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Mariano-Gomes PM, Ouverney-Braz A, Oroski-Paes G. Adverse events with arterial catheters in intensive care units: a scoping review. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00028-4. [PMID: 39004562 DOI: 10.1016/j.enfie.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/25/2024] [Accepted: 04/03/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION The installation of an arterial line is one of the invasive procedures performed for hemodynamic monitoring and, even with its clear importance in intensive care, it is still an invasive procedure and liable to cause harms to the patients. OBJECTIVE To identify the adverse events associated with the use of arterial catheters in critically-ill patients in the world scientific production. METHODOLOGY The present scoping review was conducted according to the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used for reporting. The research question was "Which adverse events related to the use of arterial catheters in patients admitted to intensive care are more evident in the literature?". Data collection took place in the following databases: LILACS; MEDLINE; EMBASE; CINAHL, EBSCOhost; and WEB OF SCIENCE. RESULTS Through the search strategies, 491 articles were found in the databases. After exclusion of duplicates, peer analysis of titles and abstracts, full reading and screening of lists of references, the final sample of studies included was 38 articles. The main harms cited by the publications were as follows: limb ischemia, thrombosis, hemorrhage, accidental removal, inadvertent connection of inadequate infusion solution, pseudoaneurysm and bloodstream infection. CONCLUSIONS It was evidenced that patients are subjected to risks of adverse events from the insertion moment to removal of the arterial catheter, focusing on the infusion solution used to fill the circuit, the type of securement and dressings chosen, as well as the Nursing care measures for the prevention of bloodstream infection.
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Affiliation(s)
- P M Mariano-Gomes
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - A Ouverney-Braz
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - G Oroski-Paes
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Schults JA, Reynolds H, Rickard CM, Culwick MD, Mihala G, Alexandrou E, Ullman AJ. Dressings and securement devices to prevent complications for peripheral arterial catheters. Cochrane Database Syst Rev 2024; 5:CD013023. [PMID: 38780138 PMCID: PMC11112983 DOI: 10.1002/14651858.cd013023.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail, requiring reinsertion. Dressings and securement devices maintain AC function and prevent complications such as infection. OBJECTIVES To evaluate the effectiveness of peripheral AC dressing and securement devices to prevent failure and complications in hospitalised people. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus up to 16 May 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to 16 May 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different dressing and securement devices for the stabilisation of ACs in hospitalised people. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias using Cochrane's RoB 1 tool. We resolved disagreements by discussion, or by consulting a third review author when necessary. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included five RCTs with 1228 participants and 1228 ACs. All included studies had high risk of bias in one or more domains. We present the following four comparisons, with the remaining comparisons reported in the main review. Standard polyurethane (SPU) plus tissue adhesive (TA) compared with SPU: we are very uncertain whether use of SPU plus TA impacts rates of AC failure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.20 to 0.98; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Neither study (165 participants) reported catheter-related bloodstream infections (CRBSI), thus we are very uncertain whether SPU plus TA impacts on the incidence of CRBSI (very low-certainty evidence). It is very uncertain whether use of SPU plus TA impacts AC dislodgement risk (RR 0.54, 95% CI 0.03 to 9.62; I² = 44%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts AC occlusion rates (RR 1.20, 95% CI 0.37 to 3.91; I² = 3%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts rates of adverse events with few reported events across groups (RR 0.89, 95% CI 0.09 to 8.33; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Bordered polyurethane (BPU) compared to SPU: we are very uncertain whether use of BPU impacts rates of AC failure (RR 0.67, 95% CI 0.21 to 2.13; 1 study, 60 participants; very low-certainty evidence). BPU may make little or no difference to CRBSI compared to SPU (RR 3.05, 95% CI 0.12 to 74.45; I² = not applicable as 1 study (60 participants) reported 0 events; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to the risk of AC dislodgement compared with SPU (RR 0.75, 95% CI 0.17 to 3.22; I² = 0%; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to occlusion risk compared with SPU (RR 0.80, 95% CI 0.60 to 1.07; I² = 0%; 2 studies, 572 participants; low-certainty evidence). It is very uncertain whether BPU impacts on the risk of adverse events compared with SPU (RR 0.33, 95% CI 0.01 to 7.87; 1 study, 60 participants; very low-certainty evidence). SPU plus sutureless securement devices (SSD) compared to SPU: we are very uncertain whether SPU plus SSD impacts risk of AC failure compared with SPU (RR 0.78, 95% CI 0.40 to 1.52; I² = 0%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain if SPU plus SSD impacts CRBSI incidence rate with no events in both groups (2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of dislodgement (RR 0.14, 95% CI 0.01 to 2.57; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of AC occlusion (RR 1.94, 95% CI 0.50 to 7.48; I² = 38%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain whether SPU plus SSD impacts on the risk of adverse events (RR 1.94, 95% CI 0.19 to 20.24; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). Integrated securement dressings compared to SPU: integrated securement dressings may result in little or no difference in risk of AC failure compared with SPU (RR 1.96, 95% CI 0.80 to 4.84; 1 study, 105 participants; low-certainty evidence); may result in little or no difference in CRBSI incidence with no events reported (1 study, 105 participants; low-certainty evidence); may result in little or no difference in the risk of dislodgement (RR 0.33, 95% CI 0.04 to 3.04; 1 study, 105 participants; low-certainty evidence), may result in little or no difference in occlusion rates with no events reported (1 study, 105 participants; low-certainty evidence), and may result in little or no difference in the risk of adverse events (RR 0.35, 95% CI 0.01 to 8.45; 1 study, 105 participants; low-certainty evidence). AUTHORS' CONCLUSIONS There is currently limited rigorous RCT evidence available about the relative clinical effectiveness of AC dressing and securement products. Limitations of current evidence include small sample size, infrequent events, and heterogeneous outcome measurements. We found no clear difference in the incidence of AC failure, CRBSI, or adverse events across AC dressing or securement products including SPU, BPU, SSD, TA, and integrated securement products. The limitations of current evidence means further rigorous RCTs are needed to reduce uncertainty around the use of dressing and securement devices for ACs.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Heather Reynolds
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Gabor Mihala
