Effectiveness and safety of measures to prevent infections and other complications associated with peripheral intravenous catheters: A systematic review and meta-analysis.

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
09 Apr 2024
Historique:
received: 14 02 2024
revised: 28 03 2024
accepted: 05 04 2024
medline: 9 4 2024
pubmed: 9 4 2024
entrez: 9 4 2024
Statut: aheadofprint

Résumé

Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL and reference lists for controlled studies, from January 1, 1980-March 16, 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with three or more trials, we conducted Bayesian random-effects meta-analyses. 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for eight research questions.Based on findings of low to high COE, wearing gloves reduced the risk for overall adverse events related to insertion compared to no gloves (one non-randomised controlled trial [RCT]; adjusted risk ratio [RR]: 0.52, 95% confidence interval 0.33-0.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR: 0.74, 95% credible interval 0.49-1.01) compared to clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared to non-chlorhexidine-containing disinfection (one RCT; 0.14 versus 0.68, p = 0.003). No statistically significant differences were found for other measures. Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications.

Sections du résumé

BACKGROUND BACKGROUND
Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications.
METHODS METHODS
We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL and reference lists for controlled studies, from January 1, 1980-March 16, 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with three or more trials, we conducted Bayesian random-effects meta-analyses.
RESULTS RESULTS
105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for eight research questions.Based on findings of low to high COE, wearing gloves reduced the risk for overall adverse events related to insertion compared to no gloves (one non-randomised controlled trial [RCT]; adjusted risk ratio [RR]: 0.52, 95% confidence interval 0.33-0.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR: 0.74, 95% credible interval 0.49-1.01) compared to clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared to non-chlorhexidine-containing disinfection (one RCT; 0.14 versus 0.68, p = 0.003). No statistically significant differences were found for other measures.
CONCLUSIONS CONCLUSIONS
Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications.

Identifiants

DOI: 10.1093/cid/ciae195 PMID: 38593192
pubmed: 38593192
pii: 7642934
doi: 10.1093/cid/ciae195
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

Auteurs

Andreea Dobrescu (A)

Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.
ORCID: 0000-0002-0427-3714

Alexandru Marian Constantin (AM)

Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila," Dionisie Lupu 37, 030167 Bucharest, Romania.

Larisa Pinte (L)

Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila," Dionisie Lupu 37, 030167 Bucharest, Romania.

Andrea Chapman (A)

Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.

Piotr Ratajczak (P)

Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Rokietnicka 7, 60806, Poznan, Poland.

Irma Klerings (I)

Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.

Robert Emprechtinger (R)

Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.

Benedetta Allegranzi (B)

Infection Prevention and Control Unit, Department of Integrated Health Services, WHO, Avenue Appia, 1211 Geneva 27, Switzerland.

Walter Zingg (W)

Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.

M Lindsay Grayson (ML)

Infection Prevention and Control Unit, Department of Integrated Health Services, WHO, Avenue Appia, 1211 Geneva 27, Switzerland.
Department of Medicine, University of Melbourne, Melbourne, Australia.
Infectious Diseases Department, Austin Health, Melbourne, Australia.

Joao Toledo (J)

Infection Prevention and Control Unit, Department of Integrated Health Services, WHO, Avenue Appia, 1211 Geneva 27, Switzerland.
High Impact Epidemics, WHO Health Emergencies Programme, WHO, Avenue Appia, 1211 Geneva 27, Switzerland.

Gerald Gartlehner (G)

Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.
Center for Public Health Methods, RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194. USA.

Barbara Nussbaumer-Streit (B)

Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Austria, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.

Classifications MeSH