• Users Online: 186
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 705-708

Comparative evaluation of bacterial growth following removal of peripheral intravenous cannula inserted in an emergency room and in aseptic condition: A prospective randomized double-blind study


Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission27-Jun-2020
Date of Decision12-Jan-2021
Date of Acceptance03-Nov-2021
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Pradeep Vathare
Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Sector-1, Kamothe, Navi Mumbai - 410 209, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_238_20

Rights and Permissions
  Abstract 


Context: Approximately 60% of hospital inpatients annually undergo peripheral intravenous cannulation to receive therapeutic intravenous (IV) medication. About 6.2% of hospital-acquired bacteremia may be directly attributable to peripheral IV cannulation. The setting in which the PICs are inserted may influence the microbial flora around the site of insertion. Aims: The study aims to evaluate and compare the incidence of bacterial growth and assess the local complications like cellulitis and phlebitis following removal of PIC inserted in an emergency room and in aseptic condition. Settings and Design: This was a prospective randomized double-blind Study. Materials and Methods: A total of 50 subjects (Group A n = 25 and Group B n = 25) were randomly divided and evaluated for the incidence of bacterial growth and assessing the cellulitis and phlebitis. Group A underwent removal of PIC inserted in aseptic condition after 72–96 h and Group B underwent removal of PIC inserted in the emergency room after 72–96 h. Statistical Analysis Used: Unpaired t-test and Chi-square test were used for statistical analysis. Results: No (0%) subjects had bacterial growth in Group A and 2 (8%) subjects in Group B had bacterial growth, but the difference was not found to be statistically significant (P = 0.149). On comparison, cellulitis and phlebitis were absent in both the groups. Conclusions: The incidence of bacterial growth and the local complications like cellulitis and phlebitis following removal of PIC inserted in the emergency room and in aseptic condition was nominal. However, strict aseptic precautions should always be followed while inserting a foreign object into the circulatory system.

Keywords: Bacteraemia, cellulitis, nosocomial infection, peripheral intravenous cannula, phlebitis


How to cite this article:
Natarajan S, Vathare P, Asnani U, Vaidya S, Baviskar P, Balkawade R. Comparative evaluation of bacterial growth following removal of peripheral intravenous cannula inserted in an emergency room and in aseptic condition: A prospective randomized double-blind study. J Datta Meghe Inst Med Sci Univ 2022;17:705-8

How to cite this URL:
Natarajan S, Vathare P, Asnani U, Vaidya S, Baviskar P, Balkawade R. Comparative evaluation of bacterial growth following removal of peripheral intravenous cannula inserted in an emergency room and in aseptic condition: A prospective randomized double-blind study. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:705-8. Available from: http://www.journaldmims.com/text.asp?2022/17/3/705/360198




  Introduction Top


It is estimated that approximately 60% of hospital inpatients annually undergo peripheral intravenous cannulation to receive therapeutic intravenous (IV) medication.[1] Peripheral IV cannula-related procedures are performed within hospitals regularly, with many admitted patients requiring IV drug therapy. However, their use is not without risk.[2] The Nosocomial Infection National Surveillance Service (2002) postulates that 6.2% of hospital acquired bacteremia's may be directly attributable to peripheral IV cannulation.[1]

PIC is a procedure in which the subject's skin is punctured with a needle to allow insertion of a temporary plastic tube into a vein. Since the procedure involves breaching the skin and leaving a foreign body in the vein, patients are exposed to a number of risks, one of which is infection (Morris).[1] Infection may be localized or systemic; however, peripheral intravenous cannulas (PICs) are more commonly associated with localized than systemic infection. Nevertheless, because of the high number of peripheral intravenous cannulas (PICs) inserted annually, serious infections have resulted in significant annual morbidity.[1]

The setting in which the PICs are inserted may influence the microbial flora around the site of insertion. Aseptic precautions are mandatory whenever it is inserted. Presumably, despite taking all aseptic precautions, an emergency room setup may be a more contaminated setting with a greater risk of infection.[3] [Figure 1][4] demonstrates the potential sources of infection, whereas [Figure 2][5] demonstrates the routes of access of microorganisms associated with PICs.
Figure 1: Potential sources of infection in a peripheral intravenous cannula

Click here to view
Figure 2: Routes of access of microorganisms in a peripheral intravenous cannula

Click here to view


Therefore, there is a need to evaluate the growth of bacteria following removal of a peripheral intravenous cannula inserted in the emergency room and in aseptic condition. The aim of the study was to evaluate and compare the incidence of bacterial growth and assess the local complications like cellulitis and phlebitis following removal of a peripheral intravenous cannula inserted in emergency room and in aseptic condition.


