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LETTER TO THE EDITOR
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 37-38

How long can peripheral venous catheter remain in situ? A short literature review


1 Department of Nursing, Islamic Azad University, Sari Branch, Iran
2 Department of Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari; PhD. Student in Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Web Publication30-Jan-2014

Correspondence Address:
Amir Emami Zeydi
Department of Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, PhD. Student in Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad
Iran
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DOI: 10.4103/1658-600X.126070

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How to cite this article:
Khezri HD, Zeydi AE, Mahmoodi G. How long can peripheral venous catheter remain in situ? A short literature review. J Health Spec 2014;2:37-8

How to cite this URL:
Khezri HD, Zeydi AE, Mahmoodi G. How long can peripheral venous catheter remain in situ? A short literature review. J Health Spec [serial online] 2014 [cited 2019 Sep 15];2:37-8. Available from: http://www.thejhs.org/text.asp?2014/2/1/37/126070

Sir,

Peripheral venous catheter (PVC) insertion is the most commonly performed invasive procedure in hospitalized patients, with an estimated 150 million PVC placement each year in North America alone. [1] This procedure can result in local or systemic complications, [2] which phlebitis is the main local complication. The incidence of thrombophlebitis related to PVCs has been reported to be from 5.3 - 77.5%. [3] However, according to our knowledge, no accurate statistics on the incidence rate of thrombophlebitis related to PVCs in the Kingdom of Saudi Arabia have been reported in the literature.

One of the causes that increases the risk for thrombophlebitis is the duration of the catheter placement. The Center for Disease Control and Prevention (CDC), advised replacing catheters every 72 - 96 hours to limit the risk of infection. [3],[4] Results from other studies have shown that the risk of phlebitis rises with increasing duration of catheter placement. [5],[6] Although, others have shown that PVCs can remain in situ without any adverse effects such as phlebitis. [7],[8] A systematic review on this issue shows that elective replacement of PVCs reduces the incidence and severity of thrombophlebitis. [3] However, Rickard et al., has shown that routine replace of PVCs every 3 days did not diminish complications (involves pain, staff procedural time, equipment costs and environmental waste) compared with clinically indicated replacement. But they also emphasized that the replacement of intravenous catheters when indicated must be accompanied by close monitoring and removal of catheters should be done when complications occur. [9] Likewise, Schichor et al., showed that replacing PVCs when clinically indicated (longer than 4 days) versus routinely replacing PVCs protocol, gave no difference in risk of phlebitis. [10] The results from another systematic review stated no clinically important or statistically significant difference in catheter-related infection or phlebitis between PVCs that were routinely replaced (at 48 - 96 hours) or replaced on clinical indication. Although, there were considerably lower costs in the group which intravenous (IV) catheters replaced on clinical indication. [8]

Routine replacement of PVCs should be reassessed considering the additional cost and discomfort to the patient. However, current CDC guidelines characterize clinically indicated catheter replacement as an unresolved issue. [11] Based on the current evidence, we believe that PVCs can remain in situ for a long time on condition that the nurses observe for signs of phlebitis carefully (patient-reported pain or tenderness, erythema, swelling and purulent discharge), which can result in cost savings, convenience and decreased pain for the patient and saving the peripheral venous system particularly in diabetic patients, and very importantly, can improve evidence for clinical practice. Considering that insertion of an IV catheter is an unpleasant and painful experience for patients, [10] we recommend catheter replacement on the basis of clinical need as an alternative to routine placement. Moreover, utilization of correct insertion procedures, accurate selection of the catheterization site and use of polyurethane catheters that are associated with low levels of phlebitis is recommended. [2],[9] Nevertheless, catheter replacement trials are frequently limited by small sample size, therefore, there needs to be larger trials to evaluate these findings.

 
  References Top

1.Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, et al. Infectious Diseases Society of America, American College of Critical Care Medicine, Society for Healthcare Epidemiology of America. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249-72.  Back to cited text no. 1
    
2.Salgueiro-Oliveir A, Veiga P, Parreira P. Incidence of phlebitis in patients with peripheral intravenous catheters: The influence of some risk factors. Aust J Adv Nurs 2012;30:32-9.  Back to cited text no. 2
    
3.Idvall E, Gunningberg L. Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: A systematic review. J Adv Nurs 2006;55:715-22.  Back to cited text no. 3
    
4.O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759-69.  Back to cited text no. 4
    
5.Mestre Roca G, Berbel Bertolo C, Tortajada Lopez P, Gallemi Samaranch G, Aguilar Ramirez MC, Caylà Buqueras J, et al. Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: An observational cohort study. Med Clin (Barc) 2012;139:185-91.  Back to cited text no. 5
    
6.Powell J, Tarnow KG, Perucca R. The relationship between peripheral intravenous catheter indwell time and the incidence of phlebitis. J Infus Nurs 2008;31:39-45.  Back to cited text no. 6
    
7.Bregenzer T, Conen D, Sakmann P, Widmer AF. Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med 1998;158:151-6.  Back to cited text no. 7
    
8.Webster J, Osborne S, Rickard C, Hall J. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2010;17:CD007798.  Back to cited text no. 8
    
9.Rickard CM, McCann D, Munnings J, McGrail MR. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: A randomised controlled trial. BMC Med 2010;8:53.  Back to cited text no. 9
    
10.Gillies D, O'Riordan E. Should intravenous catheters be replaced routinely? Lancet 2012;380:1036-8.  Back to cited text no. 10
    
11.O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39 (4 suppl 1):S1-34.  Back to cited text no. 11
    



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