Optimal Insertion Sites for Peripheral Intravenous Catheters: Insights from the CLEAN 3 Study

Introduction:
Peripheral intravenous catheters (PIVCs) are essential in hospital settings but can lead to complications, including infections. Identifying optimal insertion sites is crucial to minimize these risks.

Background:
The CLEAN 3 study provided a comprehensive analysis of PIVC-related infections. This post hoc analysis aims to understand how different insertion sites impact the risk of catheter colonization and local infections.

Study Overview:
The CLEAN 3 study was a randomized clinical trial conducted at Poitiers University Hospital, France, involving 989 adult patients. The study compared two skin disinfection procedures and two types of medical devices to prevent PIVC colonization. For this post hoc analysis, 823 PIVCs with known insertion sites were examined.

Key Findings:

1. Insertion Sites: PIVC insertion at the wrist or cubital fossa significantly increased the risk of colonization and local infection compared to other sites.
- Cubital Fossa: Hazard Ratio (HR) for colonization/infection was 1.64 (95% CI: 0.92—2.93).
- Wrist: HR for colonization/infection was 2.11 (95% CI: 1.08—4.13).
2. Positive PIVC Tip Culture: The risk of a positive tip culture was also higher for wrist and cubital fossa insertions.
- Cubital Fossa: HR for positive culture was 1.49 (95% CI: 1.02—2.18).
- Wrist: HR for positive culture was 1.59 (95% CI: 0.98—2.59).

Conclusion:
To reduce the risk of PIVC-related infections, avoid inserting catheters at the wrist or cubital fossa whenever possible. These findings highlight the importance of considering insertion sites in infection prevention strategies.

Authors: Bertrand Drugeon, Nicolas Marjanovic, Matthieu Boisson, Niccolò Buetti, Olivier Mimoz, Jérémy Guenezan

Read More: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151591/