  Materials and Methods Top


The prospective randomized double-blind study was approved by the Institutional Research and Ethics Committee. Written informed consent was obtained prospectively from all participants.

The study was conducted on participants admitted in the Oral and Maxillofacial Surgery Ward, MGM Dental and Medical Hospital, Navi Mumbai. All subjects within the age group of 18–75 years irrespective of either sex, who required IV therapy, and subjects who were willing for participation and follow-up were included in the study. The subjects with any evidences of skin disease near peripheral intravenous cannula insertion area, any local pathology of soft tissue, signs of infections, uncooperative subjects, and mentally retarded subjects were excluded from the study. Subjects included but did not wish to comply with the evaluation protocols as relevant to study due to personal reasons were withdrawn.

Subjects after inclusion were randomly divided into either Group A or Group B using Research Randomizer Software. Group A underwent removal of a peripheral intravenous cannula inserted in aseptic condition after 72–96 h and Group B underwent removal of a peripheral intravenous cannula inserted in the emergency room after 72–96 h. The subjects and the observer were blinded to the study.

The default position is usually the dorsal hand, forearm, or antecubital fossa. A straight, wide, “spongy” vein with no evidence of valves was preferred. Site preparation was done for group subjects with an antiseptic solution. Scrubbing of the field was performed using Betadine 7.5% solution. Painting of the field was performed using Betadine 5% solution. Site preparation was done for Group B subjects with the application of spirit solution. Peripheral intravenous cannula (ROMSONS INTRAFLON® GS-3028) was inserted. The cannula was flushed with 0.9% saline to confirm placement, watching for extravasation of fluid. Then, dressing was placed over the cannula.[6]

After 72–96 h, IV cannula was removed in a sterile container and was sent to the microbiology laboratory. With sterile forceps, the cannula tip segment was placed on the sheep blood agar plate. Each segment was rolled 4–6 times on the sheep blood agar plate with the sterile forceps. The plate was incubated at 35°C in 5% CO2 or in a candle jar. The plate was examined after 24 h and 48 h' incubation. The plate was discarded after 48 h if negative. If growth was present on the plate, the number of colonies of each colony type was counted and reported.[7]

This laboratory procedure was designed to detect bacteria on the outer surface of cannulas. The number of bacteria on the surface of cannulas was correlated with cannula-related bloodstream infection.


  Results Top


After removal, the PIC was inserted in the emergency room and in aseptic condition; bacterial growth, cellulitis, and phlebitis were assessed. A total of 50 subjects (Group A n = 25 and Group B n = 25) were included. As demonstrated in [Table 1], the average age of subjects in Group A was 38.32 years and in Group B was 32.96 years. P < 0.05 was considered significant. On comparison of age distribution between Group A and Group B, respectively, the age distribution was higher in Group A as compared to Group B, but the difference was not found to be statistically significant (P = 0.157); hence, it can be inferred that both the groups were comparable and with same characteristics.
Table 1: Comparison of age distribution in both Group A (intervention in aseptic condition) and Group B (intervention in the emergency room)

Click here to view


Out of the total 50 subjects (the distribution according to the gender is shown in [Table 2] below), there were 17 males and 8 females in each group. On comparison of gender distribution between Group A and Group B, respectively, the gender distribution was equal in Group A and Group B, but the difference was not found to be statistically significant (P = 1.000).
Table 2: Comparison of gender distribution in both Group A (intervention in aseptic condition) and Group B (intervention in the emergency room)

Click here to view


Out of the total 50 subjects, the distribution according to bacterial growth is shown in [Table 3] below. No (0%) subject had bacterial growth in Group A and 2 (8%) subjects in Group had bacterial growth, but the difference was not found to be statistically significant (P = 0.149). The common organism isolated in both the patients in Group B was coagulase-negative staphylococcus.
Table 3: Comparison of presence of bacterial growth in both Group A (intervention in aseptic condition) and Group B (intervention in the emergency room)

Click here to view


There was no cellulitis after removal of Peripheral intravenous cannula in all subjects in both Group A and Group B as shown in [Table 4].
Table 4: Comparison of presence of cellulitis in both Group A (intervention in aseptic condition) and Group B (intervention in the emergency room)