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Centre of Children's Health Research, South Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
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Kurata Y, Ohira G, Hayano K, Imanishi S, Tochigi T, Takahashi Y, Mamiya H, Iwata M, Uesato M, Murakami K, Toyozumi T, Matsumoto Y, Nakano A, Otsuka R, Hayashi H, Matsubara H. Peripherally inserted central catheter securement with cyanoacrylate glue and bloodstream infection: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:215-223. [PMID: 38047542 DOI: 10.1002/jpen.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Treatment via a peripherally inserted central venous catheter is important for anticancer treatment, perioperative management, and nutrition management. In this study, we aimed to investigate the usefulness of cyanoacrylate glue (CG) in managing peripherally inserted central venous catheters in adults. METHODS This retrospective cohort study enrolled 411 adults requiring a central venous catheter for treatment in the Chiba University Esophageal-Gastro-Intestinal Surgery department between January 2021 and October 2022. The preventive effect of CG in reducing adverse events, including infection, tip migration, and thrombus formation, was evaluated by reviewing electronic medical records, chest radiographs, and contrast-enhanced computed tomography scans. RESULTS CG and other dressings were used in 158 (CG group) and 253 (control group) patients, respectively. The incidence of catheter infection based on the clinical course was lower in the CG group (3.2%) than in the control group (9.1%; P = 0.03). However, cases of infection confirmed by blood or catheter cultures did not differ between the CG (1.3%) and control (1.9%) groups (P = 1.0). Chest radiographs revealed that catheter tip migration (mean ± SD) was lesser in the CG group (8.2 ± 6.7 mm) than in the control group (15.0 ± 15.8 mm; P < 0.01). There were two cases of venous thrombus formation in the control group. CONCLUSION In a population dominated by esophago-gastroenterological malignancy, peripherally inserted central catheter securement via CG was associated with decreased catheter removal because of suspected catheter infection. Further research on larger cohorts is needed to determine if other adverse events decrease following peripherally inserted central catheter securement via CG.
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Affiliation(s)
- Yoshihiro Kurata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yumiko Takahashi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisashi Mamiya
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Moe Iwata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akira Nakano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Piersigilli F, Iacona G, Yazami S, Carkeek K, Hocq C, Auriti C, Danhaive O. Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications. Eur J Pediatr 2023; 182:5607-5613. [PMID: 37816981 DOI: 10.1007/s00431-023-05253-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
A "bundle" is defined as a combination of evidence-based interventions that, if followed collectively and reliably, improve patient outcomes. The aim of this quasi-experimental study, conducted in a level-III NICU in Belgium, was to assess the impact of central line dressing and maintenance bundle implementation on the rate of catheter-related mechanical complications. We performed a quality improvement (QI) project. Prior to bundle implementation, neonatal PICC lines were secured by Steri-Strip® and occlusive dressing. We implemented a new PICC bundle consisting of the use of glue, sutureless device (Griplock®), and a transparent dressing to secure the catheter to the skin. We compared the rate of infections, mechanical complications, and dislocations before and after bundle implementation (periods 1 and 2, respectively). The use of glue resulted in a significantly decreased rate of central line-associated bloodstream infection (CLABSI) (p < 0.001), dislocations, and mechanical complications (p < 0.0001). During period 2, there was a significant increase for the average number of days the catheter stayed in place (p < 0.05). We did not observe catheter breakage or patient skin irritations attributable to the use of glue (not even in ELBW infants). CONCLUSION The implementation of the new bundle to secure neonatal PICCs in our NICU was associated with a significant reduction in CLABSI and dislodgment rates, without glue-related complications. Active surveillance of CVC placement procedure, positioning, and management, as well as analysis of related complications is crucial for improving patient safety. Continuous implementation of up-to-date central line bundles based on best practice recommendations is a key for quality improvement in NICUs. WHAT IS KNOWN • Stable vascular access is crucial in the NICU. Neonatal PICC securement issues can have serious consequences and are associated with device failure. WHAT IS NEW • Catheter securement with tissue adhesive is safe and effective in reducing failure and complication rates in the neonatal population.
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Affiliation(s)
- Fiammetta Piersigilli
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium.
| | - Giulia Iacona
- Faculty of Medicine, Imperial College London, London, UK
| | - Sarah Yazami
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Katherine Carkeek
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
| | - Catheline Hocq
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
| | - Cinzia Auriti
- Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Olivier Danhaive
- Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium
- Division of Neonatology, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
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Padilla-Nula F, Bergua-Lorente A, Farrero-Mena J, Escolà-Nogués A, Llauradó-Mateu M, Serret-Nuevo C, Bellon F. Effectiveness of cyanoacrylate glue in the fixation of midline catheters and peripherally inserted central catheters in hospitalised adult patients: Randomised clinical trial (CIANO-ETI). SAGE Open Med 2023; 11:20503121231170743. [PMID: 37152837 PMCID: PMC10155010 DOI: 10.1177/20503121231170743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Objective The objective of the study was to assess the efficacy of the use of cyanoacrylate glue (CAG) as a means of securing midline catheters and peripherally inserted central catheters with the modified micro-Seldinger technique in adult hospitalised patients. Methods Randomised clinical trial with two groups (1:1): control and intervention. The control group received a securement method with a sutureless device plus transparent dressing and the intervention group received the same securement method plus the CAG. The study was approved by the Drug Research Ethics Committee of the Lleida Health Region. Results A total of 216 patients were assessed. The two groups of the trial were homogenously distributed in terms of sociodemographic and clinical variables. The intervention group had a statistically significant lower incidence of peri-catheter bleeding and/or oozing during the 7-day study period (odds ratio (OR), 0.6; 95% confidence level (CI), 0.44-0.81; p < 0.001) and a statistically significant lower incidence of catheter dislodgements during the first 24 h (OR, 0.2; 95% CI, 0.04-0.91; p = 0.03). There were no statistically significant differences in the incidence of phlebitis (OR, 1.30; 95% CI, 0.60-2.83; p = 0.56) or catheter-related pain (OR, 0.88; 95% CI, 0.40-1.94; p = 0.84). Conclusion Midline catheters and peripherally inserted central catheters secured with CAG had fewer complications than catheters not secured with this adhesive.
