Infection Risk with PIVCs: What Large-Scale Australian Data Shows

Study Overview

This meta-synthesis pooled infection outcomes from 18 prospective studies across seven Australian public hospitals, following 14,606 peripheral IV catheters (50,096 device-days) from insertion to removal. Researchers quantified local infection and bloodstream infection (BSI) using NHSN criteria and modelled day-by-day risk (hazard) over catheter dwell time.

Key Findings

- Very low but non-zero infection rates

Local infection: 5/14,606 catheters (0.034%; 0.100 per 1,000 device-days).

PIVC-associated BSI: 6/14,606 (0.041%; 0.120 per 1,000 device-days).

- Predominantly gram-negative organisms

Enterobacter cloacae led (3/6 BSIs), with single cases of Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus (SAB incidence 0.007%).

- Risk profile of BSI cases

Most were males >60 years, often with difficult IV access, cancer, GI procedures/drains, insertion-site complications, idle/symptomatic lines, and forearm placement.

- Daily hazard stayed roughly constant through Day 1-5

Hazard ~0-0.03% on Days 1-5, rising to ~0.06-0.10% on Days 6-7; no events observed after Day 7 in this dataset (limited catheters beyond Day 7).

- Routine time-based replacement offers no benefit in the first 5 days

Findings support clinically indicated removal with vigilant assessment rather than routine resite policies.

Implications

• Keep exposure minimal and act early: remove idle or symptomatic PIVCs promptly; use structured decision tools and audit loops.
• Target prevention where it matters: older men, patients with cancer or complex GI care, and those with difficult access need intensified insertion quality, monitoring, and specialist support.
• Update surveillance thinking: risk-adjust analyses, watch for gram-negative trends, and focus on insertion technique and post-insertion management rather than arbitrary dwell limits (?5 days).

Read more: https://link.springer.com/article/10.1186/s13756-025-01645-z  

Authors: Claire M. Rickard; Jessica Schults; Gabor Mihala; Emily Larsen; Nicole Marsh; Naomi Runnegar; Tricia Kleidon; Amanda J. Ullman; Samantha Keogh; Daner Ball; Amanda Corley; Simon Bugden; Gillian Ray-Barruel.