Impact of catheter dwell time on peripheral-venous-catheter-associated bloodstream infections

Peripheral intravenous catheter (PVC) insertion is the most common invasive medical procedure in hospitals worldwide. PCV-associated bloodstream infections (PVC-BSIs) are rare, but are severe and preventable.

To study the impact of catheter dwell time on risk of infection, and investigate the incidence of PVC-BSIs.

This observational cohort study evaluated all adult hospitalized patients with PVC insertion at Helsinki University Hospital, Finland between 1^st January 2021 and 31^st December 2023. Characteristics of inserted PVCs and PVC-BSI cases were identified.

In total, 548,633 PVCs were inserted among 208,073 patients during the study period. The median patient age was 66.0 [interquartile range (IQR) 46.0-76.0] years, and 48% were male. The median PVC dwell time was 1.6 (IQR 0.9-2.9) days. In total, 134 PVC-BSIs were observed, representing 0.02% of all inserted PVCs. Staphylococcus aureus caused 89% of PVC-BSIs, and all but one PVC-BSIs were due to Gram-positive bacteria. The risk of infection increased markedly with longer dwell time, with the sharpest rise observed on catheter day 5. Mixed effects logistic regression models revealed that dwell time [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.06-1.14; P < 0.001] and insertion site [both wrist (OR 3.28, 95% CI 1.74-6.19; P < 0.001) and cubital fossa (OR 2.64, 95% CI 1.57-4.43; P < 0.001) compared with hand] were risk factors for PVC-BSIs. PVC insertion on medical wards, emergency departments and intensive care units also increased the odds of infection in comparison with surgical wards.

The results of this cohort study, based on a large prospective surveillance dataset, indicate that dwell time is associated with the development of PVC-BSIs.