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Cir Cardiov 2016;23:192-8 - DOI: 10.1016/j.circv.2016.06.001
Special Article
2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults
Documento de Consenso de 2016 sobre la prevención, diagnóstico y tratamiento de las infecciones por catéter venoso periférico en adultos
Josep A. Capdevilaa,1,2,, , María Guembeb, José Barberánc,2,3, Arístides de Alarcónd,1, Emilio Bouzab,1, M. Carmen Fariñase,1, Juan Gálvezf,1, Miguel Angel Goenagag,1, Francisco Gutiérrezg,1, Martha Kestlerb,1, Pedro Llinaresh,1, José M. Mirói,1, Miguel Montejoj,1, Patricia Muñozb,1, Marta Rodriguez-Creixemsb,1, Dolores Sousah,1, José Cuencak,4, Carlos-A. Mestresi,l,1,4, on behalf the SEICAV, SEMI, SEQ and SECTCV Societies
a Servicio de Medicina Interna, Consorcio Sanitario de Mataró, Mataró, Barcelona, Spain
b Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Medicina Interna, Hospital Universitario MontePrincipe, Madrid, Spain
d Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
e Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
f Servicio de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
g Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
h Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
i Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
j Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Spain
k Servicio de Cirugia Cardiaca, Hospital Universitario de A Coruña, A Coruña, Spain
l Cardiothoracic and Vascular Surgery, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Recibido 30 mayo 2016, Aceptado 02 junio 2016
Abstract

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications.

Resumen

El uso de catéteres vasculares es una práctica muy utilizada en los hospitales. El uso de catéteres venosos periféricos de corta duración se ha asociado con un elevado riesgo de bacteriemia nosocomial, lo que comporta una no despreciable morbilidad y mortalidad. La etiología de estas infecciones suele ser frecuentemente por Staphylococcus aureus, lo que explica su gravedad. En este documento de consenso, elaborado por un panel de expertos de la Sociedad Española de Infecciones Cardiovasculares con la colaboración de expertos de la Sociedad Española de Medicina Interna, la Sociedad Española de Quimioterapia y la Sociedad Española de Cirugía Torácica-Cardiovascular, pretende establecer unes normas para un mejor uso de los catéteres venosos periféricos de corta duración. El Documento revisa las indicaciones para su inserción, mantenimiento, registro, diagnóstico y tratamiento de las infecciones derivadas y las indicaciones para su retirada; haciendo énfasis en la formación continuada del personal sanitario para lograr una mayor calidad asistencial. Seguir las recomendaciones del consenso permitirá utilizar de una manera más homogénea los catéteres venosos periféricos minimizando el riesgo de infección y sus complicaciones.

Abreviaturas
SEICAV, SEMI, SEQ, SECTCV, PVC, ICU, NCBI, NLM, PICC, ISDA
Palabras clave
Infección de catéter, Catéter venoso periférico, Prevención de la infección de catéter, Diagnóstico de la infección de catéter, Tratamiento de la infección de catèter
Background

The use of endovascular catheters is generalized practice in the hospital setting.1 A recent prevalence study showed that 81.9% of patients admitted to Internal Medicine services are inserted with one or more catheters, out of which 95.4% are short duration peripheral lines.2 It has also recently been documented the increasing influence of peripheral catheters as a driver for nosocomial bacteremia with high associated morbidity and mortality.3–5 Several studies have shown that the risk of bacteremia related to a peripheral venous catheter (PVC) is similar to that of central venous lines6 with an estimate of 0–5 bacteremia episodes per 1000 catheter-days in admitted adult patients.4,6 Furthermore, the vast majority of cases of PVC-related bacteremia are S. aureus bacteremia; this is different from central venous lines, being S. epidermidis the most frequent isolated pathogen in the latter setting.3,4 This yields a higher complication rate including nosocomial endocarditis thus making treatment difficult. There are several guidelines and consensus documents on prevention, diagnosis and treatment of central venous catheter-related infections7–10 that have greatly contributed to reduce the infection rate and facilitate its management, especially in Intensive Care Units (ICU). However, there is scanty literature focusing on short duration peripheral catheters which are those mostly used out of the ICU setting.1,11 Several observational studies have shown that there is lack of knowledge on how to use PVC by the attending staff12 and on the opportunities to improve its handling.1,12–14

Objective

The objective of this Consensus Document is to review evidence and make recommendations for management of short duration PVC in adults. This will allow uniformity in usage thus minimizing the risk of infection and its complications.

Participating organizations

This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections (SEICAV) in cooperation with experts from the following scientific societies: Spanish Society of Internal Medicine (SEMI), Spanish Society of Chemotherapy (SEQ) and Spanish Society of Thoracic-Cardiovascular Surgery (SECTCV).

Methods

The recommendations for insertion, handling and removal of PVCs and also what to do when suspecting infection (diagnosis) and its treatment are issued based on the best scientific available evidence or, when not available, on expert opinion. Therefore, PubMed (www.PubMed.org) literature search between 1986 and 2015 has been performed. This is a well-known free access resource established and maintained by the National Center for Biotechnology Information (NCBI) of the National Library of Medicine (NLM) of the USA, which provides free access to MEDLINE, the database of citations and abstracts of the NLM. It currently stores over 24 million citations from over 5600 biomedical journals.

