Ask an answerable question (PICO)：
Peripheral venous catheter (PVC) placement is the most common invasive clinical treatment during hospital care. According to Centres for Disease Control guidelines, recommend scheduled for replacement peripheral venous catheters is at least every 72-96 hours in adults to prevent phlebitis. However, frequent PVC replacement might increase pain and stress in patients, workload of nurses, as well as medical resource consumption. Therefore, empirical methods were used in this study to understand whether irregular replacement of PVCs caused increased incidence of phlebitis in adult patients.
The Method and Analysis of Literature Review：
This study used the PICO (patient–intervention–comparison–outcome) framework to analyze the clinical questions using the following keywords: adult patients with PVCs (P), clinically indicated replacement (I), routine replacement (C), and incidence of phlebitis (O). These keywords were connected using Boolean logic (i.e., “and” or “or”) to search for literature in PubMed, Cochrane Library, EMBASE, and Airiti Library (Chinese Electronic Periodical Services). Studies which published in last 5 years (2017–2021) with adult participants were included. The search was not limited to any language, and studies with a systematic review (SR) or meta-analysis design were preferred, followed by those with a randomized controlled trial (RCT) design. Studies that did not meet the inclusion criteria were excluded, such as children, non-peripheral intravenous catheter; and interventions that were not relatively routine and changed when symptomatic. Initially, 34 studies were acquired, which were then narrowed down to 1 SR study published in 2019 and 1 RCT study published in 2021 for the subsequent appraisal.
Critical Appraisal：
The UK Critical Appraisal Skills Programme checklist (2006) was employed for the appraisal of the SR study. The appraisal yielded a result of 9 points, indicating the study to be of high quality. For the RCT study, RoB 2.0 (2016), a revised Cochrane tool for risk-of-bias assessment in randomized trials was used for the appraisal, which yielded a low risk of bias for the study. These two studies, which investigated problems that commonly occurred in clinical setting, were verified by the appraisal to have satisfactory quality and evidence; thus, their findings could provide valuable references for clinical practice.
Results, Conclusions and Recommendations：
The empirical investigations revealed conclusion unclear on the relationship between the PVC replacement timings (replacement after identification of clinical symptoms vs. routine replacement) and incidence of phlebitis in adult patients. According to the SR study, the incidence of phlebitis was not significantly different between patients receiving PVC replacement at the aforementioned two timings. By contrast, the RCT study revealed a significantly higher incidence of phlebitis in patients receiving PVC replacement after identification of clinical symptoms than those receiving routine PVC replacement. Nevertheless, the SR study showed that the injection cost was higher in routine PVC replacement by approximately AU$7–AU$654 (equivalent to NT$159–NT$13,734) than in clinical-symptom-based replacement. Despite reducing the frequency of pain experienced by adult patients in PVC injection and cost spent in hospital stay, replacing PVCs after identification of clinical symptoms, could increase the incidence of phlebitis. Considering of patients’ safety, current study recommends that PVCs should be replaced regularly for the hospital to ensure patients’ safety and higher quality of care. Given the lack of Taiwanese research on related topics, future research may be conducted with a larger sample size in the context of Taiwan to increase the referential value of research findings to Taiwan hospitals.
