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dc.contributor.authorRickard, Claireen_US
dc.contributor.authorWebster, Joanen_US
dc.contributor.authorWallis, Marianneen_US
dc.contributor.authorMarsh, Nicoleen_US
dc.contributor.authorMcGrail, Matthewen_US
dc.contributor.authorFrench, Vanessaen_US
dc.contributor.authorFoster, Lynelleen_US
dc.contributor.authorGallagher, Peteren_US
dc.contributor.authorGowardman, Johnen_US
dc.contributor.authorZhang, Lien_US
dc.contributor.authorMcClymont, Aliceen_US
dc.contributor.authorWhitby, Michaelen_US
dc.date.accessioned2017-05-03T15:25:09Z
dc.date.available2017-05-03T15:25:09Z
dc.date.issued2012en_US
dc.date.modified2013-06-17T01:15:51Z
dc.identifier.issn01406736en_US
dc.identifier.doi10.1016/S0140-6736(12)61082-4en_US
dc.identifier.urihttp://hdl.handle.net/10072/47775
dc.description.abstractBackground The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement. Methods This multicentre, randomised, non-blinded equivalence trial recruited adults (=18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370. Findings All 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0紱% (95% CI -1糳 to 2籵%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred. Interpretation Peripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications.en_US
dc.description.peerreviewedYesen_US
dc.description.publicationstatusYesen_US
dc.format.extent413661 bytes
dc.format.mimetypeapplication/pdf
dc.languageEnglishen_US
dc.language.isoen_US
dc.publisherElsevieren_US
dc.publisher.placeUnited Kingdomen_US
dc.relation.ispartofstudentpublicationNen_US
dc.relation.ispartofpagefrom1066en_US
dc.relation.ispartofpageto1074en_US
dc.relation.ispartofissue9847en_US
dc.relation.ispartofjournalThe Lanceten_US
dc.relation.ispartofvolume380en_US
dc.rights.retentionYen_US
dc.subject.fieldofresearchClinical Nursing: Secondary (Acute Care)en_US
dc.subject.fieldofresearchcode111003en_US
dc.titleRoutine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trialen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Peer Reviewed (HERDC)en_US
dc.type.codeC - Journal Articlesen_US
gro.facultyGriffith Health, School of Nursing and Midwiferyen_US
gro.rights.copyrightCopyright 2012 Elsevier. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version.en_US
gro.date.issued2012
gro.hasfulltextFull Text


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