Factors Associated With Infections From Peripheral Venous Catheters in Older Patients in the ICU and Exploration of Preventive Measures.

Abstract

Context: Intensive care units (ICUs) have the highest incidence of hospital-acquired infections. An in-depth understanding of the factors associated with PVIN infections may be the best way to prevent and control PVIN infections.

Objective: The study aimed to investigate the factors associated with peripheral venous indwelling needle (PVIN) infections in older patients in the intensive care unit (ICU) and to use the findings to develop targeted preventive-care measures.

Design: The research team conducted a prospective observational study of factors influencing PVIN infections and a prospective randomized controlled study of targeted nursing care.

Setting: The studies took place at the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.

Participants: For the first study, participants were 121 patients admitted to the hospital's ICU between April 2018 and June 2020, and for a second analysis, participants were 92 ICU patients admitted between December 2020 and March 2022. The first group took part in an analysis of the factors influencing PFIN infections and the second in a comparison of a targeted nursing intervention and routine care.

Groups: For the first analysis, the research team divided the 121 participants into two groups: (1) a control group with 69 participants who didn't develop a PVIN infection and (2) an observation group with 52 participants who developed a PVIN infection. For the second analysis, the team randomly assigned the 92 participants to one of two groups: (1) 46 participants to a targeted nursing group who received care focused on preventing PVIN infections, and (2) 46 participants to a conventional group receiving routine care.

Outcome measures: For the first analysis, the research team carried out logistic regression analysis to assess the factors related to PVIN infections, including the incidence of PVIN infections, durations of PVIN retention, ICU stays, and lengths of hospital stay (LOS). For the second analysis, the research team: (1) measured changes in blood glucose and inflammatory factor levels at baseline and postintervention and (2) conducted a nursing satisfaction survey upon patients' discharges.

Results: For the first study, logistic multiple regression analysis revealed that the durations of catheter retention of ≥7d, a number of punctures ≥2 times, a duration of antibiotic administration of ≥14d, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were independent risk factors for PVIN infections in older patients in an ICU (all P < .001). After implementing targeted nursing strategies for the second study, the targeted care group had a significantly lower incidence of PVIN infections (P < .001), shorter duration of PVIN retention (P < .001), shorter ICU stay (P < .001), and shorter LOS (P < .001) compared to those of the conventional group. Additionally, the intervention group showed significantly lower fasting plasma glucose (FPG) and 2h postprandial plasma glucose (2hPG) levels, with P < .001 and P = .002, respectively; significantly lower interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels, with P < .001, P < .001, and P = .001, respectively; and significantly higher nursing satisfaction postintervention (P = .036).

Conclusions: The duration of catheterization, antibiotic administration, and APACHE II scores were independent risk factors for PVIN infections in older patients in the ICU. Implementing targeted care based on those factors can effectively prevent PVIN infections in ICU patients and improve patient satisfaction, demonstrating high clinical practicality.