Replacing peripheral venous catheter when clinically indicated versus routine replacement

Webster J, Osborne S, Rickard C, Hall J

Published Online:

March 17, 2010

Most hospital patients receive fluids or medications via an intravenous catheter at some time during their hospital stay. An intravenous catheter is a short, hollow tube placed in the vein to allow administration of medications, fluids or nutrients directly into the bloodstream (also called a drip). These catheters are routinely replaced every three to four days, to try to prevent infection of the vein or of the blood. However, the evidence to support this practice is weak. Moreover, the procedure may cause considerable discomfort to patients and is quite costly. This review included all of the randomised controlled trials, which have compared routine catheter changes with changing the catheter only if there were signs of inflammation or infection. We found no evidence of benefit from these trials to support current practice of changing catheters every three to four days.

Abstract (click to read)

Background:

Centers for Disease Control Guidelines recommend replacement of peripheral intravenous (IV) catheters every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bacteraemia. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable.

Objectives:

To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re-siting the catheter routinely.

Search strategy:

The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched October 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue Issue 4, 2009). We also searched MEDLINE (last searched October 2009).

Selection criteria:

Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions.

Data collection and analysis:

Three review authors independently assessed trial quality and extracted data.

Main results:

In five trials (3408 participants) there was a 44% reduction in suspected catheter-related bacteraemia in the clinically-indicated group (0.2 versus 0.4%) but this was not statistically significant (odds ratio (OR) 0.57; 95% confidence interval (CI) 0.17 to 1.94; P = 0.37). Phlebitis was assessed in six trials (3455 patients); there was a non-significant increase in phlebitis in the clinically-indicated group (9% versus 7.2%); the OR was 1.24 (95% CI 0.97 to 1.60; P = 0.09). We also measured phlebitis per 1000 device days using data from five trials, (8779 device days). No statistical differences in the incidence of phlebitis per 1,000 device days was found (clinically indicated 1.6 cases per 1,000 catheter days versus 1.5 cases per 1,000 catheter days in the routine-replacement group).The combined OR was 1.04 (95% CI 0.81 to 1.32; P = 0.77). Cost was measured in two trials (961 patients). Cannulation costs were significantly reduced in the clinically-indicated group (mean difference (MD) -6.21; 95% CI -9.32 to -3.11; P = < 0.000).

Authors' conclusions:

The review found no conclusive evidence of benefit in changing catheters every 72 to 96 hours. Consequently, health care organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications.

This record should be cited as:

Webster J, Osborne S, Rickard C, Hall J. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD007798. DOI: 10.1002/14651858.CD007798.pub2

Assessed as up to date:

February 1, 2010

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Primary Review Group:

Peripheral Vascular Diseases Group

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Replacing peripheral venous catheter when clinically indicated versus routine replacement

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