Clinically indicated replacement of peripheral vascular catheters: is it safe for patients?
Replacing peripheral vascular catheters when clinically indicated rather than routinely has multiple benefits for patients and practitioners. Managing vascular catheters based on clinical indication provides early opportunities for intervention, or catheter removal or replacement. Where clinically indicated, peripheral vascular catheters can be used for a long time, and this is aided by decision-making tools such as the visual infusion phlebitis score and care bundles. Fewer cannulations result in less pain, better patient comfort and a lower risk of infection. For each cannulation avoided, about 20 minutes can be saved for other care activities. Replacing peripheral vascular catheters according to clinical indication can improve patient safety and optimise resource use.
Peripheral vascular cannulation is one of the most common invasive clinical procedures undertaken in modern healthcare. Common indications for peripheral catheters include intravascular access being required to administer medications, fluid and electrolyte therapy, as well as for aiding diagnostic procedures. The use of intravascular catheters is associated with risk of local and systemic infections. Catheter-associated bloodstream infection (BSI) is a significant risk.
Strategies to minimise the risk of catheter-associated BSI include replacing peripheral vascular cannulas (PVCs) at regular intervals; however, international guidelines vary on the frequency of replacement. The US Centers for Disease Control guidelines recommend replacing peripheral intravenous (IV) catheters no more frequently than every 72–96 hours (O'Grady et al, 2011). A Cochrane review update (Webster et al, 2015) found no evidence to support changing catheters at 72–96 hours, reaffirming the original Cochrane recommendation in 2010 (Webster et al, 2010).
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