Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial

Autor: Emily Larsen, Peter Hancock, Raymond Javan Chan, David Wyld, Nicole Gavin, Abu Choudhury, Emily Russell, Sarah Northfield, Amanda J. Ullman, Nicole Marsh, Julie Flynn, Claire M. Rickard, Anthony M. Allworth, Gabor Mihala
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Catheter Obstruction
Male
Time Factors
Complications
medicine.medical_treatment
Polyurethanes
Medicine (miscellaneous)
Peripherally inserted central catheter (PICC)
Pilot Projects
law.invention
Central venous
0302 clinical medicine
Catheters
Indwelling
Randomized controlled trial
law
Acute care
Medicine
Central Venous Catheters
Pharmacology (medical)
030212 general & internal medicine
Treatment Failure
lcsh:R5-920
Chlorhexidine
Equipment Design
Middle Aged
Catheter
Patient Satisfaction
030220 oncology & carcinogenesis
Female
Vascular access devices
Queensland
lcsh:Medicine (General)
Adult
medicine.medical_specialty
Catheterization
Central Venous
Attitude of Health Personnel
Randomised controlled trials
Peripherally inserted central catheter
Catheterization
03 medical and health sciences
Patient satisfaction
Catheterization
Peripheral
Humans
Device Removal
Aged
Inpatients
Dressing and securement methods
business.industry
Research
Bandages
Surgery
Clinical trial
Intravenous therapy
Catheter-Related Infections
Anti-Infective Agents
Local
Feasibility Studies
Tissue Adhesives
business
Complication
Zdroj: Trials, Vol 18, Iss 1, Pp 1-13 (2017)
Trials
ISSN: 1745-6215
Popis: Background Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure. Methods This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged ≥ 16 years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU + SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL + Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA + SPU). All groups except TA + SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected. Results PICC failure incidence was: PAL + CHG + Tape (1/5; 20%; 17.4/1000 days), SPU + SSD + CHG (control) (4/39; 10%; 9.0/1000 days), TA + SPU (3/35; 9%; 9.6/1000 days), and CSD + CHG (3/42; 7%; 9.4/1000 days). Recruitment to PAL + CHG + Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD + CHG, TA + SPU (TA applied only at PICC insertion time), and control treatments were acceptable to patients and health professionals. Conclusion A large RCT of CSD + CHG and TA + SPU (but not PAL + CHG + Tape) versus standard care is feasible. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415 . Registered on 15 January 2016.
Databáze: OpenAIRE
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