Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trialBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a339 (Published 08 July 2008) Cite this as: BMJ 2008;337:a339
- Joan Webster, nursing director, research; adjunct professor12,
- Samantha Clarke, clinical nurse1,
- Dana Paterson, research nurse1,
- Anne Hutton, clinical nurse1,
- Stacey van Dyk, research nurse1,
- Catherine Gale, intravenous nurse specialist1,
- Tracey Hopkins, clinical nurse consultant, intravenous service1
- 1Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia
- 2Research Centre for Clinical and Community Practice Innovation Griffith University, Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital
- Correspondence to: J Webster
- Accepted 7 May 2008
Objective To compare routine replacement of intravenous peripheral catheters with replacement only when clinically indicated.
Design Randomised controlled trial.
Setting Tertiary hospital in Australia.
Participants 755 medical and surgical patients: 379 allocated to catheter replacement only when clinically indicated and 376 allocated to routine care of catheter (control group).
Main outcome measure A composite measure of catheter failure resulting from phlebitis or infiltration.
Results Catheters were removed because of phlebitis or infiltration from 123 of 376 (33%) patients in the control group compared with 143 of 379 (38%) patients in the intervention group; the difference was not significant (relative risk 1.15, 95% confidence interval 0.95 to 1.40). When the analysis was based on failure per 1000 device days (number of failures divided by number of days catheterised, divided by 1000), no difference could be detected between the groups (relative risk 0.98, 0.78 to 1.24). Infusion related costs were higher in the control group (mean $A41.02; £19.71; €24.80; $38.55) than intervention group ($A36.40). The rate of phlebitis in both groups was low (4% in intervention group, 3% in control group).
Conclusion Replacing peripheral intravenous catheters when clinically indicated has no effect on the incidence of failure, based on a composite measure of phlebitis or infiltration. Larger trials are needed to test this finding using phlebitis alone as a more clinically meaningful outcome.
Registration number Australian New Zealand Clinical Trials Registry ACTRN12605000147684.
Contributors: JW conceived the idea, based on earlier work, secured funding, wrote the protocol, supervised the preparation and conduct of the trial, analysed the data, and wrote the paper. SE developed databases and assisted in the development of study materials and in data management. DP collected data for primary outcomes and developed a system for categorising the pH of drugs. AH was responsible for assessing suitability and supervising recruitment of acute admissions. SvD collected data for primary outcomes, helped in the development of study materials, and collated data. CD liaised with the intravenous service, hospital staff, and participants, and assisted in data management. CG contributed to the protocol and assisted with expert advice throughout the trial. All authors contributed to and approved the final draft. JW is guarantor.
Funding: Queensland Nursing Council research grant (RAN:0513) and the RBWH Research Foundation.
Competing interests: None declared.
Ethical approval: Royal Brisbane and Women’s Hospital human research ethics committee (No 2005/93).
Provenance and peer review: Not commissioned; externally peer reviewed.