Running head: LITERATURE REVIEW 1

Literature Review

Caitlyn Summers

Grand Canyon University: NSG-324

27 April 2020
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Literature Review

Peripheral intravenous lines, also known as PIVs, are used frequently in hospitals across

the world in a majority of the patients that are admitted. They are an easy, cost-effective way to

get direct access to the blood for patients that need short-term intravenous therapy, allowing

medications to be easily administered into the bloodstream and provide patients with intravenous

fluids. Although it has several benefits in the hospital setting, it is also related to a considerable

amount of complications including difficulty trying to insert, phlebitis, infiltration, occlusion,

dislodgement, and catheter associated bloodstream infections (Alexandrou, Ray-Barruel, Carr,

Frost, Inwood, Higgins, Lin, Alberto, Mermel, Rickard, 2018). A significant amount of

peripheral IVs start showing one of the complications stated above before the catheter is required

to be replaced or before the IV therapy is complete. Not only is it costly for the hospital, but it

also inflicts more pain and discomfort on the patient, especially for patients that have difficult

venous access (Alexandrou, Ray-Barruel, Carr, Frost, Inwood, Higgins, Lin, Alberto, Mermel,

Rickard, 2018). According to the Center of Disease Control, the current guideline for replace

peripheral intravenous catheter is between 72-96 hours in order to prevent infection and phlebitis

(Recommendations, 2015). There is an extensive amount of research on whether it is necessary

to replace the catheters between the recommended time or if they can just be replaced when

clinically indicated to prevent more pain and an increase risk of infection. A literature analysis of

three peer reviewed articles will be conducted to analyze and determine if replacing peripheral

IV catheters when clinically indicated versus every 72-96 hours is effective in lowering phlebitis

rates. Within this paper, each of the three articles discussing the same topic will be compared

and contrasted including, the methods and areas of further study.

Methods
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The criteria was set in order to ensure that the articles found were applicable in

determining if replacing IVs at the set time frame of 72-96 hours compared to when clinically

indicated was effective in reducing rates of complications. The first criterion ensured that the

articles researched contained the two variables, 72-96 hour removal compared to clinically

indicated removal. These criteria are extremely important because it ensures the data taken is

focused on those two factors which form the basis of the PICOT question. The second criterion

is that each article is specific on only including and gathering data from patients that have

peripheral intravenous catheters and not a midline or central catheter. The research question is

only addressing peripheral IVs to get a more focused set of data and to strengthen the results of

each article. Midline and central catheters tend to be used for long term IV therapy and including

them would alter the time frame being studied in this clinical question. The third criteria

involved having the population specifically focused on adults. It is recommended by the CDC

that children only have their PIVCs changed when clinically indicated to reduce the amount of

unnecessary sticks, therefore this would also change the data results (Recommendations, 2015).

Lastly to ensure the articles are credible, all sources must be published within the last five years.

It is important to include research that is relevant to the current practices and has data recently

studied to ensure best practices are being utilized.

Synthesis of Literature

Out of the multitude of articles that were searched, three were chosen to be analyzed.

The first article is titled “Use of short Peripheral Intravenous Catheters: Characteristics,

management, and outcome Worldwide” and is a cross-sectional study that has the purpose of

internationally investigating internationally the characteristics, management practices and the

outcomes of PIVC’s to understand why they so commonly fail and how to implement best
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practice (Alexandrou, Ray-Barruel, Carr…, 2018). The method that was used was selecting

several hospitals across the world including 51 different countries that had hospitals in various

areas, rural, metropolitan and regional. A qualified team of doctors and nurses were recruited

and trained to assess the PIVC’s, in addition to using three forms for data collection. A

questionnaire to collect information about the sites, a screening log to track participants, and a

case report form to monitor data regarding the PIVC characteristics and management practices

(Alexandrou, Ray-Barruel, Carr…, 2018). Findings showed that the dwell time for the PIVC’s

did not have an influence on the rates of phlebitis (Alexandrou, Ray-Barruel, Carr…, 2018).

Findings also showed that out of the 40,620 PIVC’s, 5,169 had nonsterile dressings covering

them, which was seen more in the lower-resourced countries (Alexandrou, Ray-Barruel, Carr…,

2018). Another finding showed 14% of all the PIVC’s had no documentation of any medication

or IV fluids that were administered in the prior 24 hours, signifying that they are no longer

needed. Both the delayed removal of the IV’s and the nonsterile dressing used on the patient,

increased the risk for infection.

Article two was titled The RESPECT trial – Replacement of peripheral intravenous

catheters according to clinical reasons or every 96 hours: a randomized, controlled non-

inferiority trial and it is a quantitative study. The methods used was a computer-generated

randomized list and trained nurses performed the IV insertion and removal (Vendramim, Avelar,

Rickard…, 2020). There was a control group, which had their IV replaced every 96 hours

regardless if no complications were present and a clinically indicated group which only had the

IV replaced when there was a need to insert a new one. The findings showed that clinically

indicated peripheral intravenous catheter replacement was not inferior to routine replacement

when it came to phlebitis occurrence, and it even was associated with substantially less phlebitis
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per 1000 days (Vendramim, Avelar, Rickard…, 2020). The clinically indicated group has only

62/132 cases of phlebitis and the routine group has 70/132 cases of phlebitis (Vendramim,

Avelar, Rickard…, 2020).

