***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 
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    ***EXAMPLES*** 
    Input: Background Although intravenous therapy is one of the most commonly performed procedures in hospitalized patients , it remains susceptible to infectious and noninfectious complications . Previous studies investigated peripheral intravenous catheter ( PIVC ) complications mainly in pediatrics , but apparently none were investigated among Saudi adult population s. The aim of this study was to assess the pattern and complications of PIVCs at King Abdulaziz Medical City ( KAMC ) , Riyadh , Saudi Arabia . Methods An observational prospect i ve cohort study investigated PIVCs pattern and complications among adults with PIVCs , admitted to various wards at KAMC .  PIVCs-related clinical outcomes ( pain , phlebitis , leaking , and others ) were recorded in 12-hour intervals , using the Visual Inspection Phlebitis scale . Density incidence ( DI ) and cumulative incidence ( CI ) of complications and their relative risks ( RRs ) were calculated . Regression analyses were applied and significance limits were set at P<0.05 . Results During the study period , 359 adults were included , mounting to 842 PIVCs and 2,505 catheter days . The majority of patients , 276 ( 76.9 % ) , had medical , chief admission complaints , whereas 83 ( 23.1 % ) were trauma/surgical and infectious cases .  Complicated catheters were found in 141 ( 39.3 % ) patients , with 273 complications ( 32.4/100 catheters ) , in 190 complicated catheters ( CI = 22.56/100 catheters and DI = 75.84/1,000 catheter days ) . Phlebitis ranked first among complications , 148 ( CI = 17.6 % ) , followed by pain 64 ( CI = 7.6 % ) , leaking 33 ( CI = 3.9 % ) , dislodgement 20 ( CI = 2.4 % ) , and extravasations and occlusion 4 ( CI = 0.5 % each ) . Phlebitis was predicted with female sex ( P<0.001 ) , insertion in fore/upper arm ( P=0.024 ) , and infusion of medication ( P=0.02 ) . Removal time for PIVCs insertion was not a significant predictor of phlebitis ( RR = 1.46 , P=0.08 ) . Conclusion Incidence of complications in this study was significantly higher than rates in previous studies . Better insertion techniques may be sought to lower the incidences of PIVC complications , thus extending their onset beyond day 3 . Changing catheters is recommended when clinical ly indicated rather than routinely post-72 hours 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 techniques of administering peripheral parenteral nutrition ( PPN ) were examined prospect ively to investigate the role of mechanical trauma in the development of infusion phlebitis .  Patients in group 1 ( n = 15 ) were fed via a st and ard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day . Group 2 patients ( n = 15 ) had a similar catheter sited in each forearm simultaneously , with rotation of the side of infusion each day . Patients in group 3 ( n = 17 ) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a st and ard cannula sited in the contralateral forearm , with alternation of infusion each day . Those in group 4 ( n = 13 ) had a fine-bore 23-G silicone catheter sited in one arm only . Patients in groups 1 , 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle . A total of 408 patient-days of PPN were given . Mean duration of PPN in groups 1 - 4 was 7.5 , 9 , 5.5 and 5 days respectively . Infusion phlebitis was not recorded in patients who had a daily change of cannula ( group 1 ) , but occurred in four patients in group 2 , eight in group 3 and eight in group 4 . Phlebitis scores were 0 , 9 , 15 and 12 for groups 1 - 4 respectively . Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter ( group 3 ) and in those fed continuously over 24 h ( group 4 ) . These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis . This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein Summary A prospect i ve , r and omised , controlled clinical study was performed to compare the incidence and severity of postoperative peripheral venous thrombophlebitis  associated with a single intravenous cannula used for both intra‐operative and postoperative purpose s , and two cannulae , one used intra‐operatively and the other postoperatively . Sixty American Society of Anaesthesiologists ( ASA ) physical status I or II patients aged 18–65 years undergoing elective surgery were studied . The technique of cannula insertion was st and ardised . After surgery , the cannulation sites were examined daily by a blinded investigator for the presence and severity of thrombophlebitis using the Baxter Scale . The two groups were similar in terms of age , gender , weight , type and duration of surgical procedures , and drugs and fluids administered both intra‐operatively and postoperatively . The proportion of patients that developed phlebitis was significantly less in the two cannulae group ( 26.1 % ) than in the single cannula group ( 63.3 % ) ( p < 0.0001 ) . The severity of phlebitis was greater in the single cannula group than in the two cannulae group . These results indicate that the use of a dedicated cannula for postoperative use decreases the incidence and severity of postoperative , peripheral , cannula‐related phlebitis INTRODUCTION Peripheral venous thrombophlebitis ( PVT ) represents a considerable source of iatrogenic morbidity , occurring in about 20 % of hospital in- patients . The aim of this prospect i ve r and omised study was to investigate the effect of elective change of intravenous cannulae on the incidence of PVT in hospital in- patients . PATIENTS AND METHODS General medical and surgical in patients requiring intravenous therapy were r and omised into control ( n = 26 ) or study ( n = 21 ) groups .  