title: Should in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials.
abstract: BACKGROUND
  In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We used MEDLINE and the Cochrane Controlled Trial Register up to August 10, 2009.
  
  
  METHODS
  Two reviewers independently assessed trial quality and extracted data. Data on phlebitis were combined when appropriate, using a random-effects model. The impact of the risk of phlebitis in the control group (baseline risk) on the effect of in-line filters was studied by using meta-regression based on the bivariate meta-analysis model. The quality of the evidence was determined by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method.
  
  
  RESULTS
  Eleven trials (1633 peripheral catheters) were included in this review to compare the effect of in-line filters on the incidence of phlebitis in hospitalized patients. Baseline risks across trials ranged from 23% to 96%. Meta-analysis of all trials showed that in-line filters reduced the risk of infusion-related phlebitis (relative risk, 0.66; 95% confidence interval, 0.43-1.00). This benefit, however, is very uncertain, because the trials had serious methodological shortcomings and meta-analysis revealed marked unexplained statistical heterogeneity (P < 0.0000, I(2) = 90.4%). The estimated benefit did not depend on baseline risk.
  
  
  CONCLUSIONS
  In-line filters in peripheral IV catheters cannot be recommended routinely, because evidence of their benefit is uncertain.
authors.affiliation: MD (B), Dutch Working Party on Infection Prevention, Leiden University Medical Center, C7-130, PO Box 9600, 2300 RC Leiden, The Netherlands. B.S.Niel-Weise@lumc.n
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Niël-Weise
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Peterhans J
authors.initials: PJ
authors.lastname: van den Broek
mesh_terms: D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D005374:Filtration; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000295:instrumentation*; D010689:Phlebitis / Q000453:epidemiology / Q000517:prevention & control*; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D018570:Risk Assessment; D016896:Treatment Outcome