Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]

Webster, Joan and Osborne, Sonya and Rickard, Claire M. and Marsh, Nicole (2019) Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]. Cochrane Database of Systematic Reviews, 1 (CD007798). pp. 1-57. ISSN 1361-6137

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Plain Language Summary
Replacing a peripheral venous catheter when clinically indicated versus routine replacement

Review question
We reviewed the evidence about the effects of changing a catheter routinely (every three to four days) or changing the catheter only if there were signs or symptoms of a problem with the catheter remaining in place.

Most hospital patients receive fluids or medications via a peripheral intravenous catheter at some time during their hospital stay. An intravenous catheter (also called an IV drip, an IV line or intravenous cannula) is a short, hollow tube placed in the vein to allow administration of medications, fluids or nutrients directly into the bloodstream. These catheters are often replaced every three to four days to try to prevent irritation of the vein or infection of the blood. However, replacing the catheter may cause discomfort to patients and is quite costly. This is the third update of a review first published in 2010.

Study characteristics
In April 2018 we searched for randomised controlled trials (RCTs) that compared changing catheters every 72 to 96 hours (routine change) with changing the catheter only if there were complications or therapy was complete. We measured catheter-related blood stream infection, phlebitis and other problems associated with peripheral catheters, such as local infection and catheter blockage. We included two new studies for this update, bringing the total to nine studies with 7412 participants.

Key results
We found no clear difference in rates of catheter-related blood stream infection, phlebitis (inflammation of the vein), blood stream infection from any cause, local infection, mortality or pain. We are uncertain if local infection is reduced or increased when catheters are changed when clinically indicated. Infiltration (fluid seeping into the tissue around the catheter) and catheter blockage (an inability to infuse fluids or medication through the catheter), are probably reduced when catheters are changed routinely. Cost is reduced when catheters are replaced when there was a clinical indication to do so. The pre-planned outcomes ’number of catheter re-sites per patient’, and ’satisfaction’ were not reported by any studies included in the review.

Quality of the evidence
The overall quality of the evidence was judged to be moderate for most outcomes, which leaves us uncertain of our findings. The uncertainty is largely due to outcomes, such as phlebitis, being assessed by people who were aware of the group allocation, which may or may not affect their decision about whether a problem is present or absent.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published version made available in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 11 Jul 2019 04:12
Last Modified: 11 Jul 2019 04:17
Uncontrolled Keywords: systematic review; peripheral venous catheters; clinically-indicated replacement
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
11 Medical and Health Sciences > 1110 Nursing > 111099 Nursing not elsewhere classified
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Identification Number or DOI: 10.1002/14651858.CD007798.pub5

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