Routine replacement of peripheral IV catheters

[Wishart, Michael]

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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[Claire Boardman]

Thankyou Michael,
I too share your concerns and note that these trials did occur with dedicated IV teams in place. If more hospitals had these types of services that are training and assessing HCWs then yes it would seem viable however, in Australia for the most part we have no such dedicated teams. Where an extended deadline for replacement is instigated we are possibly more at risk of having catheters insitu that really should have been removed much earlier but because the time line has been extended the belief may be that it is OK to leave them there up to the 96 hours. It has taken a long time to educate HCWs about the necessity of replacing lines at 72 hours, an extension of this would be problematic.
As most of the State surveillance centres are not undertaking RCA of LC-BSIs (although this may be done at a local level) we may never know how many are attributed to poor line care/ number of days insitu.
Regards,
Claire

District Infection Prevention & Control Consultant
Torres Strait and NPA Infection Control & Hospital Epidemiology Unit
Office location: Thursday island Hospital

>>> “Wishart, Michael” 16/07/2010 8:28 am >>>
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

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

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[Craig Boutlis]

Hi Michael,

I read the review and there’s no way in a million years that I’d be looking to change our current hospitals’ policy (which is to resite peripheral cannulae after 72 hours and those inserted in ambulances as soon as practicable).

We started reviewing all our Staph aureus bacteremias in detail on 1 Jan 09. In 2009 we had 11 SABs from a P-IVC in one of our 9 hospitals (1050 beds), all of which were in for > 72 hours except one ambulance case at 40 hrs. We made some changes and this year we’ve had 1 to date (a day sixer over Xmas / New Year on 3 Jan 10).

We make an exception for pediatrics and our outpatient antibiotic service: they go longer than 72 hrs but haven’t had a SAB in living memory. If that changes, we’ll look at < 72 hrs there too.

Craig

————-
Craig Boutlis, Director
Infection Management and Control Service (IMACS)
Level 1, Lawson Hse, Wollongong Hospital
LMB 8808, SouthCoast MC, NSW 2521

—–Original Message—–

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

Ramsay Health Care is an environmentally responsible corporation, please consider the environment before printing this email.

This e-mail message and any accompanying files may contain information that is confidential and subject to privilege. If you are not the intended recipient, and have received the e-mail in error, you are notified that any use, dissemination, distribution, forwarding, printing or copying of the message and any attached files is strictly prohibited. If you have received this e-mail message in error please immediately advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of the individual sender, except where the sender specifically states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.

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[Glenys.Harrington@HEALTH.VIC.GOV.AU Subject: Re: Routine replacement of peripheral IV catheters In-Reply-To:]

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

From:
“Wishart, Michael”
To:
AICALIST@AICALIST.ORG.AU
Date:
16/07/2010 08:28 AM
Subject:
Routine replacement of peripheral IV catheters
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

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

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not represent the opinion of AICA.

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[Beckingham, Wendy]

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

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.

Archive of all messages are available at http://aicalist.org.au/archives
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_________
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this communication is free of virus or that it has not been intercepted
or interfered with. If you have received this email in error or have any
other concerns regarding its transmission, please notify
Postmaster@dhs.vic.gov.au
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