Course Access
The recommendation from CDC that replacement of IV cannuales at 72-96
hours is based on studies of phlebitis however in our experience at TCH
we have found that the majority of our peripheral cannulae related BSI
occurred with dwell times of greater than 72 hours.
Therefore we have kept our policy to 48 -72 hours with good success. We
have a 24 hour rule for those inserted in an emergency or prior to
ambulance transfer. On another note we don’t routinely change children
peripheral IV unless it has ceased to work.
Wendy Beckingham
CNC Infection Control
The Canberra Hospital
pager 50390 or phone 43695
________________________________
Behalf Of Glenys.Harrington@HEALTH.VIC.GOV.AU
Michael,
The CDC Guideline for the Prevention of Intravascular Catheter-Related
Infections recommends the following:
“In adults, replace short, peripheral venous catheters at least 72–96
hours to reduce the risk for phlebitis. If sites for venous access are
limited and no evidence of phlebitis or infection is present, peripheral
venous catheters can be left in place for longer periods, although the
patient and the insertion sites should be closely monitored”
This is a Category IB recommendation – Strongly recommended for
implementation and supported by some experimental, clinical, or
epidemiologic studies, and a strong theoretical rationale.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm
However having noted the above recommendation it should be read in
context with other statements in the guideline including the following:
“Recommendations should be considered in the context of the
institution’s experience with catheter-related infections, experience
with other adverse catheter-related complications and availability of
personnel skilled in the placement of intravascular devices”.
While the reviews conclusions are of interest consideration of local
factors before a change in clinical practice (as per the CDC guideline)
would be judicious.
Glenys
Glenys Harrington, Infection Control Consultant |Communicable Disease
Prevention and Control | Public Health
Department of Health | Level 14 50 Lonsdale Street Melbourne Victoria
3000 Australia
t. 1300 651 160 (03 909 65123) | f. 03 909 69174 | e.
glenys.harrington@dhs.vic.gov.au | http://www.health.vic.gov.au/ideas
Sent by: AICA Infexion Connexion
________________________________
There has been a recent Australian published review of routine
replacement of peripheral IV catheters as recommended in the current
HIPAC guidelines. The review concludes:
The review found no conclusive evidence of benefit in changing catheters
every 72 to 96 hours. Consequently, health care organisations
may consider changing to a policy whereby catheters are changed only if
clinically indicated. This would provide significant cost savings
and would also be welcomed by patients, who would be spared the
unnecessary pain of routine re-sites in the absence of clinical
indications.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD00779
8/pdf_fs.html
[NB Here is a short link in case the longer link gets broken –
http://tinyurl.com/22m4xlf ]
Have any facilities considered this recommendation and made changes to
current routine replacement of peripheral IV catheters?
Personally, I am concerned that such a recommendation does not take into
account the variety of settings in which peripheral IV catheters are
inserted and managed. It appears possible that all of the six included
studies were in settings where additional resources were available to
manage peripheral IV’s (eg dedicated IV teams), which could in part
account for the improved outcomes of catheter management.
Whilst we should review and challenge current standards, I feel we
should be cautious in making changes which have the potential for harm
to patients. Bacteraemias associated with peripheral IV catheters are
reasonably rare events, and a rise in incidence may not be readily noted
in an individual facility.
Thanks
Michael
Michael Wishart | GPH – Infection Control Coordinator
GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au
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