The Clinical, Physiological, Psychological, and Financial Implications of Peripheral Intravenous Catheter (PIC) Replacement to Ascertain Standard Patient Care Practice: A Systematic Review

Written by Neeta Jadonath, Joseph J. Brennan, Charles E. Cal, & Edmund J. Y. Pajarillo

doi: https://doi.org/10.13178/jnparr.2021.11.02.1107

Abstract

Background: Peripheral intravenous catheters (PICs) are flexible catheters inserted to provide essential access for infusing medications or other fluids via the intravenous route. The proper insertion, functioning, and replacement of PICs is the nurses’ responsibility; however, policy variations exist concerning the frequency that PICs are changed. This systematic review highlights the rate of PIC complications (e.g., phlebitis, infection, or infiltration), cost of resources associated with catheter changes, and patient experiences related to PIC replacement. These factors were examined to understand the clinical, physiological, psychological, and financial implications of routine (every 72-96 hours) versus clinically-indicated PIC
replacement on standard patient care practices.

Objective: The purpose of this systematic review is to investigate the (1) relevance of nursing assessment, (2) cost of resources, (3) the effect on patient safety and care, and (4) lack of standards or best practice protocols related to PIC replacement. This review will be useful in promoting safe, efficient, and quality-based standards for PIC care and replacement.

Methods: Databases used in the literature search were CINAHL, EBSCO, ProQuest, Medline, PubMed, and the Cochrane Library. Specific keywords used in the initial search resulted in 704 articles. The literature search was conducted in 2020 and included pertinent studies from 2014-2019. Using the inclusion and exclusion criteria, relevant studies resulted in 18 peer-reviewed studies. Using the evidence hierarchy, these 18 articles yielded five Level I, eight Level II, and five Level V studies.

Results: Most of these studies suggested no evidence of increased complications with clinically-indicated PIC replacement. The results emphasized the importance of frequent, competent catheter site assessments as a tool for early detection of complication symptoms. The practice of routine replacement added unnecessary time, nursing hours, and waste of medical supplies, as well as anxiety and harm to patients. With diligent monitoring of the catheter site and functioning, nurses safely maintained PICs as clinically-indicated.

Conclusion: The findings from this systematic review support clinically-indicated PIC replacement as the standard for best practice. Comprehensive nursing education about PIC complications, including competent and thorough nursing evaluation of the PIC site, is an essential intervention to reduce complications, prevent patient harm, reduce cost of resources, and promote safe and effective patient care practices.

Keywords: peripheral intravenous catheter, peripheral vascular catheter, clinically-indicated replacement, routine replacement, phlebitis, catheter-related infections, standards