cdc guidelines for iv site rotation

Our results concur with several, prospective observational studies, which found no additional risk in extending intravenous device (IVD) dwell times (Abolfotouh 2014; Catney 2001; White 2001). Clinical indications include blockage, pain, redness, infiltration, swelling, leakage, and phlebitis, as well as when therapy is completed. We contacted the investigators of included trials to resolve any ambiguities. only 1 sign). Paterson D, For technical et al. There is no need to replace peripheral catheters more frequently than every 72 to 96 hours to reduce the risk for infection Haddad 2006 compared 72hour changes with 96hour changes, and Cobb 1992; Eyer 1990; Nakae 2010; and Rijnders 2004 involved central venous catheters. We use cookies to improve your experience on our site. These materials may discuss therapeutic products that have not been approved by the US Food It would be useful to see similar studies from other healthcare settings to test the robustness of results from this review. ointments; antibiotic lock prophylaxis, antimicrobial catheter flush and catheter lock prophylaxis; anticoagulants; replacement McGrail M. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial, Clinically indicated and routine replacement of peripheral IV catheters did not differ for phlebitis. The Cochrane Vascular Information Specialist (CIS) conducted systematic searches of the following databases for RCTs without language, publication year or publication status restrictions: The Information Specialist modelled search strategies for other databases on the search strategy designed for CENTRAL. 2007 Mar 8-21;16(5):281-3. doi: 10.12968/bjon.2007.16.5.22998. Mihala G, It should not be used to determine doses when converting a We considered all randomised controlled trials (RCTs) comparing routine removal of PIVC with removal only when clinically indicated. The intervention under consideration is replacing an PIVC only if there are clinical indications to do so. We planned to explore potential causes of moderate to significant heterogeneity (I2 > 30%) and use a randomeffects approach to the analyses (Deeks 2017). Before In April 2018 we searched for randomised controlled trials (RCTs) that compared changing catheters every 72 to 96 hours (routine change) with changing the catheter only if there were complications or therapy was complete. Nishanth 2009; Rickard 2010; Rickard 2012; Van Donk 2009; Vendramim 2018; Webster 2007; Webster 2008; and Xu 2017 reported power calculations but Barker 2004 did not. Anticoagulant therapy should not be used routinely to reduce the risk for catheter-related infection in general patient populations Random sequence generation (selection bias), Blinding of participants and personnel (performance bias), Blinding of outcome assessment (detection bias). If you cant locate, A nurse colleague started a new job as an infusion nurse for a physician office based practice offering infusion services (non chemo) to their patients. Torres T, Nishanth 2009 did not report any protocol violations in the trial. Chapter 10: Addressing reporting biases. Protocol first published: Issue 2, 2009 Two recently published reviews, assessing the effect of changing PIVCs only where a clinical indication exists also concurred with our results (Morrison 2015; Patel 2017). A randomized controlled trial, The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies, Improving the safety of peripheral intravenous catheters. activity online during the valid credit period that is noted on the title page. and transmitted securely. Inclusion in an NLM database does not imply endorsement of, or agreement with, Trials included in this systematic review directly addressed the review question and we were able to conduct a number of metaanalyses. There is no clear difference in the phlebitis rate between groups whether rates are reported by the incidence per participant or by 1000 device days, which is a more clinically useful measure. insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular official website and that any information you provide is encrypted Please remember that CDC guidelines are assessing only the risk of infection whereas INS is considering all complications CDC will not make any statements unless there is evidence to support it. Link to the VA/DoD For statistically significant effects, we calculated the number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH). The difference in complication rates for phlebitis and infiltration between peripheral intravenous site rotation based on clinical assessment versus length of time since insertion was evaluated. Garland J, Guidelines for the Prevention of Intravascular Catheter-Related Rickard CM, Webrecommendations as well as descriptions of mandatory safety and health standards. Gordon L, We found no clear difference in rates of catheterrelated blood stream infection, phlebitis (inflammation of the vein), blood stream infection from any cause, local infection, mortality or pain. This, Q: You will think I am a complete idiot but please explainwhen is a single use syringe considered used? Routine replacement probably reduces infiltration of fluid into surrounding tissues (747/3638; 20.5%) compared with the clinically indicated group (834/3485; 23.9%). For information on applicability Barker 2004 and Nishanth 2009 further classified phlebitis as either mild, moderate, or severe, depending on the area of erythema (Barker 2004), or on the number of symptoms (Nishanth 2009). Scheduled replacement of intravascular catheters has been proposed as a method to prevent phlebitis and catheter-related infections. That is, we calculated the 'design effect' by using the formula 1+ (M1) ICC where M is the average size of each cluster, We did identify one clusterrandomised