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Affiliation(s)
- Ferran Padilla-Nula
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Alejandro Bergua-Lorente
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Jordi Farrero-Mena
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Anna Escolà-Nogués
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Miriam Llauradó-Mateu
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Carme Serret-Nuevo
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Filip Bellon
- GESEC Group, Department of Nursing and
Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida,
Spain
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Abstract
BACKGROUND Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant. PURPOSE This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. RESULTS The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type. IMPLICATIONS FOR PRACTICE AND RESEARCH In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.
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A Revolutionary, Proven Solution to Vascular Access Concerns: A Review of the Advantageous Properties and Benefits of Catheter Securement Cyanoacrylate Adhesives. JOURNAL OF INFUSION NURSING 2022; 45:154-164. [PMID: 35537003 DOI: 10.1097/nan.0000000000000467] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravascular catheters are widely used among hospitals; however, their failure rates are high, up to 50%, when secured by traditional techniques, such as tape and gauze. The use of catheter securement cyanoacrylate adhesives provides a unique approach to the issues surrounding the use of traditional securement techniques for vascular access devices by providing significant securement strength, barrier properties, antibacterial properties, hemostatic properties, and flexibility. The purpose of this research was to perform a thorough and systematic review of the current literature existing regarding the use of cyanoacrylate adhesive for the care and maintenance of vascular access devices.
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Pittiruti M, Annetta MG, Marche B, D'Andrea V, Scoppettuolo G. Ten years of clinical experience with cyanoacrylate glue for venous access in a 1300-bed university hospital. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35439068 DOI: 10.12968/bjon.2022.31.8.s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade.
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Affiliation(s)
- Mauro Pittiruti
- Vascular Access Specialist and Vascular Access Team Member, Department of Surgery, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Maria Giuseppina Annetta
- Vascular Access Specialist and Vascular Access Team Member, Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Bruno Marche
- Vascular Access Specialist and Vascular Access Team Member, Department of Hematology, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Vito D'Andrea
- Neonatologist, Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Giancarlo Scoppettuolo
- Infectious Disease Specialist, and Consultant for the Vascular Access Team, Department of Infectious Disease, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
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McBride CA, Rahiman S, Schlapbach LJ, Schults JA, Kleidon TM, Kennedy M, Paterson RS, Byrnes J, Ware RS, Ullman AJ. Comparing ivWatch biosensor to standard care to identify extravasation injuries in the paediatric intensive care: a protocol for a randomised controlled trial. BMJ Open 2022; 12:e047765. [PMID: 35190407 PMCID: PMC8862432 DOI: 10.1136/bmjopen-2020-047765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries. METHODS AND ANALYSIS A single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children's Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals. ETHICS AND DISSEMINATION This study received approval from the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12620000317998.
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Affiliation(s)
- Craig Antony McBride
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Department of Intensive Care Medicine and Neonatology, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jessica A Schults
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Health, Herston, Queensland, Australia
| | - Tricia M Kleidon
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Melanie Kennedy
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Rebecca S Paterson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Robert S Ware
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Amanda Judith Ullman
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
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10
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Pearse I, Corley A, Bartnikowski N, Fraser JF. In vitro testing of cyanoacrylate tissue adhesives and sutures for extracorporeal membrane oxygenation cannula securement. Intensive Care Med Exp 2021; 9:5. [PMID: 33502631 PMCID: PMC7840820 DOI: 10.1186/s40635-020-00365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO is delivered via large-bore cannulae which must be effectively secured to avoid complications including cannula migration, dislodgement and accidental decannulation. Growing evidence suggests tissue adhesive (TA) may be a practical and safe method to secure vascular access devices, but little evidence exists pertaining to securement of ECMO cannulae. The aim of this study was to determine the safety and efficacy of two TA formulations (2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate) for use in peripherally inserted ECMO cannula securement, and compare TA securement to 'standard' securement methods. METHODS This in vitro project assessed: (1) the tensile strength and flexibility of TA formulations compared to 'standard' ECMO cannula securement using a porcine skin model, and (2) the chemical resistance of the polyurethane ECMO cannulae to TA. An Instron 5567 Universal Testing System was used for strength testing in both experiments. RESULTS Securement with sutures and n-butyl-2-octyl cyanoacrylate both significantly increased the force required to dislodge the cannula compared to a transparent polyurethane dressing (p = 0.006 and p = 0.003, respectively) and 2-octyl cyanoacrylate (p = 0.023 and p = 0.013, respectively). Suture securement provided increased flexibility compared to TA securement (p < 0.0001), and there was no statistically significant difference in flexibility between 2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate (p = 0.774). The resistance strength of cannula polyurethane was not weakened after exposure to either TA formulation after 60 min compared to control. CONCLUSIONS Tissue adhesive appears to be a promising adjunct method of ECMO cannula insertion site securement. Tissue adhesive securement with n-butyl-2-octyl cyanoacrylate may provide comparable securement strength to a single polypropylene drain stitch, and, when used as an adjunct securement method, may minimise the risks associated with suture securement. However, further clinical research is still needed in this area.
