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Published on: July 13, 2019
Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled
Claire M Rickard1, Joan Webster, Marianne C Wallis
1Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, QLD, Australia. c.rickard@griffith.edu.au
Insights
Clinically indicated replacement of peripheral intravenous catheters is as effective as routine replacement. This approach reduces patient discomfort, healthcare costs, and staff workload by avoiding unnecessary procedures.
Area of Science:
- Medical Interventions
- Clinical Practice Guidelines
- Patient Safety
Background:
- Millions of peripheral intravenous catheters (PIVCs) are used annually, with routine replacement every 72-96 hours recommended for adults.
- This standard practice increases healthcare costs, staff workload, and necessitates repeated invasive procedures for patients.
- The clinical effectiveness of routine PIVC replacement is not well-established.
Purpose of the Study:
- To test the hypothesis that clinically indicated PIVC replacement is equivalent in benefit to routine replacement.
- To evaluate the impact of PIVC replacement strategies on patient outcomes and healthcare resource utilization.
Main Methods:
- A multicentre, randomised, non-blinded equivalence trial involving adults (≥18 years) with PIVCs expected to be in use for over 4 days.
- Participants were randomly assigned (1:1) to either clinically indicated or routine (every third day) PIVC replacement.
- The primary outcome was phlebitis, with an equivalence margin set at 3%.
Main Results:
- Phlebitis occurred in 7% of patients in both the clinically indicated (114/1593) and routine replacement (114/1690) groups.
- The absolute risk difference for phlebitis was 0.41%, falling within the 3% equivalence margin.
- Mean catheter dwell time was longer in the clinically indicated group (99 hours) compared to the routine group (70 hours).
Conclusions:
- Clinically indicated replacement of peripheral intravenous catheters is an effective alternative to routine replacement.
- Adopting a clinically indicated replacement policy can significantly reduce catheter insertions, patient discomfort, and associated costs.
- Continued close monitoring and prompt removal of catheters upon complication are essential.
Background:
The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement.
Methods:
This multicentre, randomised, non-blinded equivalence trial recruited adults (≥18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370.
Findings:
All 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI -1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred.
Interpretation:
Peripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications.
Funding:
Australian National Health and Medical Research Council.
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