Recommendations to replace peripheral venous catheters every 72-96 hours: is a single reference enough?

The incidence of local or bloodstream infections (BSIs) associated with peripheral venous catheters (PVCs) is low (0–0.2% bacteraemia); but there is considerable annual morbidity because of the frequency with which such catheters are used. The incidence of phlebitis (3–5%) and bacterial colonisation of catheters increases for catheters left in place >72 h.1,2 In 2001 the Centers for Disease Control (CDC) changed the recommendations for PVC site rotation from 48–72 to 72–96 h, based on a study showing that rates of phlebitis were similar in PVCs left in place for 72 and 96 h.1,3 Following the publication of the CDC guideline, the William S. Middleton Memorial Veterans Hospital (Madison VAH), a 100-bed acute care university hospital affiliated facility, extended the PVC (Becton Dickinson Insyte Autoguard Safety IV catheter) catheter rotation from 48–72 to 72–96 h in September 2001. The rates of PVC-associated primary BSI rose to 0.24, 0.10 and 0.17 per 1000 patient-days in 2002, 2003 and 2004 respectively. PVC-associated primary BSI rates before the policy change were 0.0, 0.0 and 0.08 per 1000 patient-days in 1999, 2000 and 2001 respectively. We undertook a retrospective case–control study of 161 patients (20 cases and 141 controls) with PVCs to determine risk factors for complications such as BSI and phlebitis following PVC insertion. Cases were patients admitted between 2002 and 2005 with PVCs that met the criteria of PVC complications (eight cases of BSI, six of local site infection, and six of phlebitis). Controls were patients with PVCs but without PVC complications, selected randomly from patient admissions identified between May and June 2004 and between May and June 2005 (42 ICU patients and 99 medical/surgical patients). Data were