Can the implementation of a PIVC bundle reduce bloodstream infection? A systematic review

Mrs Hui (Grace) Xu1, Dr  Gillian  Ray-Barruel1, Professor Marie Cooke1, Professor  Claire Rickard1

1Griffith University, Brisbane, Australia


Introduction. A 5-item bundle has been shown to lower central line-associated bloodstream infection (CLABSI) rates in adult intensive care units. However, the impact of peripheral intravenous catheter (PIVC) insertion and maintenance bundles in the general hospital population is unclear.

Methods. This systematic review was conducted in accordance with the Cochrane Effective Practice and Organisation of Care (EPOC) guidelines. We searched electronic databases Pubmed, CINAHL, EMBASE, Medline, Cochrane CENTRAL, ISI Web of Science, trial registries and grey literature for eligible studies published in English from 1 January 2000 until 31 March 2018 to identify intervention studies evaluating PIVC insertion or maintenance care bundles with two or more components. Search terms included: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, bloodstream infection (BSI). BSI was the reported endpoint. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist.

Results. In total, 13,584 records were screened, and 8 studies (4 interrupted time-series, 4 controlled before-after) were eligible for inclusion. The methodological quality ranked between ‘low’ (3 studies) and ‘fair’ (5 studies). Various strategies were used in insertion bundles (up to 9 components) and maintenance bundles (up to 12 components). Two studies reported reduction in BSI rates with chlorhexidine gluconate skin prep and integrated closed catheter system. However, study design quality was poor, with small sample sizes.

Conclusion. Current PIVC insertion and maintenance bundles include diverse interventions and study quality is poor. The effect of PIVC care bundles on BSI rates remains uncertain. More high quality studies are required.


Grace (Hui) Xu is an experienced Nurse Practitioner in emergency medicine, Nurse Researcher with the Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, and Adjunct Lecturer at the School of Nursing and Midwifery, Griffith University. Her research interests include vascular access devices, infection prevention, staff wellness promotion, and clinical education. Her passion in promoting patient safety and staff wellness drives her interest in becoming a key driver and stakeholder of the Staff Wellness Committee in her emergency department and a member of the Medication Safety Committee in her hospital.

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