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Evaluation of clinically indicated removal versus routine replacement of peripheral vascular catheters

23 January 2020
Professional
02 January 2020
Volume 29 · Issue 2

Abstract

Latest clinical guidelines for peripheral vascular catheters (PVC) recommend that they should be removed only when clinically indicated and not routinely removed and replaced. In 2017, the authors' hospital policy was changed to align with the new recommendations and, between March and July 2019, 500 PVCs were audited at two main sites to evaluate the efficacy of the change. Of the 500 PVCs, 31% (n=155) were in situ for more than 3 days (range 4–22 days). Analysis of the combined data showed an overall prevalence of phlebitis at 8%, but variation in trends looking at each individual site (7% and 9% respectively) with a wide variation for PVCs in situ for more than 7 days. Implementing clinically indicated removal of PVCs has resulted in better patient experience with fewer PVCs for a course of treatment. Implementation has also resulted in cost savings for the Trust with a notable decrease in number of PVCs used.

Peripheral vascular catheters (PVCs) are the most commonly used vascular access devices in hospital. They are fundamental for administration of medication and fluids as part of the treatment and management of most patients, and it is estimated that around 70% of hospitalised patients require a PVC (Marsh et al, 2018); in the UK, 1 in 3 will have at least one PVC (Zhang et al, 2016). Inserting a PVC is a painful experience for the patient, and can lead to increased anxiety and stress, with the risk of associated complications such as haematoma, phlebitis, infiltration/extravasation injury and bloodstream infection. Because of the potential risks and associated complications, guidelines for prevention and management were developed in the USA (O'Grady et al, 2002) and these recommended that PVCs should be replaced every 72-96 hours and removed sooner if no longer needed. Available evidence at the time suggested that routine replacement reduced the risk of phlebitis and bloodstream infection. However, in 2002 the US Healthcare Infection Control Practices Advisory Committee/Centers for Disease Control and Prevention (CDC) tempered this with:

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Peripheral vascular catheter
Clinically indicated replacement
PVC complications
Phlebitis