Rickard C1,2, Marsh N1,2, Larsen E1,2, Runnegar N3, Gavin N1,2, Mihala G1, Playford G3, Webster J.1,2
1Griffith University, Nathan, Australia
2Royal Brisbane and Women’s Hospital, Herston, Australia,
3Princess Alexandra Hospital,Woolloongabba, QLD, Australia
Administration sets/infusion tubing are used extensively for intravenous therapy. The Centres for Disease Control recommend administration set replacement every 4-7 days, and there is great variability in policy and clinical practice nationally and internationally. The aim of this randomised controlled trial (RCT) was to establish the optimal timing for IV administration set replacement.
This multi-centre (10-hospital) NHRMC-funded RCT of equivalence design recruited 2941 participants (May 2011-December 2016). Participants were randomly allocated to have AS changed by clinical staff every 4 or 7 days. Adult and paediatric participants were sampled from cancer care; medical; surgical; and intensive care units. Administration sets infusing blood products, chemotherapy, inotropes, and lipids were excluded. An independent infectious diseases consultant, blinded to the allocation, provided the primary outcome (catheter-related bloodstream infection, CRBSI)
There were 720 arterial catheters; 846 peripherally inserted central catheters; and 1375 (other) central venous catheters. Average device dwell times were 11.9 days (4-day group) and 11.7 days (7-day group). CRBSI occurred in 21/1481 (1.42%) 4-day patients and 15/1460 (1.03%) 7-day patients. The between group CRBSI risk difference of 0.39% (90%CI -0.28% to +0.11%) was within the absolute +/-2% a priori statistical equivalence boundaries, thus equivalence was demonstrated. CRBSI and CLABSI (central line-associated bloodstream infection) rates per 1000 catheter days were also similar between groups at 0.9 and 3.4 (4-day) versus 1.2 and 3.9 (7-day) respectively.
Preliminary unadjusted results confirm that routine replacement of IV administration sets prior to Day 7 is ineffective for CRBSI prevention.
Miss Emily Larsen is a Senior Research Assistant and Project Manager with the Alliance for Vascular Access Teaching and Research (AVATAR), responsible for co-ordinating a number of multi-site randomised controlled trials involving vascular access devices (both central and peripheral). Emily’s main interest is the surveillance and prevention of central line associated bloodstream infections, particularly within a cancer care service setting.