***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Unplanned recannulations are a common occurrence in a number of hospitals both in the UK and worldwide ( Schwengel , 2004 ; Jackson , 2007 ) . In May 2008 the Clinical Nurse Specialist in IV Therapy at Brighton and Sussex University Hospital ( BSUH ) NHS Trust initiated a clinical audit to assess i.v . practice and determine the impact of recannulations within the Trust . The audit , which was initially carried out on 1000 sequential cannula insertions , and is currently ongoing , showed that 69.2 % of the cannulas failed well before the routine change of 72 hours , and that 36.3 % were removed because they had infiltrated . With the aim of reducing these numbers of unscheduled recannulations , the Nurse Specialist initiated a real-time , prospect i ve clinical evaluation of a new cannula stabilization device at BSUH . This assessed the impact of the device alongside the currently used securement strategy ( i.v . dressing ) on unscheduled i.v . restarts in 50 cannulas compared with the baseline data . During the clinical evaluation , all i.v.s were tracked every 4 hours and all complication/ reasons for removal were noted . On initiation of the use of the stabilization device , the infiltration rate was reduced from the baseline level by 100%.There was also an 81 % reduction in the rate of unscheduled i.v . restarts . The data from the clinical evaluation demonstrated the considerable benefits of using a cannula stabilization device compared with the current hospital practice of using i.v . dressings only for securement with regard to infiltration levels and unplanned restarts . This device may have significant future benefits in terms of improving patient care and reducing healthcare expenditure A prospect i ve r and omized clinical trial has been conducted to compare the clinical performance , with prolonged use , of two film-type transparent dressings used over subclavian and jugular single-lumen venous catheters . ' OpSite ' , a traditional dressing with a moderate moisture vapour permeability was compared with a new dressing of high moisture vapour permeability , ' OpSite IV3000 ' . Information was collected daily to assess the nature and incidence of complications , dressing durability and the ease of application and removal .  One hundred and one patients provided two well-matched population s receiving a total of 153 dressings for a total of 780 catheter-days . No differences between the two dressings were noted with respect to the incidence of complications , such as moisture accumulation or lifting , and dressing durability . The low incidence of catheter-related sepsis ( ' OpSite ' group three episodes and ' OpSite IV3000 ' group one episode ) suggests that transparent dressings do not increase this risk . This clinical study demonstrated the new ' OpSite IV3000 ' to be easier to h and le , leading to better application , improved catheter fixation and easy removal Background Peripheral intravenous device ( IVD ) complications were traditionally thought to be reduced by limiting dwell time . Current recommendations are to resite IVDs by 96 hours with the exception of children and patients with poor veins . Recent evidence suggests routine resite is unnecessary , at least if devices are inserted by a specialised IV team . The aim of this study was to compare the impact of peripheral IVD ' routine resite ' with ' removal on clinical indication ' on IVD complications in a general hospital without an IV team . Methods A r and omised , controlled trial was conducted in a regional teaching hospital . After ethics approval , 362 patients ( 603 IVDs ) were r and omised to have IVDs replaced on clinical indication ( 185 patients ) or routine change every 3 days ( 177 patients ) . IVDs were inserted and managed by the general hospital medical and nursing staff ; there was no IV team . The primary endpoint was a composite of IVD complications : phlebitis , infiltration , occlusion , accidental removal , local infection , and device-related bloodstream infection . Results IVD complication rates were 68 per 1,000 IVD days ( clinical ly indicated ) and 66 per 1,000 IVD days ( routine replacement ) ( P = 0.86 ; HR 1.03 ; 95 % CI , 0.74 - 1.43 ) . Time to first complication per patient did not differ between groups ( KM with log