Clinically-indicated replacement versus routine replacement of peripheral venous catheters
Article
Article Title | Clinically-indicated replacement versus routine replacement of peripheral venous catheters |
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ERA Journal ID | 15305 |
Article Category | Article |
Authors | Webster, Joan (Author), Osborne, Sonya (Author), Rickard, Claire M (Author) and Marsh, Nicole (Author) |
Journal Title | Cochrane Database of Systematic Reviews |
Journal Citation | 2019 (1), pp. i-55 |
Number of Pages | 57 |
Year | 2019 |
Publisher | John Wiley & Sons |
Place of Publication | United Kingdom |
ISSN | 1469-493X |
1361-6137 | |
Digital Object Identifier (DOI) | https://doi.org/10.1002/14651858.CD007798.pub5 |
Web Address (URL) | https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007798.pub5/full |
Abstract | Background Objectives Search methods Selection criteria Data collection and analysis Main results Primary outcomes Seven trials (7323 participants), assessed catheter‐related bloodstream infection (CRBSI). There is no clear difference in the incidence of CRBSI between the clinically indicated (1/3590) and routine change (2/3733) groups (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.08 to 4.68), low‐certainty evidence (downgraded twice for serious imprecision). All trials reported incidence of thrombophlebitis and we combined the results from seven of these in the analysis (7323 participants). We excluded two studies in the meta‐analysis because they contributed to high heterogeneity. There is no clear difference in the incidence of thrombophlebitis whether catheters were changed according to clinical indication or routinely (RR 1.07, 95% CI 0.93 to 1.25; clinically indicated 317/3590; 3‐day change 307/3733, moderate‐certainty evidence, downgraded once for serious risk of bias). The result was unaffected by whether the infusion was continuous or intermittent. Six trials provided thrombophlebitis rates by number of device days (32,709 device days). There is no clear difference between groups (RR 0.90, 95% CI 0.76 to 1.08; clinically indicated 248/17,251; 3‐day change 236/15,458; moderate‐certainty evidence, downgraded once for serious risk of bias). One trial (3283 participants), assessed all‐cause blood stream infection (BSI). We found no clear difference in the all‐cause BSI rate between the two groups (RR 0.47, 95% CI 0.15 to 1.53; clinically indicated: 4/1593 (0.02%); routine change 9/1690 (0.05%); moderate‐certainty evidence, downgraded one level for serious imprecision). Three trials (4244 participants), investigated costs; clinically indicated removal probably reduces device‐related costs by approximately AUD 7.00 compared with routine removal (MD −6.96, 95% CI −9.05 to −4.86; moderate‐certainty evidence, downgraded once for serious risk of bias). Secondary outcomes Six trials assessed infiltration (7123 participants). Routine replacement probably reduces infiltration of fluid into surrounding tissues compared with a clinically indicated change (RR 1.16 (95% CI 1.06 to 1.26; routine replacement 747/3638 (20.5%); clinically indicated 834/3485 (23.9%); moderate‐certainty evidence, downgraded once for serious risk of bias). Meta‐analysis of seven trials (7323 participants), found that rates of catheter failure due to blockage were probably lower in the routine‐replacement group compared to the clinically indicated group (RR 1.14, 95% CI 1.01 to 1.29; routine‐replacement 519/3733 (13.9%); clinically indicated 560/3590 (15.6%); moderate‐certainty evidence, downgraded once for serious risk of bias). Four studies (4606 participants), reported local infection rates. It is uncertain if there are differences between groups (RR 4.96, 95% CI 0.24 to 102.98; clinically indicated 2/2260 (0.09%); routine replacement 0/2346 (0.0%); very low‐certainty evidence, downgraded one level for serious risk of bias and two levels for very serious imprecision). One trial (3283 participants), found no clear difference in the incidence of mortality when clinically indicated removal was compared with routine removal (RR 1.06, 95% CI 0.27 to 4.23; low‐certainty evidence, downgraded two levels for very serious imprecision). One small trial (198 participants) reported no clear difference in device‐related pain between clinically indicated and routine removal groups (MD −0.60, 95% CI −1.44 to 0.24; low‐certainty evidence, downgraded one level for serious risk of bias and one level for serious imprecision). The pre‐planned outcomes 'number of catheter re‐sites per patient', and 'satisfaction' were not reported by any studies included in this review. Authors' conclusions |
Keywords | Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Device Removal; Guideline Adherence; Humans; Incidence; Phlebitis; Randomized Controlled Trials as Topic; Thrombophlebitis; Time Factors |
ANZSRC Field of Research 2020 | 420599. Nursing not elsewhere classified |
Public Notes | © Authors |
Byline Affiliations | Griffith University |
Queensland University of Technology | |
Institution of Origin | University of Southern Queensland |
https://research.usq.edu.au/item/q570q/clinically-indicated-replacement-versus-routine-replacement-of-peripheral-venous-catheters
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