The final article was also a quantitative article titled “Routine Replacement or Clinically

Indicated Replacement of Peripheral Intravenous Catheter.” The purpose of this article was to

detect potential complications of peripheral intravenous catheters 72-96 hours after indwelling

(Webster, Osborne, Rickard, Marsh, 2019). The methods utilized were a random block sampling

method and a control group, PIVCs that were replaced when clinical indicated, and an

experimental group that was routinely replaced every 72 hours. Demographic data was also

collected that included the age, sex, diagnosis, use of anticoagulant drugs, BMI, underlying

diseases, and history of smoking or drug abuse (Webster, Osborne, Rickard, Marsh, 2019). The

nurses caring for the peripheral IVs all used the same exact cleaning method, dressing and

documented the date and hour of placing the intravenous device, inserting site, catheter

indwelling time and reason for replacing were documented (Webster, Osborne, Rickard, Marsh,

2019). Findings of this study displayed the statistical significance between the control group and

the intervention group before and after the 72-hour mark (Webster, Osborne, Rickard, Marsh,

2019). Patients that had peripheral IV catheters removed when clinically indicated showed less

episodes of phlebitis than the patients that had their catheter removed every 96 hours. All three

articles researched were helpful in supporting the PICOT question.

Areas of Further Study

The three articles had some areas of limitations. Article one was really interesting

because it not only looked at the time for replacing peripheral IV’s, but it also addressed other

causes for the failure of IV’s including the location the IV was placed, the type of dressing used
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around the site and whether or not documentation was properly performed. This data could open

the door for further research as to other reasons why peripheral IVs are failing rather than just

focusing on the dwell time as the cause. However, this design of this article was a cross-

sectional study. This brought on a lot of complications, for example a follow-up of the PIVC

could not be collected until the removal (Alexandrou, Ray-Barruel, Carr…, 2018). A cross-

sectional can also be difficult because it compares regional differences that could influence the

data that is collected, especially in developing areas (Alexandrou, Ray-Barruel, Carr…, 2018).

This article also might benefit from finding a way to randomize the selection of hospitals to

eliminate the possibility of biased findings. Article two gave a well laid out diagram and

explanation of their findings, making it clear to understand. One of the limitations of this study

involves the method of their data collection. A blind study should be considered, which keeps

the patient from fully understanding what is being evaluated so that the data remains unbiased

(Vendramim, Avelar, Rickard…, 2020). If the patients know about the details of the study they

may tamper with the IV or change how they would function with it normally. Lastly, for the third

article, the main limitation was having several different nurses assess and document the IV site

which could lead to inconsistencies in the results due to differing ideas of what the complications

may look like to each nurse (Webster, Osborne, Rickard, Marsh, 2019).

Conclusion

In conclusion, all three articles are supportive of the PICOT question in various ways.

The method for selecting each article was mostly focused on if the articles incorporated the

different components of the PICOT question like the two variables being researched, the

population, and the type of catheter used. In addition, the validity and relevance of the articles

were also assessed in the methods. All three research articles also contained the necessary
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components like the methods, samples, and results that were consistent with the key findings.

The limitations of each article were different, the first regarding the cross-sectional design that

made it difficult to ensure the accuracy of the study. The second and third article’s limitations

both were related to potentially increasing the risk of biased data. The different perspectives and

data findings of each article give very well rounded and supportive evidence from for the PICOT

question.
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References

Alexandrou, E., Ray-Barruel, G., Carr, P., Frost, S., Inwood, S., Higgins, N., Lin, F., Alberto, L.,

Mermel, L., Rickard, C. (2018, May 30). Use of Short Peripheral Intravenous Catheters:

Characteristics, Management, and Outcomes Worldwide. Retrieved from

https://www.journalofhospitalmedicine.com/jhospmed/article/166494/hospital-

medicine/use-short-peripheral-intravenous-catheters-characteristics

Recommendations | BSI | Guidelines Library | Infection Control | CDC. (2015, November 5).

Retrieved from

https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html

Vendramim, P., Avelar, A., Rickard, C., & Pedreira, M. (2020, July 1). The RESPECT trial–

Replacement of peripheral intravenous catheters according to clinical reasons or every

96 h: A randomized, controlled, non-inferiority trial. Retrieved from

https://www.sciencedirect.com/science/article/abs/pii/S0020748919303116

Webster, J., Osborne , S., Rickard, C., & Marsh, N. (2019, January 23). Clinically‐indicated

replacement versus routine replacement of peripheral venous catheters. Retrieved from

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007798.pub5/full