Nurses currently replace AS more frequently that IVDs as they believe that this prevents infection. This is expensive and time consuming, with a poor evidence base. A meta-data analysis of almost 5,000 patients (Cochrane Collaboration, 2005) found AS replacement at any of 24. 48, 72 or 96 hours did not change infection risk (IVD-BSI RR 1.15, 95%CI 0.94, 1.42). Other data, including our pilot study (404 IVDs) found no difference in IVD colonisation or IVD-BSI between groups in 4 versus 7 days use.
The aim of the study is to compare intravascular device (IVD) administration set (AS) replacement at 4 days versus 7 days on infective and cost outcomes. The primary hypothesis is that there will be no difference in the incidence of IVD-related bloodstream infection (IVD-BSI) between patients whose AS are replaced every 4 days or 7 days. The study design will consist of a large, multi-centre, randomised controlled trial in the general hospital setting.
Consenting patients with a central venous, peripherally inserted central venous, or peripheral arterial devices to be indwelling for more than 4 days will be randomly assigned to have AS replaced every 4 or 7 days. The primary outcome measure is IVD-BSI. Secondary outcomes are: IVD colonisation, AS colonisation, all-cause BSI, phlebitis, mortality, IVD time in situ, AS use and costs. There will be a 3 year recruitment of 6,500 adult and paediatric patients, in 5 hospitals in South-East Queensland.
About 14 million IVDs are used in Australia each year. The current restriction of AS use to 3 to 4 days possibly has no benefit, yet it is costing the country approximately 1 billion dollars and 2 million nursing hours each year. Extension of AS use to 7 days would lead to significant cost, time and environmental savings.
This trial is already funded by the NHMRC.