Click here to view


Similarly, phlebitis was absent in Group A and Group B, as shown in [Table 5].
Table 5: Comparison of presence of phlebitis in both Group A (intervention in aseptic condition) and Group B (intervention in the emergency room)

Click here to view



  Discussion Top


PICs are the most common foreign bodies inserted into the circulatory system in hospitalized patients. Common reasons for securing a PIC include:[8]

  • Administration of IV fluids to maintain hydration
  • To Administer IV medication
  • To transfuse blood or blood products
  • To treat dehydration in patients who are unable to tolerate sufficient oral fluid
  • To assist close observation and monitoring of a deteriorating patient.


Catney et al. support the removal of all cannulas at 72 h to prevent bacteremia. In their study, one episode of bacteremia occurred in cannulas in situ <72 h, three occurred after 72 h. However, four were of unknown duration and three cannulas were responsible for septicemia at 72 h.[9] Clearly, to prevent phlebitis and bacteremia, catheters must be removed as soon as possible.

The common conception that a foreign object like PIC can harbor bacteria from the skin and subsequently act as a source of infection is not supported by this study, as the difference in bacterial growth between the two groups was not statistically significant.

The local complications, namely cellulitis and phlebitis were absent in both the groups within the study duration. The present study supports the fact that conditions at the time of insertion of PIC do not influence the variables studied. Instead, the presence of the local complications should indicate extension or removal of the same.[10]

Factors like multiple attempts as the time of securing or accessing the PIC, the gauge of the PIC, and inherent ability of the drug administered to induce cellulitis and phlebitis should be evaluated against the incidence of local complications.

The study supports the fact that the PIC does not act as a medium to foster and cultivate the bacteria inoculated by skin puncture. Hence, the condition in which PIC has been inserted does not affect bacterial growth which can cause bacteria. However, strict aseptic precautions should always be followed while inserting a foreign object into the circulatory system. Standard aseptic precautions and protocols of care are followed during insertion and further use.


  Conclusions Top


The results of the study showed that the incidence of bacterial growth and the local complications like cellulitis and phlebitis following removal of PIC inserted in the emergency room and in aseptic condition was nominal. However, strict aseptic precautions should always be followed while inserting a foreign object into the circulatory system.[11]

The limited sample size of the current study cannot be deemed adequate to address all evaluation parameters. Hence prospective randomized studies are required to further evaluate the incidence of bacterial growth following removal of PIC inserted in the emergency room and in aseptic condition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Morris W, Heong Tay M. Strategies for preventing peripheral intravenous cannula infection. Br J Nurs 2008;17:S14-21.  Back to cited text no. 1
    
2.
Higgingson R. IV cannula securement: Protecting the patient from infection. Br J Nurs 2015;24:S23-4, S26, S28.  Back to cited text no. 2
    
3.
Maki DG. Preventing infection in intravenous therapy. Anesth Analg 1977;56:141-53.  Back to cited text no. 3
    
4.
Kothari N, Sharma A. Venous cannulation: Peripheral. In: Gurjar M, editor. Manual of ICU Procedures. 1/e. Ch. 18. Jaypee Brothers Medical Publishers; 2016. p. 11.  Back to cited text no. 4
    
5.
Aziz AM. Improving peripheral IV cannula care: Implementing high-impact interventions. Br J Nurs 2009;18:1242-6.  Back to cited text no. 5
    
6.
Harty E. Inserting peripheral intravenous cannulae Tips and tricks. Updat Anaesth 2011;27:22-6.  Back to cited text no. 6
    
7.
Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296:1305-9.  Back to cited text no. 7
    
8.
Brooks N. Intravenous cannula site management. Nurs Stand 2016;30:53-63.  Back to cited text no. 8
    
9.
Catney MR, Hillis S, Wakefield B, Simpson L, Domino L, Keller S, et al. Relationship between peripheral intravenous catheter Dwell time and the development of phlebitis and infiltration. J Infus Nurs 2001;24:332-41.  Back to cited text no. 9
    
10.
Kind AC, Willians DN, Gibson J. Outpatient intravenous antibiotic therapy. Postgrad Med 1985;40:157-62.  Back to cited text no. 10
    
11.
Righter J, Bishop LA, Hill B. Infection and peripheral venous catheterization. Diagn Microbiol Infect Dis 1983;1:89-93.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed205    
    Printed14    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]