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Published on: July 13, 2019
Intravenous antimicrobial administration through peripheral venous catheters - establishing risk profiles from an
Emily N Larsen1, Nicole Marsh2, Gabor Mihala3
1Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
Introduction:
Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase the PVC failure rate, risk profiles for many are unclear.
Objective:
To synthesize data from prospective PVC studies conducted between 2013 and 2019 to determine associations between common antimicrobials and PVC failure.
Methods:
A secondary analysis was undertaken of seven randomized controlled trials and two prospective cohort studies from three quaternary hospitals (two adult and one paediatric) in Australia between 2013 and 2019. The primary outcome was PVC failure due to vessel injury (occlusion, infiltration or extravasation) or irritation (pain or phlebitis). Associations between antimicrobial use and PVC failure were explored using multi-variable Cox regression.
Results:
In total, 5252 PVCs (4478 patients) were analysed; vessel injury and irritations occurred in 19% and 11% of all PVCs, respectively. Vessel injury was significantly associated with cefepime hydrochloride [hazard ratio (HR) 2.50; 95% confidence interval (CI) 1.44-4.34], ceftazidime pentahydrate (HR 1.91, 95% CI 1.11-3.31), flucloxacillin sodium (HR 1.84, 95% CI 1.45-2.33), lincomycin hydrochloride (HR 1.67, 95% CI 1.10-2.52) and vancomycin hydrochloride (HR 1.73, 95% CI 1.25-2.40). Irritation was significantly associated with flucloxacillin sodium (HR 2.58, 95% CI 1.96-3.40).
Conclusions:
This study identified several antimicrobials associated with increased PVC failure, including some that were already known to be associated and some that had not been identified previously. Research is needed urgently to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure.
Insights
Certain antimicrobials significantly increase peripheral venous catheter (PVC) failure. Flucloxacillin and cefepime were linked to higher rates of vessel injury and irritation, necessitating further research into safer drug delivery methods.
Area of Science:
- Clinical Pharmacy
- Infectious Diseases
- Vascular Access Devices
Background:
- Peripheral venous catheters (PVCs) are crucial for antimicrobial administration but frequently fail before therapy completion.
- The risk of PVC failure associated with many antimicrobials remains poorly understood.
Purpose of the Study:
- To analyze prospective studies on PVCs from 2013-2019.
- To identify associations between common antimicrobial agents and the risk of PVC failure.
Main Methods:
- Secondary analysis of 9 studies (7 RCTs, 2 cohort studies) involving 5252 PVCs in Australia.
- Primary outcome: PVC failure due to vessel injury or irritation.
- Multivariable Cox regression used to assess antimicrobial-PVC failure associations.
Main Results:
- Vessel injury occurred in 19% of PVCs; irritation in 11%.
- Significant associations with vessel injury: cefepime, ceftazidime, flucloxacillin, lincomycin, and vancomycin.
- Flucloxacillin was also significantly associated with irritation.
Conclusions:
- Several antimicrobials, including flucloxacillin and cefepime, are linked to increased PVC failure.
- Urgent research is required to optimize antimicrobial delivery methods and prevent PVC failure.
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