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Affiliation(s)
- India Pearse
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.,School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
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11
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Larsen EN, Corley A, Mitchell M, Lye I, Powell M, Tom S, Mihala G, Ullman AJ, Gibson V, Marsh N, Kleidon TM, Rapchuk IL, Rickard CM. A pilot randomised controlled trial of dressing and securement methods to prevent arterial catheter failure in intensive care. Aust Crit Care 2021; 34:38-46. [DOI: 10.1016/j.aucc.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
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12
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Dressings and Securement Devices of Peripheral Arterial Catheters in Intensive Care Units and Operating Theaters: A Systematic Review. Dimens Crit Care Nurs 2020; 39:242-250. [PMID: 32740194 DOI: 10.1097/dcc.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemodynamic monitoring, implemented by the placement of peripheral arterial catheters (PACs), is a characterizing aspect of the intensive care units. Peripheral arterial catheters can continually detect blood pressure and quickly conduct blood sampling. The use of PACs is generally considered safe, without serious complications. Currently, only 25% of the implanted catheters are actually subject to complications, including accidental removal, dislocation, occlusion, and infection. All of these complications arise from inadequate catheter stabilization at the level of the skin. This study aimed to summarize and describe the effectiveness and characteristics of dressings and securement devices for catheter stabilization. METHODS A systematic review of literature from the following databases was conducted: MEDLINE, CINAHL, Cochrane, EMBASE, and OvidSP. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to guide article selection and reporting. RESULTS Herein 626 articles were referred, with 5 directly related to the topic under discussion. We found 3 studies that describe PAC failure and 4 about dislodgement. We described 6 types of dressings or securement devices and classified them into 3 categories for classifying PAC dressings or securement devices. These were detected and grouped as adhesive tissues, sutureless devices, and transparent polyurethane dressings. CONCLUSIONS Current research indicates that transparent polyurethane dressings offer the most effective catheter stabilization, but adhesive tissues may constitute a valid alternative. However, there are limited high-quality studies about effective dressings and securement devices for PACs.
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13
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Munday J, Higgins N, Mathew S, Dalgleish L, Batterbury AS, Burgess L, Campbell J, Delaney LJ, Griffin BR, Hughes JA, Ingleman J, Keogh S, Coyer F. Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review. J Multidiscip Healthc 2020; 13:647-660. [PMID: 32821111 PMCID: PMC7419608 DOI: 10.2147/jmdh.s255785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. METHODS This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. RESULTS From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. CONCLUSION Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
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Affiliation(s)
- Judy Munday
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Health and Nursing Science, University of Agder, Grimstad, 4879, Norway
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Niall Higgins
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Saira Mathew
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Lizanne Dalgleish
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Anthony S Batterbury
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Luke Burgess
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Jill Campbell
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Lori J Delaney
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Colleges of Health and Medicine, Australian National University, Acton, ACT2601, Australia
| | - Bronwyn R Griffin
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - James A Hughes
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Jessica Ingleman
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, 4111, Australia
| | - Fiona Coyer
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
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14
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Corley A, Marsh N, Ullman AJ, Rickard CM. Tissue adhesive for vascular access devices: who, what, where and when? ACTA ACUST UNITED AC 2019; 26:S4-S17. [PMID: 29068728 DOI: 10.12968/bjon.2017.26.19.s4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite vascular access devices (VADs) being vital for patient care, device failure rates are unacceptably high with around 25% of central venous devices, and 30-40% of peripheral venous devices, developing complications that result in VAD failure. The use of tissue adhesive is a novel method of securing VADs and is gaining popularity, however the evidence base guiding its clinical use is still emerging. This article aims to review the types and properties of tissue adhesives, provide an overview of the existing evidence base, and discuss how tissue adhesives may be used in clinical practice.
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Affiliation(s)
- Amanda Corley
- Adjunct Research Fellow, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland and PhD candidate, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Nicole Marsh
- Research Fellow Vascular Access at both AVATAR, Menzies Health Institute Queensland Griffith University and Royal Brisbane and Women's Hospital, Herston, Queensland, and PhD candidate, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- Paediatric Director and Industry Liaison, AVATAR, Menzies Health Institute Queensland, Griffith University, Queensland, Senior Lecturer, School of Nursing and Midwifery, Griffith University, Queensland and Honorary Research Fellow, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Claire M Rickard
- Principal Director, AVATAR, Menzies Health Institute Queensland, Griffith University, Queensland, Professor School of Nursing and Midwifery, Griffith University, Queensland and Visiting Scholar, Royal Brisbane and Women's Hospital, Queensland, Australia
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15
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Schults JA, Long D, Pearson K, Takashima M, Baveas T, Schlapbach LJ, Macfarlane F, Ullman AJ. Insertion, management, and complications associated with arterial catheters in paediatric intensive care: A clinical audit. Aust Crit Care 2019; 33:326-332. [PMID: 31201037 DOI: 10.1016/j.aucc.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/25/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Peripheral arterial catheters (PAC) are used for haemodynamic monitoring and blood sampling in paediatric critical care. Limited data are available regarding PAC insertion and management practices, and how they relate to device function and failure. This information is necessary to inform future interventional research. OBJECTIVES The primary objective of this study was to describe PAC insertion and management practices, and associated complications. Secondary objectives were to determine patient and clinical characteristics associated with risk of PAC successful insertion and failure. METHODS A prospective, observational study was conducted in the anaesthetic department and paediatric intensive care unit of a tertiary paediatric facility. Data were collected on PAC insertion, PAC management and PAC removal. Standard incidence and prevalence were calculated per 1,000 device days. Risk factors for multiple insertions and PAC failure were identified using Cox regression. RESULTS A total of 100 catheters in 89 children were examined capturing 472 device days. PACs were primarily inserted for blood sampling (78%) in the radial artery (78%) using ultrasound guidance (67%), with 31% inserted on first attempt. Heparin saline solution was used in 82% of devices. Median catheter dwell was 50.6 hours (IQR 24.0 - 158.0), with PAC failure occurring in 19 devices (20%), at a rate of 40.2 per 1000 catheter days (95% CI 25.7 - 63.1). Arm board immobilisation (HR 2.9; 95% CI 1.02-8.02; p = 0.05), higher PIM3 score (HR 1.06; 95% CI 1.03-1.09; p < 0.01) was associated with an increased the risk of PAC failure, and non-2% chlorhexidine antisepsis was associated with a decrease in PAC failure (HR 0.32; 95% CI 0.11-0.96; p = 0.04), in univariate analysis. CONCLUSIONS PAC insertion is challenging, and failure is common. Prospective clinical trial data is needed to identify high risk patient groups and to develop interventions which optimise practices, thereby reducing failure.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia.
