Hideto Yasuda1,2,3, Ryohei Yamamoto4, Yoshiro Hayashi4, Yuki Kotani4,5, Yuki Kishihara6, Natsuki Kondo4, Kosuke Sekine7, Nobuaki Shime8, Keita Morikane9, Takayuki Abe10,11, Toru Takebayashi12, Mikihiro Maeda13, Takuya Shiga14, Taku Furukawa15, Mototaka Inaba16, Sachito Fukuda17, Kiyoyasu Kurahashi18, Sarah Murakami19, Yusuke Yasumoto20, Tetsuro Kamo21, Masaaki Sakuraya22, Rintaro Yano23, Toru Hifumi24, Masahito Horiguchi25, Izumi Nakayama26, Masaki Nakane27, Kohei Ota8, Tomoaki Yatabe28, Masataka Yoshida29, Maki Murata30, Kenichiro Fujii31, Junki Ishii8. 1. Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. yasudahideto@me.com. 2. Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan. yasudahideto@me.com. 3. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan. yasudahideto@me.com. 4. Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan. 5. Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. 6. Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan. 7. Department of Medical Engineer, Kameda Medical Center, Chiba, Japan. 8. Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 9. Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan. 10. Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan. 11. Faculty of Data Science, Yokohama City University School of Data Science, Yokohama, Japan. 12. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan. 13. Department of Pharmacy, St. Marianna University Hospital, Kanagawa, Japan. 14. Intensive Care Unit, Tohoku University Hospital, Miyagi, Japan. 15. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan. 16. Department of Emergency and Critical Care Medicine, Okayama Saiseikai General Hospital, Okayama, Japan. 17. Intensive Care Unit, Mitsui Memorial Hospital, Tokyo, Japan. 18. Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Chiba, Japan. 19. Intensive Care Unit, Sakai city medical center, Osaka, Japan. 20. Emergency And Critical Care Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan. 21. Division of Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan. 22. Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan. 23. Division of Intensive Care Unit, Nagasaki University Hospital, Nagasaki, Japan. 24. Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan. 25. Division of Emergency Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan. 26. Intensive Care Unit, Okinawa Chubu Hospital, Okinawa, Japan. 27. Critical Care Center, Yamagata University Hospital, Yamagata, Japan. 28. Intensive Care Unit, Kochi Medical School Hospital, Kochi, Japan. 29. Intensive Care Unit, Shiroyama Hospital, Osaka, Japan. 30. Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan. 31. Emergency Intensive Care Unit, Fujita Health University, Nagoya, Japan.
Abstract
BACKGROUND: The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU). METHODS: This prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay. RESULTS: We included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9-8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7-14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4-1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7-10.0), respectively. CONCLUSION: PIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients. TRIAL REGISTRATION: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019 , July 1, 2017).
BACKGROUND: The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically illpatients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU). METHODS: This prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay. RESULTS: We included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9-8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7-14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4-1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7-10.0), respectively. CONCLUSION: PIVC-related phlebitis and complications were common in critically illpatients. The results suggest the importance of preventing PIVC-related complications, even in critically illpatients. TRIAL REGISTRATION: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019 , July 1, 2017).