Does Routine 3rd Daily Replacement of Peripheral Intravenous Catheters Reduce Patient Complications?

Abstract

Objectives: Peripheral intravenous venous catheters (IVCs) are used extensively throughout critical and acute care areas. These are traditionally recommended for routine removal at 72-96 hours in adults to prevent complications. This is not done for children, or for higher risk lines such as central venous catheters. A recent systematic review questions whether routine IVC replacement is effective. Methods: This multi-centre, open-label, randomised trial assigned patients to have IVCs removed only if clinically indicated, or routinely every third day. The primary outcome was phlebitis; secondary endpoints included bloodstream infections, infusion failure, catheters used, and hospital costs. Results: We studied 3283 patients with 5907 catheters. There was no significant between-group difference for phlebitis (clinical indication 13.08/1,000 catheter days, routine replacement 13.11/1,000 catheter days; HR 1.00; 95% CI 0.77-1.31; P=0.96). There was no significant between-group difference for all-cause bloodstream infections (clinical indication 0.46/1,000 catheter days, routine replacement 1.23/1,000 catheter days; HR 0.36; 95% CI 0.08-1.23; P=0.08). The number of catheters per patient, and treatment costs (mean difference $7.58, 95%CI $4.74-$10.43) were significantly less for clinical indication patients. IVCs in the clinically indicated group were used for up to 23 days without complication. Conclusions: Patients do not benefit from routine removal; this merely increases patient discomfort, total catheter insertions and costs. It remains essential that IVCs are inserted and cared for aseptically, monitored closely and removed immediately if complications arise, or once treatment is complete.