rank , P = 0.53 ) . There were no local infections or IVD-related bloodstream infections in either group . IV therapy duration did not differ between groups ( P = 0.22 ) , but more ( P = 0.004 ) IVDs were placed per patient in the routine replacement ( mean , 1.8 ) than the clinical indication group ( mean , 1.5 ) , with significantly higher hospital costs per patient ( P < 0.001 ) . Conclusions Resite on clinical indication would allow one in two patients to have a single cannula per course of IV treatment , as opposed to one in five patients managed with routine resite ; overall complication rates appear similar . Clinical ly indicated resite would achieve savings in equipment , staff time and patient discomfort . There is growing evidence to support the extended use of peripheral IVDs with removal only on clinical indication . Registration numberAustralian New Zeal and Clinical Trials Registry ( ANZCTR ) Number ACTRN12608000421336 Four dressing regimens for peripheral venous catheters were studied in a prospect i ve r and omized clinical trial with 2088 Teflon catheters : ( 1 ) sterile gauze , replaced every other day , and three dressings left on for the lifetime of the catheter ; ( 2 ) gauze ; ( 3 ) a transparent polyurethane dressing ; and ( 4 ) an iodophor-transparent dressing . The four dressings provided comparable coverage , except moisture accumulated more frequently under the transparent dressings ( 26 % to 28 % vs 20 % to 21 % ) . Cutaneous colonization under the dressing was low level and comparable with all four dressings ( range , 10(0.58 ) to 10(0.70 ) colony-forming units ) . The rate of local catheter-related infection ( greater than or equal to 15 colony-forming units ) was also low and did not differ significantly ( range , 4.6 % to 5.9 % ) ; no catheter caused bacteremia . Stepwise logistic multivariate analysis showed cutaneous colonization of the insertion site ( relative risk [ RR ] of infection , 3.86 ) , contamination of the catheter hub ( RR , 3.78 ) , moisture under the dressing ( RR , 2.48 ) , and prolonged catheterization ( RR , 1.75 ) to be significant risk factors for catheter-related infection . These data indicate that it is not cost-effective to redress peripheral venous catheters at periodic intervals ; for most patients , either sterile gauze or a transparent dressing can be used and left on until the catheter is removed The use of a sterile transparent dressing ( Venigard , Consoli date d Medical Equipment , London ) was compared to the use of a non-sterile tape ( Mefix , Molnlycke , Sweden ) for securing peripheral cannulae in paediatric patients . Children from all medical specialties were prospect ively r and omised into one of two groups . The failure of a cannula ( defined as the removal of the cannula before treatment was completed ) was plotted against duration in each of the two groups . Statistical tests ( life table analysis ) suggested no significant difference ( p = > 0.05 ) . The authors conclude that the use of a sterile transparent dressing  secures peripheral cannula as effectively as non-sterile tape A prospect i ve , controlled study was undertaken in a skilled nursing facility to determine whether a sterile catheter securement device ( StatLock i.v . , Venetec International , Mission Viejo , CA ) would provide better intravenous therapy outcomes than a st and ard securement technique . The StatLock-device result ed in significantly longer average catheter dwell times ( 3.95 days versus 2.45 days ) and significantly fewer total complications ( 65 versus 155 ) . In addition , the securement device reduced the total time spent managing a vascular access device by 13.5 minutes per patient . Thus , the StatLock i.v . device improved overall clinical outcomes of i.v . therapy and the quality of care OBJECTIVE To identify risk factors for  infusion-related phlebitis with peripheral intravenous catheters . DESIGN A r and omized trial of two catheter material s , with consideration of 21 potential risk factors . SETTING A university hospital . PATIENTS Hospitalized adults without granulocytopenia who received a peripheral intravenous catheter .  