Level 1: Likely reliable evidence
The necessity for routine replacement of an IV peripheral cannula to prevent bacteremia was evaluated in a high-quality randomized trial. Patients older than 18 years (N = 755) without current bacteremia or immunosuppressive therapy were randomized to IV catheter replacement only when clinically indicated vs. routine replacement every three days (BMJ. 2008;337:a339). Patients were expected to have a catheter in place for more than four days. Clinical indications for replacement included phlebitis, infiltration, or unexplained fever. Routine replacement occurred in 6% of patients who were randomized to replacement only when indicated, but patients were analyzed as randomized. The primary outcome was a composite of catheter replacement for either phlebitis or infiltration.
Comparing IV catheter replacement only when clinically indicated vs. routine replacement every three days, mean time to replacement was 90.6 hours vs. 66.5 hours (P <.0001). There were no significant differences in rates of replacement for phlebitis or inflammation, catheter failure per 1,000 device days, local infection, phlebitis, infiltration, blockage, or suspected bloodstream infection. Infusion-related costs were higher with routine placement. This finding is also supported by a previously published randomized trial (without adequate statistical power) of 206 hospitalized patients (Int J Nurs Stud. 2007;44:664-671).