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Drip replacement ‘unnecessary’

The routine replacement of IV drips every three days in hospital wards is costly and clinically unnecessary, new data has found.

Research published in The Lancet last month has the potential to save the Australian economy millions of dollars each year and to overturn 40 years of accepted practice.

Co-investigator, Professor Joan Webster from the Griffith Health Institute, said many intravenous catheters used each year could be safely changed only when clinically necessary.
Introducing this policy in hospitals would not only prevent unnecessary painful procedures in one fifth of patients but also dramatically reduce equipment and staff costs.

In the study, 3000 adult patients expected to require a catheter for longer than three days were enrolled from three hospitals in Queensland. Patients were randomly assigned to either clinically indicated or routine removal every third day to compare the effectiveness of each practice at reducing infection and phlebitis (inflammation of the vein).

The average catheter dwell time was 99 hours in the clinically indicated group and 70 hours in the routine replacement group. Phlebitis occurred in 7 per cent of patients in both groups.

Bloodstream infections were rare and did not differ between groups, and no local infections were reported in either group.

Webster, who is based at Royal Brisbane and Women’s Hospital, said that up to 70 per cent of hospitalised adult patients need a peripheral intravenous catheter.

“Catheter replacement is costly, time-consuming and causes distress to patients. Our data strongly suggests that routine replacement does not reduce complications, but rather causes many unnecessary invasive procedures,” she said. “Updated intravenous catheter policies should advocate clinically indicated removal.”

It is estimated up to 6 million unnecessary intravenous catheter insertions in the US could be prevented if a change in practice was adopted, said Webster. In addition, nurses felt it freed up a lot of their time to spend on other patient care.

The study, which also included researchers from Western Sydney Local Health District and The Children’s Hospital at Westmead also found nearly 30 per cent of catheters failed.

The failure of catheters due to infiltration, occlusion, or accidental removal was far more frequent than phlebitis or infection.

The trial was the largest ever NHMRC-funded nursing project.

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