In our PubMed search using the Medical Subject Headings (MeSH) terms “management of peripheral venous catheter” (N=363) and “peripheral catheter-related bacteremia” (N=260), studies related to newborns or pediatric patients and studies on peripherally inserted central catheters (PICC) were discarded. MeSH terms is the NLM controlled vocabulary thesaurus used for indexing articles for PubMed (www.pubmed.org). Guidelines on prevention, diagnosis and treatment of catheter infection were reviewed.7–10

The levels of evidence and strength of recommendations according to the below definitions will be shown in bold within brackets when a recommendation is made in the text.

Definitions

Table 1 describes the levels of evidence and the strength of recommendations according to the criteria of the Infectious Disease Society of America (ISDA).15

Table 1.

Infectious Disease Society of America – United States Public Health Service Grading System for ranking recommendations in clinical guidelines.15

Category, grade  Definition 
Strength of recommendation
Good evidence to support a recommendation for use 
Moderate evidence to support a recommendation for use 
Poor evidence to support a recommendation 
Moderate evidence to support a recommendation against use 
Good evidence to support a recommendation against use 
Quality of evidence
Evidence from >1 properly randomized, controlled trial 
II  Evidence from >1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from >1 center); from multiple time-series; or from dramatic results from uncontrolled experiments 
III  Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees 

PVC is a catheter shorter than 7.62cm (3in.).

Sepsis is a systemic inflammatory response syndrome secondary to an infection.16 The term phlebitis is used if one of the following criteria was fulfilled: swelling and erythema >4mm, tenderness, palpable venous cord, pain or fever with local symptoms. Isolated swelling is not defined as phlebitis.

InsertionWhen?

PVC will be inserted when the duration of a given endovenous therapy is expected to be shorter than 6 days and the PVC will not be used for major procedures as hemodialysis, plasmapheresis, chemotherapy, parenteral nutrition, monitoring or administration of fluid large volumes. When any of these circumstances is to be expected, it is preferable to insert a single-, double- or triple-lumen central venous line (peripherally inserted or not) as the risk of chemical phlebitis, the need for high-speed volume infusion or frequent manipulations do not support a short catheter (I-A).17,18 An isolated transfusion does not need a central venous line insertion. Before placing any venous line, even peripheral, it is mandatory the evaluation of the actual need. Venous lines are often placed as routine; this meant to be an act reflecting the provision of care. It is also frequently shown that to treat the patient a “prophylactic” line was not mandatory. A study showed that up to 35% of peripheral venous lines place in the emergency department are unnecessary.19

Where?

A PVC can be inserted in every accessible vein. However, upper extremity veins are preferable for patient comfort and lesser risk of contamination. Some studies reported a higher risk of phlebitis after lines were placed at the cubital crease, thus becoming preferable avoiding this site in benefit of arm, forearm or dorsal aspect of the hand/wrist20,21 (II-A).

Furthermore, other patient-related factors like accessibility to the venous system or comfort after insertion have to be taken into account. It does not make much sense to insert a PVC onto a central vein (III-A).

How?

The insertion of PVC must be performed under maximal aseptic techniques. It is not necessary to prep a surgical field as it is the when inserting a central venous line. The skin must be disinfected with 2% alcoholic chlorhexidine solution or, if not available, with a 70% iodine or alcohol solution9,22,23 (I-A).

The insertion site should not be touched after disinfection. The catheter must be handled from its proximal end when inserted. The caregiver inserting the PVC must previously perform hand hygiene with water and soap and/or wash hands with alcohol solution. Single-use clean gloves must be used. An enhanced asepsis is not required if the endovenous segment of the PVC is not manipulated9 (III-B). As it is the case when inserting central venous lines, the use of additional protection measures like facemask is not recommended. However, this is a topic for consideration and analysis if in a given institution higher than expected rates of PVC-related bacteremia are observed.

Sterile gauze dressing or semi permeable transparent sterile dressing to cover the insertion site will be used23,24 (II-A). Sterile gauze dressing will be inspected and replaced every other day and transparent dressing should not stay in place over 7 days.9 If there is humidity, sweating or blood it is more appropriate to use non-occlusive gauze dressing24,25 (III-B). Revision or replacement of dressing must be performed with single-use clean gloves.9

PVCs placed on urgent basis or without considering minimal hygiene rules must be removed and replaced before 48h to avoid the risk of infection17,26,27 (II-A).

The use of techniques facilitating identification of veins as laser or ultrasound28,29 in patients with poor venous flow are also recommended for insertion. However, these techniques do not reduce the risk of infection. A meta-analysis on this topic showed that its routine use is not justified30 (I-A).

Checklist

The adhesion to recommendations in the form of checklist is associated to better results in prevention of post-insertion complications after insertion of central venous lines and PVCs10,31 (I-A). This is reflected in Table 2.

Table 2.

Checklist for an appropriate manipulation of peripheral catheters. If these are not fulfilled, the prompt removal of the catheter is advised (Evidence A).

-Insertion 
- Correct hand hygiene 
- Field disinfection 
- Use single-use clean gloves 
- Do not touch the insertion site 
- Do not touch the endovenous segment of the catheter 
- Sterile dressing (gauze or transparent) 
 
-Manipulation 
- Daily assessment of the need for the PVC 
- Daily inspection of the insertion site 
- Daily assessment of the function of the catheter 
- Adequate replacement of infusion sets 
 
-Catheter and events registry 
- Fluid extravasation 
- Presence of blood 
- Inflammatory signs 
- Dressing status 
Maintenance

The catheter and the need for usage have to be assessed daily. It is advisable to remove the PVC if it is not necessary as the risk of infection or phlebitis gradually increases as PVC days go by18,32,33 (II-A). It is advisable to insert new PVC, if required, than keeping in place an inactive line that might be useful at later stage.