| | - Debbie Long
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Kylie Pearson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Mari Takashima
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia
| | - Thimitra Baveas
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Fiona Macfarlane
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia
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16
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Sasaki K, Shiga T, Gómez de Segura IÁ. Advantages of a Novel Device for Arterial Catheter Securement in Anesthetized Dogs: A Pilot Randomized Clinical Trial. Front Vet Sci 2019; 6:171. [PMID: 31214608 PMCID: PMC6558175 DOI: 10.3389/fvets.2019.00171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 12/04/2022] Open
Abstract
Arterial catheters are used for intraoperative continuous direct blood pressure monitoring in dogs. Factors such as bending and occlusion of the cannula are believed to be involved in direct blood pressure measurement failure. However, no method has been proposed to improve the maintenance of arterial catheter patency in veterinary medicine. The aim of this pilot study was to evaluate the patency of arterial catheters when using an arterial catheter securement device in the dorsal pedal artery of dogs under general anesthesia. Client-owned dogs (n = 120) were anesthetized for surgical procedures, during which direct arterial blood pressure was monitored using an arterial catheter secured with conventional film dressing and medical tape. A securement device, allowing an angle of 12.5° to the skin surface of the dorsal pedal area, was used in 50% of the dogs (n = 60). Significant reductions were observed in the frequency of catheter flushing and rate of occlusion in the experimental group compared to the control group (13.3 vs. 35.0%, relative risk [RR]: 0.381, 95% confidence interval [CI]: 0.183–0.792, P = 0.001 and 8.3 vs. 23.3%, RR: 0.376, 95% CI: 0.145–0.977, P = 0.044, respectively). The Kaplan-Meier curves for assessing the probability of occlusion were significantly different between the groups (P = 0.042). In conclusion, this pilot study suggests that the novel arterial catheter securement device is effective for achieving stable securement of the catheter hub in the dorsal pedal artery and for maintaining a longer duration of arterial catheter patency in dogs under general anesthesia. Therefore, the use of an arterial catheter securement device in the dorsal pedal artery of dogs would be useful for continuous hemodynamic monitoring and improve patient safety when direct arterial blood pressure monitoring is required in dogs undergoing general anesthesia.
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Affiliation(s)
- Kazumasu Sasaki
- Small Animal Emergency and Critical Care Service, Sendai Animal Care and Research Center, Sendai, Japan.,Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Department of Preclinical Evaluation, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Takuya Shiga
- Department of Anesthesiology and Perioperative Medicine, Tohoku University, Sendai, Japan
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17
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Dang FP, Li HJ, Tian JH. Comparative efficacy of 13 antimicrobial dressings and different securement devices in reducing catheter-related bloodstream infections: A Bayesian network meta-analysis. Medicine (Baltimore) 2019; 98:e14940. [PMID: 30946317 PMCID: PMC6455863 DOI: 10.1097/md.0000000000014940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.
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Affiliation(s)
| | - Hui-Ju Li
- School of Nursing of Lanzhou University
| | - Jin-Hui Tian
- School of Nursing of Lanzhou University
- Key Laboratory of Clinical Translational Research and Evidence-based Medicine of Gansu Province, Lanzhou, Gansu, China
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18
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Ullman AJ, Mihala G, O'Leary K, Marsh N, Woods C, Bugden S, Scott M, Rickard CM. Skin complications associated with vascular access devices: A secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2018; 91:6-13. [PMID: 30658228 DOI: 10.1016/j.ijnurstu.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. OBJECTIVES To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. DESIGN Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. SETTINGS Six hospitals (metropolitan and regional) in Queensland, Australia. PARTICIPANTS The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. ANALYSIS Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. RESULTS Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1-50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5-306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296; 2.9%), and dermatitis for central devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. CONCLUSIONS Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Kate O'Leary
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Christine Woods
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Simon Bugden
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Mark Scott
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia
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19
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Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years. Turk J Emerg Med 2018; 19:12-15. [PMID: 30793059 PMCID: PMC6370908 DOI: 10.1016/j.tjem.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Peripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6 h and 24 h following insertion. Material and methods We designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. Results PIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1–26.7) vs. 25.6% with standard care group (95% CI: 11.9–39.3). There was no statistically significant difference between two groups (p = 0.33). The number of patients for 24 h follow-up was not enough and the obtained data could not be included in the study. Discussion In this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. Conclusion Even though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.
