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A Randomized Controlled Trial

Neil E. Soifer, MD; Steven Borzak, MD; Brian R. Edlin, MD; Robert A. Weinstein, MD

Arch Intern Med. 1998;158:473-477.

Background  More than 25 million patients have peripheral intravenous (IV) catheters placed each year in US hospitals. Infusion therapy is believed to account for one third of all nosocomial bacteremias.

Methods  We performed a randomized, prospective, controlled study in a university-affiliated hospital to determine whether the use of an IV therapy team decreases peripheral venous catheter–related complications in adult medical patients. Patients were randomized to undergo peripheral catheter insertion and/or maintenance either by the IV team or by medical house staff. A dedicated observer reviewed catheter sites daily; findings were applied to a scoring system to define the severity of complications. Bacteremic complications were reviewed by a physician.

Results  Patients with catheters started by the house staff and maintained by ward nursing staff more often had signs or symptoms of inflammation (21.7%) than did patients with catheters maintained by the IV team (7.9%) (P<.001). Patients monitored by the IV team had a greater mean number of catheters placed per patient than did patients monitored by house staff (2.1 and 1.6, respectively) (P<.01). Three episodes of catheter-related sepsis occurred in house staff patients and none in IV team patients (P=.004).

Conclusions  An IV therapy team significantly reduced both local and bacteremic complications of peripheral IV catheters. Timely replacement of the catheter appeared to be the most important factor in reducing the occurrence of complications.

From the Michael Reese Hospital and Medical Center, Chicago, Ill. Dr Borzak is now with the Department of Medicine, Henry Ford Hospital, Detroit, Mich; Dr Edlin is now with the Institute for Health Policy Studies, University of California, San Francisco; and Dr Weinstein is now with Cook County Hospital and Rush Medical College, Chicago.

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