Changing Peripheral Intravenous Catheter When Clinically Indicated: First Evidence-Based Practice Project in Makkah, Saudi Arabia

Abstract

Context: In the past, it was advised to replace peripheral intravenous catheters every 24 to 96 hours (about four days). Regular catheter removal under a time-based method was utilized for a considerable amount of time to prevent consequences. The Infusion Nurses Society advised against routinely replacing peripheral catheters and insisted they only be replaced when clinically indicated in the Infusion Therapy Standards of Practice 2016. These patients are exposed to invasive needle sticks, infection risks, and unnecessary financial burdens when peripherally inserted catheters are replaced without a clinical need. Additionally, healthcare personnel face an increased workload in such cases. 

Aim: to assess the impact of removing peripheral intravenous catheters when clinically indicated compared to the current policy (routine replacement after 74-96 hours) on the complications and to appraise the financial implications. 

Methods: This project was carried out in the Cardiac Ward, Cardiac Surgery Ward, and Neuroscience ward at King Abdullah Medical City, Makkah, Saudi Arabia, on two patient groups. For 78 patients, PIVs were routinely replaced every 96 hours. Subsequently, they transitioned to changing PIVs solely when clinically indicated, but for a different group of 75 patients. The average patient stay on this project was 6 to 8 days.

Results: Neither the clinically indicated replacement group nor the routine replacement group showed signs of infiltration, and there was no statistically significant difference between them. Phlebitis was absent in the routine replacement group, while 2.7% of the clinically indicated group developed this condition, again without a significant statistical difference. The mean PIVC indwelling time significantly differed between the groups: 3.12±0.33 days for routine replacement versus 6.6±2.09 days for clinically indicated replacement (p=0.000). Additionally, a cost analysis highlighted a potential yearly savings of 709,999.56 SAR post-implementation of the practice change, with 2022 costs of PIV insertions at 1,540,849.36 SAR under the hospital's former policy.

Conclusion: This study's findings indicate no statistically significant difference in the incidence of infiltration or phlebitis between the clinically indicated replacement group and the routine replacement group. However, the average PIVC indwelling time was longer in the clinically indicated group, which suggests that extending the interval for PIVC replacement does not increase the risk of complications. Additionally, a cost analysis revealed substantial yearly savings associated with the clinically indicated replacement strategy. By implementing this project's recommendations, nurse leaders can reduce costs, improve patient and employee satisfaction and safety, and assure adherence to best practices.