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20
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Zhang S, Guido AR, Jones RG, Curry BJ, Burke AS, Blaisdell ME. Experimental study on the hemostatic effect of cyanoacrylate intended for catheter securement. J Vasc Access 2018; 20:79-86. [PMID: 29923442 DOI: 10.1177/1129729818779702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE: The use of cyanoacrylate for intravenous catheter securement is of interest to clinicians and patients, because of the superior adhesive strength and hemostatic effect of cyanoacrylate compared to current securement devices. The purpose of this study is to use novel in vitro and in vivo testing methods to analyze the hemostatic effect of a catheter securement cyanoacrylate (cyanoacrylate). METHODS: An unprecedented in vitro method was performed to determine the effects of a cyanoacrylate on a customized modified activated clotting time assay and blood flow inhibition assay by exposing blood or plasma to either one or three drops of cyanoacrylate. For the in vivo testing, full-thickness incisions were made on swine, and the bleeding was scored prior to treatment and at 3, 6, 9, and 12 min after treatment. RESULTS: The cyanoacrylate rapidly achieved hemostasis in the presence of anticoagulated whole blood, platelet-poor plasma, and non-anticoagulated whole blood, in vitro. The cyanoacrylate achieved hemostasis 12-fold faster than thromboplastin in the modified activated clotting time assay. The cyanoacrylate does not alter normal blood clotting, as measured by prothrombin time. In vivo, the bleeding score of cyanoacrylate prior to treatment and at 3, 6, 9, and 12 min after treatment were 2.3 ± 1.0, 0.3 ± 0.5, 0.2 ± 0.5, 0.2 ± 0.4, and 0.2 ± 0.4, respectively. CONCLUSION: This study indicates that cyanoacrylate demonstrates a potent mechanical hemostatic effect and cyanoacrylate in the presence of anticoagulated whole blood has an activated clotting time that is 12 times quicker than thromboplastin. The cyanoacrylate was found to be significantly equivalent to two known hemostatic agents, in vivo.
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Reynolds H, Ullman AJ, Culwick MD, Mihala G, Alexandrou E, Schults JA, Rickard CM. Dressings and securement devices to prevent complications for peripheral arterial catheters. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Heather Reynolds
- Royal Brisbane and Women's Hospital; Department of Anaesthesia and Perioperative Medicine; Brisbane Queensland Australia 4111
- The University of Queensland; Brisbane Queensland Australia 4111
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
| | - Amanda J Ullman
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
- Griffith University; School of Nursing and Midwifery, Menzies Health Institute Queensland; Brisbane Queensland Australia
| | - Martin D Culwick
- Royal Brisbane and Women's Hospital; Department of Anaesthesia and Perioperative Medicine; Brisbane Queensland Australia 4111
- The University of Queensland; Brisbane Queensland Australia 4111
| | - Gabor Mihala
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
- School of Medicine, Griffith University; Centre for Applied Health Economics, Menzies Health Institute Queensland; University Drive Meadowbrook Queensland Australia 4131
| | - Evan Alexandrou
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
- Western Sydney University; School of Nursing and Midwifery; Building EBLG. Room 44, Parramatta South Campus Locked Bag 1797 Penrith NSW 2751 Penrith Australia 2751
| | - Jessica A Schults
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
- Griffith University; School of Nursing and Midwifery, Menzies Health Institute Queensland; Brisbane Queensland Australia
- Lady Cilento Children’s Hospital; Department of Anaesthesia and Pain Management; Level 7, Centre for Children’s Health Research 62 Graham Street Brisbane Queensland Australia 4101
| | - Claire M Rickard
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Nathan Campus Brisbane Queensland Australia 4111
- Griffith University; National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland; Brisbane Queensland Australia 4111
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Bull T, Corley A, Smyth DJ, McMillan DJ, Dunster KR, Fraser JF. Extracorporeal membrane oxygenation line-associated complications: in vitro testing of cyanoacrylate tissue adhesive and securement devices to prevent infection and dislodgement. Intensive Care Med Exp 2018. [PMID: 29532189 PMCID: PMC5847637 DOI: 10.1186/s40635-018-0171-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) delivers cardiac and/or respiratory support to critically ill patients who have failed conventional medical therapies. If the large-bore cannulas used to deliver ECMO become infected or dislodged, the patient consequences can be catastrophic. ECMO cannula-related infection has been reported to be double the rate of other vascular devices (7.1 vs 3.4 episodes/1000 ECMO days respectively). The aim of this study was to assess the ability of cyanoacrylate tissue adhesive (TA) to inhibit bacterial growth at the ECMO cannulation site, and the effectiveness of TA and securement devices in securing ECMO cannulas and tubing. Methods This in vitro study tested the (1) antimicrobial qualities of TA against standard transparent dressing with ECMO cannula; (2) chemical compatibility between cannula, TA and removal agent; (3) pull-out strength of transparent dressing and TA at the cannula insertion site; and (4) pull-out strength of adhesive bandage and commercial sutureless securement devices (SSDs) on circuit tubing. Fisher’s exact test was used to evaluate differences in bacterial growth observed between the transparent dressing and TA groups. Data from mechanical testing were analysed using one-way ANOVA, followed by Tukey’s multiple comparison test or t test as appropriate. Statistical significance was defined as p < 0.05. Results No bacterial growth occurred under TA-covered cannulas compared with transparent dressing-covered cannulas (p = 0.002). Compared to plates lacking TA or transparent dressing, growth was observed at the insertion point and under the dressing in the transparent dressing group; however, no growth was observed in the TA group (p = 0.019). TA did not weaken the cannulas; however, the TA removal agent did after 60 min of exposure, compared with control (p < 0.01). Compared with transparent dressing, TA increased the pull-out force required for cannula dislodgement from the insertion point (p < 0.0001). SSDs significantly increased the force required to remove the tubing from the fixation points compared with adhesive bandage (p < 0.01). Conclusions Our findings suggest that the combined use of TA at the cannula insertion site with a commercial device for tubing securement could provide an effective bedside strategy to prevent or minimise infection and line dislodgement.
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Affiliation(s)
- Taressa Bull
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Level 3 Clinical Sciences Building, Rode Rd, Chermside, 4032, Queensland, Australia.
