Our findings are consistent with previous smaller randomised controlled trials,9–12 and a systematic review showed no benefit of routine replacement for phlebitis or catheter-related bloodstream infections (panel).35 Thus, much evidence now suggests that clinically indicated replacement is safe. Updated intravenous catheter policies should advocate clinically indicated removal— ie, to
monitor and immediately remove intravenous catheters for complications or as soon as treatment is complete. The CDC guidelines already recommend clinically indicated replacement in children,4 citing two non-randomised studies (total n=589).14 Thus, despite a scarcity of large randomised controlled trials, paediatric patients are not subjected to routine replacement, perhaps because of the
sensitivities of cannulating children. Our data support extension of these recommendations, and this sensitivity, to the management of adult patients. Insertion of an intravenous catheter is painful, requiring piercing of the skin, tissue, and vein with a steel needle at least once, or several times for a difficult insertion. Investigation of patients’ perspectives of strategies for replacement of intravenous
catheters have been recommended,25 but patients are presumably unlikely to want routine replacement since it has no proven benefit.