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

Anesth Analg. 2010 Jun 1;110(6):1624-9. doi: 10.1213/ANE.0b013e3181da8342. Epub 2010 Apr 30.


Background: In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We used MEDLINE and the Cochrane Controlled Trial Register up to August 10, 2009.

Methods: Two reviewers independently assessed trial quality and extracted data. Data on phlebitis were combined when appropriate, using a random-effects model. The impact of the risk of phlebitis in the control group (baseline risk) on the effect of in-line filters was studied by using meta-regression based on the bivariate meta-analysis model. The quality of the evidence was determined by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method.

Results: Eleven trials (1633 peripheral catheters) were included in this review to compare the effect of in-line filters on the incidence of phlebitis in hospitalized patients. Baseline risks across trials ranged from 23% to 96%. Meta-analysis of all trials showed that in-line filters reduced the risk of infusion-related phlebitis (relative risk, 0.66; 95% confidence interval, 0.43-1.00). This benefit, however, is very uncertain, because the trials had serious methodological shortcomings and meta-analysis revealed marked unexplained statistical heterogeneity (P < 0.0000, I(2) = 90.4%). The estimated benefit did not depend on baseline risk.

Conclusion: In-line filters in peripheral IV catheters cannot be recommended routinely, because evidence of their benefit is uncertain.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

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