trial, the results of which did not appear to have been adjusted (Xu 2017). Chin LY, Seven trials (7323 participants), assessed catheter-related bloodstream infection (CRBSI). INS uses a ranking system that includes all types of studies including some lower levels of studies that woul not get the attention of CDC. The fact is that there is absolutely no data on contamination of these sets during use. In: Higgins JP, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017, Available from training.cochrane.org/handbook. Macfie J. Larsen E, First-time success rate for peripheral IV placement ranges from 65 to 86 percent . sharing sensitive information, make sure youre on a federal We assessed reporting bias using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions (Sterne 2017). Runnegar N, There is no clear difference between groups (RR 0.90, 95% CI 0.76 to 1.08; clinically indicated 248/17,251; 3day change 236/15,458; moderatecertainty evidence, downgraded once for serious risk of bias). Pauls R, Five of the nine included trials were conducted in Australia; this imbalance is difficult to understand but the two additional studies, one from China (Xu 2017), and one from Brazil (Vendramim 2018), provide added diversity to the evidence and increase external validity. Nine RCTs, involving a total of 7392 participants met the inclusion criteria (Barker 2004; Nishanth 2009; Rickard 2010; Rickard 2012; Van Donk 2009; Vendramim 2018; Webster 2007; Webster 2008; Xu 2017), see Characteristics of included studies for details. Deeks JJ, Guidelines Library | Infection Control | CDC site is preferred to a jugular or a femoral site. Enter your email address to subscribe to this blog and receive notifications of new posts by email. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study. Gahlot R, Tingle A, CR: critically reviewed the protocol before final submission, selected trials for inclusion, assessed methodological quality of trials, extracted data, assisted with interpreting results and drafting of the final review. Shorten G. A dedicated intravenous cannula for postoperative use. We tested these assumptions by performing a sensitivity analysis, removing two of the nine studies. Bethe U, Ioannidis JP, When the duration of intravascular therapy is likely to be more than 6 days, a midline catheter or PICC is preferred to a Catney MR, We rated the evidence for methodological quality of most of the outcomes as moderate. Cobb DK, Cost is reduced when catheters are replaced when there was a clinical indication to do so. 2001 Aug;32(8):21-3. doi: 10.1097/00006247-200108000-00009. According to the latest Position Paper from the Infusion, some latest news and initiatives on infection prevention and safety.. Preventing Infections in Cancer Patients CDC is launching a new program called Preventing Infections in Cancer Patients, featuring tools to help both clinicians and patients prevent infections. Rickard CM, The addition of two new trials for this update found no further evidence to support changing catheters every 72 to 96 hours. *The credit that you receive is based on your user profile. All studies were at low risk of reporting bias. We conducted a careful literature search and the methods we used were transparent and reproducible. Any intravascular catheter that is no longer essential should be promptly removed. Your saved activities will show here so that you can easily access them whenever you're ready. EBP Paper 446 - INFECTION PREVENTION: IV SITE ROTATION WebGuidelines for Prevention of Intravascular Catheter-Related Infections,47 Guidelines for Environmental Infection Control in Healthcare Facilities,48 and Protect Patients Against Preventable Harm from Improper Use of Single-dose/ Single-use Vials,49 all from the Centers for Disease Control and Prevention (CDC), serve as the backbone for most infec - Higgins JP, Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. One trial (3283 participants), assessed all-cause blood stream infection (BSI). The updated recommendations replace previous guidelines published in 2002 by the CDC and were formulated by a working group The review is also important because insertion of a PIVC may be painful, especially when placed in the hand or wrist, with an average score of 4.5 on a 10point pain scale (Tan 2016), so preventing unnecessary replacements may reduce a potentially traumatic experience for patients. Wijngaerden E. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheterrelated infection: a randomized trial. Cochrane Database of Systematic Reviews 2019, Issue 1. Credit may be claimed for 1 year from the date of this issue. Altman DG. We included two new studies for this update, bringing the total to nine studies with 7412 participants. Routine replacement probably reduces infiltration of fluid into surrounding tissues compared with a clinically indicated change (RR 1.16 (95% CI 1.06 to 1.26; routine replacement 747/3638 (20.5%); clinically indicated 834/3485 (23.9%); moderate-certainty evidence, downgraded once for serious risk of bias). Compounding Sterile Preparations - ASHP One trial (3283 participants), assessed allcause blood stream infection (BSI). The uncertainty is largely due to outcomes, such as phlebitis, being assessed by people who were aware of the group allocation, which may or may not affect their decision about whether a problem is present or absent. country where the research was conducted; study design, randomisation processes, allocation concealment; intervention setting (hospital, home, residential aged care facilities); numbers of participants in each trial arm, withdrawals and dropouts; outcome measures, time(s) at which outcomes were assessed; prospective registration on a clinical trials registry. Bregenzer T, We resolved this issue by using the participant as the unit of