The status of the insertion site must also be assessed daily, seeking for eventual discomfort/symptoms at the endovascular segment suggesting early stages of phlebitis and checking its functional status. Phlebitis should be suspected if any of the following signs develop: warmth, tenderness, erythema or palpable cord. In an abnormality at the insertion site is detected, dressing must be removed and the site inspected34,35 (III-A). The catheter must then be removed and its tip sent for Microbiology according to the criterion of the attending physician17 (III-A).

No antiseptic cream shall be used at the insertion point36 (III-C).

Every manipulation of the catheter must be performed with single-use clean gloves. There is no consensus on the type of connectors to be used. It is preferable a three-way stopcock than caps requiring connection-disconnection after every use. Closed connectors for catheter access can be used as long as they are disinfected with alcohol-impregnated wipes at every attempt to access the catheter37 (II-A).

A meta-analysis revealed that there are no advantages of replacing the infusion system earlier than 96h38,39 (I-A) other when they are used for blood transfusion or infusion of lipid emulsions (should this be the case, they have to be replaced every time). There is no evidence that neither antibiotic prophylaxis at insertion nor the antibiotic-lock are cost-efficient to keep PVC free from infection.

Registry

It is mandatory to keep daily record of characteristics and conditions of the catheter. In this registry the type of catheter, insertion date, anatomic location, daily inspection of dressing, removal date and cause of removal (malfunction, infection, not required, …) must be recorded (III-A). The lack of a registry is synonymous of lack of knowledge on how to use catheters, their complications and the inability to establish corrective measurements should an event occur.40 These registries should ideally be electronically supported to facilitated data collection and analysis.

RemovalWhen?

As there is a causal relationship between the duration of PVC and the risk of phlebitis, the need for systematic replacement of PVC at a given time interval to avoid local and systemic complications has been proposed.18,41,42 However, this strategy may render expensive the provision of care by increasing in over 25% the cost and number of catheters to use and make the catheter resite more difficult.42,43 This, on the other side, has not avoided the complications of the use of the new catheter regardless of the inconveniences of replacing a line for the patient and caregiver.

More recently, prospective and randomized studies comparing systematic replacement at 72h versus clinically indicated replacement of PVC did not found statistically significant differences in the incidence of phlebitis/local infection/bacteremia and the number of malfunctioning catheters both in hospitalized patients and in patients on home therapy.18,41–51 These observations support the replacement of PVC only when indicated (I-A).

Systematic removal of PVC after 3–4 days is not supported, although it is not advised to keep PVC in place beyond 5 days (III-B).

Although keeping in place an unused catheter increases the risk of phlebitis,51 it is not clear if they must be rinsed with normal saline or heparin. It seems that the risk of phlebitis is reduced with heparin but it continues to be at 45%,52 thus being removal advisable if unused. Therefore, unused catheters should not be kept in place as the risk of inflammation and infection increases10,53–55 (I-A).

PVC must be removed if the following circumstances apply: end of therapy, signs of chemical phlebitis, malfunction, suspicion of infection or suspicion of inappropriate insertion or manipulation as in cases of vital emergency56,57 (II-A).

How?

Simple removal will be performed with single-use clean gloves and gauze dressing applied thereafter. Removal for suspected infection implies sending the tip of the catheter (2–3mm of distal end) in a sterile container for Microbiology. In the latter case, single-use sterile gloves and sterile instrument to cut the tip of the PVC must be used. Only catheters with suspected infection must be sent for Microbiology (III-A). There will be suspected infection if fever or signs of sepsis without evident focus and/or suppurated phlebitis appeared. Chemical phlebitis alone is not enough to submit the catheter for Microbiology. It has to be reminded that catheter-related bacteremia may develop without any suspicion that the catheter may be the cause.8,58

Diagnosis

PVC infection shall be suspected when a patient with one or more PVC develops fever and/or signs of sepsis without additional clinical focus. Under this circumstance, past history of inappropriate manipulation and prolonged duration support a PVC-suspected origin of infection. Septic phlebitis or suppuration at the insertion site support this hypothesis58,59; however simple chemical phlebitis may cause low-grade fever.

If infection is suspected, 2–3 samples for blood culture must be collected. Sampling from PVC must be performed under aseptic conditions. A cotton swab should be used to take samples from purulent exudate if present. As PVCs should be of short duration and of easy replacement it is not justified to keep a catheter in situ while awaiting results from Microbiology if infection is suspected (III-B). We then believe that conservative diagnostic techniques for diagnosis of infection are not applicable60,61 (III-A). Gram stain of a PVC segment may quickly draw the attention on the possibility of infection.62

Treatment

In the treatment of PVC infection, the first step is removal of the PVC as it has been mentioned above. Once the PVC is removed and blood samples taken for culture, the need for empirical antibiotic treatment will be related to the clinical condition of the patient (including fever and elevation of biomarkers). Treatment should be directed to PVC bacteremia. Isolated positive tips cultures do not need antibiotic treatment.