Cannulae in the control group were only removed if the site became painful , the cannula dislodged , or there were signs of PVT . Cannulae in the study group were changed electively every 48 h. All patients were examined daily for signs of PVT . RESULTS Peripheral venous thrombophlebitis developed in 11/26 patients in the control group and 1/21 patients in the study group ( P = 0.003 ) . Elective change of cannulae did not significantly increase the total number of cannulae sited ( 41 cannulae in the control group versus 43 in the study group ) . CONCLUSIONS Elective change of cannulae result ed in a significant reduction in the incidence of infusion phlebitis . The authors recommend that elective re-siting of intravenous cannulae becomes st and ard practice for all patients requiring intravenous therapy Background Millions of peripheral intravenous catheters are used worldwide . The current guidelines recommend routine catheter replacement every 72–96 h. This practice requires increasing healthcare re source use . The clinical ly indicated catheter replacement strategy is proposed as an alternative . Objectives To assess the cost effectiveness of clinical ly indicated versus routine replacement of peripheral intravenous catheters . Methods A cost-effectiveness analysis from the perspective of Queensl and Health , Australia , was conducted alongside a r and omized controlled trial . Adult patients with an intravenous catheter of expected use for longer than 4 days were r and omly assigned to receive either clinical ly indicated replacement or third-day routine replacement . The primary outcome was phlebitis during catheterization or within 48 h after catheter removal . Re source use data were prospect ively collected and valued ( 2010 prices ) . The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations . Additionally , value of information ( VOI ) and value of implementation analyses were performed . Results The clinical ly indicated replacement strategy was associated with a cost saving per patient of AU$7.60 ( 95 % confidence interval [ CI ] 4.96–10.62 ) and a non-significant difference in the phlebitis rate of 0.41 % ( 95 % CI −1.33 to 2.15 ) . The incremental net monetary benefit was AU$7.60 ( 95 % CI 4.96–10.62 ) . The expected VOI was zero , whereas the expected value of perfect implementation of the clinical ly indicated replacement strategy was approximately AU$5 million over 5 years . Conclusion The clinical ly indicated catheter replacement strategy is cost saving compared with routine replacement . It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinical ly indicated A peripheral intravenous catheter is often inserted as part of care during labour . The catheter is inserted into the back of the h and or lower forearm vein in usual practice . There is no trial data to guide the care provider on which is the better insertion site in any clinical setting . 307 women admitted to the labour ward who required insertion of intravenous catheter were r and omised to back of h and or lower forearm vein catheter insertion . Catheter insertion is by junior to mid- grade providers . We evaluated insertion success at the first attempt , pain during insertion and catheter replacement due to malfunction as main outcomes . After catheter removal , we recorded patient satisfaction with site , future site preference and insertion site swelling , bruising , tenderness , vein thrombosis and pain .  Insertion of a catheter into back of h and vein is more likely to be successful at the first attempt . Insertion pain score , catheter replacement rate , patient satisfaction , patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms . In conclusion , both insertion sites are suitable ; the back of the h and vein maybe easier to cannulate and seems to be preferred by our frontline providers Objective To find a subset of patients with suspected central venous catheter (CVC)-related infection ( CRI ) in whom CVC removal is not needed . Design R and omized controlled trial . Setting Thirty-three-bed ICU . Patients and participants One hundred and forty four patients with suspected CRI in which a change of CVCs was planned were evaluated for inclusion . Interventions Hemodynamically stable patients without proven bacteremia , no insertion site infection , and no intravascular foreign body were r and omized to a st and ard-of-care group ( SOC , all CVCs were changed as planned ) or a watchful waiting group ( WW , CVCs changed when bacteremia was subsequently confirmed or hemodynamic instability occurred).Measurement and results Study groups were compared for incidence of CVC-related bloodstream infection ( CR-BSI ) , resolution of fever , C- 
    Output:
    
The review found no evidence to support changing catheters every 72 to 96 hours .
Consequently , healthcare organisations may consider changing to a policy whereby catheters are changed only if clinical ly indicated .
This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications .