Is Routine Replacement of Peripheral Intravenous Catheters Necessary?

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Abstract
ABOUT 150 MILLION intravascular devices are purchased in the United States each year for intravenous therapy for approximately 30 million patients.1 It is estimated that 850000 catheter-related infections and 25000 to 100000 catheter-related bloodstream infections occur in the United States each year.2-4 Close to 90% of these infections are observed mainly with central venous catheter use. However, in patients with peripheral intravenous catheters, 3 types of complications occur frequently: (1) phlebitis, (2) catheter-related infection, and (3) obstruction of the catheter. To minimize the complications associated with peripheral intravenous catheter use, the Centers for Disease Control and Prevention (CDC), Atlanta, Ga, recommends in its 1981 published guidelines routine replacement of peripheral intravenous catheters every 48 to 72 hours "because of a sharp increase in the rate of infection after this length of time."5 Even in the updated guidelines in 19966 the CDC recommends rotating catheter sites at 48- to 72-hour intervals. However, new punctures cause discomfort for the patient and add to the cost of intravenous therapy, as do replacement of dressing and delivery systems. Several studies demonstrate that routine changes of dressings of peripheral intravenous catheters7 and routine changes of the delivery system every 24 hours8 are not cost-effective. Tully et al9 in 1981 and Maki and Ringer10 in 1991 demonstrated that use of new materials in the manufacture of catheters substantially reduces the rate of phlebitis even if catheters are used for longer than 2 days. The rate of complications decreased when polyvinyl chloride was replaced with polyethylene and later with fluorocarbon resins (Teflon) and polyurethane.7-12 Large studies with these materials did not show a sharp increase in catheter-related complications after the second day of catheterization.7,10 The purpose of this study is to challenge the hypotheses that risk increases after 2 days of catheterization and that routine catheter replacement is necessary.