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Level 3 Clinical Sciences Building, Rode Rd, Chermside, 4032, Queensland, Australia
| | - Danielle J Smyth
- Bacterial Pathogenesis Laboratory, Queensland Institute of Medical Research, Herston Rd, Herston, 4006, Queensland, Australia
| | - David J McMillan
- Inflammation and Healing Research Cluster, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, 4556, Queensland, Australia
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Level 3 Clinical Sciences Building, Rode Rd, Chermside, 4032, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Level 3 Clinical Sciences Building, Rode Rd, Chermside, 4032, Queensland, Australia
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Rickard CM, Marsh NM, Webster J, Gavin NC, Chan RJ, McCarthy AL, Mollee P, Ullman AJ, Kleidon T, Chopra V, Zhang L, McGrail MR, Larsen E, Choudhury MA, Keogh S, Alexandrou E, McMillan DJ, Mervin MC, Paterson DL, Cooke M, Ray-Barruel G, Castillo MI, Hallahan A, Corley A, Geoffrey Playford E. Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial. BMJ Open 2017; 7:e015291. [PMID: 28619777 PMCID: PMC5734285 DOI: 10.1136/bmjopen-2016-015291] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent PICC failure; however, no large randomised controlled trial (RCT) has compared alternative approaches. We designed this RCT to assess the clinical and cost-effectiveness of dressing and securements to prevent PICC failure. METHODS AND ANALYSIS Pragmatic, multicentre, 2×2 factorial, superiority RCT of (1) dressings (chlorhexidine gluconate disc (CHG) vs no disc) and (2) securements (integrated securement dressing (ISD) vs securement device (SED)). A qualitative evaluation using a knowledge translation framework is included. Recruitment of 1240 patients will occur over 3 years with allocation concealment until randomisation by a centralised service. For the dressing hypothesis, we hypothesise CHG discs will reduce catheter-associated bloodstream infection (CABSI) compared with no CHG disc. For the securement hypothesis, we hypothesise that ISD will reduce composite PICC failure (infection (CABSI/local infection), occlusion, dislodgement or thrombosis), compared with SED. SECONDARY OUTCOMES types of PICC failure; safety; costs; dressing/securement failure; dwell time; microbial colonisation; reversible PICC complications and consumer acceptability. Relative incidence rates of CABSI and PICC failure/100 devices and/1000 PICC days (with 95% CIs) will summarise treatment impact. Kaplan-Meier survival curves (and log rank Mantel-Haenszel test) will compare outcomes over time. Secondary end points will be compared between groups using parametric/non-parametric techniques; p values <0.05 will be considered to be statistically significant. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/15/QRCH/241) and Griffith University (Ref. No. 2016/063). Results will be published. TRIAL REGISTRATION Trial registration number is: ACTRN12616000315415.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Nicole C Gavin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Raymond J Chan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alexandra L McCarthy
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Peter Mollee
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Patient Safety Enhancement Program, University of Michigan Health System and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Rural Health, Monash University, Churchill, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Western Sydney University and Liverpool Hospital, Sydney, Australia
| | - David J McMillan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Merehau Cindy Mervin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David L Paterson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrew Hallahan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Ullman A, Marsh N, Rickard C. Securement for vascular access devices: looking to the future. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S24-S26. [PMID: 28453328 DOI: 10.12968/bjon.2017.26.8.s24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda Ullman
- Senior Lecturer, School of Nursing and Midwifery, Griffith University, Alliance for Vascular Access Teaching and Research
| | - Nicole Marsh
- Nurse Researcher and PhD Candidate, Royal Brisbane and Women's Hospital, Alliance for Vascular Access Teaching and Research Group, Griffith University
| | - Claire Rickard
- Professor of Nursing, School of Nursing and Midwifery, Griffith University, Alliance for Vascular Access Teaching and Research, Australia
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Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study). Intensive Care Med 2016; 42:1753-1765. [PMID: 27734108 DOI: 10.1007/s00134-016-4582-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe all post-insertion complications involving most used intravascular access, and to determine whether the use of a new-generation transparent dressing (3M™ IV Advanced) might reduce their number and impact on ICU patient outcomes. METHODS Patients older than 18, with an expected length of stay ≥48 h and requiring at least one central venous catheter (CVC), arterial catheter (AC), haemodialysis catheter (HDC), pulmonary arterial catheters (PAC) or peripheral venous catheter (PVC) were randomized into two groups: a new-generation transparent dressing, or the hospital's classical transparent dressing, and were followed daily for any infectious and non-infectious complications. Complications were graduated for severity by an independent international multicentre multidisciplinary panel of practitioners using a Delphi process. RESULTS We included 628 patients, 2214 catheters (873 PVCs, 630 CVCs, 512 ACs and 199 HDCs and PACs) and 4836 dressings. Overall incidence rate was of 60.9/1000 catheter-days. The most common complication was dysfunction (34.6/1000 catheter-days), mainly for PVCs (16/1000 catheter-days) and ACs (12.9/1000 catheter-days). Infectious complications incidence rate in CVCs and ACs was of 14.5/1000, mostly due to colonization (14.2/1000 catheter-days). Thrombosis incidence was of 3.8/1000 catheter-days with severe and very severe complications in 16 cases (1.8/1000 catheter-days) and one thrombosis-related death. 3M™ IV Advanced dressing did not decrease the rate of catheters with at least a minor complication [57.37/1000 vs. 57.52/1000 catheter-days, HR 1.03, CI (0.84-1.27), p = 0.81]. Incidence rates for each single complication remained equivalent: infectious [HR 0.93 (0.62-1.40), p = 0.72], deep thrombosis [HR 0.90 (0.39-2.06), p = 0.80], extravasation and phlebitis [HR 1.40 (0.69-2.82), p = 0.35], accidental removal [1.07 (0.56-2.04), p = 0.84] and dysfunction [HR 1.04 (0.80-1.35), p = 0.79]. CONCLUSION The ADVANCED study showed the overall risk of complications to intravascular catheters in ICU patients being dysfunction, infection and thrombosis. The 3M™ IV Advanced dressing did not decrease complication rates as compared to standard dressings.
