Friday, October 5, 2012

Replacing IV catheters as needed is as safe as routine replacement, study finds

Replacing peripheral intravenous (IV) catheters when clinically indicated is just as safe as routine, time-based replacement, a new study found.
Researchers randomized 3,283 patients from three hospitals in Queensland, Australia to clinically indicated replacement, or routine replacement every third day, of IV catheters. "Clinically indicated" circumstances for replacement included completion of therapy, phlebitis, infiltration, occlusion, accidental removal, or suspected infection. At randomization, all patients were at least 18 years old and were expected to need an intravenous catheter for more than four days. The main outcome was phlebitis during catheterization or within 48 hours after catheter removal, and the secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonization, infusion failure, number of catheters used, duration of therapy, mortality and costs.
IV catheter dwell times were 48-561 hours in the clinically indicated group and 48-96 hours in the routine replacement group. The mean dwell time for catheters that were in situ on day three was 99 hours for the clinically indicated group and 70 hours for the routine replacement group. In both groups, 7% of patients had phlebitis. Secondary outcomes were also similar between groups, and there were no serious adverse events in either group. Results were published online Sept. 22 by The Lancet.
The data predict that, with a "clinical indication" approach, IV catheter use will be extended by a little more than a day on average, the authors noted, and that one in every five patients will avoid an unnecessary procedure. In the U.S., switching to this approach could save up to $60 million and two million hours of staff time, as well as prevent up to six million unnecessary IV catheter insertions. Since routine replacement doesn't help lower the rate of catheter-related complications, policies should be revised and "research attention should now focus on other interventions," such as improved insertion, securement and flushing strategies, they wrote.
In a comment, colleagues said the study was of high quality and makes a "major contribution" to the debate about catheter replacement. It also made an important finding that almost 30% of catheters had some sort of failure, thus future studies that target ways to prevent such failures "might have even greater implications for cost, reduction of unnecessary invasive procedures, and staff workloads," they wrote.

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