Sakmann P, This week, the Infusion Nurse Blog is celebrating its two year blog anniversary!!! NM is an academic researcher and her employer has received funding on her behalf for her to provide expert advice, or educational lectures on her research at professional symposia and other events from BD and Hospira. We assessed the certainty of the body of evidence against five principle domains: 1) limitations in design and implementation; 2) indirectness of evidence or generalisability of findings; 3) inconsistency of results, for example unexplained heterogeneity and inconsistent findings; 4) imprecision of results where confidence intervals were wide; and 5) other potential biases, for example publication bias or high manufacturer involvement (Schnemann 2017). Appropriate nursing staff levels in intensive care units should be ensured (Category IB). Additionally, only Nishanth 2009 included participants who were from a lowincome country and who were, "usually asthenic, many underhydrated/dehydrated on admission" (personal correspondence), so the evidence may be regarded as indirect for these types of patients. Osborne S, A CVC should be used with the minimal number of ports or lumens essential for treatment of the patient (Category IB). Loveday HP, Rickard CM, We used GRADE to assess the overall evidence certainty. Altman DG, Comparison 1 Clinicallyindicated versus routine change, Outcome 9 Mortality. McGrail MR, Appendix B - Centers for Disease Control and Prevention Randomisation ensures risk factors that may affect the outcome, are equally distributed between groups. Webster J, We acknowledge the input of Dr Karen New in previous versions of the review. Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. Rickard CM, Online, choose the best answer to each test question. Catney MR, Webster J, Cerra F. Catheterrelated sepsis: prospective, randomized study of three methods of longterm catheter maintenance, Peripheral venous catheter inflammation. For CVCs, a subclavian site, rather than a jugular or a femoral site, should be used in adult patients to minimize infection 2008 Apr;20(4):172-80. doi: 10.1111/j.1745-7599.2008.00305.x. In: Higgins JP, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). We analysed data using the Cochrane Collaboration's Review Manager 5 software (Review Manager 2014). Nurs Stand. This would provide significant cost savings, spare patients the unnecessary pain of routine resites in the absence of clinical indications and would reduce time spent by busy clinicians on this intervention. Relationship between peripheral intravenous catheter dwell time and the development of phlebitis and infiltration. For statistically significant effects, we calculated the number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH). Webster J, If a patient requires therapy, for example for five days, they may have one catheter used for the entire time or alternately multiple IVDs used over the five days. Inclusion in an NLM database does not imply endorsement of, or agreement with, MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming. The difference in complication rates for phlebitis and infiltration between peripheral intravenous site rotation based on clinical assessment versus length of time since insertion was evaluated. Nigam C, This result was based on three studies and results were consistent and intuitively logical (fewer catheters, less clinician time and equipment). Studies have been unable to demonstrate a high correlation between phlebitis and catheter infection and Maki has suggested that phlebitis may primarily be a physical response (Maki 1991). Sivaram G, May J, Food and Drug Administration Abolfotouh MA, Similarly, in a prospective investigation of 305 PIVC there were 10 cases of infusion phlebitis amongst patients who had their catheter in situ for fewer than 72 hours whereas none were reported in patients where the dwell time was longer (White 2001). There is moderate-certainty evidence that infiltration and catheter blockage is probably lower when PIVC are changed routinely; and moderate-certainty evidence that clinically indicated removal probably reduces device-related costs. There are no other published papers showing phlebitis rates of 100%. When results of all trials were combined, heterogeneity was 65%. To assess the effects of removing peripheral intravenous catheters when clinically indicated compared with removing and resiting the catheters routinely. The bacterial source may be the patient's own skin or that of a healthcare provider; CRBSI has an attributable mortality rate of 12% to 25% (Maki 2006). Similarly, in the De Vries 2016 study, peripheral line start kits were reduced by 48% in the year following the policy change. The incidence of peripheral intravenous catheter failure and complications within the adult population: a systematic review. education for physicians. Bak A, There is moderatecertainty evidence of no clear difference in rates of CRBSI, thrombophlebitis, allcause BSI, mortality and pain between clinically indicated or routine replacement of PIVC. 2007 Mar 8-21;16(5):281-3. doi: 10.12968/bjon.2007.16.5.22998. catheter-related infections. WebEducate healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and WebGuideline IV CSTs should complete continuing education and training to remain current in their knowledge of event-related sterility in the OR.10 The orientation of new employees should include completing continuing education in the methods of event-related sterility. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food Six trials provided thrombophlebitis rates by number of device days (32,709 device days). Consequently, we conducted a sensitivity analysis and removed the two trials with fewer than 100 participants (combined total n = 89), both of which used a twoday replacement schedule and reported extreme results (Barker 2004; Nishanth 2009). Patients aged eighteen and older, from two So Paulo City hospital" (personal communication), "blood stream infection and or sepsis, neutrophil less than or equal to 1000/mm. All of the included studies reported incidence of phlebitis; the initial analysis was based on 7412 participants. Despite adherence to other strategies, if the rate of CRBSI is not decreasing, use of antiseptic/antibiotic impregnated short-term et al. Walsh TA, Br J Nurs. Cochrane Handbook for Systematic Reviews of Interventions. Compounding Sterile Preparations - ASHP Anticoagulant therapy should not be used routinely to reduce the risk for catheter-related infection in general patient populations There is no clear difference in allcause blood stream infections between the clinically indicated and routinechange groups. "The updated CDC guidelines are rich with new recommendations that are based on additional scientific research that has emerged since the prior version was published," said Russell N. Olmsted, MPH, CIC, 2011 president of the Association of Professionals of Infection Control and Epidemiology (APIC), in a news release. We judged the evidence as moderate certainty, as we downgraded once for serious risk of bias (no blinding of outcome assessment in any of the trials). Nine RCTs, involving a total of 7392 participants met the inclusion criteria (Barker 2004; Nishanth 2009; Rickard 2010; Rickard 2012; Van Donk 2009; Vendramim 2018; Webster 2007; Webster 2008; Xu 2017), see Characteristics of included studies for details. Metaanalysis of seven trials (7323 participants), found that rates of catheter failure due to blockage were probably lower in the routinereplacement group compared to the clinically indicated group (RR 1.14, 95% CI 1.01 to 1.29; routinereplacement 519/3733 (13.9%); clinically indicated 560/3590 (15.6%); moderatecertainty evidence, downgraded once for serious risk of bias). These include the Maddox scale (Maddox 1977), and the Baxter scale (Panadero 2002), which rank infusion thrombophlebitis according to the severity of clinical signs and symptoms. PMC The reason for the discrepancy between the two reviews is the inclusion criteria. Description Describes the infection control guidelines to prevent intravenous catheter-related infections II. The American Journal of Infection Control will also present a video roundtable highlighting the viewpoints of healthcare professionals on the anticipated effects of Im talking about best practices related to syringes, needles and injection safety, that nurses and other healthcare providers should know and follow. Clinicallyindicated replacement versus routine replacement of Similarly, blinding was not possible in any of the studies. ITT analysis available, Expected outcomes reported. We excluded participants receiving parenteral fluids. I consider the CDC statement about changing intermittet sets as an unresolved issue to be a great step forward. INS has always said change at 24 hours. Because outcome assessment could not be blinded (except for CRBSI), we classified all trials as high risk of bias. Rationale Webster J, Maddox RR, 2001] - PubMed - NCBI Altman DG (editors). Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study. This is the third update of a review first published in 2010. to enhance patient care. This could be expected; all catheters will fail eventually and will need to be replaced if treatment is ongoing. Confidence intervals were wide in the pooled outcomes of CRBSI, allcause blood stream infection, local infection, mortality and pain, indicating a high level of uncertainty around the effect size. short peripheral catheter. Systems, Cook Urological, TyRx, Medtronic, Biomet, Eisai Pharmaceuticals, Discovery Laboratories, Molnlycke, Cardinal Healthcare AAFP Accreditation Questions, For questions regarding the content of this activity, contact the should be replaced as soon as possible (within 48 hours). Seven trials (7323 participants) assessed catheterrelated bloodstream infection (CRBSI; Rickard 2010; Rickard 2012; Van Donk 2009; Vendramim 2018; Webster 2007; Webster 2008; Xu 2017). Gotzsche PC, Most hospital patients receive fluids or medications via a peripheral intravenous catheter at some time during their hospital stay. There was also an imbalance in the number of participants reported by group in this trial, which may indicate either a failure in the randomisation process in such a small trial or incomplete reporting. insertion site (Category II). Verwaest C, Ultrasonographic investigation of the pathogenesis of infusion thrombophlebitis. Guidelines for the Prevention of Intravascular Catheter-Related We are a charity that produces accessible evidence to help people make health and care decisions.