If empirical antibiotic treatment is initiated, Gram-positive cocci (including methicillin-resistant S. aureus) and Gram-negative bacilli (including P. aeruginosa) must be addressed according to individual patient risk factors and the institutional flora. Other possible etiologies, albeit infrequent, have to be considered in special subsets of patients as those previously treated with antibiotics, with multiple comorbidities, immune depressed or hospitalized for long periods of time.63S. aureus has become an increasingly impactful etiologic pathogen for bacteremia as it has been shown in several studies.3,4,64–66 For bacteremia related to central venous catheters, the etiology is well diversified.

A reasonable empirical regimen is a combination of daptomycin and a β-lactam active against P. aeruginosa. In patients with β-lactam allergies, aztreonam, an aminoglycoside or a quinolone could be an alternative. In any case, treatment should follow sensitivity patterns at 24–72h after cultures are taken67,68 (I-A).

The duration of antibiotic treatment will be related to the isolated pathogen. S. epidermidis can be treated with removal of PVC if no other inert material that can be colonized and/or infected exists; duration of treatment should not be longer than 7 days. If no antibiotic treatment is given, the patient must be symptom-free and cultures must be negative upon removal of PVC.

A different situation is S. aureus or C. albicans infection as those require a minimum of 14 days of treatment69 and follow-up cultures at 72h. Secondary infectious foci like endocarditis and/or osteomyelitis must be ruled out.70 This is even more important if bacteremia persists after removal of the PVC thus indicating a more prolonged presence of bacteria in the blood stream.70–73 This Consensus Document does not pretend reviewing the treatment of S. aureus or other bacteremias and the reader is referred to specific guidelines.70,71 Gram-negative bacilli infections usually need 7–14 days of treatment after removal of PVC and after the first negative blood culture is confirmed.7

Continuous education

Continuous education of healthcare caregivers on the indications for PVC insertion and the convenience of having PVC inserted is necessary. It is necessary to periodically remind the nursing staff inserting PVC the guidelines for insertion and maintenance74–81 (I-A). Table 3 summarizes the recommendations and degree of evidence and references as produced in this document. The lack of a continuous education program leads to relaxation of the norm, abandonment of good clinical practices and increase in infection and complication rates. On the contrary, specific educational programs help in reducing infection rates.82–87 There are different ways to provide education. Education among peers has shown the best benefits in guideline follow-up as the staff is engaged in education.

Table 3.

Summary of recommendations and degree of evidence and (references) (see - 1).

Always assess the need of inserting a catheter. If necessary, a central venous line should be preferred over a PVC if duration of intravenous treatment longer than 6 days or blood transfusion, parenteral nutrition or chemotherapy.  I-A17,18 
If possible, PVC should not be placed in the lower extremities or at the elbow crease due to higher risk of phlebitis.  II-A20,21 
Insertion of PVC must be performed with the maximum hygiene with no need for a surgical field. There are no preferences as to which disinfectant solution to use.  I-A9,22,23 
An sterile dressing must be used to cover the insertion site (gauze dressing or transparent semi permeate).  II-A24,25 
Adherence to pre-insertion checklist improves prevention of complication outcomes.  I-A10,31 
The need for PVC should be assessed on daily basis. If it is not necessary, it is advisable to remove the PVC.  II-A18,32,33 
The insertion site must be inspected daily. If abnormalities, malfunction or discomfort at the subcutaneous site, PVC should be removed.  III-A17,34,35 
No antiseptic cream/gel should be used at the insertion site.  III-C36 
Closed connectors to access the PVC can be used; its external surface must always be decontaminated.  II-A37 
Infusion sets can be utilized up to 96h, exception made of blood transfusion or lipid emulsions.  I-A38,39 
It is mandatory that the nursing files a daily record of the PVC.  III-A40 
It is not advisable to remove PVC on a routine basis. PVC should be replaced when clinically indicated.  I-A18,41–51 
It is advisable not to keep a PVC in place for over 5 days.  III-B 
Unused catheters must be removed.  II-A10,53,55 
When there is suspicion of PVC inserted under suboptimal conditions, it must be removed.  III-A56,57 
If there is suspicion of infection, it is not indicated to use diagnostic technique leaving the PVC in place.  III-A 
If there is a suspicion of catheter-related infection, the tip of the PVC must be submitted for Microbiology. Removed PVC non-suspected to be infected not need Microbiology.  III-A 
Empiric antibiotic treatment of PVC-related bacteremia has to be deescalated according to microbiology results.  I-A67,68 
Continuous education in insertion and maintenance guidelines is an appropriate way to reduce complications.  I-A74–87 

It is advisable that the infection and complication rates are periodically disclosed to the staff in charge of inserting PVCs. This is positive reinforcement on guideline/protocol follow-up and a warning if deviations occur. Furthermore, the adherence to the checklist can be monitored (Table 2).

Source of funding

No external funding sources.

Conflict of interest

No conflicts of interest declared.

