated research grants from Becton Dickinson (BD) and 3M. The investigators also received professional translation services for most languages that were funded by B. Braun. All funds have been made payable to Griffith University and not to researchers themselves. These funders played no role in the conception, design, execution, analysis or reporting of the study. BD, 3M, CareFusion, Smiths Medical, B Braun, Vygon, and Teleflex assisted in disseminating study information and assisting with translation of data forms where necessary. No commercial entity had any involvement in the design, execution and analysis, or reporting of the study. Evan Alexandrou has provided education services for CareFusion, Teleflex, Cook Medical, and 3M. Peter Carr is undertaking a PhD, which is partly funded by BD. He has received payment for educational lectures from CareFusion. Claire Rickard's department (Griffith University) has received investigator‐initiated, unrestricted research/educational grants from suppliers of vascular access device products including: 3M, BD, CareFusion, and Centurion. Claire Rickard has undertaken contract research or educational lectures for Bard, BBraun, BD, CareFusion, and Teleflex. Sheila Inwood is an employee of CareFusion. Leonard Mermel has received research funding from Theravance, Astellas Pharma, Marvao Medical, and CareFusion, and he has been a consultant for 3M, CareFusion, Catheter Connections, Fresenius Medical, Marvao Medical, Bard Access, and ICU Medical.

Peripheral intravenous catheters (PIVCs) are ubiquitous devices that can have serious complications including bloodstream infections.[1] The annual use of PIVCs in North America has been reported to be in excess of 330 million. The estimated number of PIVCs used across greater Europe or other regions of the world is largely unknown, although estimates from global device sales have been reported to be approximately 1.2 billion.[1, 2]

Robust data on the prevalence of PIVCs and their associated management and infection prevention practices remain poor in Western countries; even more concerning is that PIVC data in developing nations remain relatively unknown.[3] Healthcare‐associated infection rates are significantly higher in developing nations, where the lack of resources and staff training can contribute to poor PIVC insertion and management.[4, 5]

There are currently scant data on PIVC management practices across different regions of the world. Localized complication rates such as phlebitis and infiltration are an under‐reported problem, yet are known to be a contributing factor for PIVC failure that leads to premature cessation of intravenous (IV) therapy, device removal, and the requirement for resiting of a new PIVC. Such failure can lead to delays in IV therapy, increased length of hospital stay, and cost.[6] Importantly, it can also lead to patient‐reported anxiety and pain. This lack of information has made it difficult to identify contributing factors for PIVC failure that may include inserter characteristics, patient‐related factors, and anatomical placement as well as healthcare facility adherence to international best practice and infection prevention guidelines.[6, 7]

The aim of this study was to undertake a multicenter, international study to assess the prevalence of PIVCs across different countries, to review population and PIVC characteristics from different regions of the world, and ascertain whether a larger study would provide beneficial data. The data of interest for this study included: (1) prevalence of PIVC use, (2) patient and PIVC characteristics, (3) prevalence of localized symptoms such as phlebitis, and (4) PIVC securement and dressing practices.

MATERIALS AND METHODS

RESULTS

DISCUSSION

This study has shown variation in the prevalence, characteristics, and management practices of PIVCs across sites from different regions of the world. Estimates for global PIVC prevalence in hospitalized patients vary widely from 30% to 80%.[8, 9, 10] The overall prevalence of PIVCs in this pilot study at 59% lay in the midrange of those reported in recent literature,[11] yet we found disproportionate PIVC prevalence between sites and regions. This heterogeneity could be explained by a number of factors including cohort acuity, clinician preference, and hospital guidelines. The generalizability of results from participating hospitals to their country is limited, because in most countries only a single institution participated.

Insertion of PIVCs was mainly by nurses, except in the Oceania region, where specialist teams and medical staff were the primary inserters. Of concern was the disparity in training provided by sites, with medical staff being less likely to receive instruction in how to prevent infection during this important procedure. A larger study would be needed to understand the effect on patient and infection outcomes of different inserter models and training provided.

A small proportion of patients from a site in Western Europe were observed to have gauze and tape as the PIVC dressing. The preference for gauze and tape is not common in developed nations, although recommended in clinical practice guidelines as an acceptable option.[12] There is currently no strong evidence to suggest that any 1 dressing or securement device to secure PIVCs is more effective than any other.[13] Nearly a quarter of PIVCs were loose or lifting from the Oceania region, this is of concern as interrupted dressings have been shown to increase the risk of catheter failure and catheter‐related bloodstream infection.[14]

We found that 17% of PIVCs overall had no IV order for fluids or medication. This proportion of redundant catheters increases the burden of preventable intravascular infection.[15] The prevalence of unnecessary PIVCs was lowest in Asia and greatest in the Oceania region, where 43% had no documented IV orders.

We reported PIVC prevalence from only a small number of nonrepresentative international sites for the purpose of considering a larger prevalence study. Observed differences in PIVC care and management cannot be generalized to entire regions. We asked sites to focus on medicalsurgical wards, and as such some PIVCs in higher acuity areas were likely not included. A larger study will help to assess PIVC outcomes and contributing factors for any differences, and improve external validity.

Operational challenges also may have affected sample selection and size. This was an unfunded study undertaken by hospital investigators, with competing workload demands. Poor or slow internet connection at the bedside was reported by every participating site, and may have contributed to the small numbers of patients screened at some sites.

CONCLUSION

More than half of hospitalized patients screened internationally had a PIVC, and 1 in 4 patients had no VAD, with wide variability from country to country both in prevalence and practice. The data gained have provided valuable initial insights into the global variation in PIVC use and care, and confirm that a larger international study with multiple sites is warranted. In particular, it remains important to understand variations in PIVC use and whether country or regional trends increase the risk of infection.

Disclosures

All authors have made substantial contributions to the study conception and design, acquisition of the data, and analysis and interpretation of the data. Each author has contributed to drafting and editing the manuscript and approved the final version for publishing as per the International Committee of Medical Journal Editors convention. The authors wish to declare they have received unrestricted investigator‐initiated research grants from Becton Dickinson (BD) and 3M. The investigators also received professional translation services for most languages that were funded by B. Braun. All funds have been made payable to Griffith University and not to researchers themselves. These funders played no role in the conception, design, execution, analysis or reporting of the study. BD, 3M, CareFusion, Smiths Medical, B Braun, Vygon, and Teleflex assisted in disseminating study information and assisting with translation of data forms where necessary. No commercial entity had any involvement in the design, execution and analysis, or reporting of the study. Evan Alexandrou has provided education services for CareFusion, Teleflex, Cook Medical, and 3M. Peter Carr is undertaking a PhD, which is partly funded by BD. He has received payment for educational lectures from CareFusion. Claire Rickard's department (Griffith University) has received investigator‐initiated, unrestricted research/educational grants from suppliers of vascular access device products including: 3M, BD, CareFusion, and Centurion. Claire Rickard has undertaken contract research or educational lectures for Bard, BBraun, BD, CareFusion, and Teleflex. Sheila Inwood is an employee of CareFusion. Leonard Mermel has received research funding from Theravance, Astellas Pharma, Marvao Medical, and CareFusion, and he has been a consultant for 3M, CareFusion, Catheter Connections, Fresenius Medical, Marvao Medical, Bard Access, and ICU Medical.