Research On The Insertion Site And Bacterial Colonization Of Peripheral Intravenous Indwelling Catheter In Cardiovascular Disease Patients

ObjectivesTo investigate the characteristics of bacterial colonization of peripheral intravenous indwelling catheter in cardiovascular disease patients, and explore the best insertion site, indwelling time, and indwelling time at different insertion sites. Thus to provide scientific evidence for further research on peripheral intravenous indwelling catheter-related infections in cardiovascular disease patients, then provide clinical guidelines for the management of peripheral intravenous catheter insertion sites and indwelling time and the prevention of catheter-related infections in cardiovascular disease patients.Methods240 hospitalized patients in this study were randomly recruited in cardiovascular department of Xiang-Ya Hospital of Central South University from Sep 2009 to Jul 2010. All subjects were divided into 3 groups according to the insertion site of peripheral intravenous indwelling catheter:forearms (group 1), back of hands (group 2), feet (group 3). After obtaining specimens at skin puncture site respectively after skin disinfection and extracting catheters, as well as on the extracted catheters, culture and identification of bacteria were performed. Multiple measurements were performed at 4 different times for each group. All calculations were performed using SPSS V13.0 for Windows. Statistical analyses were made using statistical description, one-way ANOVA, chi-square test and two-way ANOVA for factorial design.Results1. After skin disinfection, bacterial culture of these three groups showed to be sterile.2. After extracting catheters, culture of bacteria showed 41 cases with bacterial growth above 15cfu/cm2; no bacteria growth were detected among three groups at T1 and T2; Comparison among three groups was considered statistically significant (P< 0.05) and comparison among three groups at T3 and T4 was considered statistically significant (P< 0.05).3. Specimens from the extracted catheters were cultured and results showed 10 cases with bacterial growth above 15cfu/cm2; no bacterial growth was assessed in group1 and group 2 at 4 different times; bacterial culture of group 3 showed to be sterile at T1 and T2,4 cases at T3 and 6 cases at T4 with bacterial growth. Comparison among three groups was considered statistically significant (P< 0.05). Comparison in group 3 was considered statistically significant (P< 0.05) at 4 different times.4. When extracting catheters, there was redness of the skin at the puncture sites in all groups at different times except at T1. The differences of the incidence of redness at skin puncture sites among groups were statistically significant (P< 0.05). The incidence of redness among groups was considered statistically significant (P< 0.05) at 4 different times.5. When extracting catheters, there was swelling of the skin at the puncture sites in all groups at T3 and T4, while there was no swelling at T1 and T2. The differences of the incidence of swelling at skin puncture sites among groups were statistically significant (P< 0.05). The incidence of swelling among groups was considered statistically significant (P< 0.05) at 4 different times.6. When extracting catheters, the differences of the incidence of pain at skin puncture sites among groups were statistically significant (P< 0.05). The incidence of pain among groups was considered statistically significant (P< 0.05) at 4 different times.7. The relation between the incidence of redness, swelling, pain of the skin at skin puncture sites and bacterial colonization was not direct.Conclusion1. The skin puncture sites should be infected twice using complex iodine normally to remove resident and transient bacteria.2. Forearms are the safest indwelling sites for peripheral intravenous indwelling catheter in cardiovascular disease patients.3. The duration of indwelling on the back of hands or feet with peripheral intravenous catheter should be no more than 96 hours, while on the forearms it should be no more than 120 hours.4. The incidence of redness, swelling, pain on feet group is highest, while it is the lowest on forearms. There is a negative association between indwelling time and the incidence of redness, swelling and pain of the skin at the puncture sites.5. The appearance of redness, swelling and pain of the skin at the puncture sites could indicate mechanical phlebitis, not peripheral intravenous indwelling catheter-related infections directly. When peripheral intravenous indwelling catheter-related infections may occur, even there is not symptom like redness, swelling and pain. It should be taken seriously, especially when the indwelling time is long or the puncture site is on feet.