References
1
M.J. Pérez-Granda,M.R. Guembe,C. Rincón,P. Muñoz,E. Bouza
A prevalence survey of intravascular catheter use in a general hospital
J Vasc Access, 25 (2014), pp. 524-528
2
M. Guembe,M.J. Pérez-Granda,J.A. Capdevila,J. Barberan,B. Pinilla,P. Martín-Rabadán
Nationwide study of the use of intravascular catheters in internal medicine departments
3
M. Pujol,A. Hornero,M. Saballs,M.J. Argerich,R. Verdaguer,M. Cisnal
Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital
J Hosp Infect, 67 (2007), pp. 22-29 http://dx.doi.org/10.1016/j.jhin.2007.06.017
4
M. Delgado,A. Gabillo,L. Elias,J.C. Yebenes,G. Sauca,J.A. Capdevila
Caracteristicas de la bacteriemia relacionada con catéter venoso periférico en un hospital general
Rev Esp Quimio, 25 (2012), pp. 129-133
5
B. Almirante,E. Limón,N. Freixas,F. Gudiol
Vigilancia de bacteriemias relacionadas con el uso de catéteres venosos en los hospitales de Catalunya. Resultados del Programa VINCAT (2007–2010)
Enf Infecc Microbiol Clin, 30 (2012), pp. 13-19
6
V. Chopra,S. Anand,S.L. Krein,C. Chenoweth,S. Saint
Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence
7
C. León,X. Ariza
Guías para el tratamiento de las infecciones relacionadas con catéteres intravasculares de corta permanencia en adultos: conferencia de consenso SEIMC-SEMICYUC
Enf Infecc Microbiol Clin, 22 (2004), pp. 99-101
8
L.A. Mermel,M. Allon,E. Bouza,D.E. Craven,P. Flynn,N.P. O’Grady
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009. Update by the Infectious Diseases Society of America
Clin Infect Dis, 49 (2009), pp. 1-45 http://dx.doi.org/10.1086/599376
9
N. O??Grady,M. Alexander,L.A. Burns,E.P. Dellinger,J. Garland,S.O. Heard
Guideline for the prevention of intravascular catheter-related infections
Clin Infect Dis, 52 (2011), pp. 162-193
10
P. Pronovost,D. Needham,S. Berenholtz,D. Sinopoli,H. Chu,S. Cosgrove
An intervention to decrease catheter-related bloodstream infections in the ICU
N Engl J Med, 355 (2006), pp. 2725-2732 http://dx.doi.org/10.1056/NEJMoa061115
11
J.A. Capdevila
El catéter periférico: el gran olvidado de la infección nosocomial
Rev Esp Quimioter, 26 (2013), pp. 1-5
12
G. Cicolini,V. Simonetti,D. Comparcini,S. Labeau,S. Blot,G. Pelusi
Nurse's knowledge of evidence-based guidelines on the prevention of peripheral venous catheter-related infections: a multicentre survey
J Clin Nurs, 17–18 (2014), pp. 2578-2588 http://dx.doi.org/10.1111/jocn.13485
13
M. Ahlqvist,B. Beerglund,M. Wiren,B. Klang,E. Johansson
Accuracy in documentation – a study of peripheral venous catheters
J Clin Nurs, 13 (2009), pp. 1945-1952
14
E. Véliz,T. Vergara,A. Fica
Evaluación de las condiciones de manejo de catéteres vasculares periféricos en pacientes adultos
Rev Chilena Infectol, 31 (2014), pp. 666-669 http://dx.doi.org/10.4067/S0716-10182014000600004
15
M.A. Kish
Guide to development of practice guidelines
Clin Infect Dis, 32 (2001), pp. 851-854 http://dx.doi.org/10.1086/319366
16
American College of Chest Physicians/Society of Critical Care Medicine
Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
Crit Care Med, 20 (1992), pp. 864-874
17
D. Maki,M. Ringer
Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial
Ann Intern Med, 114 (1991), pp. 845-854
18
G. Mestre,C. Berbel,P. Tortajada,G. Gallemí,M. Aguilar,J. Caylà
Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: an observational cohort study
Med Clin, 139 (2011), pp. 185-191
19
K.E. Göransson,E. Johansson
Indication and usage of peripheral venous catheters inserted in adult patients during emergency care
J Vasc Access, 3 (2011), pp. 193-1999
20
S. Dunda,E. Demir,O. Mefful,G. Grieb,A. Bozkurt,N. Pallua
Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: a retrospective study
Phlebology, 30 (2014), pp. 381-388 http://dx.doi.org/10.1177/0268355514537254
21
E. Uslusoy,S. Mete
Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study
J Am Acad Nurse Pract, 20 (2008), pp. 172-180 http://dx.doi.org/10.1111/j.1745-7599.2008.00305.x
22
D.G. Maki,M. Ringer,C.J. Alvarado
Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters
Lancet, 338 (1991), pp. 339-343
23
Canadian Agency for drugs and technology in health. Use of chlorhexidine gluconate with alcohol for the prevention of peripheral intravenous device infections: a review of clinical and cost effectiveness and guidelines
(2014, April 3)
24
D.G. Maki,S.S. Stolz,S. Wheeler,L.A. Mermel
A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management
Crit Care Med, 22 (1994), pp. 1729-1737
25
R. Bijma,A.R. Girbes,D.J. Kleijer,J.H. Zwaveling
Preventing central venous catheter-related infection in a surgical intensive-care unit
