Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial

Abstract

Aims and objectives To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. Background Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. Design A multisite randomised controlled trial. Methods The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter‐related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter‐related bloodstream infection, all‐cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. Results The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter‐related bloodstream infection reported in either group. Patients’ first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. Conclusions In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. Relevance to clinical practice In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.

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

“…Seven of the RCTs (9-11, 14, 21-23) were conducted at a single hospital, and 2 RCTs (13,20) were multicenter studies (Table 1). Five studies (10, 20-23) were conducted in Australia, 3 were conducted in China (9,13,14), and 1 was conducted in Brazil (11).…”

“…Seven of the RCTs (9-11, 14, 21-23) were conducted at a single hospital, and 2 RCTs (13,20) were multicenter studies (Table 1). Five studies (10, 20-23) were conducted in Australia, 3 were conducted in China (9,13,14), and 1 was conducted in Brazil (11). One study (21) included patients in a home program, and the other studies (9-11, 13, 14, 20, 22, 23) focused on hospitalized patients.…”

“…One study (21) included patients in a home program, and the other studies (9-11, 13, 14, 20, 22, 23) focused on hospitalized patients. In the control group, PIVCs were routinely replaced every 72 h in 5 studies (10, 14,20,22,23), every 96 h in 3 studies (9,11,13), and every 72-96 h in 1 study (21). Overall, 10 973 patients were included in this metaanalysis, of whom 5,546 and 5,527 were randomly assigned to the study group (clinically indicated replacement of PIVCs) and control group (routine replacement of PIVCs every 72-96 h), respectively.…”

“…According to the findings of several studies, the routine replacement of PIVCs to prevent intravascular catheter-related infections is recommended (7)(8)(9) and many hospitals have adopted this recommendation and routinely replace PIVCs. Nevertheless, several studies have demonstrated that replacing PIVCs only when clinically indicated, such as with the presence or signs of inflammation, infiltration, occlusion, infection, or blockage, was not associated with an increased risk of phlebitis or infections, but could reduce equipment costs, reduce staff workload, and improve patient comfort (10)(11)(12)(13)(14). Moreover, guidelines suggested that routine replacement PIVCs more frequently than every 72-96 h to reduce risk of infection and phlebitis in adults is not needed (15).…”

“…However, Buetti et al recently conducted a large observational cohort study, and reported an association of increased risk of CRBSI when the catheters were replaced due to clinical indication instead of routine replacement every 96 h [incidence rate ratio (IRR) = 7.20; 95% confidence interval (CI), 3.65-14.22, P < 0.001], but no significant difference was observed in the reversion period (IRR = 1.35; 95% CI, 0.30-6.17, P = 0.69) (17). In 2021, three more randomized controlled trials (RCTs) reported this comparison in 2021 (9,12,13), however, the results were not consistent. To clarify this important issue after incorporating the updated information, we conducted this systematic review and meta-analysis to compare the safety outcomes of clinically indicated replacement and routine replacement of PIVCs.…”