Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial.

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Title Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial.
Author Rickard, Claire; McCann, Damhnat; Munnings, Jane; McGrail, Matthew R
Journal Name BMC Medicine
Year Published 2010
Place of publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background Peripheral intravenous device (IVD) complications were traditionally thought to be reduced by limiting dwell time. Current recommendations are to resite IVDs by 96 hours with the exception of children and patients with poor veins. Recent evidence suggests routine resite is unnecessary, at least if devices are inserted by a specialised IV team. The aim of this study was to compare the impact of peripheral IVD 'routine resite' with 'removal on clinical indication' on IVD complications in a general hospital without an IV team. Methods A randomised, controlled trial was conducted in a regional teaching hospital. After ethics approval, 362 patients (603 IVDs) were randomised to have IVDs replaced on clinical indication (185 patients) or routine change every 3 days (177 patients). IVDs were inserted and managed by the general hospital medical and nursing staff; there was no IV team. The primary endpoint was a composite of IVD complications: phlebitis, infiltration, occlusion, accidental removal, local infection, and device-related bloodstream infection. Results IVD complication rates were 68 per 1,000 IVD days (clinically indicated) and 66 per 1,000 IVD days (routine replacement) (P = 0.86; HR 1.03; 95% CI, 0.74-1.43). Time to first complication per patient did not differ between groups (KM with log rank, P = 0.53). There were no local infections or IVD-related bloodstream infections in either group. IV therapy duration did not differ between groups (P = 0.22), but more (P = 0.004) IVDs were placed per patient in the routine replacement (mean, 1.8) than the clinical indication group (mean, 1.5), with significantly higher hospital costs per patient (P < 0.001). Conclusions Resite on clinical indication would allow one in two patients to have a single cannula per course of IV treatment, as opposed to one in five patients managed with routine resite; overall complication rates appear similar. Clinically indicated resite would achieve savings in equipment, staff time and patient discomfort. There is growing evidence to support the extended use of peripheral IVDs with removal only on clinical indication.
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1186/1741-7015-8-53
Copyright Statement Copyright 2010 Rickard et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Volume 8
Issue Number 53
Page from 1
Page to 10
ISSN 1741-7015
Date Accessioned 2010-10-22
Date Available 2011-01-27T06:44:47Z
Language en_AU
Comments Page numbers are not for citation purposes. Instead, this article has the unique article number of 2010, 8:53.
Research Centre Centre for Health Practice Innovation; Griffith Health Institute
Faculty Griffith Health Faculty
Subject Clinical Nursing: Secondary (Acute Care)
URI http://hdl.handle.net/10072/34984
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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