The millions of peripheral intravenous catheters used each year are recommended for
72-96 h replacement in adults. This routine replacement increases health-care costs
and staff workload and requires patients to undergo repeated invasive procedures.
The effectiveness of the practice is not well established. Our hypothesis was that
clinically indicated catheter replacement is of equal benefit to routine replacement.
This multicentre, randomised, non-blinded equivalence trial recruited adults (≥18
years) with an intravenous catheter of expected use longer than 4 days from three
hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated
random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before
allocation) was to clinically indicated replacement, or third daily routine replacement.
Patients, clinical staff, and research nurses could not be masked after treatment
allocation because of the nature of the intervention. The primary outcome was phlebitis
during catheterisation or within 48 h after removal. The equivalence margin was set
at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related
bloodstream and local infections, all bloodstream infections, catheter tip colonisation,
infusion failure, catheter numbers used, therapy duration, mortality, and costs. This
trial is registered with the Australian New Zealand Clinical Trials Registry, number
ACTRN12608000445370.
All 3283 patients randomised (5907 catheters) were included in our analysis (1593
clinically indicated; 1690 routine replacement). Mean dwell time for catheters in
situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13)
when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically
indicated group and in 114 of 1690 (7%) patients in the routine replacement group,
an absolute risk difference of 0·41% (95% CI -1·33 to 2·15%), which was within the
prespecified 3% equivalence margin. No serious adverse events related to study interventions
occurred.
Peripheral intravenous catheters can be removed as clinically indicated; this policy
will avoid millions of catheter insertions, associated discomfort, and substantial
costs in both equipment and staff workload. Ongoing close monitoring should continue
with timely treatment cessation and prompt removal for complications.
Australian National Health and Medical Research Council.
Copyright © 2012 Elsevier Ltd. All rights reserved.