Safety of prolonging peripheral cannula and IV tubing use from 72 hours to 96 hours,☆☆,

Presented in part at the 4th Annual SHEA Meeting, New Orleans, Louisiana, March 20–22, 1994.
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Abstract

Objective: To compare the rates of phlebitis of peripheral intravenous lines left in place for 72 hours versus rates of those left in place 96 hours. Design: A prospective, nonrandomized study. Setting: A university teaching hospital with 375 beds. Patients: Consecutive adult patients who received peripheral intravenous lines and were admitted to the wards. Measurements: The phlebitis rates were monitored by the IV Team for 1 month according to a predetermined definition for phlebitis: palpable cord or at least two of the following: tenderness, warmth, erythema, and induration. Results: A total of 2503 peripheral lines were evaluable. The overall phlebitis rate was 6.8%. The phlebitis rates for lines left in for 72 and 96 hours were not significantly different (3.3% vs 2.6%, p = 1.000) by Fisher’s Exact Test and survival analysis. It was estimated that in 1 month approximately 300 intravenous lines potentially could be prolonged beyond 72 hours; 215 lines were changed at 72 hours despite no signs of inflammation, 61 lines were kept till 96 hours, and 19 lines were kept beyond 96 hours. Conclusions: Phlebitis rate for our peripheral intravenous catheters at 96 hours was not significantly different from that at 72 hours. If intravenous cannulas and lines were prolonged to 96 hours, a potential cost saving of $61,200 per year could be realized. (AJIC Am J Infect Control 1998;26:66-70)

Section snippets

Study population

All adult medical-surgical patients, including oncology patients, who had peripheral lines inserted during their hospitalization in December 1992 were included in the study. The peripheral lines were prospectively monitored daily by the IV Team and phlebitis rates were tracked. Peripheral lines with unknown date of insertion and lines in patients subsequently transferred to the intensive care units were excluded. A 20-gauge angiocatheter (Intima; Becton-Dickinson-Deseret, Sandy, Utah) and

RESULTS

In 1 month, 1292 inpatients received a total of 3118 peripheral lines. Most lines were started by the IV Team (Table 1), and the phlebitis rates were not significantly different from those of lines started by other health care personnel. After discarding lines with unknown dates of insertion and lines in patients subsequently transferred to the intensive care units, where peripheral lines were not monitored by the IV Team, a total of 2503 lines were evaluable.

Inflammation rates by length of

DISCUSSION

From this prospective observational study, we infer that the length of time that peripheral IV lines can be safely left at the same site could be prolonged from 72 hours to 96 hours in our institution. There was no significant difference in the phlebitis rate between the two time intervals (3.3% vs 2.6%, respectively). Use of our dedicated IV Team to monitor peripheral lines for evidence of inflammation would ensure the safety of prolongation of such lines. We further estimated that a cost

Acknowledgements

I thank Nancy Carlson and the IV Team for data collection; Sally Fontecchio, Patricia Navin, and Zita Melvin for their helpful comments; Steven Baker for his assistance in data analysis; and Suzanne Hedstrom for her role in the preparation of the manuscript.

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From the Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester.

☆☆

Reprint requests: Kwan Kew Lai, DMD, MD, Division of Infectious Disease and Immunology, University of Massachusetts Medical School, 55 Lake Ave. N., Worcester, MA 01655.

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