Review: routine changes of IV administration sets (not containing lipids or blood products) at intervals ⩽96 hours do not affect infusate or catheter related bloodstream infection
Q What is the optimal interval for routine replacement of IV administration sets when infusate or parenteral nutrition solutions are administered by central or peripheral venous catheters?
Cochrane Central Register of Controlled Trials, Medline, CINAHL, and EMBASE/Excerpta Medica (all up to February 2004); reference lists; and researchers.
Study selection and assessment:
randomised or quasi-randomised controlled trials that assessed the effects of different frequencies of replacing IV administration sets among inpatients of any age receiving parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) by central or peripheral catheter. 13 studies (n = 4783) met the selection criteria. Methodological quality of individual studies was assessed based on allocation concealment and loss to follow up.
infusate colonisation, infusate related bloodstream infection (BSI), catheter colonisation, catheter related BSI, all cause BSI, and mortality.
Meta-analysis was done using a fixed effects model. Rates of infusate colonisation did not differ when the interval between set changes was increased overall (5 trials, n = 1374), from 24 to 48 hours (3 trials, n = 773), 48 to 72 hours (1 trial, n = 173), or 72 to 96 hours (1 trial, n = 428). Similarly, rates of catheter colonisation did not differ when the interval between set changes was increased overall (6 trials, n = 1448), from 24 to 48 hours (1 trial, n = 182), 48 to 72 hours (2 trials, n = 198), or 72 to 96 hours (3 trials, n = 1068). Rates of infusate related BSI, catheter related BSI, and all cause BSI did not differ for any interval between set changes (table). Set changes at intervals ⩾48 hours resulted in higher mortality rates than set changes at 24 hour intervals (table).
Changing IV administration sets that do not contain lipids, blood, or blood products at intervals ⩽96 hours does not affect infusate related or catheter related bloodstream infection.
- Simon Stewart, RN, PhD
Nosocomial BSIs are one of the single largest contributors to iatrogenic complications arising from hospital treatment. For example, up to 1 in 20 intensive care unit (ICU) admissions in Canada are complicated by BSIs.1 Such events are not confined to ICUs. Any routine procedure that provides direct pathogen access to the blood stream is potentially fatal.
Gillies et al did a systematic review of the effects of routine changes of IV administration sets (not containing lipids or blood products) on the risk of infusate or catheter related BSI. They concluded that more frequent routine changes to IV administrations sets had no incremental benefit for avoiding BSIs. At face value, these data suggest that from a combined cost effectiveness and patient safety perspective, there are advantages to adjusting standard clinical practice to delay routine changes of IV sets to closer to 72 hours, regardless of peripheral or central access.
However, a major caveat should be considered. Although the major end point was BSIs and there were no detectable differences in BSI related deaths, there was a significantly higher fatal event rate among neonates who had IV sets changed after 24 hours.
In this context, we need to make some sense of the findings of this review. Firstly, these data highlight the dangers of combining results from heterogeneous patient cohorts and clinical settings. On one hand, less frequent IV set changes appear to have some clinical and cost benefits in limiting BSI. On the other hand, they appear to be associated with increased mortality in neonates. Until these results are fully explained (eg, do new “closed” systems or frequency of IV line access affect outcomes, and should we better stratify meta-analyses according to clinical context?), we should continue to employ high standards of infection control (including monitoring infection rates and mortality), monitor the age of all IV sets, and strongly consider changing them within 48 hours.
For correspondence: Dr D Gillies, Sydney West Area Health Service, Parramatta BC, New South Wales, Australia. Donna_
Source of funding: not stated.