Research in context
Evidence before this study
We searched MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, and international clinical trials registries for randomised, controlled trials comparing durations of infusion set use. Search terms included “Catheterisation”, “Catheters, indwelling”, “Parenteral Nutrition”, “Infusions, intravenous”, “Line change”, “Administration/infusion set”, “Transducer”, “Tubing”, “Replacement”, “Timing”, and “Time-frame”. The search was not restricted by language or date. We also searched reference lists of articles identified by this strategy. We published a systematic review in 2013 with the last search being June, 2012; a repeat of this search in March, 2020, identified no additional trials.
Our review summarised 16 trials with a total of 5001 participants. The trials compared various timeframes of infusion set replacement, from 1 to 7 days. Many studies were of low to medium quality. No evidence was found for differences in catheter-related bloodstream infection (CRBSI) with more frequent infusion set replacement (risk ratio (RR) 1·06, 95% CI 0·67–1·69) although less frequent infusion set replacement reduced all-cause bloodstream infection (RR 0·72, 0·54–0·98). One study suggested that less frequent infusion set replacement increased mortality within the neonatal population (RR 1·84, 1·00–3·36). No evidence revealed interactions between the effects of frequency of set replacement and subgroups of infusion (parenteral nutrition or fat emulsions), participant (adults, children, or neonates), or catheter (arterial or venous) type.
Previous studies did not provide a conclusive answer as to the optimal timing for infusion set replacement. Only two small studies tested use beyond 4 days. Some studies were limited to particular groups of patients, and costs were not considered. We concluded that a large trial was needed.
Added value of this study
In this large, randomised, controlled, pragmatic trial in ten hospitals, adult and paediatric patients with central venous access devices or peripheral arterial catheters were randomised to infusion set replacement every 7 days, or 4 days (controls). The study showed that 7-day compared with 4-day infusion set replacement for the prevention of CRBSI was equivalent for central venous access devices and non-inferior for peripheral arterial catheters. Costs were lower in the 7-day infusion set replacement group.
Implications of all the available evidence
Our trial indicates that 7-day compared with 4-day replacement of infusion sets is safe. Our results confirm the findings of previous, smaller trials in patients in intensive care and in patients with cancer. Extension of use to 7 days can substantially reduce workload and health-care costs.