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Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial.
- Source :
- Trials; 10/4/2017, Vol. 18, p1-13, 13p, 1 Color Photograph, 1 Diagram, 3 Charts, 1 Graph
- Publication Year :
- 2017
-
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. [ABSTRACT FROM AUTHOR]
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 17456215
- Volume :
- 18
- Database :
- Complementary Index
- Journal :
- Trials
- Publication Type :
- Academic Journal
- Accession number :
- 125493184
- Full Text :
- https://doi.org/10.1186/s13063-017-2207-x