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Clinically indicated and routine replacement of peripheral IV catheters did not differ for phlebitis.
MedLine Citation:
PMID:  23318342     Owner:  NLM     Status:  In-Data-Review    
QUESTION In hospitalized patients, is clinically indicated replacement of peripheral IV catheters (PIVCs) equivalent to routine replacement every 3 days for phlebitis? METHODS DESIGN Randomized, controlled, equivalency trial. ACTRN12608000445370. ALLOCATION Concealed.* BLINDING Blinded* (laboratory staff, outcome assessor, and safety committee). FOLLOW-UP PERIOD 48 hours after catheter removal. SETTING 3 university-affiliated hospitals in Queensland, Australia. PATIENTS 3283 hospitalized medical or surgical patients ≥ 18 years of age (mean age 55 y, 63% men) with a PIVC in place and expected treatment > 4 days. Exclusion criteria were bloodstream infection, planned removal of catheter within 24 hours, catheter already in situ for > 72 hours, or catheter inserted in an emergency. INTERVENTION Replacement of PIVCs as indicated clinically by completion of therapy, phlebitis, infiltration, occlusion, accidental removal, or suspected infection (n = 1593); or routinely every third calendar day, unless otherwise clinically indicated (e.g., catheter failure before day 3 or unable to recannulate) (n = 1690). 39% (2322/5907) of catheters were inserted by an IV insertion service. OUTCOMES Primary outcome was phlebitis during use or within 48 hours of catheter removal. Phlebitis was defined as simultaneous presentation of ≥ 2 of the following: patient-reported pain or tenderness, with severity ≥ 2 on a 10-point scale; erythema extending ≥ 1 cm from insertion site; swelling extending ≥ 1 cm from insertion site; purulent discharge; or palpable venous cord beyond the catheter tip. 3000 patients were needed to detect equivalence of therapies at 4% phlebitis (equivalence margin 3%) with 95% power (α = 0.05). PATIENT FOLLOW-UP 100% (intention-to-treat analysis). MAIN RESULTS Main results are in the Table. The absolute risk difference between groups for phlebitis (0.41%, 95% CI -1.33 to 2.15) was within the equivalence margin of 3%. CONCLUSION Clinically indicated peripheral IV catheter replacement did not differ from routine replacement every 3 days for phlebitis in hospitalized patients.Clinically indicated vs routine removal of peripheral IV catheters in hospitalized patients†OutcomesEvent ratesDuring catheterization or within 48 h after IV removalClinically indicatedRoutineRRI (95% CI)NNH (CI)Phlebitis‡7.2%6.7%6% (-17 to 36)NS†NS = not significant; other abbreviations defined in Glossary. RRI and CI calculated from relative risk in article.‡≥ 2 of patient-reported pain or tenderness with severity ≥ 2 on a 10-point scale; erythema extending ≥ 1 cm from insertion site; swelling extending ≥ 1 cm from insertion site; purulent discharge; or palpable venous cord beyond catheter tip.
Dennis G Maki
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  JC8     Citation Subset:  AIM; IM    
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