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      Comparison of clinically indicated replacement and routine replacement of peripheral intravenous catheters: A systematic review and meta-analysis of randomized controlled trials

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          Abstract

          Background

          It is unknown whether clinically indicated replacement of peripheral intravenous catheters (PIVCs) increases the risks of PIVC-associated complications and infections compared to routine replacement of PIVCs.

          Methods

          We searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) that compare the safety outcomes of routine replacement and clinically indicated replacement of PIVCs were included for meta-analysis. The primary outcome was the incidence of phlebitis, and secondary outcomes included the risks of occlusion, local infection, infiltration, catheter-related bloodstream infection (CRBSI), and accidental removal of the PIVC.

          Results

          A total of 9 RCTs involving 10 973 patients were included in this meta-analysis, of whom 5,546 and 5,527 were assigned to the study group (clinically indicated replacement of PIVCs) and control group (routine replacement of PIVCs every 72–96 h), respectively. The incidence of phlebitis in the study group was significantly higher than that in the control group [risk ratio (RR), 1.20; 95% confidence interval (CI), 1.01–1.44, P = 0.04, I 2 = 49%]. In addition, the study group was associated with a higher risk of occlusion (RR, 1.45; 95% CI, 1.08–1.95, P = 0.01, I 2 = 82%) and infiltration (fluid leaks) (RR, 1.27; 95% CI, 1.06–1.53, P = 0.01, I 2 = 72%) than the control group. However, no significant differences were observed in the risks of local infection (RR, 1.75; 95% CI, 0.38–8.16, P = 0.48, I 2 = 0%) and CRBSI (RR, 0.61; 95% CI, 0.08–4.68, P = 0.64, I 2 = 0%) between the study and control groups.

          Conclusion

          The clinically indicated replacement of PIVCs may increase the risks of PIVC-associated phlebitis, infiltration, and occlusion compared to the routine replacement of PIVCs, but did not increase the risk of PIVC-associated infections. Based on these findings, routine replacement of PIVCs every 72–96 h maybe a preferred option than clinically indicated replacement of PIVCs.

          Systematic review registration

          [ www.crd.york.ac.uk/prospero/], identifier [CRD42022302021].

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          Most cited references23

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2014)
          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement

            Matthew J T Page, Joanne E McKenzie, Patrick Bossuyt … (2021)
            To describe the processes used to update the PRISMA 2009 statement for reporting systematic reviews, present results of a survey conducted to inform the update, summarize decisions made at the PRISMA update meeting, and describe and justify changes made to the guideline.
            Article 0 comments Cited 515 times – based on 0 reviews     Review now
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              Guidelines for the prevention of intravascular catheter-related infections.

              Naomi P O'Grady, Mary C. Alexander, Lillian Burns … (2011)
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Med (Lausanne)
                Journal ID (iso-abbrev): Front Med (Lausanne)
                Journal ID (publisher-id): Front. Med.
                Title: Frontiers in Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-858X
                Publication date (Electronic): 12 August 2022
                Publication date Collection: 2022
                Volume: 9
                Electronic Location Identifier: 964096
                Affiliations
                [1] 1Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University , Kaohsiung, Taiwan
                [2] 2Department of Pharmacy, E-Da Hospital, I-Shou University , Kaohsiung, Taiwan
                [3] 3Institute of Biotechnology and Chemical Engineering, I-Shou University , Kaohsiung, Taiwan
                [4] 4School of Medicine, College of Medicine, I-Shou University , Kaohsiung, Taiwan
                [5] 5Department of Internal Medicine, E-Da Hospital , Kaohsiung, Taiwan
                [6] 6Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center , Tainan, Taiwan
                [7] 7Department of Internal Medicine, E-Da Cancer Hospital , Kaohsiung, Taiwan
                [8] 8School of Medicine for International Students, College of Medicine, I-Shou University , Kaohsiung, Taiwan
                Author notes

                Edited by: Yizhong Wang, Shanghai Children’s Hospital, China

                Reviewed by: Mohamed Yassin, University of Pittsburgh, United States; Jacek Smereka, Wroclaw Medical University, Poland

                *Correspondence: Chih-Cheng Lai, dtmed141@ 123456gmail.com

                This article was submitted to Family Medicine and Primary Care, a section of the journal Frontiers in Medicine

                Article
                DOI: 10.3389/fmed.2022.964096
                PMC ID: 9411788
                PubMed ID: 36035414
                SO-VID: e54a69b5-909a-4826-84ba-924f4a7b43b3
                Copyright © Copyright © 2022 Chen, Chen, Chen, Lai and Wei.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 08 June 2022
                Date accepted : 28 July 2022
                Page count
                Figures: 8, Tables: 2, Equations: 0, References: 23, Pages: 10, Words: 4453
                Categories
                Subject: Medicine
                Subject: Systematic Review

                Keywords: catheter-related infection,peripheral intravenous catheter,pivc,phlebitis,routine replacement,clinically indicated replacement
                Data availability:
                Keywords: catheter-related infection, peripheral intravenous catheter, pivc, phlebitis, routine replacement, clinically indicated replacement

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