Regularly replacing intravenous administration sets, which do not contain lipids or blood, does not appear to affect the risk of infection

Gillies D, Wallen MM, Morrison AL, Rankin K, Nagy SA, O'Riordan E

Published Online:

October 8, 2008

Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination and related bloodstream infection. The purpose of this review was to identify the optimal interval for the routine replacement of intravenous administration sets. It appears that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the incidence of infection. There is no evidence to contradict current recommendations that administration sets which contain lipids should be changed every 24 hours.

Abstract (click to read)

Background:

Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination. If decreasing the frequency of changing intravenous administration sets does not increase infection rates, a change in practice could result in considerable cost savings.

Objectives:

The objective of this review was to identify the optimal interval for the routine replacement of intravenous administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered to people in hospital via central or peripheral venous catheters.

Search strategy:

We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE: all from inception to February 2004; reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. We did not have a language restriction.

Selection criteria:

We included all randomized or quasi-randomized controlled trials addressing the frequency of replacing intravenous administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered to people in hospital via a central or peripheral catheter.

Data collection and analysis:

Two authors assessed all potentially relevant studies. We resolved disagreements between the two authors by discussion with a third author. We collected data for the outcomes; infusate contamination; infusate-related bloodstream infection; catheter contamination; catheter-related bloodstream infection; all-cause bloodstream infection and all-cause mortality.

Main results:

We identified 23 references for review. We excluded eight of these studies; five because they did not fit the inclusion criteria and three because of inadequate data. We extracted data from the remaining 15 references (13 studies) with 4783 participants. We conclude that there is no evidence that changing intravenous administration sets more often than every 96 hours reduces the incidence of bloodstream infection. We do not know whether changing administration sets less often than
every 96 hours affects the incidence of infection. In addition, we found that there were no differences between participants with central versus peripheral catheters; nor between participants who did and did not receive parenteral nutrition, or between children and adults.

Authors' conclusions:

It appears that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the incidence of infection. There was no evidence to suggest that administration sets which contain lipids should not be changed every 24 hours as currently recommended.

This record should be cited as:

Gillies D, Wallen MM, Morrison AL, Rankin K, Nagy SA, O'Riordan E. Optimal timing for intravenous administration set replacement. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003588. DOI: 10.1002/14651858.CD003588.pub2

Assessed as up to date:

July 15, 2005

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Post-anaesthetic unit/intensive care unit > Infection control

Infectious disease > Infection control

Wounds > Infection control

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Regularly replacing intravenous administration sets, which do not contain lipids or blood, does not appear to affect the risk of infection

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