Infect Control Hosp Epidemiol, 20 (1999), pp. 618-620 http://dx.doi.org/10.1086/501682
26
K.E. Göransson,E. Johansson
Prehospital peripheral venous catheters: a prospective study of patients complications
J Vasc Access, 13 (2012), pp. 16-21 http://dx.doi.org/10.5301/JVA.2011.8418
27
C. Forni,L. Loro,M. Tremosini,C. Trofa,F. D’Alessandro,T. Sabattini
Cohort study of peripheral catheter-related complications and identification of predictive factors in a population of orthopedic patients
Assist Inferm Ric, 29 (2010), pp. 166-177
28
J. Aulagnier,C. Hoc,E. Mathieu,J.F. Dreyfus,M. Fischler,M. Le Guen
Efficacy of accuvein to facilitate peripheral intravenous placement in adults presenting to an emergency department: a randomized clinical trial
Acad Emerg Med, 21 (2014), pp. 858-863 http://dx.doi.org/10.1111/acem.12437
29
A.K. Au,M.J. Rotte,R.J. Grzybowski,B.S. Ku,J.M. Fields
Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters
Am J Emerg Med, 30 (2012), pp. 1950-1954 http://dx.doi.org/10.1016/j.ajem.2012.04.016
30
Y.T. Liu,A. Alsaawi,H.M. Bjornsson
Ultrasound (US) guidance for the placement of peripheral venous access: a systematic review of randomized-controlled trials
Eur J Emerg Med, 21 (2014), pp. 18-23 http://dx.doi.org/10.1097/MEJ.0b013e328363bebc
31
P.C. Chiu,Y.H. Lee,H.T. Hsu,Y.T. Feng,I.C. Lu,S.L. Chiu
Establish a perioperative check forum for peripheral intravenous access to prevent the occurrence of phlebitis
Kaohsiung J Med Sci, 31 (2015), pp. 215-221 http://dx.doi.org/10.1016/j.kjms.2015.01.007
32
I.B. Targer,M.B. Ginsberg,S.E. Ellis,N.E. Walsh,I. Dupont,E.A. Simchen
An epidemiological study of the risks associated with peripherals intravenous catheters
Am J Epidemiol, 118 (1983), pp. 839-851
33
N.P. O??Grady,M. Alexander,E.P. Dellinger,J.L. Gerberding,S.O. Heard,D.G. Maki
Guidelines for the prevention of intravascular catheter-related infections
Infect Control Hosp Epidemiol, 23 (2002), pp. 759-769 http://dx.doi.org/10.1086/502007
34
M.C. White
Infections and infection risks in home care settings
Infect Control Hosp Epidemiol, 13 (1992), pp. 535-539
35
M.C. White,K.E. Ragland
Surveillance of intravenous catheter-related infections among home care clients
Am J Infect Control, 22 (1994), pp. 231-235
36
A. Zakrzewska-Bode,H.L. Muytjens,K.D. Liem,J.A. Hoogkamp-Korstanje
Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters
J Hosp Infect, 31 (1995), pp. 189-193
37
J.C. Yébenes,M. Delgado,G. Sauca,M. Serra-Prat,M. Solsona,J. Almirall
Efficacy of three different valve systems of needle-free closed connectors in avoiding access of microorganisms to endovascular catheters after incorrect handling
Crit Care Med, 36 (2008), pp. 2558-2561 http://dx.doi.org/10.1097/CCM.0b013e318183effb
38
A.J. Ullman,M.L. Cooke,E.D. Gillies,N.M. Marsh,A. Daud,M.R. McGrail
Optimal timing for intravascular administration set replacement
Cochrane Database Syst Rev, (2013), http://dx.doi.org/10.1002/14651858
39
K.K. Lai
Safety of prolonging peripheral cannula and IV tubing use from 72hours to 96hours
Am J Infect Control, 26 (1998), pp. 66-70
40
M. Ahlqvist,B. Berglund,M. Wirén,B. Klang,E. Johansson
Accuracy in documentation – a study of peripheral venous catheters
J Clin Nurs, 18 (2009), pp. 1945-1952 http://dx.doi.org/10.1111/j.1365-2702.2008.02778.x
41
T. Bregenzer,D. Conen,P. Sackmann,A. Widmer
Is routine replacement of peripheral intravenous catheters necessary?
Arch Intern Med, 158 (1998), pp. 151-156
42
P. Van Donk,C.M. Rickard,M.R. McGrail,G. Doolan
Routine replacement versus clinical monitoring of peripheral intravenous catheters in a regional hospital in the home program: a randomized controlled trial
Infect Control Hosp Epidemiol, 30 (2009), pp. 915-917 http://dx.doi.org/10.1086/599776
43
J. Webster,S. Clarke,D. Paterson,A. Hutton,S. van Dyk,C. Gale
Routine care of peripheral intravenous catheters versus clinically indicated replacement; randomized controlled trial
44
J. Webster,S. Osborne,C. Rickard,J. Hall
Clinically-indicated replacement versus routine replacement of peripheral venous catheters
Cochrane Database Syst Rev, 3 (2010), pp. CD007798 http://dx.doi.org/10.1002/14651858.CD007798.pub2
45
G. Mestre,C. Berbel,P. Tortajada,M. Alarcia,R. Coca,M. Fernández
Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events; A quasi experimental cohort study
46
F. Grüne,M. Schrappe,J. Basten,H.M. Wenchel,E. Tual,H. Stützer
Phlebitis rate and time kinetics of short peripheral intravenous catheters
47
W.L. Lee,H.L. Chen,T.Y. Tsai,I.C. Lai,W.C. Chang,C.H. Huang
Risk factors for peripheral intravenous catheter infection in hospitalized patients: a prospective study of 3165 patients
