Letters
Health services administration
Volume 201 - Issue 4

Preventing peripheral intravenous catheter-associated bloodstream infection: the randomised controlled trial versus the real world

Authors:  Diana Egerton-Warburton, George Braitberg and Anthony Kambourakis

Med J Aust 2014; 201 (4): 197-198. || doi: 10.5694/mja14.00363
Published online: 18 August 2014
Consider all the evidence to ensure safe stewardship of PIVCs
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To the Editor: Debate regarding the prevention of peripheral intravenous catheter (PIVC)-associated bloodstream infection has been enriched by research and letters published in the Journal.1-3 Stuart and colleagues and Collignon and colleagues highlighted an association of long dwell times with PIVC-associated bloodstream infection.1,2 Rickard and colleagues refer to contrasting high-level evidence in a Cochrane review.3,4 We would suggest that important lessons can be learnt from both perspectives.

The Hawthorne effect and strict inclusion and exclusion criteria mean that, while largely free of bias, the outcomes of clinical trials are not generalisable. The retrospective data on PIVC-associated bloodstream infections reported by Stuart et al and Collignon et al, while methodologically limited, demonstrate the real-world experience of hundreds of patients.1,2

We believe that clinicians should consider all forms of evidence when designing processes to ensure safe stewardship of PIVCs. In health services with independent “line teams” and a comprehensive PIVC insertion bundle, a “replace as clinically indicated” approach may be appropriate. Other health care services may be better suited to a mandatory replacement policy.

Given evidence that half of PIVCs inserted in our tertiary emergency department (ED) were unused,5 along with the evidence of PIVC-associated infection,1 Monash Health introduced a comprehensive multimodal change process to reduce unused PIVCs and subsequent bloodstream infections. Clinicians in Monash Health EDs are asked to only insert a PIVC if they feel it is at least 80% likely it will be used in the following 4 hours. An accompanying education campaign provides guidance in cases where a precautionary PIVC may be required, such as for patients who present after a seizure. The aim of the intervention is to avoid insertion of unnecessary PIVCs, while ensuring appropriate insertion, and to improve insertion methods. Four months after the intervention began, we demonstrated a reduction in total monthly PIVCs from 1413 to 928 and an unused PIVC rate of 19.3% (unpublished data). This change process has been offered to EDs throughout Victoria by the Department of Health.6

We would support the establishment of a specific national standard regarding the stewardship of PIVCs, which should include the need to carefully evaluate whether insertion of the PIVC is necessary.

Authors

  • Diana Egerton-Warburton1,2
  • George Braitberg1
  • Anthony Kambourakis1
  • 1. Monash Health, Melbourne, VIC.
  • 2. Southern Clinical School, Monash University, Melbourne, VIC.

Correspondence: diana.egertonwarburton@monashhealth.org

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library

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