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AUGUST 01

INS standards of practice: Don’t overlook peripheral IVs as a source of infection

5 ways to target underrated CABSI risk from PIVs

PIV insertion

Clinicians work hard to prevent central line associated blood stream infections (CLABSIs)—and for good reason. Central line catheter tips terminate in the superior vena cava making them high risk. And because CLABSIs are called “never events” by the CDC—meaning they’re considered 100% preventable—when they do occur, related care is not reimbursed by Medicare or other insurers.

But many vascular access clinicians believe that infection related to peripheral IVs has long been underestimated and deserves equal attention. In fact, studies back them up showing that peripheral IVs (PIVs) may cause as many or more BSIs as central lines.1

About 200 million PIVs

are inserted annually in the United States,2 compared to about 5 million central lines.3 BSIs linked to PIVs could approach or even surpass that of central lines.1

The Infusion Nurses Society (INS) recognizes that infection risk from peripheral IVs requires more attention in its 2021 Infusion Therapy Standards of Practice. It introduced the term catheter associated bloodstream infection (CABSI) to describe any infection stemming from peripheral intravenous catheters (PIVCs) and/or central venous catheters (CVCs). This shift expands clinician awareness beyond central lines and CLABSI risk. It recognizes that all BSIs can cause serious harm to patients4 and can come from any catheter source.

About 200 million PIVs2 are inserted annually in the United States, compared to roughly 5 million central lines.3 Given the high volume of peripherals and even accounting for central lines’ longer dwell times, the number of BSIs linked to PIVs could approach or even surpass that of central lines.1

Donna Matocha, DNP, a Medline Manager of Clinical Resources-Critical Care and former ICU nurse says, “If you have a patient with both a central line and a PIV and that patient gets a BSI, who can say where it originated from? Bugs don’t choose one line over another. Infection occurs because there’s a break in the skin providing an opportunity for bugs to enter the body and proliferate.”

The INS CABSI terminology focuses everyone’s attention on “a risk that’s always been there,” says Matocha adding, “You have to reduce risk around all catheters, not just central lines. PIVs aren’t benign.”

Donna Matocha

“We’ve made great strides around getting central lines out as soon as we no longer need them. We’re not as good about removing PIVs when they should be removed.”

Donna Matocha, DNP, Medline Manager of Clinical Resources—Critical Care

Hospitals are starting to mandate the same kinds of protocols for PIVs that central lines require to reduce cost and improve care quality. A patient with a CABSI may spend up to five extra days in the hospital for antibiotic therapy, adding to length of stay. And a BSI can cost a hospital an average of $48,000 each occurrence.5

“We’ve made great strides around getting central lines out as soon as we no longer need them,” Matocha says. “We’re not as good about removing PIVs when they should be removed. Let those veins heal. Eliminate the infection risk. Awareness and culture change, that’s how you begin.”

5 best practices to help reduce CABSIs

Matocha consults closely with healthcare leaders on discovery assessments, an opportunity to review a facility’s practices and problems and develop a plan for them to improve outcomes. Following are some key recommendations she offers to improve safety culture around catheters.

  1. Choose the catheter thoughtfully
    Consider which catheter is least invasive to the patient as recommended by INS standards.
  2. Remove peripheral catheters if unused
    Remove unused or dormant PIVs as soon as possible. Having a PIV in for greater than three days significantly increases risk.2 And allowing the veins to heal without a PIV creates a better opportunity for successful insertion later if a catheter is needed.
  3. Support best practices with easy-to-use kits and procedures
    Every catheter insertion, line access and dressing change can open the door to microbial invaders. Training on best practices is important. And using products like insertion and maintenance bundles to help standardize procedures is key.
  4. Practice consistent hand hygiene
    It’s easy to overlook, but aseptic techniques and consistent hand hygiene go a long way toward preventing infection. Use hand sanitizer and sterile gloves when inserting a catheter and providing maintenance care.
  5. Put a disinfection cap on every line, every time
    The INS recommends using a disinfection cap on all lines, including unused lumens, to kill germs and create an infection barrier. Caps should be replaced every time the line is accessed or flushed. A syringe with an integrated cap helps standardize practice.

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Key takeaway

The 2021 INS Infusion Therapy Standards of Practice uses the term catheter-associated blood stream infection (CABSI) to recognize that harmful BSIs can come from any catheter source, not just central lines. CLABSI reduction has received much focus while the infection risks of peripheral IVs have been mostly overlooked. PIVs have lower BSI rates than central lines but are used in such high volume that bloodstream infections from peripheral IVs could match or outnumber those from central lines. PIVs and central lines should be removed as soon as they’re no longer needed to reduce CABSI risk. Use of insertion and maintenance bundles and putting disinfection caps on every line helps to reduce CABSIs.

Looking for more ways to help clinicians keep patients safe from CABSIs?

Explore a comprehensive Vascular Access Management Solution offering best practice guidance, educational resources and a system of products designed to make CABSI prevention second nature.

Discover the 10 most common gaps in catheter care according to 3,900 clinician surveys. Medline’s 2019 BSI Discovery Assessment Findings reveals practice gaps that can lead to CABSIs.

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References:

  1. Nickel, B. (2020). Hiding in Plain Sight: Peripheral Intravenous Catheter Infections. Critical Care Nurse, 40(5), 57–66. Available at: https://doi.org/10.4037/ccn2020439 (Accessed June 14, 2021)
  2. Mermel, L. A. (2017). Short-term Peripheral Venous Catheter–Related Bloodstream Infections: A Systematic Review. Clinical Infectious Diseases, 65(10), 1757–1762. Available at: https://doi.org/10.1093/cid/cix562 (Accessed June 14, 2021)
  3. Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: internal jugular versus subclavian access–a systematic review. Crit Care Med 2002; 30:454. Available at: https://www.uptodate.com/contents/overview-of-central-venous-access-in-adults (Accessed June 14, 2021)
  4. Sato, A., Nakamura, I., Fujita, H., Tsukimori, A., Kobayashi, T., Fukushima, S., Fujii, T., & Matsumoto, T. (2017). Peripheral venous catheter-related bloodstream infection is associated with severe complications and potential death: a retrospective observational study. BMC Infectious Diseases, 17(1). Available at: https://doi.org/10.1186/s12879-017-2536-0 (Accessed June 14,2021)
  5. Agency for Healthcare Research and Quality. Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital-Acquired Conditions. Available at: https://www.ahrq.gov/professionals/quality-patient-safety/pfp/haccost2017-results.html Accessed June 14, 2021.
  6. Seiler, L. Rachel, Meyer, Shante, Bayshore Medical Center Case study. Improving Infection Control Compliance Using Combined Cap/Flush Syringe Technology to Reduce Central Line Associated Infections
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