Intravenous therapy in critically ill adults: developing a clinically and cost-effective approach

Intravenous therapies are the most common intervention for critically ill adults. Using a systematic approach as described by Droogan and Song (1996), a review of the literature was undertaken to determine whether the frequency of changing intravenous administration sets in critically ill adults with central venous catheters (CVCs) affected the incidence of CVC-related sepsis/systemic inflammatory response syndrome (SIRS)/bacteraemia. Two major randomized controlled trials were included in the review (Maki et al. 1987; Snydman et al. 1987), which conclude that increasing the change frequency of administration sets from 24 to 72 hours does not significantly increase the incidence of sepsis. This can therefore lead to considerable cost savings as well as ensuring clinically effective care. The review criteria excluded a plethora of related studies. However, these studies do corroborate the findings of Maki et al. and Snydman et al. They are summarized in the tables and are taken into account when making recommendations for clinical practice and future research. Clinical practice guidelines which are being implemented and evaluated locally are offered for the reader's consideration.