Clinically-indicated replacement versus routine replacement of peripheral venous catheters

Webster, Joan, Osborne, Sonya, Rickard, Claire and Hall, Jennifer (2010) Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews, 2010 3: CD007798-1-CD007798-39. doi:10.1002/14651858.CD007798.pub2

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Author Webster, Joan
Osborne, Sonya
Rickard, Claire
Hall, Jennifer
Title Clinically-indicated replacement versus routine replacement of peripheral venous catheters
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2010
Sub-type Article (original research)
DOI 10.1002/14651858.CD007798.pub2
Volume 2010
Issue 3
Start page CD007798-1
End page CD007798-39
Total pages 39
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2011
Language eng
Formatted abstract Background.
Centers forDisease 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.

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
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Keyword Catheter infection
Device removal
References References to studies included in this review Barker P, Anderson ADG, Macfie J. Randomised clinical trial of elective re-siting of intravenous cannulae. Annals of the Royal College of Surgeons of England 2004;86(4):281–3. Rickard CM, McCann D, Munnings J, McGrail M. 3rd daily resite of peripheral intravenous devices did not reduce complications compared with removal only on clinical indication. A randomized controlled trial in a hospital without an IV service. Data on file. Rickard CM, Webster J, Wallis M, Whitby M, Gowardman J, McGrail M. Routine re-siting compared with removal only on clinical indication of peripheral intravenous devices: A multi-centre randomised controlled trial. Data on file. Van Donk P, Rickard CM, McGrail MR, Doolan G. Routine replacement versus clinical monitoring of peripheral intravenous catheters in a regional hospital in the home program: A randomized controlled trial. Infection Control and Hospital Epidemiology 2009; 30(9):915–7. Webster J, Lloyd S, Hopkins T, Osborne S, Yaxley M. Developing a Research base for Intravenous Peripheral cannula re-sites (DRIP trial). A randomised controlled trial of hospital in-patients. International Journal of Nursing Studies 2007;44(5):664–71. Webster J, Clarke S, Paterson D, Hutton A, van Dyke S, Gale C, et al.Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ 2008; 337:a339. References to studies excluded from this review Arnold RE, Elliot EK, Holmes BH. The importance of frequent examination of infusion sites in preventing post infusion phlebitis. Surgery, Gynecology and Obstetrics 1977;145(1):19–20. Cobb DK, High KP, Sawyer RG, Sable CA, Adams RB, Lindley DA, et al.A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. The New England Journal of Medicine 1992;327(15):1062–8. Eyer S, Brummitt C, Crossley K, Siegel R, Cerra F. Catheter-related sepsis: prospective, randomized study of three methods of long term catheter maintenance. Critical Care Medicine 1990;18(10): 1073–9. Haddad FG, Waked CH, Zein EF. Peripheral venous catheter inflammation. A randomized prospective trial. Le Journal Médical Libanais 2006;54:139–45. Kerin MJ, Pickford IR, Jaeger H, Couse NF, Mitchell CJ, Macfie J. A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition. Clinical Nutrition 1991;10(6):315–9. May J, Murchan P, MacFie J, Sedman P, Donat P Palmer D, et al.Prospective study of the aetiology of infusion phlebitis and line failure during peripheral parenteral nutrition. British Journal of Surgery 1996;83(8):1091–4. Panadero A, Iohom G, Taj J, Mackay N, Shorten G. A dedicated intravenous cannula for postoperative use. Effect on incidence and severity of phlebitis. Anaesthesia 2002;57(9):921–5. References to ongoing studies Rickard CM, Webster J, Gowardman J, Wallis M, McCann D, Whitby M, McGrail M. Routine re-siting compared with removal only on clinical indication of peripheral intravenous devices: A multi-centre randomised controlled trial. Data on file - in the process of being analysed. Additional references Bregenzer T, Conen D, Sakmann P, Widmer AF. Is routine replacement of peripheral intravenous catheters necessary?. Archives of Internal Medicine 1998;158:51–6. Catney MR, Hillis S,Wakefield B, Simpson L, Domino L, Keller S, Connelly T, White M, Price D, Wagner K. Relationship between peripheral intravenous catheter dwell time and the development of phlebitis and infiltration. Journal of Infusion Nursing 2-41. 2001; 24:33. Cornely OA, Bethe U, Pauls R, Waldschmidt D. Peripheral Teflon catheters: factors determining incidence of phlebitis and duration of cannulation. Infection Control and Hospital Epidemiology 2002; 23:249–53. Everitt NJ, Krupowicz DW, Evans JA, McMahon MJ. Ultrasonographic investigation of the pathogenesis of infusion thrombophlebitis. British Journal of Surgery 1997;84:642–5. Gupta A Mehta Y, Juneja R, Trehan N. The effect of cannula material on the incidence of peripheral venous thrombophlebitis. Anaesthesia 2007;62:1139–42. Higgins JPT, Deeks JJ. Selecting studies and collecting data. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Wiley-Blackwell, 2008. Homer LD, Holmes KR. Risks associated with 72- and 96-hour peripheral intravenous catheter dwell times. Journal of Intravenous Nursing 1998;21:301–5. Lai KK. Safety of prolonging peripheral cannula and i.v. tubing use from 72 hours to 96 hours. American Journal of Infection Control 1998;26:66–70. Maddox RR, Rush DR, Rapp RP, Foster TS, Mazella V, McKean HE. Double-blind study to investigate methods to prevent cephalothin-induced phlebitis. Americal Journal of Hospital Pharmacy 1977;34:29–34. Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial. Annals of Internal Medicine 1991;114:845–54. Maki DG. Improving the safety of peripheral intravenous catheters. BMJ 2008;337(7662):122–3. Monreal M, Quilez F, Rey-Joly C, Vega J, Torres T, Valero P, Mach G, Ruiz A, Roca J. Infusion phlebitis in patients with acute pneumonia: a prospective study. Chest 1999;115:1576–80. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology 2002;23:759–69. Panadero A, Iohom G, Taj J, Mackay N, Shorten G. A dedicated intravenous cannula for postoperative use effect on incidence and severity of phlebitis. Anaesthesia 2002;57:921–5. Shimandle RB, Johnson D, Baker M, Stotland N, Karrison T, Arnow PM. Safety of peripheral intravenous catheters in children. Infection Control and Hospital Epidemiology 1999;20:736–40. Uslusoy E, Mete S. Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study. Journal of the American Academy of Nurse Practitioners 2008;20:172–80. White SA. Peripheral intravenous therapy-related phlebitis rates in an adult population. Journal of Intravenous Nursing 2001;24:19–24.
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Institutional Status UQ
Additional Notes Published under [Intervention Review]. Article # CD007798. Publication status and date: New, published in Issue 3, 2010. Review content assessed as up-to-date: 31 January 2010. Citation: 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.

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Sub-type: Article (original research)
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