Optimal timing for intravenous administration set replacement

Objectives: The objective of this review was to identify the optimal interval for the routine replacement of IV administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered via central or peripheral venous catheters to people in hospital. 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 IV administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered via a central or peripheral catheter to people in hospital. 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 IV 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 among participants with central versus peripheral catheters; nor between participants who did and did not receive parenteral nutrition, or between children and adults. Reviewers’ 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.