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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Should in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials

BS Niel-Weise, T Stijnen, and PJ van den Broek.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

This review concluded that in-line filters in peripheral intravenous catheters could not be recommended routinely because evidence of their benefit was uncertain. These conclusions were supported by the data and take into consideration the methodological limitations of the included studies, heterogeneity between studies and the possibility of publication bias.

Authors' objectives

To assess the effect of in-line filters on infusion-related phlebitis associated with peripheral intravenous catheters.

Searching

MEDLINE and The Cochrane Library were searched to August 2009 for full-text published studies. Search terms were reported and the full strategy was available as a web appendix. Reference lists of retrieved studies were screened. No language restrictions were applied.

Study selection

Randomised controlled trials (RCTs) or quasi-randomised trials that assessed in-line filters and reported sufficient data to calculate the risk of phlebitis in both treatment and control groups were eligible for inclusion. Studies needed to define phlebitis.

Study populations included surgical, medical, general hospital, paediatric oncology and cardiac patients. Patients were assumed to have received short peripheral catheters (<7.5cm) except in two trials that reported using long peripheral catheters (7.5cm to 20cm). Intravenous solutions included hyperalimentation, isotonic glucose, cephalothin, clear fluids, buffered solutions and "various kinds of fluids and additives". In-line filters ranged from 0.22μm to 0.5μm. Control groups received dummy filters or no filter. Phlebitis was diagnosed based on various clinical findings.

Two reviewers independently assessed studies for inclusion. Disagreements were resolved through consensus.

Assessment of study quality

Two reviewers independently assessed studies according to criteria of concealment of treatment allocation, randomisation, double blinding, completeness of follow-up, use of intention-to-treat analysis, selective reporting of events and premature discontinuation of the trial due to benefit. Disagreements were resolved through consensus.

Data extraction

Two reviewers independently extracted data to enable calculation of relative risk (RR) and 95% confidence intervals (CIs).

Methods of synthesis

Summary relative risks and 95% CIs were estimated using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using X2 and I2. Publication bias was assessed using a funnel plot. Subgroup analyses were not defined a priori.

Results of the review

Eleven RCTs (1,633 peripheral catheters) were included. All trials were double blinded. Seven trials reported adequate concealment of treatment allocation. Two trials provided an adequate description of drop-outs. None of the trials conducted an intention-to-treat analysis. No trials were stopped early due to benefit. Baseline risk of phlebitis ranged from 23% to 96%.

In-line filters were associated with a borderline decrease in risk of phlebitis (RR 0.66, 95% CI 0.43 to 1.00). There was substantial heterogeneity (p<0.001, I2=90%). Seven studies showed no difference associated with in-line filters. Four studies indicated strong treatment effects (RR<0.5). Catheter type, filter type and study quality did not explain the observed heterogeneity.

There was no evidence of funnel plot asymmetry, but publication bias could not be excluded due to the small number of included studies.

Authors' conclusions

In-line filters in peripheral intravenous catheters could not be recommended routinely because evidence of their benefit was uncertain.

CRD commentary

The review addressed a clear question supported by defined inclusion criteria. The literature search was adequate for published studies. No language restrictions were applied. Restriction to published studies risked publication bias, which was assessed in the review and could not be excluded. Appropriate steps were taken to minimise bias and errors at all stages of the review process. Study quality was assessed using relevant criteria and the results were reported and considered in the analysis. Appropriate methods were used to pool studies and these included assessment and investigation of heterogeneity.

The authors conclusions were supported by the data and took into consideration the methodological limitations of the included studies, heterogeneity between studies and the possibility of publication bias.

Implications of the review for practice and research

Practice: The authors stated that in-line filters in peripheral intravenous catheters could not be recommended routinely.

Research: The authors stated a need for large high-quality RCTs to assess the benefit of in-line filters, determine which in-line filter was most effective in reducing phlebitis and assess their cost effectiveness. Such trials should include direct measures of clinical outcomes and express risks as incidence per unit time (such as 100 catheter days).

Funding

Not stated.

Bibliographic details

Niel-Weise BS, Stijnen T, van den Broek PJ. Should in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials Anesthesia and Analgesia 2010; 110(6): 1624-1629. [PubMed: 20435946]

Indexing Status

Subject indexing assigned by NLM

MeSH

Data Interpretation, Statistical; Evidence-Based Medicine; Filtration; Humans; Infusions, Intravenous /adverse effects /instrumentation; Phlebitis /epidemiology /prevention & control; Quality Control; Randomized Controlled Trials as Topic /standards; Risk Assessment; Treatment Outcome

AccessionNumber

12010004611

Database entry date

24/08/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20435946

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