Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial.

Autor: Marsh N; Royal Brisbane and Women's Hospital, Herston, QLD, Australia.; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia., Webster J; Royal Brisbane and Women's Hospital, Herston, QLD, Australia.; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia., Larsen E; Royal Brisbane and Women's Hospital, Herston, QLD, Australia.; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia., Genzel J; Royal Brisbane and Women's Hospital, Herston, QLD, Australia.; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia., Cooke M; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia., Mihala G; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia.; School of Medicine, Griffith University, Gold Coast, QLD, Australia.; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD, Australia., Cadigan S; Royal Brisbane and Women's Hospital, Herston, QLD, Australia., Rickard CM; Royal Brisbane and Women's Hospital, Herston, QLD, Australia. c.rickard@griffith.edu.au.; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia. c.rickard@griffith.edu.au.; Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia. c.rickard@griffith.edu.au.
Jazyk: angličtina
Zdroj: Trials [Trials] 2018 Oct 17; Vol. 19 (1), pp. 564. Date of Electronic Publication: 2018 Oct 17.
DOI: 10.1186/s13063-018-2946-3
Abstrakt: Background: Peripheral intravenous catheters (PVCs) are essential invasive devices, with 2 billion PVCs sold each year. The comparative efficacy of expert versus generalist inserter models for successful PVC insertion and subsequent reliable vascular access is unknown.
Methods: A single-centre, parallel-group, pilot randomised controlled trial (RCT) of 138 medical/surgical patients was conducted in a large tertiary hospital in Australia to compare PVC insertion by (1) a vascular access specialist (VAS) or (2) any nursing or medical clinician (generalist model). The primary outcome was the feasibility of a larger RCT as established by predetermined criteria (eligibility, recruitment, retention, protocol adherence). Secondary outcomes were PVC failure: phlebitis, infiltration/extravasation, occlusion, accidental removal or partial dislodgement, local infection or catheter-related bloodstream infection; dwell time; insertion success, insertion attempts; patient satisfaction; and procedural cost-effectiveness.
Results: Feasibility outcomes were achieved: 92% of screened patients were eligible; two patients refused participation; there was no attrition or missing outcome data. PVC failure was higher with generalists (27/50, 54%) than with VASs (33/69, 48%) (228 versus 217 per 1000 PVC days; incidence rate ratio 1.05, 95% confidence interval 0.61-1.80). There were no local or PVC-related infections in either group. All PVCs (n = 69) were successfully inserted in the VAS group. In the generalist group, 19 (28%) patients did not have a PVC inserted. There were inadequate data available for the cost-effectiveness analysis, but the mean insertion procedure time was 2 min in the VAS group and 11 min in the generalist group. Overall satisfaction with the PVC was measured on an 11-point scale (0 = not satisfied and 10 = satisfied) and was higher in the VAS group (n = 43; median = 7) compared to the generalist group (n = 20; median = 4.5). The multivariable model identified medical diagnosis and bed-bound status as being significantly associated with higher PVC failure, and securement with additional non-sterile tape was significantly associated with lower PVC failure.
Conclusion: This pilot trial confirmed the feasibility and need for a large, multicentre RCT to test these PVC insertion models.
Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12616001675415 . Registered on 6 December 2016.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje