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. 2013 Sep 15;2013(9):CD003588. doi: 10.1002/14651858.CD003588.pub3

Rickard 2004.

Methods Randomized controlled trial
Participants 251 ICU patients with a CVC receiving any combination of crystalloids, lipids and non‐lipid PN
Interventions Administration set changes at 72 hours or no change up to 144 hours
Outcomes
  • Catheter colonization

  • CR‐BSI

Notes Fluid container bags were changed every 24 hours
 Central catheters: 100%
 PN: separate data available for participants receiving PN
 Loss to follow‐up: 5%
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Adequate random sequence generation
Quote: "A computerised random‐number generator randomized each CVC to either receive a routine set change or have the original administration set left intact for the duration of catheterization" (p. 651)
Allocation concealment (selection bias) High risk Not originally reported, after checking with author: not adequately concealed
Blinding (performance bias and detection bias) 
 All outcomes Unclear risk Not discussed, not feasible because of study design
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Not discussed, not feasible because of study design
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Main outcome: CR‐BSI concealed: laboratory staff were blinded to the study group
Quote: "a blinded intensivist reviewed microbiological results .... and cases of systemic inflammatory response syndrome using strict definitions to diagnose" (p. 651)
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Quote: "29 (7.1%) of the CVCs were not cultured due to autopsy or lost or contaminated specimens ... these were equally distributed between the groups" (p. 652)
No information in manuscript re CR‐BSI missing outcomes; clarified with author, daily check of microbiological reporting system was undertaken
Selective reporting (reporting bias) Low risk No pre‐protocol
Primary outcome variables were specified and reported on