Dennis G. Maki, MD, MACP
In hospitalized patients, is clinically indicated replacement of peripheral IV catheters (PIVCs) equivalent to routine replacement every 3 days for phlebitis?
Randomized, controlled, equivalency trial. ACTRN12608000445370.
Blinded* (laboratory staff, outcome assessor, and safety committee).
48 hours after catheter removal.
3 university-affiliated hospitals in Queensland, Australia.
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.
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.
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).
100% (intention-to-treat analysis).
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%.
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†
†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.
Maki DG. Clinically indicated and routine replacement of peripheral IV catheters did not differ for phlebitis. Ann Intern Med. ;158:JC8. doi: 10.7326/0003-4819-158-2-201301150-02008
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Published: Ann Intern Med. 2013;158(2):JC8.
Hospital Medicine, Hospital-Acquired Infections, Infectious Disease.
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