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

Article


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.. 2017. "Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial." Trials. 18 (1), pp. 1-13. https://doi.org/10.1186/s13063-017-2207-x
Article 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

ERA Journal ID35155
Article CategoryArticle
AuthorsChan, Raymond J. (Author), Northfield, Sarah (Author), Larsen, Emily (Author), Mihala, Gabor (Author), Ullman, Amanda (Author), Hancock, Peter (Author), Marsh, Nicole (Author), Gavin, Nicole (Author), Wyld, David (Author), Allworth, Anthony (Author), Russell, Emily (Author), Choudhury, Md Abu (Author), Flynn, Julie (Author) and Rickard, Claire M. (Author)
Journal TitleTrials
Journal Citation18 (1), pp. 1-13
Article Number458
Number of Pages13
Year2017
Place of PublicationUnited Kingdom
ISSN1745-6215
Digital Object Identifier (DOI)https://doi.org/10.1186/s13063-017-2207-x
Web Address (URL)https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2207-x
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≥16years 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%; 17.4/1000days), SPU+SSD+CHG (control) (4/39; 10%; 9.0/1000days), TA+SPU (3/35; 9%; 9.6/1000days), and CSD+CHG (3/42; 7%; 9.4/1000days). 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 onlyat PICCinsertion 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.

KeywordsCatheterization; Central venous; Complications; Dressing and securement methods; Peripherally inserted central catheter (PICC); Randomised controlled trials; Vascular access devices
ANZSRC Field of Research 2020420506. Sub-acute care
420501. Acute care
420599. Nursing not elsewhere classified
Byline AffiliationsDepartment of Health, Queensland
Queensland University of Technology
Griffith University
Institution of OriginUniversity of Southern Queensland
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