How often should peripheral IV dressings be changed
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The review found significant evidence that routinely changing or replacing peripheral venous catheters is no better than replacing when clinically indicated. The Group has reported that this evidence has a potential cost saving to the NHS of £40 million over a five-year period. Show Here’s its story from publication to informing policy. How it began The US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72-96 hours - ie every 3-4 days. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients, and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. The Cochrane researchers wanted to assess the effects of removing peripheral IV catheters when clinically indicated, compared with removing and re-siting the catheter routinely. The Cochrane Review found no evidence of benefit to support the widespread current practice of changing catheters routinely. What’s been the Impact of this Cochrane evidence? This Cochrane Review directly informed two recommendations (IVAD29 and IVAD28) in the UK's National Institute for Health and Clinical Excellence (NICE) accredited national guideline for preventing healthcare-associated infections in National Health Service (NHS) hospitals in England (Epic3). These recommended implementing a clinically indicated strategy rather than routine replacement. A recent cost analysis to asses how much adopting this evidence-based practice would save the NHS came to the following conclusions: “To implement clinically indicated replacement of peripheral catheters, hospitals that currently undertake routine catheter replacement practice will need to update their policy… . [I]f only one-third of the 11.5 million hospital admissions to NHS England hospitals every year required peripheral venous catheterization for more than three days, the expected population for the proposed strategy implementation over five years would be around 20 million patients. Accordingly, we calculate that if the clinically indicated strategy was fully implemented in all NHS hospitals in England, then the cost savings to the system would be around ₤40 million over five years.” Supporting resources Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Browne J, Prieto J, Wilcox M. epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. London: Richard Wells Research Centre, University of West London; 2013. Journal of Hospital Infection 2014; 86S1: S1-70. This update contains two new trials, taking the total to nine included studies with 7412 participants. Eight trials were conducted in acute hospitals and one in a community setting. We rated the overall certainty of evidence as moderate for most outcomes, due to serious risk of bias for unblinded outcome assessment or imprecision, or both. Because outcome assessment was unblinded in all of the trials, none met our criteria for high methodological quality. 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. How long is a peripheral IV site good for?Replace peripheral IV catheters every 72–96 hours, but not more often, in adult patients.
How often should IV tubing be changed?Replace intravenous tubing, including add-on devices, no more frequently than at 72-hour intervals unless clinically indicated. Replace tubing used to administer blood, blood products, or lipid emulsions within 24 hours of initiating the infusion.
How often should a peripheral IV be assessed?The INS Infusion Therapy Standards of Practice state an assessment should be done every 1 to 2 hours for the critically ill and sedated; hourly for neonatal and pediatric patients; and more frequently for patients receiving vesicant medications.
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