Marta Piriz-Marabajan, Alexander Rombauts, Nerea Roch-Villaverde, Ana Pilar Cortes-Palacios, Engracia Fernandez-Piqueras, Susana Serrano-Condal, Marta Taltavull-Menendez, Sara Grillo, Antonella Francesca Simonetti, Pol Duch, Virginia Pomar-Solchaga, Laura Escolà-Vergé, Joaquin Lopez-Contreras
{"title":"与直管中心相比，使用集成无连接器的延伸装置对外周导管失效的影响：一项前瞻性准实验研究。","authors":"Marta Piriz-Marabajan, Alexander Rombauts, Nerea Roch-Villaverde, Ana Pilar Cortes-Palacios, Engracia Fernandez-Piqueras, Susana Serrano-Condal, Marta Taltavull-Menendez, Sara Grillo, Antonella Francesca Simonetti, Pol Duch, Virginia Pomar-Solchaga, Laura Escolà-Vergé, Joaquin Lopez-Contreras","doi":"10.1016/j.jhin.2025.09.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Peripheral intravenous catheter (PIVC) failure is a significant clinical issue. Evidence is needed on the impact of different PIVC systems on outcomes.</p><p><strong>Aim: </strong>To analyze the effect of add-on extension sets with integrated connectors on PIVC outcomes in real-world practice.</p><p><strong>Methods: </strong>A prospective, open-label, quasi-experimental study with blinded analyst was conducted at a tertiary hospital in Barcelona, Spain, comparing two PIVC systems. The control system (standard winged PIVC with add-on needleless connector) was evaluated from March 1 to April 6, 2022, and the study system (with add-on extension set and integrated needleless connector) from September 9 to December 14, 2023. The primary endpoint was overall PIVC failure per 1000 catheter-days, analyzed as relative rate.</p><p><strong>Findings: </strong>A total of 1019 PIVCs (607 patients) in the control group and 1028 PIVCs (634 patients) in the study group were followed. Groups had similar hospital stay, dwell times, and mortality. Patients in the study group were more likely to have heart disease, COPD, and be physically restrained. Overall, 795 (39.7%) PIVCs failed, a rate of 86.0 per 1000 catheter-days. The most common reasons for unplanned removal were extravasation (10.6%), occlusion (8.1%), accidental removal (7.7%), phlebitis (7.4%), and discomfort (5.5%). PIVC failure was significantly lower in the study group compared with control (37.2% vs. 42.1%, p = 0.025). Failure per 1000 catheter-days showed a non-significant reduction (RR = 0.89; 95% CI 0.77-1.03).</p><p><strong>Conclusion: </strong>PIVC failure remains high. 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Evidence is needed on the impact of different PIVC systems on outcomes.</p><p><strong>Aim: </strong>To analyze the effect of add-on extension sets with integrated connectors on PIVC outcomes in real-world practice.</p><p><strong>Methods: </strong>A prospective, open-label, quasi-experimental study with blinded analyst was conducted at a tertiary hospital in Barcelona, Spain, comparing two PIVC systems. The control system (standard winged PIVC with add-on needleless connector) was evaluated from March 1 to April 6, 2022, and the study system (with add-on extension set and integrated needleless connector) from September 9 to December 14, 2023. The primary endpoint was overall PIVC failure per 1000 catheter-days, analyzed as relative rate.</p><p><strong>Findings: </strong>A total of 1019 PIVCs (607 patients) in the control group and 1028 PIVCs (634 patients) in the study group were followed. Groups had similar hospital stay, dwell times, and mortality. Patients in the study group were more likely to have heart disease, COPD, and be physically restrained. Overall, 795 (39.7%) PIVCs failed, a rate of 86.0 per 1000 catheter-days. The most common reasons for unplanned removal were extravasation (10.6%), occlusion (8.1%), accidental removal (7.7%), phlebitis (7.4%), and discomfort (5.5%). PIVC failure was significantly lower in the study group compared with control (37.2% vs. 42.1%, p = 0.025). Failure per 1000 catheter-days showed a non-significant reduction (RR = 0.89; 95% CI 0.77-1.03).</p><p><strong>Conclusion: </strong>PIVC failure remains high. 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引用次数: 0
摘要
背景：外周静脉导管（PIVC）失败是一个重要的临床问题。需要证据来证明不同的PIVC系统对结果的影响。目的：分析具有集成连接器的附加扩展集在实际应用中对PIVC结果的影响。方法：在西班牙巴塞罗那的一家三级医院进行了一项前瞻性、开放标签、准实验研究，比较了两种PIVC系统。2022年3月1日至4月6日对控制系统（带附加无针连接器的标准带翼PIVC）进行了评估，2023年9月9日至12月14日对研究系统（带附加扩展集和集成无针连接器）进行了评估。主要终点是每1000导管日总PIVC失败率，以相对率进行分析。结果：共随访对照组1019例（607例），研究组1028例（634例）。两组的住院时间、住院时间和死亡率相似。研究组的患者更有可能患有心脏病、慢性阻塞性肺病，并且身体受到限制。总体而言，795例（39.7%）pivc失败，发生率为86.0 / 1000导管天。意外取出的最常见原因是外渗（10.6%）、闭塞（8.1%）、意外取出（7.7%）、静脉炎（7.4%）和不适（5.5%）。研究组PIVC失败率明显低于对照组（37.2% vs 42.1%, p = 0.025）。每1000个导管日的失败率没有显著降低（RR = 0.89; 95% CI 0.77-1.03）。结论：PIVC失败率居高不下。具有附加扩展和集成无针连接器的PIVC在统计上没有显着降低故障率。
Impact on peripheral catheter failure with the use of an extension set with integrated needless connector compared to a straight hub: a prospective quasi-experimental study.
Background: Peripheral intravenous catheter (PIVC) failure is a significant clinical issue. Evidence is needed on the impact of different PIVC systems on outcomes.
Aim: To analyze the effect of add-on extension sets with integrated connectors on PIVC outcomes in real-world practice.
Methods: A prospective, open-label, quasi-experimental study with blinded analyst was conducted at a tertiary hospital in Barcelona, Spain, comparing two PIVC systems. The control system (standard winged PIVC with add-on needleless connector) was evaluated from March 1 to April 6, 2022, and the study system (with add-on extension set and integrated needleless connector) from September 9 to December 14, 2023. The primary endpoint was overall PIVC failure per 1000 catheter-days, analyzed as relative rate.
Findings: A total of 1019 PIVCs (607 patients) in the control group and 1028 PIVCs (634 patients) in the study group were followed. Groups had similar hospital stay, dwell times, and mortality. Patients in the study group were more likely to have heart disease, COPD, and be physically restrained. Overall, 795 (39.7%) PIVCs failed, a rate of 86.0 per 1000 catheter-days. The most common reasons for unplanned removal were extravasation (10.6%), occlusion (8.1%), accidental removal (7.7%), phlebitis (7.4%), and discomfort (5.5%). PIVC failure was significantly lower in the study group compared with control (37.2% vs. 42.1%, p = 0.025). Failure per 1000 catheter-days showed a non-significant reduction (RR = 0.89; 95% CI 0.77-1.03).
Conclusion: PIVC failure remains high. A PIVC with add-on extension and integrated needleless connector did not show a statistically significant reduction in failure rate.
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
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