Is routine replacement of peripheral intravenous catheters necessary?
BACKGROUND
Guidelines developed by the Centers for Disease Control and Prevention, Atlanta, Ga, recommend that peripheral intravenous catheters be changed every 3 days. However, routine replacement of central venous catheters is no longer supported in their latest update.


OBJECTIVE
To evaluate the risk to patients of having peripheral intravenous catheters left in place for as long as they are clinically indicated.


METHODS
This observational study in a university-affiliated, 700-bed hospital was designed to evaluate the day-specific risk (incidence density) for phlebitis, catheter infection, and obstruction with catheters remaining in place as long as clinically indicated. All consecutive patients who required peripheral intravenous catheterization for 24 hours or more were enrolled during a 10-week period. Outcome variables are phlebitis, catheter-related infections, and obstruction. Evaluated risk factors include age, sex, underlying disease, anatomical insertion site, catheter diameter, first or subsequent catheter, duration of catheterization, type of admission, hospital location, type of infusate, and antibiotic therapy.


RESULTS
A total of 609 catheters that were in place for 1 to 28 days were evaluated. Phlebitis, catheter-related infection, and obstruction occurred in 19.7%, 6.9%, and 6.0% of catheters, respectively. We were unable to demonstrate an increased risk after 3 days of catheterization. The day-specific risk indicated a linear function of all outcome variables.


CONCLUSIONS
The hazard for catheter-related complications--phlebitis, catheter-related infections, and mechanical complications--did not increase during prolonged catheterization. The recommendation for routine replacement of peripheral intravenous catheters should be reevaluated considering the additional cost and discomfort to the patient.
Bregenzer
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Division of Infectious Diseases, University Hospital Basel, Switzerland.
Conen
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Sakmann
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Widmer
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation*; D004866:Equipment Contamination; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000295:instrumentation*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000517:prevention & control; D016016:Proportional Hazards Models; D013557:Switzerland