Replacing IV catheters as needed just as effective as routine practice [The Lancet]
Key study points:
- Replacing intravenous catheters only when clinically indicated did not increase the risk of phlebitis when compared to routine replacement protocol (≤ 72-96h)
- Nearly 30% of IV catheters had to be replaced and failure due to occlusion, infiltration, or accidental removal was more common than phlebitis and infection.
Primer: Intravenous (IV) catheters are usually needed for extended periods of time (≥ 7 days) but are recommended for routine replacement (72-96 hours) to decrease the risk of both infection and phlebitis. This places additional strain on the staff workload, increases health care costs, and puts the patient through another invasive procedure. The researchers aimed to show that clinically indicated IV catheter replacement was of equal benefit to routine practices (3% equivalence margin).
This [randomized] study: Investigators enrolled 3,283 patients who required catheterization and randomized them to routine catheter replacement every third day (n=1690) or to replacement as clinically indicated (n=1593). This group had their IV catheters removed only for: completion of therapy, phlebitis, occlusions, accidental removal, or suspected infection. A standard procedure was used for the preparation and insertion of IV catheters and the primary endpoint was phlebitis during catheterization or within 48 hours after catheter removal. Phlebitis was defined as two or more of the following presenting at the same time: patient reported pain or tenderness, swelling, erythema, purulent discharge, and palpable venous cord beyond catheter tip.
Phlebitis occurred in 114 patients (7%) in the clinically indicated group and an identical number of cases (114, 7%) occurred in the routine replacement group. The absolute risk difference was 0.41% (95% CI: -1.33% to 2.15%). There was an average reduction of 0.2 IV catheters per patient in the clinically indicated group. A surprising finding was the high proportion of catheter failures, about 30%
In Sum: Replacing IV catheters only when clinically indicated did not increase the risk of phlebitis. Also, under the clinically indicated policy, one fifth of patients can avoid an unnecessary procedure. The authors acknowledge that non-masking the research nurses could have biased the reading of phlebitis and that these results do not apply to emergency situations. With respect to the high IV catheter failure rate, the investigators noted that this is not indicative of poor outcomes at hospitals and that new research attention should focus on interventions to reduce that rate.
Written by AM