Volume 1 Issue 2

I have recently returned from attending the Association of Vascular Access (AVA) Annual Scientific Meeting (ASM) in Dallas, Texas. In my career I have been to numerous scientific meetings and world congresses. In the past attending could be a frustrating experience. When there were many concurrent sessions it was not possible to access everything and I often regretted my choices; especially when hearing others discussing a great paper that was delivered in another room. At AVA the degree of sophistication of the electronic media was amazing. The mobile app meant you could review all the sessions and map out a timetable which would sync to your calendar and tell you where you needed to be. There were also electronic posters with enhanced content available and most of the presentations were available as slides shows and/or audio mp3 files soon after the presentation. There was all the technical wizardry of a virtual conference with the benefits of in-depth discussions with international colleagues — well done AVA.

I was at the AVA ASM to debate the issue of routine replacement of peripheral intravenous catheters (PIVCs) versus replacement on clinical indication. I have presented the work^1-3 of the Alliance for Vascular Access Training and Research (AVATAR: www.avatargroup.org.au) group in this area and debated this issue many times. I admit to being disappointed that, despite the weight of evidence being clearly on the side of replacement on clinical indication^4,5, it is so difficult to change policy and practice. Indeed, a blog on the Australian Centre for Health Services Innovation (AusHSI) website (http://aushsiblog.com/?p=228) describes how one hospital changed policy to PIVC change on clinical indication only to change it back to 3-day change because a key healthcare-associated infection indicator rose above a national benchmark. The AusHSI blog states that, “Despite no proof the new policy was to blame the hospital executive returned to routine 3-day changes. A magic wand had been waved to re-invigorate old inefficiencies. It nullified a massive research and implementation effort and pushed costs up again for no health benefit”⁶.

One of the key aspects of this whole debate is that we do not have good epidemiological research on the rates of catheter-related bloodstream infection associated with peripheral IVs, because we do not sample and culture PIVCs once removed. We are also not really sure of the biological mechanisms that underpin all bloodstream infection. The work of Australian microbiologists like Dr Li Zhang ad Dr David McMillan is going to be central to developing a better understanding of the mechanisms by which both central and peripheral catheters do and do not lead to bloodstream infection. However, we may also need a concerted epidemiological data collection effort — maybe an international effort.

Also at AVA the One Million Global (OMG) Peripheral Intravenous Catheters (PIVC) team presented the findings of their pilot study⁷ and some preliminary findings. Having engaged over 400 hospitals in 49 countries in this massive PIVC prevalence study they hope to set up a PIVC International Registry. The idea is that any hospital around the world can use the standardised tools developed for this study to collect data and then by submitting their data to the Registry they will be able to benchmark their activity against local, national and international centres. If this could also be expanded at some point in the future to include infection and colonisation data we might be closer to understanding the issues. This vision will require support and funding.

We need continuing innovation in technology to help us ensure the best care for all our patients with PIVCs, but we also need further laboratory-based research and better ways of integrating evidence into practice. There is still plenty of work to do and organisations like the AVA, the relatively new Australian Vascular Access Society (AVAS: http://avas.org.au/) and AVATAR need to work with healthcare service providers, health research funding bodies and commercial interests to keep advancing our knowledge and making our care safer and of higher quality. I hope that, in Australia, the roll-out of the Medical Research Future Fund will mean that increasing funds will be available to continue the research agenda related to PIVC research. After all, what other invasive intervention affects 60–80% of all hospitalised patients?

Author(s)

Professor Marianne Wallis RN, PhD, FACN University of the Sunshine Coast

References

1. Rickard CM, Webster J, Wallis MC, Marsh N, McGrail MR, French V, Foster L, Gallagher P, Gowardman JR, Zhang L et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet 2012; 380(9847):1066–1074.
2. Tuffaha H, Rickard CM, Webster J, Marsh N, Gordon L, Wallis MC & Scuffham P. Cost-effectiveness analysis of clinically indicated vs routine replacement of peripheral IV catheters. Appl Health Econ Heath Policy 2014; 12(1):51–58.
3. Wallis MC, McGrail MR, Webster J, Marsh N, Gowardman JR, Playford EG & Rickard CM. Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a RCT. Infect Control Hosp Epidemiol 2014; 35(1):63–68.
4. Webster J, Osborne S, Rickard CM & New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2013; 4.
5. Bregenzer T, Conen D, Sakmann P & Widmer AF. Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med 1998; 158(2):151–156.
6. Graves G. A magic wand of inefficiency. AusHSI Blog 2015. Available from: http://aushsiblog.com/?p=228. Accessed 22/10/2015 16.00hrs.
7. Alexandrou E, Ray-Barruel G, Carr P, Frost S, Inwood S, Higgins N, Lin F, Mermel L & Rickard CM. A global prevalence study on the use of peripheral intravenous catheters: results of a pilot study in 13 countries. J Hosp Med 2015; 10(8):530–3.