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- Title
Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial.
- Authors
Chan, Raymond J.; Northfield, Sarah; Larsen, Emily; Mihala, Gabor; Ullman, Amanda; Hancock, Peter; Marsh, Nicole; Gavin, Nicole; Wyld, David; Allworth, Anthony; Russell, Emily; Choudhury, Md Abu; Flynn, Julie; Rickard, Claire M.
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>A large RCT of CSD + CHG and TA + SPU (but not PAL + CHG + Tape) versus standard care is feasible.<bold>Trial Registration: </bold>Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415 . Registered on 15 January 2016.
- Subjects
QUEENSLAND; CATHETER-related infections; PERIPHERALLY inserted central catheters; PERIPHERAL central venous catheterization; SURGICAL dressings; NOSOCOMIAL infections; BACTERICIDES; ADHESIVES in surgery; ATTITUDE (Psychology); CATHETERS; CHLORHEXIDINE; COMPARATIVE studies; HOSPITAL patients; INTRAVENOUS catheterization; RESEARCH methodology; MEDICAL cooperation; MEDICAL personnel; PATIENT satisfaction; POLYURETHANES; RESEARCH; TIME; PILOT projects; PRODUCT design; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; CENTRAL venous catheterization; MEDICAL equipment reliability; MEDICAL device removal; CENTRAL venous catheters; EQUIPMENT &; supplies; DIAGNOSIS; THERAPEUTICS; INFECTION prevention
- Publication
Trials, 2017, Vol 18, p1
- ISSN
1745-6215
- Publication type
journal article
- DOI
10.1186/s13063-017-2207-x