INTERVENTIONS House officers or ward nurses inserted the catheters , and each insertion was r and omized to a catheter made of tetrafluoroethylene-hexafluoropropylene ( FEP-Teflon ) or a novel polyetherurethane without leachable additives ( PEU-Vialon ) . MEASUREMENTS Research nurses scored insertion sites each day for inflammation and cultured catheters at removal . RESULTS The Kaplan-Meier risk for phlebitis exceeded 50 % by day 4 after catheterization . intravenous antibiotics ( relative risk , 2.00 ) , female sex ( relative risk , 1.88 ) , prolonged ( greater than 48 hours ) catheterization ( relative risk , 1.79 ) , and catheter material ( PEU-Vialon : FEP-Teflon ) ( relative risk , 0.73 ) strongly predicted phlebitis in a Cox proportional hazards model ( each , P less than 0.003 ) . The best-fit model for severe phlebitis identified the same predictors plus catheter-related infection ( relative risk , 6.19 ) , phlebitis with a previous catheter ( relative risk , 1.54 ) , and anatomic site ( h and : forearm , relative risk , 0.71 ; wrist : forearm , relative risk , 0.60 ) . The low incidence of local catheter-related infection was comparable with the two catheter material s ( 5.4 % [ 95 % CI , 3.8 % to 7.6 % ] and 6.9 % [ CI , 4.9 % to 9.6 % ] ) ; none of the 1054 catheters prospect ively studied caused bacteremia . CONCLUSIONS Multiple factors , including the infusate and the duration of cannulation , contribute to the development of infusion-related phlebitis . The use of peripheral intravenous catheters made of PEU-Vialon appears to pose the same risk for catheter-related infection as the use of catheters made of FEP-Teflon , and PEU-Vialon can permit longer cannulation with less risk for phlebitis . The risk for catheter-related bacteremia with FEP-Teflon and PEU-Vialon catheters is sufficiently low that it no longer seems justifiable to recommend the use of small steel needles for most peripheral intravenous therapy STUDY OBJECTIVES To prospect ively assess the relative risk for phlebitis in a series of consecutive patients with pneumonia and to identify risk factors that predict an increased risk for phlebitis . SETTING Internal medicine department of a tertiary teaching hospital . PATIENTS Seven hundred sixty-six consecutive patients with acute pneumonia receiving IV therapy .  INTERVENTIONS Only the first catheter was taken into account . There were 308 short lines ( a 51-mm , 18-gauge Teflon catheter ) ; 307 midsized lines ( a 28-cm , 16-gauge polyvinyl chloride catheter ) ; and 151 long lines ( 71-cm , 14-gauge plain polyurethane catheter ) . Eighteen variables were prospect ively evaluated in an open , nonr and omized study for their contribution to the occurrence of phlebitis . RESULTS The overall phlebitis rate was 39 % . Phlebitis developed in 53 % of patients with short lines , in 41 % of patients with midsized lines , and in 10 % of patients with long lines , and these catheters remained in place an average ( + /- SD ) of 3.0+/-2.4 days , 4.6+/-3.4 days , and 7.8+/-6.6 days , respectively . The variables that influenced the development of phlebitis , as determined by multivariate analysis , were the following : type of catheter ; blood hemoglobin levels ; and IV therapy with either  corticosteroids  or  erythromycin .  CONCLUSIONS According to our data , when the use of a catheter is expected to be required for < or = 36 h , a short line can be used . If a longer duration is expected , a longer line is warranted . Ours is the first study in which the relationship between blood hemoglobin levels and phlebitis has been reported . Because the use of intravascular devices is increasingly common , a more complete knowledge of the factors that influence their acceptance has become essential Previous studies of various br and s of polyurethane dressings have noted differences in the rates of catheter colonization . We compared Bioclusive transparent polyurethane ( TP ) dressing with a cotton gauze ( CG ) dressing on peripheral intravenous ( IV ) access sites for the incidence of phlebitis , catheter tip colonization , skin colonization , and catheter-related bacteremia . The study , involving 598 ward patients , was case controlled , prospect i ve , and r and omized for a period of 4 months . Each patient was entered into the study only once , and all dressings were applied by a member of the IV therapy team . No significant difference was seen for phlebitis rate ( TP : 9 
    Output:
    
It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters .