The impact of Cochrane evidence on how often to change peripheral venous catheters

The impact of Cochrane evidence on how often to change peripheral venous catheters

The Cochrane Review Clinically-indicated replacement versus routine replacement of peripheral venous catheters is an update of a review previously published in April 2013, and first published in 2010 from the Cochrane Vascular Group.

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.

Here’s its story from publication to informing policy.

How it began
Most hospital patients receive fluids or medications via an intravenous catheter at some time during their hospital stay. An intravenous catheter (also called an IV drip or intravenous cannula) is a short, hollow tube placed in the vein to allow administration of medications, fluids, or nutrients directly into the bloodstream.

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?
Upon assessment of these findings, healthcare organizations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings, and would also spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimize peripheral catheter-related complications in the context this revised procedure, insertions site should be inspected at each shift change and catheters removed if signs of inflammation, infiltration, or blockage are present.

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
Webster J, Osborne S, Rickard CM, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD007798. DOI: 10.1002/14651858.CD007798.pub4
Tuffaha HW, Rickard CM, Inwood S, Gordon L, Scuffham P. The epic3 recommendation that clinically indicated replacement of peripheral venous catheters is safe and cost-saving: how much would the NHS save? J Hosp Infect 2014;87(3):183-4. doi: 10.1016/j.jhin.2014.04.004.

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.


Wednesday, December 21, 2016