Comparison of clinically indicated replacement and routine replacement of peripheral intravenous catheters: A systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundIt is unknown whether clinically indicated replacement of peripheral intravenous catheters (PIVCs) increases the risks of PIVC-associated complications and infections compared to routine replacement of PIVCs.MethodsWe searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) that compare the safety outcomes of routine replacement and clinically indicated replacement of PIVCs were included for meta-analysis. The primary outcome was the incidence of phlebitis, and secondary outcomes included the risks of occlusion, local infection, infiltration, catheter-related bloodstream infection (CRBSI), and accidental removal of the PIVC.ResultsA total of 9 RCTs involving 10 973 patients were included in this meta-analysis, of whom 5,546 and 5,527 were assigned to the study group (clinically indicated replacement of PIVCs) and control group (routine replacement of PIVCs every 72–96 h), respectively. The incidence of phlebitis in the study group was significantly higher than that in the control group [risk ratio (RR), 1.20; 95% confidence interval (CI), 1.01–1.44, P = 0.04, I2 = 49%]. In addition, the study group was associated with a higher risk of occlusion (RR, 1.45; 95% CI, 1.08–1.95, P = 0.01, I2 = 82%) and infiltration (fluid leaks) (RR, 1.27; 95% CI, 1.06–1.53, P = 0.01, I2 = 72%) than the control group. However, no significant differences were observed in the risks of local infection (RR, 1.75; 95% CI, 0.38–8.16, P = 0.48, I2 = 0%) and CRBSI (RR, 0.61; 95% CI, 0.08–4.68, P = 0.64, I2 = 0%) between the study and control groups.ConclusionThe clinically indicated replacement of PIVCs may increase the risks of PIVC-associated phlebitis, infiltration, and occlusion compared to the routine replacement of PIVCs, but did not increase the risk of PIVC-associated infections. Based on these findings, routine replacement of PIVCs every 72–96 h maybe a preferred option than clinically indicated replacement of PIVCs.Systematic review registration[www.crd.york.ac.uk/prospero/], identifier [CRD42022302021].

Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction

“…15,30 This finding was mirrored in an adult RCT in the ED, suggesting environmental dynamics, such as increased PIVC longevity from tissue adhesive reduced unintentional dislodgement, may reduce the ability for infection/ phlebitis to develop. 18,37 When comparing our standard care and both ISD groups, the up to 21% absolute reduction in PIVC failure rates was predominantly due to reductions in unintentional dislodgement and occlusion. Given the increased tensile pull-out strength of the ISD, this finding supports use of additional securement, such as TA, might prevent dislodgement and occlusion in more active pediatric patients.…”

“…Compared with previous studies demonstrating infiltration to be the leading cause of device failure, we found unintentional dislodgement and occlusion were responsible for most failures in the control group . This finding was mirrored in an adult RCT in the ED, suggesting environmental dynamics, such as increased PIVC longevity from tissue adhesive reduced unintentional dislodgement, may reduce the ability for infection/phlebitis to develop …”

A machine learning-guided strategy for replacement of peripheral venous catheters in the prevention of hospital-acquired bacteremia: A comparative cost-effectiveness analysis

“…Relying on clinical indication or routine replacement of PVC has been a widely studied discussion in a clinical context 12,23,[38][39][40][41][42] . Traditional, yet often older, studies have suggested that replacement from clinical indication is superior due to sparse changes in HAB numbers with a reduced economic cost 23,38,39 .…”

“…Traditional, yet often older, studies have suggested that replacement from clinical indication is superior due to sparse changes in HAB numbers with a reduced economic cost 23,38,39 . However, recent studies have proposed a shift in the belief in these best-practices, suggesting that routine replacement of PVC may result in avoiding some adverse instances of HAB 12,42 . Nevertheless, with the low incidence of HAB, routine replacement of PVC with an increased time consumption and cost raises questions of feasibility, with the potential result of the intended changes remaining arduous to implement in a clinical setting 12,42 .…”

“…However, recent studies have proposed a shift in the belief in these best-practices, suggesting that routine replacement of PVC may result in avoiding some adverse instances of HAB 12,42 . Nevertheless, with the low incidence of HAB, routine replacement of PVC with an increased time consumption and cost raises questions of feasibility, with the potential result of the intended changes remaining arduous to implement in a clinical setting 12,42 . Meirson et al [21] further supported these feasibility concerns, suggesting an NNH of ~3500 for a strategy that relies entirely on routine PVC replacement in preventing HAB.…”