Routine Shifting of Intravenous Drips Unnecessary

Small intravenous devices (IVDs) commonly used in the hand or arm do not need to be re-sited routinely every three days, according to a new study.

Researchers at Griffith University (Nathan, Australia), Gippsland Medical School (Churchill, Australia), and other institutions conducted a randomized controlled trial involving a total of 362 patients (603 IVDS) that were randomized to have IVDs replaced on clinical indication (185 patients) or following a routine change every 3 days (177 patients). The IVDs were inserted and managed by the general hospital medical and nursing staff. The primary endpoint was a composite of IVD complications: phlebitis, infiltration, occlusion, accidental removal, local infection, and device-related bloodstream infection.

The results showed that IVD complication rates were 68 per 1,000 IVD days in the clinically indicated group, compared to 66 per 1,000 IVD days in the routine replacement group. The time to first complication per patient did not differ between groups, and there were no local infections or IVD-related bloodstream infections in either group. Intravenous (IV) therapy duration did not differ between groups, but more IVDs were placed per patient in the routine replacement than the clinical indication group, with significantly higher hospital costs per patient. The study was published on September 10, 2010, in BMC Medicine, a publication of BioMed Central.

"Recommended timelines for routine re-site have been extended over the past three decades from 24 to 72 hours. Currently, 72- to 96-hour re-site is recommended,” said lead author Professor of Nursing Claire Rickard, Ph.D., R.N. "Even with these extended durations, such policies still cause increased workload in hospitals, where the task of removing and replacing well-functioning IVDs generally falls to busy nursing and junior medical staff.”

According to the study, the average duration of IV therapy is 5-6 days and many catheters can remain complication-free for this period. A policy of re-site on clinical indication would mean that one of every two patients would need a single cannula to receive treatment, whereas a 3-day change policy would result in only one in five patients having this scenario, with the rest requiring multiple cannulations, and therefore additional pain and inconvenience.

Related Links:
Griffith University
Gippsland Medical School