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Re: Routine replacement of peripheral IV catheters

Home Forums Infexion Connexion Routine replacement of peripheral IV catheters Re: Routine replacement of peripheral IV catheters

#68371
Craig Boutlis
Participant

Author:
Craig Boutlis

Email:
Craig.Boutlis@SESIAHS.HEALTH.NSW.GOV.AU

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State:

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

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