Meta Analysis Optimal timing for intravenous administration set replacement.
This review may be edited
Summary
Posted By:	Sharon McKinley
E-Mail:	sharon.mckinley@uts.edu.au
Posted Date:	14th December, 2005
Title:	Optimal timing for intravenous administration set replacement.
Authors:	Gillies D, O'Riordan L, Wallen M, Morrison A, Rankin K, Nagy S.
Reference:	Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003588.
Link:	Click here for a direct link to the paper. A password may be required for access to fulltext.
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 STRATEGY: 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 betweenthe 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 thanevery 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.
Are the Results Valid?
1. Did the overview address a focused clinical question?
	Yes. Population: patients in acute hospital care with peripheral or central venous access devices Intervention: frequency of replacement of infusate administration sets Comparisons: 24 hrly vs 48 hrly or longer, 48 hrly vs 72 hrly or longer, 72 hrly vs 96 hrly or longer Outcomes: infusate colonization (any); infusate-related blood stream infection (BSI); catheter colonization (any); catheter-related BSI; overall BSI; all-cause mortality
2. Were the criteria used to select articles for inclusion appropriate?
	Questionable. Studies without true randomization and with unclear allocation concealment were included. From the perspective of central lines in ICU patients, one study included had a large no. of patients that influenced the overall results and was published as an abstract only in 1998. Another in this population randomized catheters rather than patients and did not control for this in the analysis.
3. Is it unlikely that important, relevant studies were missed?
	The search of electronic databases and reference lists, plus contact with known investigators on the topic is not likely to have missed relevant studies.
4. Was the validity of the included studies appraised?
	Validity appraisal was attempted but data from questionable studies were included in the analyses.
5. Were assessments of studies reproducible?
	Not clear; no measures reported
6. Were the results similar from study to study?
	Yes; the authors tested for heterogeneity with chi-square (p<0.10) and report none; there were minimal observed differences in either direction in any of the comparisons of less frequent vs more frequent set changes.
What are the Results?
1. What are the overall results of the overview?
	No significant differences were found in either direction in any of the comparisons of less frequent vs more frequent set changes, but because of the studies included in the meta-analyses this cannot be interpreted as longer times between set changes being associated with no increases in BSI and mortality.
2. How precise were the results?
	Not applicable
Will the Results Help Me In Caring For My Patients?
1. Can the results be applied to my patient care
	The meta-analysis of the included studies provides little or no useful information applicable to CVC giving set changes in adult intensive care patients
2. Were all clinically important outcomes considered?
	Not applicable
3. Are the benefits worth the harms and costs?
	Indeterminate
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