Phlebitis Clinical Trial
Official title:
Removal Peripheral Intravenous Catheters According to Clinical Signs or Every 96 Hours: A Non Inferiority Study (ResPeCt)
This is a two-centers, open label, prospective, randomized, noninferiority controlled trial with cost-effectiveness analysis to verify if is non inferior to remove peripheral intravenous catheter according to clinical signs in relation to every 96 hours.
The care practice standards related to infusion therapy (IT) are stipulated and regulated by
US institutions, such as the Infusion Nurses Society (INS) and the Center for Disease and
Control (CDC), and, in Brazil, by the Brazilian National Health Surveillance Agency (ANVISA).
Within this topic, the investigators can mention peripherally administered IT through
peripheral intravenous catheters (PIC) as the most used one, since this is less complex and
less invasive, and it offers a lower risk of severe complications compared to central line
IT.
PIC placement, maintenance and removal procedures are not free of complications, and in order
to prevent them, regulatory agencies publish formal recommendations. One of these refers to
the time the PIC remains at the same site (residence time), which has been determined to be
96 hours for the adult population, i.e., it should be removed and punctured again at another
site, systematically, even if not showing any inflammatory sign within 96 hours.
Following literature review, one can see that these recommendations are based on limited
evidence, and supported by data from old studies. For this reason, the investigators discuss
if employing a systematic and elective change procedure for adults would be the best option,
as the investigators have taken some aspects into consideration, such as: Patient safety -
The PIC dwell time at the placement site, as shown by research results, has increased
throughout the decades to 24, 48, 72, and 96 hours. If the PIC change is performed on a child
who, theoretically, is a less immune-competent patient as compared to adults, this is
performed according to clinical signs, then the investigators can conclude that adopting the
same procedure for adults would be safe. Peripheral venous depletion - Logic leads us to
consider that the less the investigators puncture a patient, more access is available, and
less outcomes with IT-specific complications occur. Patient satisfaction - With reduced
exposures to painful and invasive events, the patient will also benefit from it. Few patients
refrain from showing dissatisfaction when the PIC is to be placed again electively. Quality -
Producing scientific evidence and adopting the best practices in hospital environments is
practicing quality. Economic aspects - If these PIC changes were less frequent, they would
necessarily imply less spending with inputs and devices, as well as less time spent by the
team performing the procedure, which represents less cost and workload. Occupational safety -
Studies show an estimated relationship between the occurrence of an accident with biological
material and performing invasive procedures. Reducing the number of punctures performed by a
professional, in addition to decreasing the workload, may reduce the exposure to risk and
accidents.
Research studies carried out mostly in Australia aim at showing that the systematic PIC
removal and change do not bring benefits, when compared to change based on clinical
manifestations. However, a systematic review study in 2010 did not find conclusive evidence,
and suggested the development of other projects in several regions, of different natures and
realities, so as to further mature the hypothesis. To support this, the INS has also formally
stated that this theme is a research priority at this time.
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