Towards Evidence-Based Practice: A Comparative Safety Analysis of Venous Catheters in Critically Ill Adults

Venous catheter selection is a crucial aspect of patient care, impacting treatment outcomes, patient safety and healthcare sustainability performance. While central venous catheters (CVCs) offer advantages for certain clinical situations, their safety profile compared to peripheral venous catheters (PVCs) remains a subject of debate.

This study aimed to compare the safety profiles of CVCs and PVCs to inform evidence-based practice and improve sustainability performance in venous catheter selection.

A two-group, prospective observational cohort study included adult patients (≥ 18 years) admitted to the emergency department and intensive care units of a university hospital in Assiut, Egypt. The safety profile was assessed using three key metrics: the Infection Probability Score (IPS), rates of Healthcare-Associated Infections and Sepsis (HAIS) and in-hospital mortality.

While all 200 enrolled patients completed the study (160 ICU, 40 ED), the subgroup analysis was limited to 160 ICU patients due to the smaller ED group size. Central venous catheters were associated with a higher rate of catheter occlusion (40.0% (n=32) vs. 31.3% (n=25), p=0.248), while peripheral venous catheters were predominantly associated with phlebitis (18.8% (n=15) vs. 27.5% (n=22), p=0.189) and extravasation (0.0% (n=0) vs. 3.8% (n=3), p=0.080, OR = 7.2, 95% CI 2.7-140.2). Furthermore, patients with central venous catheters had a higher mean infection prevention score (17.6 ± 2.4 vs. 12.7 ± 5.1, p < 0.001, r = 0.520) and a significantly greater likelihood of healthcare-associated infections (91.3% (n=73) vs. 25.0% (n=29), p < 0.001, OR = 31.3, 95% CI 12.4-79.0). Notably, mortality was significantly higher among patients with central venous catheters (71.3% (n=57) vs. 6.3% (n=5), p < 0.001, OR = 37.2, 95% CI 13.3-103.8).

These findings suggest that, despite the potential benefits of central venous catheters, the presence of a CVC is associated with a higher risk of severe complications, including infection, healthcare-associated infections, and mortality, compared to peripheral venous catheters in this observational cohort. This elevated risk profile may negatively impact sustainability performance by increasing resource utilization, treatment costs, and the burden of harm. The large observed effect sizes, supported by high post-hoc power, strengthen the evidence for this association within the study population. However, as this was an observational study without adjustment for potential confounding factors such as severity of illness or indication for catheter type, these results demonstrate association and cannot infer causation. The findings highlight the complex risk-benefit assessment required in clinical decision-making.

These findings highlight the importance of a meticulous assessment of patient needs and risk factors when selecting a venous catheter. Clinicians should carefully weigh the potential benefits of central venous catheters against the increased risk of complications, particularly in patients with heightened susceptibility to infection or those requiring shorter-term intravenous access. Prioritising peripheral venous catheters whenever feasible may contribute to improved patient safety, outcomes and overall sustainability performance of healthcare delivery by preventing costly complications and enhancing resource efficiency.