Clinically Indicated Peripheral Intravenous Catheter Replacement Carries No Greater Risk Over Routine Replacement
A randomized, controlled equivalence trial showed no difference in adverse events between groups.
Mandy Huggins, MD
September 19, 2012 – Routine peripheral intravenous catheter replacement and clinically indicated replacement carry a similar risk of phlebitis, according to the results of a recent randomized, controlled equivalence trial.
Claire M Rickard, PhD, with the Research Centre for Clinical and Community Practice Innovation in Nathan, Australia, and colleagues reported their findings in the September 22, 2012 issue of The Lancet.
According to the researchers, approximately 200 million peripheral intravenous catheters are used in US hospitals each year. The Centers for Disease Control (CDC) recommends routine replacement of intravenous catheters every 72-96 hours to prevent infection and phlebitis. They reference four recent trials that suggest clinically indicated catheter replacement, rather than routine replacement, is safe. However, the 2011 CDC guidelines designate catheter replacement as an unresolved issue
The authors aimed to evaluate the effects of extending the life of peripheral intravenous catheters, replacing them as clinically indicated rather than every 3 days. They hypothesized that both interventions, clinically indicated intravenous catheter replacement and routine catheter replacement, would have equal benefit.
A total of 3283 patients (5907 catheters) were randomized by computer generation into the clinically indicated replacement group or the routine replacement group. Due to the type of intervention, blinding was not possible. Clinical indication for removal included therapy completion, phlebitis, infiltration, occlusion, or suspected infection. Patients in the routine replacement group underwent routine intravenous catheter replacement every third day.
The primary outcome was phlebitis. Adherence to protocol was 85% in the clinically indicated group versus 70% in the routine replacement group.
The authors reported that phlebitis occurred at 7% in each group, with an absolute risk difference of 0.41% (95% CI –1.33 to 2.15%). In the clinical indication group, one catheter was left in place for 3 weeks without complication. No serious adverse events in either group were reported.
Additionally, no local venous infections were reported, and the only catheter-related bloodstream infection was in the routine replacement group. According to the authors, “this finding is reassuring, with no suggestion that clinically indicated replacement increased risk of bloodstream infection; this is a major piece of evidence that routine removal is not warranted.”
According to the researchers, the patients in the clinical indication group required fewer catheters and had lower hospital costs. Both were found to be statistically significant (p<0.0001).
“Our data strongly suggest that routine replacement does not (reduce complications), but rather causes many unnecessary invasive procedures,” the authors conclude. They suggest that “updated intravenous catheter policies should advocate clinically indicated removal— i.e., to monitor and immediately remove intravenous catheters for complications or as soon as treatment is complete.”
The authors declare no financial conflicts of interest.
The Lancet 2012;380:1066-1074