The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the editor
Editor, – In the article 'Controlling intravascular catheter infections' (Aust Prescr 2003;26:41-3), Table 2 states 'Routinely replace peripheral catheters within 48-72 hours...'.
The Centers for Disease Control in the USA found no evidence to support the routine changing of peripheral venous catheters. The 'Guidelines for the prevention of intravascular catheter-related infections' recommend: 'In adults replace catheter and rotate site no more frequently than every 72-96 hours. Replace catheters inserted under emergency basis and insert a new catheter at a different site within 48 hours. In pediatric patients, do not replace peripheral catheters unless clinically indicated.'1
Hospital bureaucracies frequently mandate routine changing of peripheral catheters within 72 hours, at the cost of great discomfort to patients and effort by resident medical officers. Given that routine changing of central lines has been shown to be unnecessary, and the daily infection risk quoted for peripheral cannulae is much lower than for central lines, it is also implausible that any benefit from routine changing of peripheral lines has been missed.
It would seem beneficial for Australian Prescriber to acquaint its readers with the evidence and discourage them from continuing what seems to be an unnecessary as well as painful custom.
- MMWR 2002 Aug 16;51:711. Appendix B.
- Smits H, Freedman LR. Prolonged venous catheterization as a cause of sepsis. N Engl J Med 1967:276:1229-33.
- Collignon PJ, Sorrell TC, Uther JB. Prevention of sepsis associated with the insertion of intravenous cannulae. The experience in a coronary care unit. Med J Aust 1985;142:346-8.
- Maki DG, Goldman DA, Rhame FS. Infection control in intravenous therapy. Ann Intern Med 1973;79:867-87.
- Collignon P. Intravascular catheter associated sepsis: a common problem. The Australian study on intravascular catheter associated sepsis. Med J Aust 1994;161:374-8.