Learning Objective #1: describe two outcome measures for peripheral IV studies of routine replacement. | |||
Learning Objective #2: identify the recommended timeframe for replacing peripheral IVs. |
A national guideline recommendation was made for routine
replacement of peripheral IVs every 72-96 hours yet more recent research was
available and an updated summary of study findings was needed. Therefore, an
integrative review was conducted to provide a comprehensive presentation of the
research and make a practice recommendation for a system of acute care
hospitals. Routine replacement of peripheral IVs every 96 hours was shown to
have no more risks than IVs replaced every 72 hours. Several studies supported
this finding, although a variety of outcome measures were used. One study used
three outcome measures, including phlebitis assessment, catheter-related
infection identified through colonization, and obstruction. The remaining
studies all used observation of the IV for phlebitis although each study used a
different tool. Sample sizes ranged from 34 to 2,503 catheters. Even though
phlebitis rates ranged from a low of 2.6% to 19.7%, all authors recommended
routine replacement at least after 72 hours or longer. Based on the literature
review, a practice change was approved for 96-hour routine replacement. Before implementation, a one-day prevalence
survey of all hospitalized patients with peripheral IVs was done. IVs were assessed for phlebitis using a modification
of one published tool; all cases of suspected phlebitis were reviewed by two
observers for scoring and then reported to the patient's nurse for IV change if
needed. Phlebitis rates ranged from 0% to 2.3%. Once the practice change was
implemented, two follow-up surveys were done. Phlebitis rates ranged from 0% to
1.25%. Routine replacement every 96 hours did not increase the risk of
phlebitis. A growing body of evidence supports the routine replacement of
peripheral IVs every 96 hours without putting patient safety at risk.
Standardizing a phlebitis assessment tool would be most helpful for future
work.
See more of Using Evidence to Determine Health Strategies
See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)