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Cochrane Database of Systematic Reviews

依臨床狀況更換與常規更換周邊靜脈導管之比較

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Information

DOI:
https://doi.org/10.1002/14651858.CD007798.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 14 August 2015see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Vascular Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Joan Webster

    Correspondence to: Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia

    [email protected]

    [email protected]

    NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    School of Nursing and Midwifery, University of Queensland, Brisbane, Australia

  • Sonya Osborne

    School of Nursing, Queensland University of Technology, Kelvin Grove (Brisbane), Australia

  • Claire M Rickard

    NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    Royal Brisbane and Women's Hospital, Brisbane, Australia

  • Karen New

    The University of Queensland, School of Nursing, Midwifery and Social Work, Brisbane, Australia

Contributions of authors

JW conceived the idea for the review. JW and SO wrote the protocol. CR critically reviewed the protocol before final submission.

JW selected trials for inclusion, assessed methodological quality of trials and extracted data. JW entered the data, developed the analysis plan for the update and drafted the review update.

SO arbitrated on the selection of trials, assisted with data extraction, assessed methodological quality and assisted in drafting the final review.

CR selected trials for inclusion, assessed methodological quality of trials, extracted data, assisted with interpreting results and drafting of the final review.

KN assessed methodological quality of trials, extracted data, and commented on the review update.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.

    The Cochrane Vascular editorial base is supported by the Chief Scientist Office.

Declarations of interest

JW: none known
SO: none known
CMR: CMR's employer has received unrestricted grants in aid from manufacturers of peripheral intravenous catheters and products, on her behalf for academic research projects. These sponsor had no involvement in the study design, execution, analysis or publication of these projects and they were unrelated to the topic of this review. CMR is an academic researcher and her employer has received funding on her behalf for her to provide expert advice, or educational lectures on her research at professional symposia and other events. CMR's employer has received payments on her behalf, for consultancy research projects which have been commissioned by manufacturers of vascular catheters and equipment, these were not on the topic of this review.
KN: KN, as Professional Officer of the Australian College of Neonatal Nurses, has received payment from Johnson and Johnson Consumer Companies and Johnson and Johnson Pacific to a conference to present on the experience of undertaking an educational road show and rollout of the AWHONN skin care guidelines around Australia; and to attend a baby advisory meeting.

Some of the review authors were also the investigators on several of the included trials, To eliminate any potential for a conflict of interest, assessment was allocated to a review author who was not an investigator.

Acknowledgements

We are grateful to Marlene Stewart, Cochrane Vascular Managing Editor, for her support and speedy responses, and to the editors Mr Paul Tisi and Dr Jackie Price for their useful comments.

Version history

Published

Title

Stage

Authors

Version

2019 Jan 23

Clinically‐indicated replacement versus routine replacement of peripheral venous catheters

Review

Joan Webster, Sonya Osborne, Claire M Rickard, Nicole Marsh

https://doi.org/10.1002/14651858.CD007798.pub5

2015 Aug 14

Clinically‐indicated replacement versus routine replacement of peripheral venous catheters

Review

Joan Webster, Sonya Osborne, Claire M Rickard, Karen New

https://doi.org/10.1002/14651858.CD007798.pub4

2013 Apr 30

Clinically‐indicated replacement versus routine replacement of peripheral venous catheters

Review

Joan Webster, Sonya Osborne, Claire M Rickard, Karen New

https://doi.org/10.1002/14651858.CD007798.pub3

2010 Mar 17

Clinically‐indicated replacement versus routine replacement of peripheral venous catheters

Review

Joan Webster, Sonya Osborne, Claire Rickard, Jennifer Hall

https://doi.org/10.1002/14651858.CD007798.pub2

2009 Apr 15

Clinically indicated replacement versus routine replacement of peripheral venous catheters

Protocol

Joan Webster, Sonya Osborne, Jennifer Hall, Claire Rickard

https://doi.org/10.1002/14651858.CD007798

Differences between protocol and review

The primary outcome was changed to catheter‐related bloodstream infection; all‐cause bloodstream infection was added as a separate primary outcome. This was done to more closely differentiate between the two outcomes.

The methodological quality assessment of the included studies has been updated to the Cochrane Collaboration tool for assessing risk of bias (Higgins 2011a).

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.1 Catheter‐related bloodstream infection.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.1 Catheter‐related bloodstream infection.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.2 Phlebitis.
Figures and Tables -
Figure 5

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.2 Phlebitis.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.3 Phlebitis per device days.
Figures and Tables -
Figure 6

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.3 Phlebitis per device days.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.4 All‐cause bloodstream infection.
Figures and Tables -
Figure 7

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.4 All‐cause bloodstream infection.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.5 Cost.
Figures and Tables -
Figure 8

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.5 Cost.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.6 Infiltration.
Figures and Tables -
Figure 9

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.6 Infiltration.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.7 Catheter blockage.
Figures and Tables -
Figure 10

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.7 Catheter blockage.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.8 Local infection.
Figures and Tables -
Figure 11

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.8 Local infection.

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.9 Mortality.
Figures and Tables -
Figure 12

Forest plot of comparison: 1 Clinically‐indicated versus routine change, outcome: 1.9 Mortality.

Comparison 1 Clinically‐indicated versus routine change, Outcome 1 Catheter‐related blood stream infection.
Figures and Tables -
Analysis 1.1

Comparison 1 Clinically‐indicated versus routine change, Outcome 1 Catheter‐related blood stream infection.