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Tuffaha HW, Gordon LG, Scuffham PA. Value of Information Analysis Informing Adoption and Research Decisions in a Portfolio of Health Care Interventions. MDM Policy Pract 2016; 1:2381468316642238. [PMID: 30288400 PMCID: PMC6125050 DOI: 10.1177/2381468316642238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/01/2016] [Indexed: 01/13/2023] Open
Abstract
Background: Value of information (VOI) analysis quantifies the value of additional research in reducing decision uncertainty. It addresses adoption and research decisions simultaneously by comparing the expected benefits and costs of research studies. Nevertheless, the application of this approach in practice remains limited. Objectives: To apply VOI analysis in health care interventions to guide adoption decisions, optimize trial design, and prioritize research. Methods: The analysis was from the perspective of Queensland Health, Australia. It included four interventions: clinically indicated catheter replacement, tissue adhesive for securing catheters, negative pressure wound therapy (NPWT) in caesarean sections, and nutritional support for preventing pressure ulcers. For each intervention, cost-effectiveness analysis was performed, decision uncertainty characterized, and VOI calculated using Monte Carlo simulations. The benefits and costs of additional research were considered together with the costs and consequences of acting now versus waiting for more information. All values are reported in 2014 Australian dollars (AU$). Results: All interventions were cost-effective, but with various levels of decision uncertainty. The current evidence is sufficient to support the adoption of clinically indicated catheter replacement. For the tissue adhesive, an additional study before adoption is worthwhile with a four-arm trial of 220 patients per arm. Additional research on NPWT before adoption is worthwhile with a two-arm trial of 200 patients per arm. Nutritional support should be adopted with a two-arm trial of 1200 patients per arm. Based on the expected net monetary benefits, the studies were ranked as follows: 1) NPWT (AU$1.2 million), 2) tissue adhesive (AU$0.3 milliion), and 3) nutritional support (AU$0.1 million). Conclusions: VOI analysis is a useful and practical approach to inform adoption and research decisions. Efforts should be focused on facilitating its integration into decision making frameworks.
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Affiliation(s)
- Haitham W. Tuffaha
- Haitham W. Tuffaha, Centre for Applied
Health Economics, School of Medicine, Griffith University, Meadowbrook,
Queensland 4131, Australia; telephone: 61 7 338 21156; fax: 61 7 338 21338;
e-mail:
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Rickard CM, Edwards M, Spooner AJ, Mihala G, Marsh N, Best J, Wendt T, Rapchuk I, Gabriel S, Thomson B, Corley A, Fraser JF. A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients. J Crit Care 2016; 36:35-42. [PMID: 27546745 DOI: 10.1016/j.jcrc.2016.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. MATERIALS AND METHODS Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU; control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU). Midtrial, due to safety, the TA+SPU intervention was replaced with a suture + TA+SPU group. RESULTS A total of 221 patients were randomized with 2 postrandomization exclusions. Central venous access device failure was as follows: suture + BPU controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56 (0.26/1000 hours, P=.560); SSD+SPU, 4 (7%) of 55 (1.04/1000 hours, P=.417); TA+SPU, 4 (17%) of 23 (2.53/1000 hours, P=.049); and suture + TA+SPU, 0 (0%) of 30 (P=.263; intention-to-treat, log-rank tests). Central venous access device failure was predicted (P<.05) by baseline poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval, 1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2; 95% confidence interval, 3.0-68.4). CONCLUSIONS Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
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Affiliation(s)
- C M Rickard
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia.
| | - M Edwards
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - A J Spooner
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - G Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Meadowbrook, 4131, Queensland, Australia.
| | - N Marsh
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, 4006, Queensland, Australia.
| | - J Best
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - T Wendt
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - I Rapchuk
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - S Gabriel
- Cardiac Surgery Research Unit, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - B Thomson
- Department of Cardiac Surgery, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - A Corley
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
| | - J F Fraser
- AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia.
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Bugden S, Shean K, Scott M, Mihala G, Clark S, Johnstone C, Fraser JF, Rickard CM. Skin Glue Reduces the Failure Rate of Emergency Department-Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial. Ann Emerg Med 2015; 68:196-201. [PMID: 26747220 DOI: 10.1016/j.annemergmed.2015.11.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/08/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Peripheral intravenous catheters are the most common invasive device in health care yet have very high failure rates. We investigate whether the failure rate could be reduced by the addition of skin glue to standard peripheral intravenous catheter care. METHODS We conducted a single-site, 2-arm, nonblinded, randomized, controlled trial of 380 peripheral intravenous catheters inserted into 360 adult patients. The standard care group received standard securement. The skin glue group received standard securement plus cyanoacrylate skin glue applied to the skin insertion site. The primary outcome was peripheral intravenous catheter failure at 48 hours, regardless of cause. Secondary outcomes were the individual modes of peripheral intravenous catheter failure: infection, phlebitis, occlusion, or dislodgement. RESULTS Peripheral intravenous catheter failure was 10% lower (95% confidence interval -18% to -2%; P=.02) with skin glue (17%) than standard care (27%), and dislodgement was 7% lower (95% confidence interval -13% to 0%; P=.04). Phlebitis and occlusion were less with skin glue but were not statistically significant. There were no infections. CONCLUSION This study supports the use of skin glue in addition to standard care to reduce peripheral intravenous catheter failure rates for adult emergency department patients admitted to the hospital.
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Affiliation(s)
- Simon Bugden
- Department of Emergency Medicine, Caboolture Hospital, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Critical Care Research Group, the Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia.
| | - Karla Shean
- Department of Emergency Medicine, Caboolture Hospital, Queensland, Australia
| | - Mark Scott
- Department of Emergency Medicine, Caboolture Hospital, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Logan Campus, Queensland, Australia
| | - Sean Clark
- Department of Emergency Medicine, Caboolture Hospital, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Johnstone
- Department of Emergency Medicine, Caboolture Hospital, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Critical Care Research Group, the Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Critical Care Research Group, the Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
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