4 results on '"Marsh, Nicole"'
Search Results
2. Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial.
- Author
-
Cadigan, Sue, Marsh, Nicole, Larsen, Emily, Genzel, Jodie, Rickard, Claire M, Webster, Joan, Cooke, Marie, and Mihala, Gabor
- Subjects
- *
CATHETERS , *INSERTION reactions (Chemistry) , *PATIENTS , *HOSPITALS , *FEASIBILITY studies - Abstract
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. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
3. Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial.
- Author
-
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, and Rickard, Claire M.
- Subjects
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 - Abstract
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. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
4. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients.
- Author
-
Keogh, Samantha, Flynn, Julie, Marsh, Nicole, Mihala, Gabor, Davies, Karen, and Rickard, Claire
- Subjects
INTRAVENOUS catheterization complications ,VASCULAR endothelium ,HEALTH outcome assessment ,PHLEBITIS ,SURGICAL hospitals ,ARTERIAL occlusions ,HEALTH of adults ,RANDOMIZED controlled trials ,PREVENTION ,BLOOD vessels ,CATHETERS ,COMPARATIVE studies ,INTRAVENOUS catheterization ,IRRIGATION (Medicine) ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL equipment ,RESEARCH ,SALT ,SEX distribution ,TIME ,PILOT projects ,EVALUATION research ,SPECIALTY hospitals ,TREATMENT effectiveness ,PROPORTIONAL hazards models ,MEDICAL equipment reliability ,KAPLAN-Meier estimator ,EQUIPMENT & supplies - Abstract
Background: Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices.Methods: This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis.Results: PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3-3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0-2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1-1.4], p < 0.01) significantly predicted PIVC failure.Conclusion: Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required.Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000025538 . Registered on 19 January 2015. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.