ISSUE

Short Peripheral Intravenous Catheters (PIVCs) are a critical tool in today’s healthcare settings. They are the most commonly used device for vascular access, with more than 300 million used each year in U.S. hospitals alone. But despite their frequent use, they are not without risks. IV infection, either local around the IV catheter insertion site, or systemic in the bloodstream, can be a potential complication with any IV start.

The statistics on healthcare-associated infections (HAIs) in general show they are now the most common complication of hospitalized patients, with one out of every twenty patients in acute care settings acquiring one or more infections. These infections cause approximately 90,000 deaths and cost almost $4.5 billion annually.

The four major types of HAIs are pneumonia, catheter-related bloodstream infections (CRBSIs), surgical site infections, and infection related to urinary catheters. Of these, perhaps the least common but most deadly and costly is CRSBIs. The incidence of local or catheter-related bloodstream infections (CRBSIs) associated with PIVCs has historically been reported to be low. However, there is emerging evidence suggesting that IV catheter infections are not as rare as once thought, and because these devices are so widely used, there is the potential for them to cause a large number of serious or deadly infections every year.

One recent study conducted by Rhode Island Hospital, found that more than one in ten CRBSIs in their hospitalized patients were caused by infected PIVCs. Some risk factors for IV infection include extended duration of catheterization, concurrent infection, poor IV catheter insertion technique, and improper catheter care.

CHALLENGES

How can a PIVC cause infection?

IV catheter insertion penetrates the skin, creating an open pathway for organisms to enter the bloodstream. Skin antisepsis can’t eliminate all organisms in the lower layers of the skin. During insertion, the needle and catheter pass through the skin and come in contact with these organisms. The needle is removed and the catheter remains in place, to be accessed over and over to administer medication, flush the line, and change the tubing or caps, potentially introducing microorganisms into the system each time.

One study found that catheters removed because of a complication such as phlebitis, leakage, or infiltration had high rates of culture-positivity. It may be that the practice of manipulating occluded, leaking, or infiltrated catheters provides an opportunity for introducing contaminants and perpetuating infections of short-term intravascular devices, including peripheral venous catheters, mainly from microorganisms colonizing the skin around the IV catheter insertion site.

Most patients with phlebitis do not have systemic infection, but the presence of phlebitis confers an 18-fold increased risk of related sepsis as compared with no phlebitis. In fact, approximately one half of the patients with catheter-related septicemia will have phlebitis. When present, phlebitis is very suggestive of an IV-related origin of infection. Published incidences of phlebitis may be underestimating the true number of occurrences.

Securement is important.

One way to minimize the chance of IV catheter infection is to make sure the PIVC is held securely in place. Even a small amount of catheter movement may put a patient at risk for complications from their IV, and complications have been linked to a higher likelihood of infection. Once the PIVC is inserted, the catheter should be firmly secured in place to prevent movement that might traumatize the cannulated vein and facilitate entry of organisms into the IV catheter insertion site. IV catheter-related sepsis can occur if phlebitis is allowed to progress.

Tape has been shown to be inadequate in preventing catheter movement and it can be a possible contributor to complications that can lead to IV infection at the insertion site. Yet it is still commonly used to secure IV catheters to the patient, either alone or in combination with other dressings. One published study demonstrated that after only 24 hours, 74 percent of tape samples (taken from rolls used to secure PIVCs) cultured positive for pathogenic bacteria. When non-sterile tape is placed close to the insertion site for extended periods infection may occur. Beyond that, tape can injure a patient’s skin, which is the body’s first line of defense against infection.

Unnecessary PIVCs pose problems

The length of time an IV catheter is left in place may heighten the potential for infection. One study highlighted the “idle IV,” left in place in case access might be needed but with no present therapeutic use, as a common source of IV infection. Their data suggests that PIVCs are frequently used unnecessarily and recommends focusing on reducing unnecessary use as one way to reduce infection rates.

SOLUTION

The practice of eliminating add-on components, minimizing handling, and striving to keep infusion systems “closed” as a measure for IV infection prevention has been applied to IV fluid containers and tubings for quite some time. Now this same concept is being applied to a recently introduced IV catheter system at the point of insertion into the patient. A traditional IV catheter requires the addition of an extension set or needleless connector or both.

The NovaCathTM Integrated IV Catheter system provides a closed system at the point of insertion, eliminating the need to connect an extension set to a catheter hub. The NovaCath Advanced Catheter Stabilization System combines integrated tubing and a built-in securement frame with two stabilization platforms. After insertion, the tubing is flipped over and secured in place to provide 360 degrees of stabilization. This eliminates the need for any manipulation of the catheter hub and removes the loop of tubing created when an extension set is attached. 

This closed IV catheter system prevents blood leakage during insertion, reduces vein trauma, and decreases the potential for touch contamination of the catheter hub. The NovaCath Integrated IV Catheter system technology is designed to prevent the complications of IV therapy that can lead to IV catheter infection.

NovaCath is the only FDA 510(k) cleared Safety IV Catheter system and patent protected technology that uniquely offers Advanced Catheter Stabilization, Next Generation Tubing Management and Passive Needle Encapsulation. To view a demo video, click here.