Changing iv catheters only when necessary 'could benefit millions'

Sep 21 2012

By Liam Davenport, medwireNews Reporter

Peripheral intravenous (iv) catheters need be removed only when clinically indicated, rather than every 72 to 96 hours, as is currently recommended, conclude Australian researchers in findings that could have dramatic patient and cost benefits.

Lead researcher Claire Rickard, from Griffith University, in Nathan, Queensland, commented to the press: "Of the 200 million catheters estimated to be inserted each year in the USA alone, if even 15% are needed for more than 3 days, then a change to clinically required replacement would prevent up to 6 million unnecessary [iv] catheter insertions, and would save about 2 million hours of staff time, and up to US$ 60 million [€ 46 million] in health costs each year."

Writing in The Lancet, the investigators say their data strongly suggest that routine replacement does not prevent complications but instead causes many unnecessary invasive procedures.

"Updated [iv] catheter policies should advocate clinically indicated removal - ie, to monitor and immediately remove [iv] catheters for complications or as soon as treatment is complete," says the team.

The researchers studied 3283 patients, with a total of 5907 catheters in place and expected treatment of more than 4 days, who were randomly assigned to receive clinically indicated catheter replacement or routine third-day catheter replacement. Criteria for clinically indicated catheter removal were completion of therapy, phlebitis, infiltration, occlusion, accidental removal, or suspected infection.

The dwell times of iv catheters were 48 to 561 hours in the clinically indicated group and 48 to 96 hours in the routine replacement group, at mean dwell times of 99 hours and 70 hours, respectively.

In both groups, 7% of patients had phlebitis, at an absolute risk difference of 0.41%. This was within the predefined 3% value for indicating clinical equivalence between the two approaches. This was maintained even when analyzing per patient, per 1000 catheter days, and on survival analysis.

The team also reports that there were no significant differences in iv catheter colonization rates between the two patient groups, at a hazard ratio of 1.05 for clinically indicated versus routine replacement.

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