Stop Routine Cannula Replacement

A Cochrane review published in August 2015 (see here) found no evidence to support the routine changing of peripheral intravenous cannulae every 3 to 4 days.

Healthcare facilities should consider a policy whereby catheters are changed only if clinically indicated.

The implications of this for reducing unnecessary workload on the front line are great.

Help:
If you know of any institution which has a policy of routine replacement of peripheral cannulae then please forward this Cochrane review to the hospital managers.

The AVATAR group have provided some excellent resources outlining how best to assess peripheral venous cannula sites (see here).

Perhaps a convenient place to assess cannula insertion site every shift would be on the patient observation chart. We highly recommend hospital managers review the benefits of the ‘Between the Flags’ system of patient observation charts developed in NSW, Australia (see here).

 

Below is the relevant section of the current NSW policy concerning the management of peripheral intravenous cannulae (click here for full policy):

You may want to contact NSW Health to update this policy so that it is consistent with the best available evidence.

You can send them an email via this link: http://www.cec.health.nsw.gov.au/get-involved/contact-us

9 Comments

  1. My nan’s cannula was left in longer than four days and she ended up criticly ill with septicaemia

    • patientsafe@icloud.com

      Hi Emma, I’m very sorry to hear that. Was the septicaemia from the cannula? Was the site checked during every shift? We know of patients who have died from complications due to more invasive lines being inserted because their peripheral veins had been damaged from routine cannula replacement. It is important that we get the balance right – this is why we look towards the best available evidence. Thank you for your comment.

      • Lee johnson

        Excellent reply. So many lines are replaced without clinical indications. As mentioned lines should be assessed every shift for phebitis and treated appropriately. PIVL has a very low infection rate and would be unlikely to have caused systemic septic shock within an 8hr shift.

  2. Jyoti Tuladhar

    It’s a new evidence base which we can follow but an keen observation is needed.

  3. This would really help those difficult cannula insertion with very fine veins patients. However it really takes time for the management level to implement this change.

  4. They are not routinely replaced in America. Only when clinically indicated

    • patientsafe@icloud.com

      Thanks Jenny,

      Would you have a link to any protocols related to this – perhaps we could adapt them for use in Australia. Is there an easy and recognised location for documentation to demonstrate that the peripheral cannulae have been assessed each change of shift.

      Sorry it’s taken a few days to get in touch. Your commented most appreciated. Thanks

  5. so how long do you think the iv line can stay in the vein? for example: if the patient is in 2 weeks and the site looks fine are you saying thats its ok to leave it there?

    • patientsafe@icloud.com

      Hi Erica – Thank you for what is an extremely important question. The Michigan Guidelines perhaps provide the best current guidelines for which IV line to use for the expected duration of intravenous access. I appreciate this doesn’t answer your question completely. I believe there needs to be a shift away from policy which is not supported by best available evidence in the interest of patient safety.

      Thanks

      Rob

      See: http://www.improvepicc.com/uploads/5/6/5/0/56503399/0000605-201509151-00001.pdf

Leave a Comment

Your email address will not be published. Required fields are marked *

*