Paper
Friday, 21 July 2006
This presentation is part of : Using Evidence to Determine Health Strategies
Routine Replacement of Peripheral Intravenous Catheters (IVs) Every 96 Hours: Evidence for Practice
Mary Hagle, PhD1, Lee Jeske, MS2, and Terri Pawlak, RN, CRRN2. (1) Center for Nursing Research, Aurora Health Care, Milwaukee, WI, USA, (2) Nursing, Aurora Health Care, Milwaukee, WI, USA
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.     

   

         

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