Massive savings beckon from IV drip research

A Griffith Health Institute (GHI) study into the use of IV drips in hospital wards has the potential to save the Australian economy millions each year.

The new research published in The Lancet suggests that the millions of intravenous catheters used each year can be safely changed only when clinically necessary, overturning 40 years of accepted practice involving routine replacement every three days.

Introducing such a policy would not only prevent unnecessary painful procedures in one fifth of patients but also dramatically reduce equipment and staff costs.

The study was led by Professor Claire Rickard and Professor Joan Webster from the Griffith Health Institute’s Research Centre for Clinical and Community Practice Innovation (RCCCPI).

“Of the 200 million catheters estimated to be inserted each year in the USA alone, if even 15 per cent are needed for more than three days, then a change to a clinically required replacement would prevent up to 6 million unnecessary intravenous catheter insertions,” said Professor Webster. “It would also save about two million hours of staff time, and up to US$60 million in health costs each year for that country alone.”

In the study, 3283 adult patients expected to require a catheter for longer than three days wereenrolled from three hospitals in Queensland. Patients were randomly assigned to either clinically indicated or routine removal every third day to compare the effectiveness of each practice at reducing infection and phlebitis (inflammation of the vein).

The average catheter dwell time was 99 hours in the clinically indicated group and 70 hours in the routine replacement group. Phlebitis occurred in 7 per cent of patients in both groups.

Bloodstream infections were rare and did not differ between groups, and no local infections were reported in either group.

Professor Webster, who is based at Royal Brisbane and Women’s Hospital, said that up to 70 per cent of hospitalised adult patients need a peripheral intravenous catheter.

“Catheter replacement is costly, time consuming and causes distress to patients. Our data strongly suggests that routine replacement does not reduce complications, but rather causes many unnecessary invasive procedures. Updated intravenous catheter policies (including CDC guidelines for adult patients) should advocate clinically indicated removal.”

The study, which also included researchers from Western Sydney Local Health District and The Children’s Hospital at Westmead also found nearly 30 per cent of catheters failed.

The failure of catheters due to infiltration, occlusion, or accidental removal was far more frequent than phlebitis or infection. Therefore, future studies which identify means of prevention
of such catheter failures might have even greater implications for cost, reduction of unnecessary
invasive procedures and staff workloads, than do the present findings.