Peripherally Inserted Intravenous Catheters: When to Replace
Mary-Margaret Whitten RN
Abstract
Millions of peripheral intravenous catheters (PIVC) are used around
the world. About 200 million catheters are used in the US alone
each year (Rickard et al., 2012). Most hospital policies and
protocols follow the recommendation of the CDC to routinely
change PIVCs every 72-96 hours to prevent complications. The
effectiveness of this practice is not well established by research
and clinical trials.
The purpose of this poster is to share the evidence that suggests
clinically indicated replacement of PIVCs is a better option for
patients. It reduces patient procedures and discomfort related to
unnecessary needle sticks, it reduces costs to the hospital and
patient and it decreases workload for our already over worked
and understaffed nurses. Most importantly there has been no
evidence that routine replacement decreases complications
related to PIVCs when compared to clinically indicated
replacement of PIVCs.
Introduction
• PIVCs are used all over the world for many different purposes.
• A PIVC is a cannula that is inserted into a vein for medical access.
• Uses include – administration of
• Fluids
• Blood products
• Medications
• Nutrients
• PIVCs are used both in and out of hospital settings affecting a
huge sector of health care professionals and patients
• Almost all acute care hospital units
• Long term care facilities
• Infusion centers
• Skilled Nursing Facilities
• Inpatient Rehabs
• Up to 70% of patients in an acute care hospital need a short
PIVC (Rickard et al., 2012).
• Typical complications related to PIVCs regardless of in-dwell
time.
• Phlebitis
• Infection
• Infiltration
• Extravasation
• Oftentimes infections related to PIVC are caused by bacteria
entering the patient at the time of insertion as well as when
using the catheters to administer medications and other
Policy change from routine PIVC change every 72-96 hours to
products. Proper care and handling of PIVCs is essential to
prolonging their patency and increasing dwell times.
Template ID: basicprofessional Size: 36x48
Old Dominion University
Current Policy Guidelines
Current Recommendations from Centers for
Disease Control for PIVC replacement
• There is no need to replace peripheral catheters more
frequently than every 72–96 hours to reduce risk of infection
and phlebitis in adults [36, 140, 141]. Category 1B (Center for
Disease Control [CDC], 2011)
• No recommendation is made regarding replacement of
peripheral catheters in adults only when clinically indicated
[142–144]. Unresolved issue (CDC, 2011)
Evidence For Clinically Indicated PIVC Change
Following the CDC guidelines many hospitals across the globe have
adopted the policy of routinely changing PIVCs every 72-96
hours per protocol. This practice has not been well established
to be effective in reducing complications and infections from
PIVCs. Routine changing of PIVCs is uncomfortable for the
patient and a waste of valuable healthcare resources in the
form of lost nursing time and money. Many are proposing a
change in policy to clinically indicated PIVC change replace
routine replacement in light of new evidence that changing a
PIVC every 72-96 hours is of no benefit to the patient.
Three studies comparing the incidence of phlebitis or infection
related to PIVC used randomized control trials to prove that
there is no advantage to routine changing of PIVCs. Patients
were chosen at random to either have their PIVC change every
72 hours or to leave the PIVC in until clinically indicated that it
must be changed (i.e. PIVC is no longer patent or working).
All studies found that there was no difference in incidence of
complications in either group, routinely changed or not. The
evidence suggests that proper and careful clinical management
could be as effective in reducing complications alone. This
research lends itself to a change in policy across the globe.
Clinically indicated PIVC change is a safe strategy.
Pathogenesis of catheter bloodstream infections shows most
infections are initially related to insertion procedure (i.e. poor
aseptic technique). Additionally later infections are caused by
colonization along the skin tract or contaminate hubs or fluids.
Routine replacement exposes the patient to more insertion
procedures and therefore more initial infections (Rickard et al.,
2012).
CDC will allow PIVC to remain in place longer than 72-96 hours if
sites for IV access are limited and the patient is known to have
poor venous access. (CDC, 2011)
Recommended Nursing Intervention
clinically indicated catheter change.
What We Already Know:
• Many factors have been known to influence
phlebitis
• Different guidelines give different intervals of
time between replacing PIVCs electively
What the New Evidence Shows:
• Routinely changing PIVCs does not reduce risk
of complications
• Leaving PIVC in until clinically indicated to
change it does not increase risk of
complications
Recommended Further Research
• We need more clinical trials to investigate different types of
patients under different circumstances related to clinically
indicated catheter change.
• Tests need to be performed studying different intervals for
replacement of PIVCs.
• More studies with larger sample sizes will raise reliability.
• Studies testing the experiences and discomforts of patients
related to PIVCs and clinically indicated replacement
• More studies outlining the cost effectiveness of the clinically
indicated replacement need to be conducted.
Discussion
• Routine replacement of PIVCs does not reduce the rate of
complications compared to those in PIVCs changed when
clinically indicated (Tuffaha et al., 2014)
• Replacing catheters only when clinically indicated saves in
healthcare costs to patients and healthcare providers
• Clinically indicated catheter replacement is safe and does not
result in higher rates of complications
• It is estimated that a change to clinically indicated replacement
“would prevent up to 6 million unnecessary intravenous
catheter insertions, and would save about 2 million hours of
staff time, and up to US $60 million health costs each year”
(Rickard et al., 2012).
References
Gonzalez Lopez, J. L., Arribi Vilela, A., Fernandez del Palacio, E.,
Olivares Corral, J., Benedicto Marti, C., & Herrera Portal, P.
(2014). Indwell times, complications and costs of open vs closed
safety peripheral intravenous catheters: a randomized study. J
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replacement of peripheral intravenous catheter to prevent
thrombophlebitis: a systematic review. J Adv Nurs, 55(6), 715-
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O'Grady, N. P., Alexander, M., A., B. L., Dellinger, E. P., Garland, J.,
Heard, S. O., . . . (HICPAC), H. I. C. P. A. C. (2011). Guidelines for
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Rickard, C. M., Webster, J., Wallis, M., Marsh, N., McGrail, M. R.,
French, V., . . . Whitby, M. (2012). Routine versus clinically
indicated replacement of peripheral intravenous catheters: a
randomised control equivalence trial The Lancet, 380(9847),
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Tuffaha, H. W., Rickard, C. M., Webster, J., Marsh, N., Gordon, L.,
Wallis, M., & Scuffham, P. A. (2014). Cost-effectiveness analysis
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