title: Optimal timing for intravascular administration set replacement.
abstract: BACKGROUND
  The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012.
  
  
  OBJECTIVE
  The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death.
  
  
  METHODS
  We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction.
  
  
  METHODS
  We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants.
  
  
  METHODS
  Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours.
  
  
  RESULTS
  We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters.
  
  
  CONCLUSIONS
  Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, 4111.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ullman
authors.forename: Marie L
authors.initials: ML
authors.lastname: Cooke
authors.forename: Donna
authors.initials: D
authors.lastname: Gillies
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Marsh
authors.forename: Azlina
authors.initials: A
authors.lastname: Daud
authors.forename: Matthew R
authors.initials: MR
authors.lastname: McGrail
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Riordan
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000517:prevention & control*; D001769:Blood; D055499:Catheter-Related Infections / Q000401:mortality / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D020878:Device Removal / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000295:instrumentation*; D008055:Lipids; D010288:Parenteral Nutrition / Q000295:instrumentation*; D013997:Time Factors
chemical_list: D008055:Lipids
references.citation: Crit Care Med. 1994 Sep;22(9):1424-30
references.pmid: 8062565
references.citation: JAMA. 1986 Feb 21;255(7):916-20
references.pmid: 3944997
references.citation: Ann Intern Med. 1979 May;90(5):764-8
references.pmid: 373560
references.citation: JPEN J Parenter Enteral Nutr. 1985 Jul-Aug;9(4):443-6
references.pmid: 3928918
references.citation: Clin Infect Dis. 2011 May;52(9):1087-99
references.pmid: 21467014
references.citation: Infect Control. 1985 Sep;6(9):367-70
references.pmid: 3932250
references.citation: J Infect Dis. 1995 Jan;171(1):220-4
references.pmid: 7798668
references.citation: Infect Control Hosp Epidemiol. 2004 Aug;25(8):650-5
references.pmid: 15357156
references.citation: J Clin Hosp Pharm. 1985 Mar;10(1):79-88
references.pmid: 3923044
references.citation: Can J Gastroenterol. 1999 Mar;13(2):147-51
references.pmid: 10203434
references.citation: J Pediatr. 1992 Mar;120(3):455-61
references.pmid: 1538298
references.citation: J Intraven Nurs. 1995 Mar-Apr;18(2):84-7
references.pmid: 7707174
references.citation: JAMA. 1984 Apr 27;251(16):2112-5
references.pmid: 6708261
references.citation: Am J Infect Control. 1996 Aug;24(4):262-77
references.pmid: 8870910
references.citation: BMJ. 2009 Jul 21;339:b2700
references.pmid: 19622552
references.citation: JPEN J Parenter Enteral Nutr. 1985 May-Jun;9(3):322-5
references.pmid: 3925176
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003588
references.pmid: 16235329
references.citation: Am J Infect Control. 1988 Oct;16(5):206-13
references.pmid: 3195780
references.citation: J Hosp Infect. 1986 Nov;8(3):217-23
references.pmid: 2878025
references.citation: Infect Control Hosp Epidemiol. 2001 Mar;22(3):136-9
references.pmid: 11310690
references.citation: Med J Aust. 1994 Sep 19;161(6):374-8
references.pmid: 8090116
references.citation: JAMA. 1987 Oct 2;258(13):1777-81
references.pmid: 3114506
references.citation: Infect Control Hosp Epidemiol. 1999 Jun;20(6):396-401
references.pmid: 10395140
references.citation: Infect Control Hosp Epidemiol. 1994 Apr;15(4 Pt 1):253-64
references.pmid: 8207192
references.citation: Am J Infect Control. 2012 Apr;40(3):227-32
references.pmid: 21621875
references.citation: Ann Intern Med. 1979 Aug;91(2):173-8
references.pmid: 111593
references.citation: Infect Control Hosp Epidemiol. 1999 Jul;20(7):487-93
references.pmid: 10432161
references.citation: Heart Lung. 1998 May-Jun;27(3):200-8
references.pmid: 9622407
references.citation: Infect Control. 1987 Mar;8(3):113-6
references.pmid: 3646182
references.citation: BMJ. 1997 Sep 13;315(7109):629-34
references.pmid: 9310563
references.citation: J Hosp Infect. 1997 Nov;37(3):225-36
references.pmid: 9421774
references.citation: Clin Infect Dis. 2009 Jul 1;49(1):1-45
references.pmid: 19489710
references.citation: J Trauma. 1989 Jun;29(6):811-6
references.pmid: 2738979
references.citation: Am J Infect Control. 2007 Apr;35(3):177-82
references.pmid: 17433941
references.citation: JPEN J Parenter Enteral Nutr. 1986 Sep-Oct;10(5):494-7
references.pmid: 3093706
references.citation: J N Y State Nurses Assoc. 1989 Sep;20(3):12
references.pmid: 2778552
references.citation: Am J Respir Crit Care Med. 2001 Jun;163(7):1584-90
references.pmid: 11401878
references.citation: Oncol Nurs Forum. 1998 Jun;25(5):907-13
references.pmid: 9644707
references.citation: MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29
references.pmid: 12233868
references.citation: JPEN J Parenter Enteral Nutr. 1991 Jul-Aug;15(4):460-3
references.pmid: 1910111
references.citation: Eur Surg Res. 2008;41(4):341-5
references.pmid: 18841020
references.citation: Mayo Clin Proc. 2006 Sep;81(9):1159-71
references.pmid: 16970212
references.citation: Infect Control Hosp Epidemiol. 2004 Mar;25(3):240-50
references.pmid: 15061417
references.citation: J Pediatr Oncol Nurs. 1991 Oct;8(4):173-9
references.pmid: 1930810
references.citation: Eur J Clin Microbiol Infect Dis. 2000 Jan;19(1):1-8
references.pmid: 10706172
references.citation: Ann Intern Med. 2010 Jun 1;152(11):726-32
references.pmid: 20335313