Evidence for routine replacement of peripheral intravenous cannulae in adults : a systematic review

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Evidence for routine replacement of peripheral intravenous cannulae in adults : a systematic review

 

Author: Wong, Kwan-wai
Title: Evidence for routine replacement of peripheral intravenous cannulae in adults : a systematic review
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Intravenous catheterization.
Phlebitis.
Nursing.
Department: School of Nursing
Pages: xii, 63 leaves : col. ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2301023
URI: http://theses.lib.polyu.edu.hk/handle/200/5208
Abstract: Aim: This systematic review, was to review the scientific evidence for the practice of routine peripheral intravenous cannulae replacement. Objectives: The objectives were to determine the optimal time interval for the routine replacement of peripheral intravenous cannulae used in a clinical setting and to evaluate the need for routine peripheral intravenous cannulae replacement. Method: We searched the Cochrane Library, MEDLINE, EMBASE, CINAHL, CAJ Full-text Database 中國期刊全文數據庫: all from inception to September 2008; reference lists of identified trials, bibliographies of published reviews, relevant conference proceedings and any product information. We included all randomized controlled trials addressing the frequency of the replacement of peripheral intravenous cannulae. Two observers independently assessed trial quality and extracted data. We collected data for the outcomes: phlebitis, catheter-related bloodstream (CRBS) infection, infiltration, unplanned cannula removal, occlusion or blockage, local infection at the site of the cannula, number of cannulae replaced, duration of cannulation and cost. Results: The title and abstract of 2,379 citations were eligible for screening. We identified one hundred and two references for review. We excluded eighty eight of these studies: forty-two because they were not randomized controlled trials, thirty-two because of irrelevant interventions and fourteen because of used mixed patient group. We further screened from the remaining fourteen references (nine studies). We excluded three studies after quality assessment and excluded one because of a difference in the type of dichotomous data reported, which could not be converted. We extracted data from the remaining five studies in relation to 1,085 participants. The study showed no significant difference in the risk of all studies outcome measures when the interval between cannulae replacement was every 72 hrs with non-routine replacement; the risk of phlebitis, (risk ratio 0.83; 95% confidence interval 0.41 -1.66); risk of CRBS infection (risk ratio 1.01; 95% confidence interval 0.06 - 16.06); risk of infiltration (risk ratio 0.90; 95% confidence interval 0.73 -1.09); incidence of unplanned cannula removal (risk ratio 0.89; 95% confidence interval 0.65-1.23); incidence of occlusion or blockage (risk ratio 0.67; 95% confidence interval 0.39-1.16); risk of local infection (risk ratio 0.20; 95% confidence interval 0.01-4.19). Discussion: We identified that there was no evidence to suggest that peripheral intravenous cannulae should be routinely rotated at 96-hour intervals to reduce the incidence of phlebitis. There was weak evidence to suggest that the differences between participants who did and did not receive peripheral parenteral nutrition (PPN) have some influence on the different outcomes. Conclusion: When comparing the routine replacement of peripheral intravenous cannulae at 72-hour intervals with non-routine replacement, the prevalence of phlebitis, CRBS infection, infiltration, unplanned cannula removal, occlusion or blockage, local infection at the site of the cannula were not affected. The evidence from this systematic review suggests that it is not necessary to have routine peripheral intravenous cannulae replacement at or less than 72-hour intervals.

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