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The article
Rickard et al. (2012) asked whether peripheral intravenous catheters need to be replaced every 3 days, as many policies required, or only when there is a clinical reason, such as phlebitis, infiltration or the end of therapy. Routine replacement means more needlesticks for patients and more work for nurses, but its benefit was not well established.
Research question and design
The study was a multicenter, randomized, non-blinded equivalence trial at three hospitals in Queensland, Australia. An equivalence design fits the question: the researchers weren't trying to show that one policy was better, but that clinically indicated replacement was no worse and no better than routine replacement within a set margin. They set that margin at 3% for phlebitis before the study began.
Sample and methods
Adults expected to need an IV catheter for more than 4 days were randomly assigned by computer, with allocation concealed until assignment, to clinically indicated replacement or routine replacement every third day. All 3,283 patients (5,907 catheters) were analyzed by intention to treat. The primary outcome was phlebitis during catheterization or within 48 hours after removal. Secondary outcomes included bloodstream and local infections, infusion failure, catheter numbers and costs.
Findings
Phlebitis occurred in 7% of patients in each group (114 of 1,593 vs. 114 of 1,690). The absolute risk difference was 0.41% (95% CI −1.33% to 2.15%), inside the 3% margin, so the policies were equivalent. Catheters in the clinically indicated group stayed in longer (a mean of 99 vs. 70 hours for those still in place on day 3), and no serious adverse events were linked to either policy.
Strengths
- Large sample, randomization by computer and concealed allocation, which reduce selection bias (Polit & Beck, 2021).
- A prespecified equivalence margin and intention-to-treat analysis, so patients stayed in the group they were assigned to.
- A clinically meaningful primary outcome that nurses assess every day.
- Three hospitals rather than one, which helps generalizability.
Limitations
- Patients, staff and research nurses couldn't be blinded. Because phlebitis is assessed partly by judgment, knowing the group could influence how it was recorded.
- All three hospitals were in one Australian state, so practices such as catheter type and dressing may differ elsewhere.
- Bloodstream infections were too rare to compare with confidence.
Applying the findings
The evidence supports replacing peripheral IV catheters when clinically indicated, combined with close monitoring of the site every shift and prompt removal of catheters that are no longer needed. For a unit, that means changing the policy, teaching a standard site assessment and documenting the reason for every removal.
References
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Rickard, C. M., Webster, J., Wallis, M. C., Marsh, N., McGrail, M. R., French, V., Foster, L., Gallagher, P., Gowardman, J. R., Zhang, L., McClymont, A., & Whitby, M. (2012). Routine versus clinically indicated replacement of peripheral intravenous catheters: A randomised controlled equivalence trial. The Lancet, 380(9847), 1066–1074. https://doi.org/10.1016/S0140-6736(12)61082-4
