Our fi ndings are consistent with previous smaller randomised controlled trials,9–12 and a systematic review showed no benefi t 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 chil dren,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 recom men dations, and this sensitivity, to the manage ment of adult patients. Insertion of an intravenous catheter is painful, requiring piercing of skin, tissue, and vein with a steel needle at least once, or several times for a diffi cult insertion. Investigation of patients’ per spectives of strategies for replacement of intravenous
catheters has been recommended,25 but patients are presumably unlikely to want routine replacement since it has no proven benefit.