Multicentre Prospective Cohort Study of Continuous Antibiotic Infusion via Peripheral Intravenous Cannula in the Hospital in the Home Setting

Importance Continuous intravenous (IV) antibiotic infusion via peripheral intravenous cannula (PIVC) is utilised in some Hospital in the Home (HITH) services, but current Australian guidelines advise against this practice due to concerns about device failure and complication risk. Objective To evaluate the safety, efficacy, and patient experience of continuous IV antibiotic therapy delivered via PIVC in Australian HITH services. Design Multicentre prospective observational cohort study. Setting Four Australian hospitals with established HITH services. Participants Adults (≥18 years) receiving anticipated short-term (<14 days) continuous IV antibiotic infusion via PIVC. Patients with central or midline catheters, intermittent dosing, or <12-hour infusions were excluded. Exposure Continuous 12–24 hour IV antibiotic administration using an elastomeric pump. Outcomes Primary outcomes were the frequency and reasons for PIVC failure (unplanned removal due to complication). Secondary outcomes included complication types, predictors of failure, PIVC dwell time, guideline adherence, and patient satisfaction. Results 309 patients were included (461 PIVCs; 1,776 catheter-days). Overall PIVC failure rate was 9.98% (46/461; 95% CI 7.40–13.09%), or 25.901 failures per 1,000 catheter-days. No PIVC-related bacteraemia or local infection occurred. Dislodgement (2.82%), phlebitis and pain (each 2.39%) were the most common causes of failure. Higher final Visual Infusion Phlebitis (VIP) score predicted failure (OR 1.89 per point; 95% CI 1.06–3.18; p=0.018). Charlson Comorbidity Index was the only independent predictor of failure (HR 1.26, 95% CI 1.02–1.56; p=0.030). Clinically indicated PIVC replacement was associated with a reduced PIVC failure rate (IRR 0.26, 95% CI 0.13-0.48; p<0.001). Patient satisfaction was high (mean 9.6/10). Conclusion Continuous PIVC antibiotic infusion in HITH is safe, effective, and associated with excellent patient experience. The findings support clinically indicated PIVC replacement guided by VIP score assessment and may inform guideline updates for short-course therapy in HITH settings. Trial Registration: ACTRN12625000384459