This Cochrane review shows that there is little or no difference in the safety of replacing intravenous drip (peripheral venous catheter) when there are clinical indications compared with regular replacement. The cost of replacing the catheter only when there is clinical indication may be lower than that of regular replacement.
What will the study tell us?
A systematic review collects available studies and conducts a rigorous evaluation. The question studied in this systematic Cochrane review is: For patients undergoing medical infusion, what does it mean for patients to change the catheter when clinical indications appear, compared to the regular replacement (every 3-4 days) of the peripheral venous catheter? Difference in effect?
The results showed that intravenous catheters were replaced only when clinically indicated:
There may be almost no difference in the number of patients with bloodstream infections related to intravenous drip
There may be little difference in the number of patients getting blood infections (all sources)
May have little or no effect on the number of patients with thrombophlebitis
May reduce care costs associated with intravenous drip
Effectiveness of changing catheters only when clinical indications appear compared to changing catheters regularly
Background
Most hospitalized patients may need to receive fluids or medications through a peripheral intravenous catheter at some time during their hospitalization. A peripheral venous catheter (also called intravenous drip, intravenous access, or intravenous cannula) is a short hollow tube that is placed in a vein to inject drugs, liquids, or nutrients directly into the bloodstream.
These catheters are usually replaced every 3-4 days to try to prevent vein irritation or blood infection. However, changing the catheter may make the patient feel uncomfortable, because the peripheral venous catheter may be very painful, especially when placed on the back of the hand or wrist. If the pain score is 10 points, the average score for the operation is 4.5 points.
Another important factor to consider is that more frequent replacement of catheters may have a cost impact on the facility (materials used for intravenous drip and manual care).
The answer that the authors of this review hope to find is whether it is effective and safe to replace the catheter when the symptoms or signs of catheter-related problems occur, compared with the regular catheter replacement (every 3-4 days) Significant differences.
What is this information based on?
The Cochrane authors searched the research database for relevant studies as of April 2018. They found 9 studies (randomized controlled trials) with a total of 7392 patients. They found that seven of the studies recruited adult patients with an average age of about 60.
The other two studies recruited patients of all ages. One study had an average age of about 40 years old and the other had an average age of about 60 years. Eight of these studies included patients receiving continuous or intermittent infusion therapy, while the other study involved only intermittent therapy.
All interventions studied were to replace catheters when clinically indicated.
Five studies defined "clinical indications" as the presence of one of the following manifestations: phlebitis, local infection, bacteremia, infiltration (vascular damage that may occur when the catheter is loose or passing through the vein wall) or obstruction sign. Two studies defined it as pain at the catheter puncture site, catheter displacement, or signs of thrombophlebitis due to peripheral vein infusion. Two studies did not describe the definition of clinical indications. The studies compared the catheters on a regular basis, with 7 replacement cycles every 3-4 days, and the other 2 studies every 2 days. They did not report which type of peripheral venous catheter (material, coating, dressing) was used in the study. Five of the studies were conducted in a single-center acute inpatient setting, two were multi-center studies conducted in large tertiary hospitals, one study was a randomized cluster study of 20 hospital wards, and the last one The research is conducted in a community environment. Studies were conducted in Australia (5 studies), Brazil, China, the United Kingdom and India.
Here, we introduce 4 of the 7 most important results reported in the results summary table of the Cochrane review. For the remaining two main outcomes, namely infiltration and catheter obstruction, the study found that compared with regular replacement, the incidence of the two outcomes of replacing the catheter only when clinical indications appeared was slightly increased. For all results, the certainty is mostly moderate. The main reason for the decline is the risk of inconsistency and prejudice.
Certainty of Evidence (GRADE)
When we summarize the research and present the results (effect estimates), we also need to say something about our certainty of this result. The certainty of the evidence can tell people that we believe that the result reflects real life/reality. GRADE is the system (or tool) we use to make these judgments. The elements we judge in GRADE include:
How is the research going
Is the study large enough
Whether the research is sufficiently similar
Research relevance
Have all relevant studies been identified