Should a peripheral IV cannula be replaced to a fixed timetable, or removed only when there is a clinical reason?

An updated 2026 Cochrane review brings together 14 randomised controlled trials involving 11,428 participants

What the review examined

The Cochrane review compared two approaches to managing peripheral IV cannulas:

• Routine removal, where a cannula is removed and replaced after a set period.
• Clinically indicated removal, where it is removed when it is no longer needed, no longer functioning, uncomfortable or showing signs of a complication.

The review included 14 randomised controlled trials conducted in Australia, Brazil, China, India, Iran, Taiwan and the United Kingdom. Thirteen studies were conducted in acute hospitals and one in a community setting.

The evidence was rated low to moderate certainty. All included studies had a high risk of bias in at least one assessed area, and serious outcomes such as bloodstream infection and death were rare.

What the evidence found

Compared with routine removal, clinically indicated removal resulted in little to no difference in catheter-related bloodstream infection, primary bloodstream infection or local infection. There was also no clear difference in mortality.

Routine removal may produce a small reduction in infiltration and catheter occlusion when outcomes are measured per participant. However, the evidence for these findings was low certainty, and the review found little to no difference when infiltration and occlusion were measured per 1,000 catheter-days.

Clinically indicated removal was associated with a small reduction in device-related costs and a small reduction in the number of cannulas required per participant.

“The true effect may be substantially different from the estimate of the effect.”

This sentence from the review is important. It prevents a low-certainty result from being presented as a definitive instruction.

How this relates to current UK practice

The 2026 NIVAS Standards for Infusion Therapy and Vascular Access state that routine replacement is not always necessary when a PIVC remains clinically indicated and complication-free.

NIVAS also requires continuing review:

“…measures must be put in place to ensure the PIVC is continuously reviewed and not left in situ when no longer required.”

This is the practical connection between the review and UK governance. Clinically indicated removal does not mean leaving a cannula in place without structured assessment. It depends on regular review, recognition of complications, clear documentation and prompt removal when the device is no longer required or is no longer safe to use.

What organisations should do with this evidence

Organisations should compare the review and the NIVAS standards with their current local policy, infection-prevention requirements, patient population and monitoring arrangements.

The evidence does not justify an immediate or informal change to practice. Any policy change remains a clinical-governance decision owned by the employer or healthcare organisation.

Training should make the distinction clear: the decision is not simply routine replacement versus leaving the cannula alone. The real requirement is structured assessment, clinical judgement, escalation when concerns arise and removal when the device is no longer necessary.

This is evidence for careful policy review, not an instruction to change practice overnight and connect with VeinTrain to see how we can support you to make policy reviews and implementation part of the workflow of your own vein leaders. 

Related reading: Difficult IV Access, VAD Selection and Escalation: More Than a Technique Question.

VeinTrain's role

VeinTrain helps practitioners and organisations understand the evidence, practise structured assessment and connect learning with local policy and employer governance.

A VeinTrain certificate documents learning or training completion. It does not replace local employer competency sign-off, local policy, supervision, scope of practice or employer assurance.

Explore VeinTrain's Train the Trainer courses, or review the distinction between certificates and clinical competency.

Sources

Charles KR, Schults JA, Marsh N, Osborne SR, Rees S, Mihala G, Smith S and Rickard CM (2026). Clinically indicated removal versus routine removal of peripheral venous catheters. Cochrane Database of Systematic Reviews, Issue 1. DOI: 10.1002/14651858.CD007798.pub6. PubMed PMID: 41589916.

National Infusion and Vascular Access Society (NIVAS) (2026). Standards for Infusion Therapy and Vascular Access, first edition. See Standard 15.3, Practice Guidance H-I, printed page 32. Read the NIVAS standards.