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Systematic Review Protocol

Examining Effectiveness of Peripheral Intravenous Dwell Times Greater than Seventy-Two Hours in Adult Patients in a Community Setting: A Systematic Review

JBI Library of Systematic Reviews: Volume 6 - Issue 17 - p 1-12
doi: 10.11124/jbisrir-2008-486
  • Free

Centre Conducting the Review

Saint Elizabeth Health Care

Markham, Ontario, Canada

Contact for the Review

Name: Alison MacDonald

Telephone: (905) 968-6508

Facsimile: (866) 619-4067

Email: [email protected]

Primary Reviewer

Name: Alison MacDonald

Telephone: (905) 968-6508

Facsimile: (866) 619-4067

Email: [email protected]

Review Panel: Secondary Reviewers

Name: Kim Dalla Bona

Telephone: (519) 819-1243

Facsimile: (866) 619-4067

Email: [email protected]

Name: Karen Ray

Telephone: (905) 968-6438

Facsimile: (866) 619-4067

Email: [email protected]

Commencement Date

May 2008

Expected Completion Date

September 2008

Background

The insertion of peripheral vascular access devices (PVAD) is one of the most common procedures performed in health care today. The use of these devices has increasingly extended beyond the hospital setting, into the community (1).

The risk for complications associated with PVAD's is low; however, as millions of PVAD catheters are utilized in the health care industry each year, the total number of complications is significant (1). Potential complications associated with PVADs include phlebitis, obstruction of the catheter and catheter related infection (2-4). Site rotation is often touted as an intervention to prevent these complications (3), however, the recommended interval for replacement varies between 72 and 96 hours (3-6).

The use of PVAD's in the community sector is extensive. A dwell time of 96 hours, versus 72 hours, will benefit clients receiving care in a community setting for various reasons, including: patient preference ability to maintain site integrity as client performs normal activities of daily living, human resource shortages and client safety and a desire to provide optimal client care. Re-initiating a PVAD too frequently puts the client at risk for insertion related nerve damage, hematoma, infection and anxiety. New punctures cause discomfort for the patient (2). Multiple punctures may also limit future vascular access (7).

The purpose of this review is to evaluate research, to determine the risk of rotating PVADs at 96 hours versus 72 hours. This review will consider studies that evaluate the dwell time for PVAD's in the adult population (18 years and older) at 72 and/ or 96 hours. Paediatric studies will not be included as the recommendations for the care of paediatric populations differs from the adult guidelines. Studies using immunocompromised patients as subjects will not be included due to the increased risk for infection and complication with this client population. Outcome variables include phlebitis, obstruction of the catheter and catheter related infection. These 3 outcome variables are the most documented and significant clinical complications impacting PVAD therapy (1, 3, 6-7). This review will provide clinical recommendations regarding the most appropriate dwell time for PVADs in a community setting.

Objective

To conduct a systematic review to synthesize the best available evidence on dwell times of 72 and 96 hours for peripheral vascular access devices (PVADs) for adult clients in a community setting, considering outcome variables of phlebitis, obstruction of the catheter and catheter related infection.

Criteria for Considering Studies for this Review

Types of studies

This review will consider any quantitative studies including randomised controlled trials, experimental, quasi experimental studies, and observational studies that provide clinical evidence to determine the optimal dwell time for a PVAD at 72 hours or beyond.

Setting

Studies will be included if they occur in a community setting, which includes care provided in diverse settings such as homes, schools, places of employment, shelters, churches, community health centres and on the street.

Types of participants

This review will consider studies that evaluate the dwell time for PVADs in the adult population (18 years and older) at 72 and/ or 96 hours. Studies using immunocompromised patients as subjects will not be included due to the increased risk for infection and complication with this client population.

Types of interventions

Studies will be included if they evaluate the effect of PVAD dwell time of 72 and/ or 96 hours on client outcomes in the community setting. The use of a midline or extended dwell PVAD's will not be considered. This review will focus only on the short peripheral intravenous catheter. Any studies that evaluate the dwell time of PVAD's for Total Parental Nutrition will not be included as this is an intervention not performed in the community setting.

