Intravenous antibiotics can be delivered through a variety of devices

Prayle AP, Hurley MN, Smyth AR

Published Online:

November 10, 2010

In cystic fibrosis, patients require prolonged courses of intravenous antibiotics. There are several devices which can be used to administer intravenous antibiotics, including peripheral cannulae (which we have termed short intravenous lines) and percutaneous (through the skin) long intravenous lines. A percutaneous long intravenous line is a flexible narrow tube which is inserted with a needle through the skin into a vein and threaded further up the vein than a short intravenous line. We have found two trials comparing these devices and including 67 participants in total. The studies compared different devices, so we could not pool the information from the two studies. However, one study showed that long intravenous lines last for longer than short intravenous lines (thus reducing the number of procedures which a participant has to undergo for a course of antibiotics). Patient satisfaction was higher with long intravenous lines compared to short intravenous lines. The study comparing two different types of long intravenous line did not show that one type was clearly better than another. Neither study was large enough to show differences in complications for the different devices. Neither study reported on important outcomes, such as the number of attempts required to insert the device. We recommend further research to compare different types of percutaneous long intravenous line.

Abstract (click to read)

Background:

Percutaneous long lines (long intravenous lines) and short intravenous lines (also termed cannulae) are both used to deliver intravenous antibiotics in cystic fibrosis to treat respiratory exacerbations of the disease. The perceived advantage of a long intravenous line is a greater duration of line function, which has to be balanced against a technically more challenging insertion procedure, and the possibility of more discomfort on insertion.

Objectives:

To compare long intravenous lines with short intravenous lines in people with cystic fibrosis receiving intravenous antibiotics, in terms of lifespan of the line, ease of insertion, complication rates of the line and patient satisfaction. This will help patients and clinicians choose between devices.

Search strategy:

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Date of most recent search: 26 August 2010.

Selection criteria:

Randomised studies comparing long intravenous lines lines with short intravenous lines or comparing different types of long intravenous lines.

Data collection and analysis:

We identified two studies, one comparing long intravenous lines with short intravenous lines, and one comparing two different types of long intravenous lines.

Main results:

Two studies (67 participants) were included in the review. Based on the published reports, both studies had potential for bias in several domains. There is some evidence that long intravenous lines are superior to short intravenous lines. One study of 20 participants found that the lifespan of a long intravenous line is longer than that of a short intravenous line, and that participants preferred the long intravenous lines to short intravenous lines. A further study of 47 participants found no difference in lifespan, or participant preference when comparing two different long intravenous lines (the Hydrocath and Vygon EC). Neither study was powered to detect differences in serious complications of the devices.

Authors' conclusions:

There is some evidence to support the use of long intravenous lines rather than short intravenous lines, in terms of lifespan of the line and patient satisfaction. There is no evidence to suggest that any one type of long intravenous line is superior, and currently choice of line should be determined by operator and patient preference. There are numerous devices available which are used in cystic fibrosis. Further research is required to identify clinically important differences between these devices.

This record should be cited as:

Prayle AP, Hurley MN, Smyth AR. Percutaneous lines for delivering intravenous antibiotics in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD008243. DOI: 10.1002/14651858.CD008243.pub2

Assessed as up to date:

September 22, 2010

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Primary Review Group:

Cystic Fibrosis and Genetic Disorders Group

Health topics:

Genetic disorders > Cystic fibrosis > Antibiotic treatment

Lungs & airways > Cystic fibrosis > Antibiotic treatment

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Intravenous antibiotics can be delivered through a variety of devices

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