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Published on: December 23, 2014
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Clinically-indicated replacement versus routine replacement of peripheral venous catheters
Joan Webster1, Sonya Osborne, Claire M Rickard
1National Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, 4111.
The Cochrane Database of Systematic Reviews
|January 24, 2019
Summary
Routine replacement of peripheral intravenous catheters (PIVC) shows no clear benefit over clinically indicated removal for infection or phlebitis. Clinically indicated removal likely reduces costs but may increase infiltration and blockage risks.
Area of Science:
- Evidence-based medicine
- Infection control
- Vascular access devices
Background:
- Current guidelines recommend routine replacement of peripheral intravenous catheters (PIVC) every 72-96 hours to prevent complications.
- Routine PIVC replacement may cause patient discomfort and incur significant costs.
- This review assesses whether PIVC removal based on clinical need is as effective as routine replacement.
Purpose of the Study:
- To compare the outcomes of removing peripheral intravenous catheters (PIVC) when clinically indicated versus routine replacement.
- To evaluate the impact on infection rates, thrombophlebitis, infiltration, catheter failure, costs, and other complications.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searches included major databases (MEDLINE, Embase, CENTRAL) and clinical trial registries up to April 2018.
- Nine RCTs involving 7412 participants were included, comparing clinically indicated removal with routine PIVC replacement.
Main Results:
- No significant differences were found in catheter-related bloodstream infections (CRBSI), all-cause bloodstream infections (BSI), or thrombophlebitis between the groups.
- Clinically indicated removal was associated with lower device-related costs but potentially higher rates of infiltration and catheter blockage.
- Evidence for local infection and mortality showed uncertainty; pain differences were not significant.
Conclusions:
- There is moderate-certainty evidence that routine PIVC replacement does not offer significant advantages over clinically indicated removal regarding infection and thrombophlebitis.
- Switching to a clinically indicated PIVC replacement policy may reduce costs and patient discomfort.
- Continuous monitoring for signs of inflammation, infection, or blockage is crucial for timely PIVC removal.
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