Optimal timing for intravenous administration set replacement

  • Review
  • Intervention

Authors


Abstract

Background

Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination. If decreasing the frequency of changing intravenous administration sets does not increase infection rates, a change in practice could result in considerable cost savings.

Objectives

The objective of this review was to identify the optimal interval for the routine replacement of intravenous administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered to people in hospital via central or peripheral venous catheters.

Search methods

We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE: all from inception to February 2004; reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. We did not have a language restriction.

Selection criteria

We included all randomized or quasi-randomized controlled trials addressing the frequency of replacing intravenous administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered to people in hospital via a central or peripheral catheter.

Data collection and analysis

Two authors assessed all potentially relevant studies. We resolved disagreements between the two authors by discussion with a third author. We collected data for the outcomes; infusate contamination; infusate-related bloodstream infection; catheter contamination; catheter-related bloodstream infection; all-cause bloodstream infection and all-cause mortality.

Main results

We identified 23 references for review. We excluded eight of these studies; five because they did not fit the inclusion criteria and three because of inadequate data. We extracted data from the remaining 15 references (13 studies) with 4783 participants. We conclude that there is no evidence that changing intravenous administration sets more often than every 96 hours reduces the incidence of bloodstream infection. We do not know whether changing administration sets less often than
every 96 hours affects the incidence of infection. In addition, we found that there were no differences between participants with central versus peripheral catheters; nor between participants who did and did not receive parenteral nutrition, or between children and adults.

Authors' conclusions

It appears that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the incidence of infection. There was no evidence to suggest that administration sets which contain lipids should not be changed every 24 hours as currently recommended.

摘要

背景

靜脈注射裝置更換的最佳時機

靜脈注射療法是一種住院常見的設置。例行更換靜脈注射裝置已被建議,以減少靜脈輸液污染。如果降低更換靜脈給藥裝置的頻率能不增加感染率,那實務上的改變將可獲得相當大的成本節約。

目標

此篇回顧文章的目的是找出例行更換靜脈裝置的最佳時間間隔。而在醫院中這靜脈注射治療,常用於經中央或周邊靜脈導管輸液或腸外營養(脂質和非脂質)。

搜尋策略

我們查詢登記在Cochrane的對照試驗(中央)、medline、cinahl、embase:時間自各資料庫成立起至2004年2月;各確認試驗的參考資料,以及回顧文章的評語。我們還接觸了在該領域的研究者。在搜尋上我們沒有語言的限制。

選擇標準

我們包括所有隨機或半隨機的靜脈注射裝置更換頻率對照試驗,而這些靜脈注射裝置無論是中央或周邊導管,皆用於住院病人的腸外營養(含脂質和非含脂的溶液)或輸液(不包括血液)的給予。

資料收集與分析

兩位作者評估了所有可能相關的研究。我們經由與第三作者討論,來解決兩位作者的分歧意見。我們收集預後的數據,包括:infusate污染; infusate相關的血流感染;導管污染;導管相關性血液感染;各種原因造成的血液感染和死亡率。

主要結論

我們找出23個研究資料來回顧。這其中我們排除8個研究:5個是因為他們不符合納入標準和3個是因為不適當的資料。我們提取出來的摘錄資料,是從餘下的15個資料(13組研究)而來,共包含4783個案。我們的結論是:目前並沒有證據顯示比每96小時更經常地更換靜脈注射裝置,可降低血液感染的機率。我們也不知道比96小時更久才更換靜脈注射裝置是否會影響感染率。此外,我們發現無論是中央或周邊靜脈導管、是否使用腸外營養輸液、或者兒童和成人間,在感染率有任何的差異。

作者結論

結果顯示未沾染脂肪或血液的靜脈注射裝置可以留置達96小時而不增加感染的機會。目前沒有證據支持不需要每24小時更換沾染脂質靜脈留置裝置的建議。

翻譯人

本摘要由臺灣大學附設醫院周韋翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

定期更換未沾染脂肪或血液的靜脈注射裝置並不影響感染風險。靜脈注射是住院常用的治療途徑。定期更換注射裝置已經證實可以減低注射時染污與血液感染。此篇回顧文章目的是確認更換管路的最佳時間間隔。結果顯示未沾染脂肪或血液的靜脈注射裝置可以留置達96小時而不增加感染的機會。目前沒有證據可以否定每24小時更換沾染脂肪靜脈留置裝置的建議。

Plain language summary

Regularly replacing intravenous administration sets, which do not contain lipids or blood, does not appear to affect the risk of infection

Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination and related bloodstream infection. The purpose of this review was to identify the optimal interval for the routine replacement of intravenous administration sets. It appears that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the incidence of infection. There is no evidence to contradict current recommendations that administration sets which contain lipids should be changed every 24 hours.

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