Intravascular device administration sets: Replacement after Standard Versus Prolonged use (The RSVP Trial)
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.