We know all about reducing risks from central venous catheters (CVCs). Matching Michigan. High Impact Interventions. And reductions in CVC-associated BSIs. But we don’t spend enough time or effort in addressing risks associated with peripheral venous catheters. Infection Prevention in Practice recently published an expert opinion piece about achieving best practice in the use of PVCs.

The numbers around PVCs are stark. Something like 70% of inpatients will have a PVC at some point during their stay, and at any point in time, around 30-50% of inpatients will have a PVC in place. Around 50% of PVCs will fail, due to infiltration, occlusion, phlebitis, dislodgement, or infection. Whilst infections are relatively uncommon (linked to around 0.2% of PVCs overall), they are the most impactful complication (excellent review of PVC-associated BSIs here).

The expert consensus review is well worth a read, and illustrates that there was pretty broad agreement amongst the international panel of experts. There were a couple of areas where the expert panel didn’t reach a consensus:

• Routine replacement versus clinically indicated replacement. Whilst in the UK, the guidance recommends clinically indicated replacement, some experts argued that without a routine change, PVCs are at risk of being neglected or even completely forgotten about. Some also pointed to evidence that some PVC complications are more common with a policy of clinically indicated removal.
• Gloves for insertion and care. 3/12 panel members argued that sterile gloves should be used for PVC insertion, whereas 9/12 argued that non-sterile gloves should be used. Similarly, some panel members agreed that sterile gloves should be used for PVC care, whereas others voted for non-sterile gloves.
• Active or passive hub disinfection. The expert panel agreed that disinfection caps are effective to prevent hub contamination but there was no consensus about whether such devices are superior to scrubbing the hub before use.

Whilst, as is always the case, the experts don’t agree on every point, there is no doubt in my mind there is much more we can to do improve our management of PVCs and make tangible improvements in patient outcomes as a result.

Finally, a reminder that next Wednesday’s IPC Journal Club will be on “Vascular access and infection prevention: making peripheral lines a central focus” – you can register here.