# Infection risk of peripheral intravenous catheters: meta-synthesis of 18 prospective studies with 14,606 catheters

## TL;DR

This study analyzed 14,606 peripheral intravenous catheters to find that infection rates are very low but pose a serious risk for complex patients, with Gram-negative bacteria being common in Australia.

## Contribution

The study provides new insights into the low but significant infection risk of peripheral intravenous catheters and identifies high-risk patient characteristics and bacterial patterns in Australia.

## Key findings

- PIVC-associated bloodstream infections occurred in 0.041% of catheters, with Gram-negative organisms being predominant.
- Infection risk was highest on Days 6 and 7, with a daily hazard of 0.06% to 0.10%.
- High-risk factors included male patients over 60 with difficult IV access and delayed catheter removal.

## Abstract

To quantify the incidence of peripheral intravenous catheter (PIVC) infections and to describe the influence of clinical characteristics, including dwell time, on risk.

Meta-synthesis of 18 prospective studies (16 randomized controlled trials and two prospective cohort studies) reporting PIVC infections. In total, 14,606 PIVCs (50,096 device-days) were studied from insertion to removal in seven Australian government hospitals. PIVC care was provided by clinical staff with daily follow up by research nurses. We calculated incidences and rates of local infection (without bloodstream infection [BSI]) and PIVC-associated bloodstream infection (i.e., primary BSI) using the National Healthcare Safety Network criteria. The hazard function was assessed by fitting a parametric survival model. PIVC-associated BSI was further categorized as PIVC-related BSI and/or Staphylococcus aureus BSI. Case study methodology explored characteristics of PIVC-associated BSI, and life tables explored the hazard function of PIVC-associated BSI over dwell time.

Of 14,606 PIVCs (dwell 0–42 days), there were five local infections (0.034%; 0.100/1,000 device-days) and six PIVC-associated BSI (0.041%; 0.120/1,000 device-days), of which four were PIVC-related and one was S. aureus BSI. PIVC-associated BSI involved Enterobacter cloacae (n = 3 including one co-infection with Citrobacter braakii), Proteus mirabilis (n = 1), Pseudomonas aeruginosa (n = 1) and S. aureus (n = 1; S. aureus BSI incidence 0.007% catheters or 0.020/1000 device-days). PIVC-associated BSI cases commonly featured: males > 60 years with difficult intravenous access, delayed removal of idle or symptomatic PIVCs, cancer diagnoses, invasive gastrointestinal drains/procedures, insertion site complications, and forearm placement. PIVC-associated BSI daily hazard was constant over time with zero to 0.03% on Days 1 to 5 (n = 11,491), 0.06% to 0.10% on Days 6 and 7 (n = 2,571), and zero on Days 8 to 42 (n = 544).

Infection incidence is very low but remains a serious risk, mainly for complex patients. Gram-negative organisms may now be predominant in Australia. Infection surveillance should be risk-adjusted and prevention efforts to improve both insertion and post-insertion management targeted at high-risk groups. While overall intravenous therapy (exposure) should be minimised, daily risk per PIVC appears constant for at least 5 days.

The online version contains supplementary material available at 10.1186/s13756-025-01645-z.