Comparison 1 Clinically‐indicated versus routine change, Outcome 2 Phlebitis.
Figures and Tables -
Analysis 1.2

Comparison 1 Clinically‐indicated versus routine change, Outcome 2 Phlebitis.

Comparison 1 Clinically‐indicated versus routine change, Outcome 3 Phlebitis per device days.
Figures and Tables -
Analysis 1.3

Comparison 1 Clinically‐indicated versus routine change, Outcome 3 Phlebitis per device days.

Comparison 1 Clinically‐indicated versus routine change, Outcome 4 All‐cause blood stream infection.
Figures and Tables -
Analysis 1.4

Comparison 1 Clinically‐indicated versus routine change, Outcome 4 All‐cause blood stream infection.

Comparison 1 Clinically‐indicated versus routine change, Outcome 5 Cost.
Figures and Tables -
Analysis 1.5

Comparison 1 Clinically‐indicated versus routine change, Outcome 5 Cost.

Comparison 1 Clinically‐indicated versus routine change, Outcome 6 Infiltration.
Figures and Tables -
Analysis 1.6

Comparison 1 Clinically‐indicated versus routine change, Outcome 6 Infiltration.

Comparison 1 Clinically‐indicated versus routine change, Outcome 7 Catheter blockage.
Figures and Tables -
Analysis 1.7

Comparison 1 Clinically‐indicated versus routine change, Outcome 7 Catheter blockage.

Comparison 1 Clinically‐indicated versus routine change, Outcome 8 Local infection.
Figures and Tables -
Analysis 1.8

Comparison 1 Clinically‐indicated versus routine change, Outcome 8 Local infection.

Comparison 1 Clinically‐indicated versus routine change, Outcome 9 Mortality.
Figures and Tables -
Analysis 1.9

Comparison 1 Clinically‐indicated versus routine change, Outcome 9 Mortality.

Summary of findings for the main comparison. Clinically‐indicated versus routine changes for peripheral venous catheter‐related complications

Clinically‐indicated versus routine changes for peripheral venous catheter‐related complications

Patient or population: patients with peripheral venous catheter‐related complications
Settings: Hospitals and community settings
Intervention: clinically‐indicated versus routine changes

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Clinically indicated versus routine changes

Catheter‐related bloodstream infection
Positive blood culture from a peripheral vein; clinical signs of infection; no other apparent source for the bloodstream infection except the intravenous catheter; and colonised intravenous catheter tip culture with the same organism as identified in the blood

Study population

RR 0.61
(0.08 to 4.68)

4806
(5 studies)

⊕⊕⊕⊖
moderate1,2,3,4

1 per 1000

1 per 1000
(0 to 5)

Moderate

0 per 1000

0 per 1000
(0 to 0)

Phlebitis
Any definition used by the author

Study population

RR 1.14
(0.93 to 1.39)

4806
(5 studies)

⊕⊕⊕⊕
high1,3

68 per 1000

78 per 1000
(63 to 95)

Moderate

68 per 1000

78 per 1000
(63 to 95)

All‐cause bloodstream infection

Study population

RR 0.47
(0.15 to 1.53)

3283
(1 study)

⊕⊕⊕⊕
high1,3

5 per 1000

3 per 1000
(1 to 8)

Moderate

5 per 1000

2 per 1000
(1 to 8)

Cost
Estmated. Based on materials and staff costs5,6

The mean cost in the intervention groups was
AUD $6.96 lower
(9.05 to 4.86 lower)

4244
(3 studies)

⊕⊕⊕⊕
high

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Although patients and those recording outcomes were aware of group allocation, it seems unlikely that this knowledge would have affected results. None of those recording outcomes were investigators and the diagnosis was based on verifiable data in patients medical records.
2 In three of the five trials, no CRBSI occurred in either arm of the study. In the other two trials there was considerable overlap in the confidence intervals, consequently there was no statistical heterogeneity.
3 Participants, interventions and outcomes were similar across studies.
4 Confidence intervals were wide for this outcome, indicating a level of uncertainty around the effect size.
5 The overall cost for cannula replacement varies by cost of materials, time, solutions, additives to the solution.
6 Mean cost is reported in Australian dollars.

Figures and Tables -
Summary of findings for the main comparison. Clinically‐indicated versus routine changes for peripheral venous catheter‐related complications
Comparison 1. Clinically‐indicated versus routine change

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related blood stream infection Show forest plot

5

4806

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.08, 4.68]

2 Phlebitis Show forest plot

5

4806

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.93, 1.39]

2.1 Continuous infusion

4

4606

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.89, 1.39]

2.2 Intermittent infusion

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.85, 1.96]

3 Phlebitis per device days Show forest plot

5

26191

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.84, 1.27]

4 All‐cause blood stream infection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5 Cost Show forest plot

3

4244

Mean Difference (IV, Fixed, 95% CI)

‐6.96 [‐9.05, ‐4.86]

6 Infiltration Show forest plot

4

4606

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [1.05, 1.31]

7 Catheter blockage Show forest plot

5

4806

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.91, 1.71]

8 Local infection Show forest plot

4

4606

Risk Ratio (M‐H, Fixed, 95% CI)

4.96 [0.24, 102.98]

9 Mortality Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Clinically‐indicated versus routine change