Influence of Different Climates on the Replacement Time of Peripheral Intravenous Catheters: A Meta-Analysis

Background: The newly conducted meta-analysis of the Cochrane database of systematic reviews has indicated that, compared to routine three-day replacement, clinically indicated replacement of peripheral intravenous catheters does not significantly increase the incidence of phlebitis. However, the literature included in that analysis did not compare subgroups of different climates. This induces the barriers of translating the evidence-based knowledge of clinically indicated peripheral intravenous catheter replacement as standard care in areas with warm and humid tropical/subtropical island climate like Taiwan.

Purpose: To explore the influence of different climates on the replacement time of peripheral intravenous catheters, through a systematic review and meta-analysis.

Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodology followed the Cochrane handbook. Six English and Chinese databases: Airiti Library, CINAHL, Cochrane Library, ProQuest, PubMed/MEDLINE, and the Index of the Taiwan Periodical Literature System were searched. For the search of the literature published prior to October 2017, Medical Subject Headings (MeSH) and synonymous keywords including "peripheral intravenous catheter*, peripheral IV catheter*, peripheral intravenous cannulation*, or peripheral intravenous device*" and " replacement, re-site*, or indwell*" were used. Adults and randomized controlled trials or controlled clinical trials were included. A total of nine articles met the criteria. The literature quality was assessed according to the Cochrane risk of bias 2.0 tool by independently two reviewers. The RevMan 5.3.5 software was used for the analysis of the different climate subgroups. The terrain and Köppen–Geiger climate classification was used to define the climate subgroups of tropical/subtropical island climate, temperate island climate, and temperate continental climate.

Results: The research quality of the nine included RCTs ranged from 4–5 points, according to the Cochrane RoB 2.0 tool. The Kappa value for consistency between the two reviewers was 0.965 (p< .0001), indicating that the rating consistency of the reviewers was extremely high and that there was significant correlation. The results showed that the average indwelling time of catheters in the clinically indicated replacement group ranged from 84.53 hours to 109.4 hours, which indicated that, even for the clinically indicated replacement group, the average indwelling time was 96 ± 12 hours.

The meta-analysis of the climate subgroups indicated that there was no significant difference in the incidences of phlebitis (risk ratio= 0.37, 1.44, 1.13; p= .21, .31, .15, respectively), local infection (risk ratio= 0, 0, 4.96; p= 1.00, 1.00, .30, respectively), bloodstream infection (risk ratio= 1.27, 0.00, 0.64; p= .71, 1.00, .63, respectively), and catheter occlusion (risk ratio= 0, 0.77, 1.19; p = 1.00, .69, .12, respectively) in the three climatic subgroups, between the clinically indicated replacement group and the routine three-day replacement group. Clinically indicated replacement can significantly reduce the medical material costs (five RCTs, 4747 participants, MD= −6.26 AUD ≒151.43 new Taiwan dollars, 95% CI= [−7.06, −5.47], p< .00001) and nursing time (two RCTs, 3424 participants, MD= -2.97mins, 95% CI= [-3.65, -2.29], p< .00001) of peripheral intravenous catheter insertion.

Conclusions/Implications for Practice: Based on this systematic review and meta-analysis, clinically indicated replacement is the best, in terms of peripheral intravenous catheters. In areas with a warm, humid tropical/subtropical island climate, such as Taiwan, clinically indicated intravenous catheter replacement can be considered if each shift change and random assessment shows no symptoms of infection in the insertion sites.