National Prevalence of Peripheral Intravenous Catheters among hospital patients in England, 2009

Background:  Peripheral intravenous catheters (PVCs) are commonly used to deliver fluids and medication in hospitalised and community patients. The complications from the use of these invasive devices range from sepsis at the insertion site to bacteraemia. Recent national data indicates that overall, PVC accounts for 12% of bacteraemia cases. PVC complications lead to increased hospital stay and increased costs.

Objective:  To investigate the prevalence of PVC use in English hospitals; to obtain evidence of problems with their management and to estimate the prevalence of associated phlebitis.

Methods: A short questionnaire was designed focusing on prevalence of use, clinical indication (unnecessary use), duration of PVCs and dressing. During November 2009, this questionnaire was circulated among health care professionals who were members of the surveillance forum of the Infection Prevention Society. Completed questionnaires were returned by five different hospitals. Data on 2,409 patients and 734 PVCs were available for analysis. Data on specialities were collected and grouped into medical and surgical groups. A Fisher’s exact test was computed to evaluate differences between these two groups.

Results:  Overall, 31% patients had an indwelling PVC (734/2,409). The prevalence of use was higher among medical patients than surgical patients: 34.0% (273) vs 28.7% (461); p=0.010. The proportion of PVCs without valid clinical indication was 18.5% overall but it was higher among surgical patients compared to medical patients (24.1% vs 9.2% p<0.001). Overall, the delivery of drugs was the most common reason for PVC use (43.6%) followed by intravenous fluids (36.7%). Overall the difference between medical and surgical groups was significant with respect to reason for use (p<0.001). Most of the difference was accounted for by emergency access (chi square contribution=16.1 in medical vs 10.8 in surgical) . Duration (defined as 72/86hrs) was higher among medical patients compared to surgical patients (13.6% vs 7.6%; p=0.010). Insertion time was not documented in a third of patients with PVC (31.1%) and this pattern was similar across each group. Dressing was reported as being intact for 86.4% of patients overall but in medical patients this was significantly higher than the surgical group: 92.3% vs 82.9%; p<0.001.  Of devices with phlebitis score data, 5.3% had a score of one or more (24/456).

Conclusions:  The data based on five responding hospitals in England indicate that PVC prevalence is 31% overall with a significantly higher prevalence in the the medical group compared to the surgical group (p=0.010). Apparently unnecessary use was high overall at 18.5% and it was significantly higher among surgical patients than medical patients (p<0.001). Although based on a small sample, this study suggests that there is still considerable scope for improvements in PVC management.