COVE R S TORY
New standard-setting best practices for peripheral IV catheters
The results of the CLEAN3 trial show that the risk of complications associated with the placement of peripheral intravenous catheters can be reduced through the use of a vascular care solution.1
Inserting peripheral intravenous catheters (PIVCs) is one of the most frequently performed invasive procedures in hospitals,2 with around two billion PIVCs placed annually worldwide.3
Despite this, current PIVC
practices are inconsistent, which can lead to sub-optimal care.4
The evidence shows that
catheter-related complications are common – leading to bloodstream infections and resulting in increased length of hospital stay, treatment costs and mortality.5 Catheter replacement can also cause unnecessary pain for patients and additional cost for the healthcare provider.6
In fact,
in hospitals, 35% to 50% of PIVCs do not meet their intended dwell time and need to be removed prematurely due to preventable complications, such as infection, occlusion, phlebitis, dislodgement and infiltration.2 However, robust evidence demonstrates that using a vascular care solution can help improve outcomes for patients requiring PIVCs. The results of the CLEAN3 trial,1 published in the [February] edition of The
Lancet Infectious Diseases, showed the use of the BD vascular care solution resulted in fewer PIVC failures compared with the standard group (34.8% vs. 47.5%. respectively) and extended the median time between catheter insertion and failure (50.4 hours vs 30.0 hours, respectively). The CLEAN3 trial also evaluated skin antiseptics with 2% chlorhexidine-gluconate (CHG) 70% isopropyl alcohol (IPA) single use, sterile applicator (BD ChloraPrep™), versus 5% povidone iodine (PVI) 69% ethanol applied with sterile gauze, in preventing infectious complications related to the use of PIVCs (catheter colonisation: 0.9% vs. 16.9%, respectively; local infection: 0% vs. 1.2%, respectively). The trial, which involved approximately 1,000 patients from nine different medical wards within a single university hospital (Poitiers University Hospital, France), evaluated PIVC failure rates by comparing the BD vascular care solution for peripheral IV catheters, which included an integrated
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PIVC (BD Nexiva™), a positive displacement needle-free connector (BD MaxZero™), a disinfecting cap (BD PureHub™) and a sterile prefilled flush syringe (BD Posiflush™) – compared with a standard group, which included a straight safety PIVC (BD Insyte™ Autoguard™ BC Winged), extension set three-way stopcock, and the PIVCs were continuously infused with saline or polyionic solution, by gravity. “The findings of the CLEAN3 trial
support the use of an integrated solution as the best practice standard when peripheral IV catheter dwell time is expected to exceed 24 hours,” said Professor Olivier Mimoz, head of the emergency department at Hôpital Universitaire de Poitiers, France, and principal investigator of the CLEAN3 trial. “We recommend that the use of 2% CHG 70% IPA single use, sterile applicator should become the first-line antiseptic for skin disinfection prior to PIVC insertion. We believe that the results can be extrapolated to all adult patients admitted to a medical ward requiring a PIVC placement and to those admitted to a surgical ward.”
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WWW.CLINICALSERVICESJOURNAL.COM SEPTEMBER 2021
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