analysis if the number of catheters and number of participants were similar (assuming one catheter per individual). WebIn adults, replace catheter and rotate site no more frequently than every 72 96 hours. of iodine, an iodophor, or 70% alcohol can be used as alternatives (Category IA). Comparison 1 Clinicallyindicated versus routine change, Outcome 7 Catheter blockage. Eight trials were conducted in acute hospitals and one in a community setting. McCann D, Foundation, Sanofi-Pasteur, Semprus, and/or Society for Healthcare Epidemiology of America. In summary, two were very small studies involving the administration of peripheral parenteral nutrition. The rate of catheterrelated bloodstream infection was similar in both groups, between 0.03% and 0.05%, and comparable to that previously reported in prospective studies (Maki 2006). Liberati A, Wallis M, NIOSH 2014 List of Antineoplastic & Other Hazardous Drugs in Healthcare Settings, Infusion Therapy Resources and References. INS no longer states a specific number of days or hours for catheter removal. on behalf of the Cochrane Applicability and Recommendations Methods Group. any therapies described in this educational activity. We changed the primary outcome to catheterrelated bloodstream infection; and added allcause bloodstream infection as a separate primary outcome. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 18 April 2018. National Library of Medicine patient population being served, the universal presence of micro-organisms in the human environment, and the limitations of This was to more closely differentiate between the two outcomes. infections (Category IB). develop. MacFie J, if the CRBSI rate is not decreasing, despite adherence to basic prevention measures (Category 1B). We did not exclude any new studies in this update. Each time a catheter is inserted, the patient's skin integrity is breached and a potential portal for pathogens is provided. Hillis S, an education activity to disclose all relevant financial relationships with any commercial interest. We combined data from the remaining seven studies, with 7323 participants (Rickard 2010; Rickard 2012; Van Donk 2009; Vendramim 2018; Webster 2007; Webster 2008; Xu 2017). Nishanth S, Six trials provided thrombophlebitis rates by number of device days (32,709 device days). These catheters are often replaced every three to four days to try to prevent irritation of the vein or infection of the blood. Evidence was generated for a policy change that will impact the quality of patient care. This website also contains material copyrighted by 3rd parties. We found no clear difference in rates of catheter-related blood stream infection, phlebitis (inflammation of the vein), blood stream infection from any cause, local infection, mortality or pain. In: Higgins JP, Green S, editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). 2011 Guidelines for the prevention of intravascular catheterrelated infections, Routine replacement of peripheral intravenous catheters. More recently, a new definition for phlebitis has been proposed, one based on a more objective assessment of the insertion site (Rickard 2012). Webster J, Jaeger H, The catheter insertion site should be evaluated daily, and peripheral venous catheters should be removed if signs of phlebitis Because outcome assessment was unblinded in all of the trials, none met our criteria for high methodological quality. For peripheral catheters and midline catheters in adults, use of an upper-extremity site for catheter insertion is preferred The other excluded study was not an RCT (Arnold 1977). Peripheral intravenous cannulation: what is considered "best practice'? Kerin MJ, The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational Knowledge of and adherence to these guidelines should be assessed periodically for all personnel Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships. University of Minnesota, Ethicon, Angiotech, Astellas, Theravance, Pfizer, Ash Access, CorMedix, Catheter Connections, Carefusion, Comparison 1 Clinicallyindicated versus routine change, Outcome 6 Infiltration. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection. To assess the effects of removing peripheral intravenous catheters when clinically indicated compared with removing and re-siting the catheter routinely. McGoldrick M, Routine replacement probably leads to a slightly lower incidence of infiltration compared to a clinically indicated change. There is some support for this approach from observational studies that have compared outcomes between catheters remaining in situ for varying periods. Catheter failure due to blockage was more frequent in the clinically indicated group. There is no clear difference in the incidence of thrombophlebitis whether catheters were changed according to clinical indication or routinely (RR 1.07, 95% CI 0.93 to 1.25; clinically indicated 317/3590; 3-day change 307/3733, moderate-certainty evidence, downgraded once for serious risk of bias). NM: NM's employer has received unrestricted grants in aid from manufacturers of peripheral intravenous catheters and products, on her behalf for academic research projects. Relationship between peripheral intravenous catheter dwell time and the development of phlebitis and infiltration. Q&A: When is a single use syringe considered used? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Six trials provided thrombophlebitis rates by number of device days (32,709 device days). The pre-planned outcomes 'number of catheter re-sites per patient', and 'satisfaction' were not reported by any studies included in this review. This result was based on three studies and results were consistent and intuitively logical (fewer catheters, less clinician time and equipment).
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