Am J Infect Control, 37 (2009), pp. 683-686 http://dx.doi.org/10.1016/j.ajic.2009.02.009
48
M. Giménez Pérez
Systematic withdrawal of peripheral vein catheters: does it salvage lives or increase costs?
Med Clin, 139 (2012), pp. 203-205
49
D. Hasselberg,B. Ivarsson,R. Andersson,B. Tingstedt
The handling of peripheral venous catheters – from non-compliance to evidence-based needs
J Clin Nurs, 19 (2010), pp. 3358-3563 http://dx.doi.org/10.1111/j.1365-2702.2010.03410.x
50
M.E. Juvé,M.D. Carbonell,R.M. Soldevila,I. Campa,M. Juarez
Mantenimiento de catéteres venosos periféricos durante más de 4 días. En busca de la mejor evidencia
Enf Clin, 13 (2003), pp. 208-216
51
L.C. Do Rego Furtado
Maintenance of peripheral venous access and its impact on the development of phlebitis: a survey of 186 catheters in a general surgery department in Portugal
J Infus Nurs, 34 (2011), pp. 382-390 http://dx.doi.org/10.1097/NAN.0b013e318230636b
52
G. Bertolino,A. Pitassi,C. Tinelli,A. Staniscia,B. Guglielmana,L. Scudeller
Intermittent flushing with heparin versus saline for maintenance of peripheral intravenous catheters in a medical department: a pragmatic cluster-randomized controlled study
Worldviews Evid Based Nurs, 9 (2012), pp. 221-226 http://dx.doi.org/10.1111/j.1741-6787.2012.00244.x
53
S.M. Berenholtz,P.J. Pronovost,P.A. Lipsett,D. Hobson,K. Earsing,J.E. Farley
Eliminating catheter-related bloodstream infections in the intensive care unit
Crit Care Med, 32 (2004), pp. 2014-2020
54
F.A. Lederle,C.M. Parenti,L.C. Berskow,K.J. Ellingson
The idle intravenous catheter
Ann Intern Med, 116 (1992), pp. 737-738
55
C.M. Parenti,F.A. Lederle,C.L. Impola,L.R. Peterson
Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project
Arch Intern Med, 154 (1994), pp. 1829-1832
56
I.I. Raad,D.C. Hohn,B.J. Gilbreath,N. Suleiman,L.A. Hill,P.A. Bruso
Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion
Infect Control Hosp Epidemiol, 15 (1994), pp. 231-238
57
J.M. Boyce,D. Pittet
Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
Infect Control Hosp Epidemiol, 23 (2002), pp. S3-S40 http://dx.doi.org/10.1086/503164
58
J.C. Yébenes,J.A. Capdevila
Infección relacionada con catéteres intravasculares
Med Clin, 121 (2003), pp. 238
59
E. Bouza,A. Burillo,P. Muñoz
Catheter-related infections: diagnosis and intravascular treatment
Clin Microb Infect, 8 (2002), pp. 265-274
60
J.A. Capdevila,A.M. Planes,M. Palomar,I. Gasser,A. Pahissa,E. Crespo
Value of differential quantitative blood cultures in diagnosis of catheter related sepsis
Eur J Clin Microbiol, 11 (1992), pp. 403-407
61
F. Blot,E. Schmidt,G. Nitemberg,C. Tancredo,B. Leclercq,A. Laplanche
Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catéter-related sepsis
J Clin Microbiol, 36 (1998), pp. 105-109
62
G. Aygun,H. Yasar,M. Yilmaz,K. Karasahin,Y. Dikmen,E. Polat
The value of gram staining of catheter segments for rapid detection of peripheral venous catheter infections
Diagn Microbiol Infect Dis, 54 (2006), pp. 165-167 http://dx.doi.org/10.1016/j.diagmicrobio.2005.09.006
63
E. Reigades,M. Rodriguez-Créixems,C. Sánchez-Carrillo,P. Martín-Rabadán,E. Bouza
Uncommon aetiological agents of catheter-related bloodstream infections
Epidemiol Infect, 143 (2015), pp. 741-744 http://dx.doi.org/10.1017/S0950268814001435
64
R.L. Stuart,D.R. Cameron,C. Scout,D. Kotsanas,M.L. Grayson,T.M. Korman
Peripheral intravenous catheter-associated Staphylococcus aureus bacteremia: more than 5 years of prospective data from two tertiary health services
Med J Aust, 198 (2013), pp. 551-553
65
T.T. Trinh,P.A. Chan,O. Edwards,B. Hollenbeck,B. Huang,N. Burdick
Peripheral venous catheter-related Staphylococcus aureus bacteremia
Infect Control Hosp Epidemiol, 32 (2011), pp. 579-583 http://dx.doi.org/10.1086/660099
66
B. Almirante,E. Limón,N. Freixas,F. Gudiol
Vincat Program. Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the Vincat Program (2007–2010)
Enf Infecc Microbiol Clin, (2012), pp. 13-19
67
T.H. Dellit,R.C. Owens,J.E. McGowan,D.N. Gerding,R.A. Weinstein,J.P. Burke
Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing and institutional program to enhance antimicrobial stewardship
Clin Infect Dis, 44 (2007), pp. 159-177 http://dx.doi.org/10.1086/510393
68
J. Rodríguez-Baño,J.R. Paño-Pardo,L. Alvarez-Rocha,A. Asensio,E. Calbo,E. Cercenado
Grupo de Estudio de la Infección Hospitalaria-Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica; Sociedad Española de Farmacia Hospitalaria; Sociedad Española de Medicina Preventiva, Salud Pública e Higiene. Programas de optimización de uso de antimicrobianos (PROA en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH
