Does longer peripheral intravenous catheter length optimise antimicrobial delivery? A randomised controlled trial

Does longer peripheral intravenous catheter length optimise antimicrobial delivery? A randomised controlled trial

Amanda Corley^1,2,3,4,5, Catherine O’Brien^1,2, Elizabeth Wignall², Hannah Peach², Emily Larsen^1,2,3,4, Claire Rickard^1,2,3,4,5,6, Barbara Hewer^2,7, Nicole Marsh^1,2,3,4,5,6, ,

¹School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
²Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
³Menzies Health Institute QLD, Nathan, QLD, Australia
⁴AVATAR group, School of Nursing and Midwifery & School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
⁵School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia
⁶Herston Infectious Diseases Institute, Metro North Health, Herston, QLD, Australia
⁷Vascular Access Surveillance and Education, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia










Introduction
Nearly half of short peripheral intravenous catheters (PIVCs) inserted for antimicrobials fail before treatment completion, resulting in delayed antimicrobial administration and repetitive insertions. This randomised controlled trial (RCT) assessed if long-PIVCs optimise antimicrobial delivery by reducing PIVC failure compared with short-PIVCs.

Methods
Single-centre RCT conducted in adult medical/surgical patients requiring a PIVC for intravenous antimicrobial treatment ≥3 days. Participants were randomised to receive a short-PIVC (<4cm length), or long-PIVC (4.5-6.4cm). Primary outcome was antimicrobial administration disruption from all-cause PIVC failure (composite of infiltration/extravasation, occlusion, phlebitis, thrombosis, dislodgement, suspected/confirmed infection). Secondary outcomes: dwell time; number of devices to complete antimicrobial therapy. The number and proportion of PIVCs experiencing antimicrobial therapy disruption due to all-cause failure were calculated per group. Results 188 (94/arm) participants were included in this early analysis. Fifty-eight (31%) participants were female, mean age was 60 (standard deviation [SD] 18) and the most delivered antibiotic was Piperacillin-Tazobactam. All-cause failure was similar in each arm (Short-PIVC: 22/94 [23.4%]; Long-PIVC: 20/94 [21.3%]) as was dwell time (Short-PIVC: mean 76hrs (SD 52); Long-PIVC: mean 72hrs [SD 48]). Failure/1000 catheter days was slightly lower for long-PIVCs compared to short-PIVCs (69 vs 74). Nearly half of the short-PIVC group required subsequent devices to complete antimicrobial therapy (42/94, 44.7%) compared with 24.5% (23/94) of the long-PIVC group. Conclusion All-cause PIVC failure was similar for short- and long-PIVCs in patients requiring antimicrobials, however long-PIVCs may minimise the number of devices required to complete therapy. Further analysis will more fully explore causes of PIVC failure.

Biography

Amanda is a critical care nurse of 20 years+ experience and is a conjoint Research Fellow (Clinician Researcher) with Griffith University and Royal Brisbane and Women’s Hospital. She is an Early Career Researcher (PhD conferred 9 March 2022) and has a strong national and international track record in patient-focused clinical and health services research. She has published over 80 peer-reviewed publications and 4 book chapters, with career funding of around $2.5m in competitive and industry grants. Her research interests include respiratory management in ICU and vascular access devices, particularly extracorporeal membrane oxygenation cannulae.