Infusion Set Extension Decreases Healthcare Utilization Without Increasing Risk of Infection

Extension of infusion-set use to 7 days among patients with a central venous access device (CVAD) or peripheral artery catheter (PAC) was found to reduce health care costs and nurse workloads without increasing the rate of device-related infections. These findings from a randomized, controlled, assessor-masked trial (Australian New Zealand Clinical Trials Registry Identifier: ACTRN12610000505000) were published in The Lancet.

Patients (N=2944) of any age who had a CVAD or PAC were recruited from 10 hospitals across Australia from 2011to 2016. Stratified by device type, patients were randomly assigned in a 1:1 ratio to receive infusion-set replacement every 7 (n=1481) or 4 (n=1460) days. Infections, costs, and workloads were assessed.

In the 7- and 4-day groups, the median ages of adult patients were 59 years and 57 years, the median ages of pediatric patients were 3.2 years and 2.3 years, 63.1% and 62.7% of the study population were of male sex, 75.9% and 75.1% had a CVAD, and 24.1% and 24.9% had a PAC, respectively.

Among patients with a CVAD, catheter-related bloodstream infections (CRBSI) were found among 1.78% of the 7-day and 1.46% of the 4-day groups (absolute risk difference [ARD], 0.32%; 95% CI, -0.73 to 1.37). The risk of CRBSI per 1000 days did not differ between the 2 groups (hazard ratio [HR], 1.33; 95% CI, 0.69-2.57; P =.40) nor did time to CRBSI (P =.45).

Removal of CVADs occurred among 16.5% of patients due to concern about CRBSI, but only 9.8% were confirmed (P =.57). Among patients with a PAC, 0.28% of the 7-day and 0% of the 4-day groups had CRBSI (ARD, 0.28%; 95% CI, -0.27 to 0.83). More PACs were removed because of suspected CRBSI (10%) than were confirmed (0.14%). Most confirmed cases of CRBSI were caused by Gram-positive bacteria (62.2%).

The patients in the 7-day group received a median of 1 fewer infusion-set replacement procedure and 1 fewer individual infusion-set replacement (both P <.0001). These reduced replacement rates corresponded to AU$483 (89%) savings for patients with a CVAD and AU$43 (66%) savings for patients with a PAC. The median time nurses saved for the 7-day group was 174 minutes for CVADs and 7 minutes for PACs.

This study may have been biased by the inability of researchers to mask patient assignment to the clinical staff. However, the study authors concluded that an extended infusion-set use for patients with a CVAD or a PAC reduced healthcare utilization and costs without increasing the risk of CRBSI.

Disclosure: Several study authors declared affiliations with the vascular access products industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Rickard CM, Marsh NM, Larsen EN, et al. Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)–non-inferiority (peripheral arterial catheter) trial. Lancet. 2021;397(10283):1447-1458. doi:10.1016/S0140-6736(21)00351-2