Enferm Infecc Microbiol Clin, 30 (2012), pp. 22.e1-22.e23 http://dx.doi.org/10.1016/j.eimc.2011.09.018
69
J.A. Jernigan,B.M. Farr
Short-course therapy of catheter-related Staphylococcus aureus bacteremia: a meta-analysis
Ann Intern Med, 119 (1993), pp. 304-311
70
F. Gudiol,J.M. Aguado,B. Almirante,B. Bouza,E. Cercenado,M.A. Domínguez
Diagnosis and treatment of bacteremia and endocarditis due to Staphylococcus aureus. A clinical guideline from the Spanish Society of Clinical Microbiology and Infectious Diseases
71
J.M. Cisneros-Herrerosa,J. Cobo-Reinoso,M. Pujol-Rojo,J. Rodríguez-Baño,M. Salavert-Lletíe
Guía para el diagnóstico y tratamiento del paciente con bacteriemia. Guías de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC)
Enferm Infecc Microbiol Clin, 25 (2007), pp. 111-130
72
V.C. Fowler,A. Justice,C. Moore,D.K. Benjamin,C.W. Woods,S. Campbell
Risk factors for haematogenous complications of intravascular catheters-associated S. aureus bacteremia
Clin Infect Dis, 40 (2005), pp. 95-103
73
K.T. Sanchez,K.M. Obeid,S. Szpunar,M.G. Fakih,R. Khatib
Delayed peripheral venous catheter-related Staphylococcus aureus bacteremia: onset ≥24hours after catheter removal
Scand J Infect Dis, 44 (2012), pp. 551-554 http://dx.doi.org/10.3109/00365548.2012.669841
74
S. Yoo,M. Ha,D. Choi,H. Pai
Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea
Infect Control Hosp Epidemiol, 22 (2001), pp. 433-436 http://dx.doi.org/10.1086/501930
75
D.K. Warren,J.E. Zack,M.J. Cox,M.M. Cohen,V.J. Fraser
An educational intervention to prevent catheter-associated bloodstream infections in a non-teaching community medical center
Crit Care Med, 31 (2003), pp. 1959-1963 http://dx.doi.org/10.1097/01.CCM.0000069513.15417.1C
76
D.K. Warren,J.E. Zack,J.L. Mayfield,A. Chen,D. Prentice,V.J. Fraser
The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU
Chest, 126 (2004), pp. 1612-1618 http://dx.doi.org/10.1378/chest.126.5.1612
77
D.K. Warren,S.E. Cosgrove,D.J. Diekema,G. Zuccotti,M.W. Climo,M.K. Bolon
A multicenter intervention to prevent catheter-associated bloodstream infections
Infect Control Hosp Epidemiol, 27 (2006), pp. 662-669 http://dx.doi.org/10.1086/506184
78
F. Higuera,V.D. Rosenthal,P. Duarte,J. Ruiz,G. Franco,N. Safdar
The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico
Crit Care Med, 33 (2005), pp. 2022-2027
79
C.M. Coopersmith,T.L. Rebmann,J.E. Zack,M.R. Ward,R.M. Corcoran,M.E. Schallom
Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit
Crit Care Med, 30 (2002), pp. 59-64
80
C.M. Coopersmith,J.E. Zack,M.R. Ward,C.S. Sona,M.E. Schallom,S.J. Everett
The impact of bedside behavior on catheter-related bacteremia in the intensive care unit
Arch Surg, 139 (2004), pp. 131-136 http://dx.doi.org/10.1001/archsurg.139.2.131
81
R.J. Sherertz,E.W. Ely,D.M. Westbrook,K.S. Gledhill,S.A. Streed,B. Kiger
Education of physicians in-training can decrease the risk for vascular catheter infection
Ann Intern Med, 132 (2000), pp. 641-648
82
P. Eggimann,S. Harbarth,M.N. Constantin,S. Touveneau,J.C. Chevrolet,D. Pittet
Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care
83
I. Lolom,C. Deblangy,A. Capelle,W. Guerinot,E. Bouvet,B. Barry
Effect of a long-term quality improvement program on the risk of infection related peripheral venous catheters
84
S. Boy,I. Aggarwal,P. Davey,M. Logan,D. Nathwani
Peripheral intravenous catheters: the road to quality improvement and safer patient care
J Hosp Infect, 77 (2011), pp. 37-41 http://dx.doi.org/10.1016/j.jhin.2010.09.011
85
S. Frigerio,P. Di Giulio,D. Gregori,D. Gavetti,S. Ballali,S. Bagnato
Managing peripheral venous catheters: an investigation on the efficacy of a strategy for the implementation of evidence-based guidelines
J Eval Clin Pract, 18 (2012), pp. 414-419 http://dx.doi.org/10.1111/j.1365-2753.2010.01590.x
86
N.E. Soifer,S. Borzak,B.R. Edin,R.A. Weinstein
Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial
Arch Intern Med, 158 (1998), pp. 473-477
87
E. Vidal,J.A. Capdevila,G. Sauca,L. Force,N. Floriach,M. Usas
Reducción de la tasa de bacteriemia asociada a catéter venoso periférico después de aplicar un programa de prevención. Abstract presentado en el XV Congreso SEIMC
Bilbao, (2012),

This article has also been published in Rev Esp Quimioter 2016;29(4).

Representing the Spanish Society of Cardiovascular Infections (SEICAV).

Representing the Spanish Society of Internal Medicine (SEIM).

Representing the Spanish Society of Chemotherapy.

Representing the Spanish Society of Cardiovascular-Thoracic Surgery (SECTCV).

Corresponding author. (Josep A. Capdevila jcapdevila@csdm.cat)
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