Improved Peripheral Intravenous Catheter Maintenance by In-Line Mechanical Pulse.

The World Health Organization (WHO) has identified infections associated with peripheral intravenous catheters (PIVCs) as a major health burden affecting patients across countries and income status categories, meriting particular attention from care providers and researchers. As many as 70% of inpatients worldwide require PIVC placement, making it one of the most commonly performed invasive procedures in current medical practice. WHO guidelines for preventing PIVC-related infections, including bloodstream infections, focus on maintaining optimal achievable local sterility of PIVCs. The closely related complication of PIVC infiltration has attracted a great deal of research and technological focus to mitigate tissue damage due to fluid or vesicant medication delivery through infiltrated PIVCs. In this study, we report a novel approach to anti-bacterial therapy in PIVCs based on applying a low-force pulse to the fluidic system encompassing a PIVC. A 60-beats-per-minute pulse was introduced by periodic compression of the intravenous tubing upstream from the PIVC, resulting in a fluid displacement of 1-3 mm through the PIVC and into the downstream vein. In the presence of a bacterial inoculum, this pulsatility prevented bacterial growth in PIVCs, as evidenced by near-elimination of colony formation in cultured PIVC flush effluent. The introduction of pulsatility also allowed for identifying PIVC infiltration or malplacement in an ex vivo model, as infiltrated or malplaced PIVCs did not permit pulse propagation. A computationally economical digital signal processing methodology for pulse analysis was employed, providing a statistically based "two-factor authentication" of PIVC non-infiltrated status. We believe the simple intervention described in this study has the potential to reduce PIVC-associated infections and improve the early detection of PIVC infiltration, thereby improving the quality of PIVC therapy.