Infection Control Guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections Dr. NAHLA ABDEL KADERوMD, PhD. INFECTION CONTROL CONSULTANT, MOH INFECTION CONTROL CBAHI SURVEYOR Infection Control Director, KKH.

1. GUIDELINES FOR PREVENTION
OF
INFECTIONS ASSOCIATED
WITH
PERIPHERAL VENOUS CATHETERS
How to use it to reduce the risk
of insertion site sepsis and
blood stream infections in your
ward
Dr. Nahla Abdel Kader, MD. PhD.
Infection Control Consultant, MOH
Infection Control CBAHI Surveyor
Infection Prevention Control Director,
KKH

2. What do we know about PVCs from
the recent prevalence survey?
• 1 in every 3 patients has a PVC!
• The majority of patients with PVCs are in the medical
wards
• 11% of all HAIs identified were skin and soft tissue
infections (many related to PVCs)
• So big a problem was identified that skin and soft
tissue infections related to PVCs are considered a
‘Priority Area’.
Source: Scottish National Prevalence Survey 2010

3. One study of Peripheral Vascular
Catheters found the following
•
•
•
•
•
•
•
•
52% Of patients had a PVC
33% Of PVCs were incorrectly dressed
52% Of PVCs were incorrectly positioned
46% Of PVCs were unused for 24 hours
23% Of PVCs had never been used
23% Of PVCs had no documented purpose
12% Of PVCs had visible phlebitis
6% Of PVCs had infiltration
Thomas et al JHI 2010

4. Extracts from a study into deaths
following MRSA infections
‘Six days post-operatively the patient
was noted to have pus coming
from a cannula site.’ Case study 6
‘After 8 days the PVC inserted on
admission showed signs of infection with
a purulent discharge.’ Case study 4
‘For almost half of the cases reviewed,
The source of the MRSA infection was
an invasive device, particularly PVC and CVC.’
http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=107

5. Researchers reported that blood stream
infections (BSIs) caused by PVCs were
statistically more likely to be caused by
Staph. aureus than BSIs from central vascular
catheters
53% of PVC – BSIs were S. aureus
33% of CVC – BSIs were S. aureus
P = 0.01
Staph aureus bacteraemia includes MRSA.
Pujol et al JHI 2010

6. These are Staphylococci sitting on a
skin scale that infect PVCs

7. The blood should
be sterile – free
from microbes

8. Infections start locally at
the catheter insertion
site,, but then…

9. If the catheter is not
removed and the infection
is not treated effectively, the
organisms can infect the
blood

10. Once the organisms are in
the blood a Staph aureus
bacteraemia (SAB) has
occurred

11. The best way to prevent
microbes from getting
into the blood is….

13. Peripheral intravenous cannulae present a high
risk for HCAIs.
 The need for an intravenous cannula requires
careful consideration.
 It should not be a routine procedure when
admitting/ assessing patients.
 Due care should be taken when handling
sharps/needles to avoid sharps/needle stick
injury.

14. Prevention of
PVC-BSI
Insertion
Maintenance
Removal

36. The date of cannula removal
must be documented in the medical/nursing
notes.
If a peripheral venous cannula
is not being used/required for access, it
should be removed.

37. Peripheral Vascular Catheter Care Bundle
Don’t put them in; Get them out; Look after them properly
The Bundle
1.Checking the PVC in situ is still required.
2. Removing PVC where there is extravasation or
inflammation.
3. Checking PVC dressings are intact.
4. Considering removal of PVC in situ longer than 72
hours.
5. Performing hand hygiene before and after all PVC
procedures.