Types of outcome measures

Outcomes of interest include: phlebitis, catheter occlusion, and infection (See Appendix 1 for checklist of inclusion criteria).

Search Strategy for Identification of Studies

The search will seek both published and unpublished studies. A two step search method will be used. An initial limited search will be undertaken of all journals indexed in MEDLINE and CINAHL for a one year period. An analysis of the text words contained in the title, abstract and MeSH terms of relevant articles will be undertaken to identify additional key words. For example, for MEDLINE and CINAHL, intravenous therapy, vascular access devices, peripheral intravenous, peripheral catheterization, dwell time, in situ, phlebitis, infection, infiltration will be useful key words. In addition to this, each electronic database has its own indexing terms, and individual search strategies will also be developed for each search. The second search of databases will utilize all the key words. The search for published studies will include the following sources, from 1998 - present:

  • CINAHL
  • Medline
  • EMBASE
  • EBM Review
  • Cochrane Library of Controlled Trials
  • Reference Lists of identified studies and review papers
  • Direct communication with key organizations and key researchers in the area
  • Online gray literature search

Electronic searching is expected to result in the lists of articles with details of title, author, source, and sometimes abstract. All identified articles will be assessed on the basis of the abstract (or title if abstract not available) by two reviewers, and full reports will be retrieved for all studies that meet the inclusion criteria for the review. Where doubt exists, the full article will be retrieved.

Discussion with key organizations and researchers in this area will help to identify any possible unpublished literature that should be included in the review.

Methods of the Review

Assessment of methodological quality

Methodological quality will be assessed using a critical appraisal tool developed by the Joanna Briggs Institute (JBI), (Appendix 2). Two reviewers will independently assess all the articles, and disagreements between reviewers will be resolved by discussion with a third reviewer.

Data extraction

Data will be extracted from retrieved studies using a JBI data extraction tool (Appendix 3). When necessary, the principal primary researcher will be contacted to obtain further information regarding a retrieved study.

Data synthesis

Where possible quantitative research study data will be pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration (Review Manager V 4.2.8). All results will be double entered. Odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible the findings will be presented in narrative form.

Acknowledgements

The authors would like to acknowledge the support and guidance of the Queen's Joanna Briggs Collaboration for their support and guidance.

Potential conflict of interest

None.

References

1) Lai, K. Safety of prolonging peripheral cannula and IV tubing use from 72 to 96 hours. American Journal of Infection Control, 1998; 25(1).
2) Bregenzer, T., Conen, D., Sakmann, P., & Widmer, A. Is routine replacement of peripheral intravenous catheters necessary? Archives of Internal Medicine. 1998; 158: 151-156.
3) O'Grady, N.P, Patchen Dellinger, M, Gerberding, J, Heard, S., Maki, D., Masur, H., McCormick, R., Mermel, L., Pearson, M., Raad, I., Randolph, A., & Weinstein, R. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recommendations and Reports. 2002; 51(RR-10):1-29.
4) Registered Nurses Association of Ontario. Nursing Best Practice Guideline: Care and Maintenance to Reduce Vascular Access Complications. Toronto: Author. 2005.
5) Registered Nurses Association of Ontario. Best Practice Guideline: Assessment and Device Selection for Vascular Access. Toronto: Author. 2004.
6) Royal College of Nurses. Standards for Infusion Nursing. London: Author. 2005.
7) Intravenous Nurses Society. Infusion nursing: Standards of practice. Journal of Infusion Nursing. 2006; 29(1S): S1-S90.

Appendices

Appendix 1 - Checklist of Inclusion Criteria

Participants

  • Adults (18 years or older) with a peripheral intravenous catheter. (Not a centrally inserted catheter)

Setting

  • Community

Research Methods

  • any quantitative method such as
    • experimental designs
    • quasi experimental designs
    • observational designs

Outcome Variables

  • phlebitis
  • infection
  • catheter occlusion

Appendix 2 - Critical Appraisal of Evidence of Effectiveness

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Appendix 3 - Data Extraction of Evidence of Effectiveness

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© 2008 by Lippincott Williams & Wilkins, Inc.