Dwell Time and Risk of Bloodstream Infection With Peripheral Intravenous Catheters

Importance Bloodstream infections (BSIs) associated with peripheral intravenous catheters (PIVCs) are rare but preventable adverse events. The association of dwell time with the risk of BSIs with PIVCs remains controversial. Objective To analyze the risk of BSIs during PIVC maintenance therapy. Design, Setting, and Participants In this observational cohort study, all patients hospitalized at Geneva University Hospitals with at least 1 PIVC insertion on the upper extremity (N = 371 061) between January 1, 2016, and February 29, 2020, were evaluated. Statistical analysis was performed from January 2023 to January 2025. Exposure At least 1 PIVC insertion on the upper extremity. Main Outcomes and Measures The primary outcome was BSIs with PIVCs; data were collected by prospective BSI surveillance. The daily risk of BSIs with PIVCs was analyzed using the hazard rate function by kernel-based methods. Multivariable logistic models were performed to evaluate the risk of BSIs with PIVCs comparing different cutoff values of dwell times (>3 vs ≤3 days, >4 vs ≤4 days, >5 vs ≤5 days, and >6 vs ≤6 days). Results A total of 371 061 PIVCs (median patient age, 63 years [IQR, 41-79 years]; 187 786 women [51%]) with documented catheter duration were included. A total of 140 178 PIVCs (38%) had a dwell time of 1 to 2 days, 119 252 (32%) had a dwell time of 3 to 4 days, and 111 631 (30%) had a dwell time of more than 4 days. The instantaneous risk of BSIs with PIVCs was low in the first 2 days of dwell time and increased rapidly thereafter. The risk of BSIs was significantly increased after 3 days of catheter maintenance (adjusted odds ratio [AOR], 13.55; 95% CI, 5.44-34.00). This risk was the highest after 3 days and remained increased thereafter (>4 days: AOR, 8.53; 95% CI, 4.47-16.28; >5 days: AOR, 5.38; 95% CI, 3.23-8.96; and >6 days: AOR, 7.63; 95% CI, 4.57-12.74). Conclusions and Relevance In this cohort study of 371 061 PIVCs, dwell time was associated with the development of BSIs with PIVCs. After day 3, PIVC indication should be reviewed and PIVC replacement considered.