38. Peripheral Vascular Catheter (PVC) Care Bundle – Standard Operating Procedure
Statement
PVCs cause phlebitis and insertion site sepsis; PVCs are the third leading cause of device-related blood stream infections.
Complications arise directly from their use and in particular if the care is sub optimal. We have a duty to our patients to
optimise PVC care and to ensure that our PVC care does not cause the patients harm. Monitoring our PVC care will assist us to
optimise procedures and reduce the risk to patients.
Objectives
Objectives:
1.To optimise Peripheral Vascular Catheter (PVC) care in OUR ward and reduce as far as possible any infectious
complications.
2.To be able to demonstrate quality PVC care in OUR ward
Requiremen Before the PVC Bundle Procedure can be Considered
ts Signed commitment from the clinical team: consultants; junior doctors, ward manager and nurse team to optimising PVC care.
Signed agreement from all consultants that named individuals on a weekly/named basis will undertake a PVC bundle,
including agreement from the clinical team for the actions within the bundle.
Named individuals competent in performing the bundle as written.
Prior to starting the PVC Bundle Procedure
Small clean trolley containing:
Alcohol hand gel; Cotton wool balls;
Orange or Yellow waste bag; Small sharps container
Personal Protective Equipment (PPE): Disposable Gloves – non-sterile; disposable plastic apron
Procedure
Perform hand hygiene..١
2.Collect a bundle sheet and complete the top boxes: name, location, etc.
3.Proceed to the first patient.
4.Introduce yourself to the patient and explain that you are checking all catheters to see if any need removed.
5.If it is not obvious ask ‘Do you have any of these needles, catheters or cannulae?’ If the answer is ‘no’ thank the
patient, move on to the next patient and go back to step 4. If the answer is ‘yes’ proceed to number 6.
6.If it is obvious they do have a catheter, or they have said they do, perform hand hygiene
7.Maintaining the patient’s privacy, ask to see the catheter insertion site – complete the bundle questions. Ask ‘buddy
nurse’* to confirm hand hygiene procedures and alcohol hub procedures have been optimal. NB Extra-vasiation may
still be detected even if there is a sterile gauze dressing over the insertion site, however, NEVER, removes a dressing just
to view an insertion site. If the dressing does not facilitate observation of the insertion site then score on extra-vasiation
alone.
8.If deemed necessary, remove the catheter aseptically [wearing appropriate PPE]. If you are unsure as to whether to
remove the catheter – confirm with a member of the medical team the appropriateness of removing the catheter
remaining in situ.
9.Perform hand hygiene.

39. Ward:
Name of person performing the bundle
Date
Observation
number
The PVC is still in
use;
Absence of
inflammation and or
extra-vasation
The PVC
dressing is intact
Yes
Continue
bundle
Yes
Continue
bundle
Yes
No
Sample
Remove
catheter
No
Remove
catheter
No
Yes
Continue
bundle
Remove
catheter
Continue
bundle
1
No
Yes
Continue
bundle
Yes
Continue
bundle
Remove
catheter
No
Remove
catheter
No
Remove
catheter
The PVC has
been inserted for
<72 hrs.
Yes
No
Yes
No
Continue
bundle
Request
removal
Continue
bundle
Remove
catheter
Hand Hygiene
before & after all
PVC procedures
Yes
Continue
bundle
No
Request
removal
Yes
Continue
bundle
No
What was
done
PVC left in
situ
PVC Removed
PVC left in situ
Request
removal
PVC Removed
Yes
2
No
Continue
bundle
Remove
catheter
Yes
No
Continue
bundle
Remove
catheter
Yes
No
Continue
bundle
Yes
Continue
bundle
Yes
Continue
bundle
Remove
catheter
No
Remove
catheter
No
Request
removal
PVC left in situ
PVC Removed
Yes
Continue
bundle
Yes
Continue
bundle
Yes
Continue
bundle
Yes
Continue
bundle
Yes
Continu
e bundle
No
3
Remove
catheter
No
Remove
catheter
No
Remove
catheter
No
Remove
catheter
No
Request
removal
PVC left in situ
PVC Removed
4
Yes
Continue
bundle
Yes
Continue
bundle
Yes
Continue
bundle
No
Remove
catheter
No
Remove
catheter
No
Remove
catheter
Yes
Continue
bundle
Yes
Continue
bundle
PVC left in situ
No
Remove
catheter
No
Request
removal
PVC Removed

40. Summary Table of PVC Bundle Findings
NO.
Comment (if required)
Total number of PVCs in situ at start of PVC Bundle
Total number of PVCs removed because they were not being used or were no longer required.
Total number of PVCs removed because of extravasation or insertion site inflammation
Total number of PVCs removed because the dressing was not intact or was inappropriate
Total number of PVCs in situ longer than 72 hours.
Total number of PVCs where hand hygiene has been performed before and after all PVC
procedures*
All or None Table – Was PVC Care Today Optimal
100% of PVCs in situ are required
0% (Zero) PVCs had extravasation or insertion site inflammation
100% of PVCs had appropriate and intact dressings
0% (Zero) PVCs removed as a consequence of the bundle round
0% (Zero) of PVCs were in situ >72 hours.
100% of PVCs were visible and well positioned
If all the above were achieved the PVC care was optimal
Signature of person completing the PVC bundle:
Date bundle completed
Tick if achieved