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E
ach year, nearly 200 million periph- ized patients to routine or clinically indicated
eral IV catheters are placed in patients replacement of peripheral IV lines, with me-
in hospitals throughout the United dian dwell times of 71 and 85 hours, respec-
States.2 Many of the catheters need to be re- tively. There was no significant difference in
placed due to phlebitis, infiltration, pain, or rates of phlebitis between the routine replace-
swelling at the IV site, but the rate of blood- ment (7%) and clinically indicated (10%)
stream infections associated with peripheral groups (RR=1.44; 95% CI, 0.71-2.89; P=.34).
IVs is just 0.5 per 1000 catheter days.2 No local infections or IV-related bloodstream
infections occurred in either group.5
Timing of replacement zA 2010 Cochrane review included
is unresolved 5 randomized controlled trials (with a total
The Centers for Disease Control and Pre- of 3408 patients) that compared rates of sus-
vention (CDC)s 2011 guidelines state that pected catheter-related phlebitis in patients
jfponline.com Vol 62, No 4 | April 2013 | The Journal of Family Practice 201
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be necessary to ensure that all clinicians
who place peripheral IV catheters are
jfponline.com
taught the clinical signs of phlebitis and
are using a standardized protocol. That
said, we think that this is a worthwhile
change to achieve the long-term ben-
efits of fewer unnecessary IV catheter N
ew concussion
replacements. JFP
guideline dispenses
Acknowledgement with grading system
The PURLs Surveillance System was supported in part
by Grant Number UL1RR024999 from the National
Christopher C. Giza, MD, UCLA
Center for Research Resources, a Clinical Translational Brain Injury Research Center
Science Award to the University of Chicago. The con-
tent is solely the responsibility of the authors and
does not necessarily represent the official views of Asthma still
the National Center for Research Resources or the Na-
tional Institutes of Health. uncontrolled? Try
Copyright 2013. Family Physicians Inquiries
these troubleshooting
Network. tips
Jennie Broders, PharmD, BCPS
References UPMC St. Margaret, Pittsburgh
1. Rickard CM, Webster J, Wallis MC, et al. Routine versus .
clinically indicated replacement of peripheral intrave-
nous catheters: a randomised controlled equivalence
2 ways to listen to these audiocasts:
trial. Lancet. 2012;380:1066-1074. 1. Go to jfponline.com
2. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream
infection in adults with different intravascular devices: a 2. Scan the QR codes
systematic review of 200 published prospective studies.
Mayo Clin Proc. 2006;81:1159-1171.
3. Centers for Disease Control and Prevention. 2011 guide-
lines for the prevention of intravascular catheter-related
See how the Neers and
infections. Available at: http://www.cdc.gov/hicpac/
BSI/references-BSI-guidelines-2011.html. Accessed
Hawkins tests are done
March 13, 2013. Courtesy of: Christopher Faubel,
4. Webster J, Clarke S, Paterson D, et al. Routine care of MD, ThePainSource.com
peripheral intravenous catheters versus clinically indi-
cated replacement: randomised controlled trial. BMJ.
2008;337:a339.
5. Rickard CM, McCann D, Munnings J, et al. Routine resite
of peripheral intravenous devices every 3 days did not
INSTANT poll
reduce complications compared with clinically indi-
cated resite: a randomised controlled trial. BMC Med.
With what frequency do you encounter
2010;8:53. adverse effects when prescribing
6. Webster J, Osborne S, Rickard C, et al. Clinically-indi-
cated replacement versus routine replacement of pe-
fluoroquinolones?
ripheral venous catheters. Cochrane Database Syst Rev.
2010;(3):CD007798.
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