Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study

Abstract

Background: Catheter-related infections (CRIs) caused by peripheral intravenous catheters (PIVCs) are an increasingly common iatrogenic complication. To prevent this, recommended timelines for routine replacement of PIVCs have increased from 48 h to 72 h and subsequently to 96 h, despite a lack of supporting scientific evidence.

Aim: To compare closed-system (COS) PIVCs with open-system (MOS) PIVCs.

Methods: This prospective, randomized controlled trial compared the indwell time of COS PIVCs without complications with that of MOS PIVCs, removed only by clinical indication. In total, 1199 PIVCs (642 inpatients) were randomized and 283 PIVCs were cultured. Sixteen catheters (11 patients) were lost to the study after randomization.

Findings: In total, 104,469 catheter-hours (54,173 h in 584 COS and 50,296 h in 599 MOS) were recorded. The median dwell time was 137.1h for COS PIVCs and 96 h for MOS PIVCs (P = 0.001). Among PIVCs in place for ≥ 24 h, the median dwell time was 144.5h for COS PIVCs [95% confidence interval (CI) 123.4-165.6] and 99 h for MOS PIVCs (95% CI 87.2-110.8). Use of COS PIVCs reduced phlebitis rates by 29% (31 vs 45 cases/1000 catheter-days; P = 0.004). The probability that a MOS PIVC would last for 96 h was 79.9%, and the probability that a COS PIVC would last for 144 h was 80.4%. There were no significant differences in rates of bacterial colonization per 1000 catheter-days (51.1 COS vs 54.1 MOS) or CRI (5.76 COS vs 6.65 MOS). Nevertheless, there was a 20% relative risk reduction in CRI.

Conclusion: Use of COS PIVCs reduced episodes of phlebitis and risk of infection at a cost of only € 0.09/day. When PIVCs are replaced based on clinical indication, COS PIVCs last for up to 144 h and MOS PIVCs last for up to 96 h without increased risk and with significant cost savings (€ 786,257/year/1000 beds).

Keywords: Catheter-related infection; Closed system; Cost analysis; Indwell time; Phlebitis; Safety peripheral intravenous catheters.