Insertion site and risk of peripheral intravenous catheter colonisation: A post hoc analysis of the CLEAN 3 study including more than 800 catheters

Abstract Aim: Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications. Methods: We performed a post hoc analysis of the CLEAN 3 database, a randomised 2x2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in adults patients before admission to a medical ward. PIVC insertion sites were grouped into five groups: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonisation (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models. Results: Overall, we included 823 PIVCs with known site of insertion that were sent to the laboratory for quantitative culture. After adjustment for confounding factors, PIVC insertion in the wrist or the cubital fossa was associated with an increased risk of positive and colonised tip culture. In other words, insertion of a PIVC into a site of the upper limb other than the wrist or the cubital fossa reduced the risk of colonised PIVC (HR 0.57 [0.35-0.92], p=0.020) and of positive PIVC tip culture (HR 0.75 [95%CI, 0.55-1.02], p=0.065).