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

Chan, Raymond J. and Northfield, Sarah and Larsen, Emily and Mihala, Gabor and Ullman, Amanda and Hancock, Peter and Marsh, Nicole and Gavin, Nicole and Wyld, David and Allworth, Anthony and Russell, Emily and Choudhury, Md Abu and Flynn, Julie ORCID: https://orcid.org/0000-0003-1512-2089 and Rickard, Claire M. (2017) Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials, 18 (1):458. pp. 1-13.

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

Background: Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure. Methods: This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged≥16years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU+SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL+Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA+SPU). All groups except TA+SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected. Results: PICC failure incidence was: PAL+CHG+Tape (1/5; 20%; 17.4/1000days), SPU+SSD+CHG (control) (4/39; 10%; 9.0/1000days), TA+SPU (3/35; 9%; 9.6/1000days), and CSD+CHG (3/42; 7%; 9.4/1000days). Recruitment to PAL+CHG+Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD+CHG, TA+SPU (TA applied onlyat PICCinsertion time), and control treatments were acceptable to patients and health professionals. Conclusion: A large RCT of CSD+CHG and TA+SPU (but not PAL+CHG+Tape) versus standard care is feasible.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Faculty/School / Institute/Centre: No Faculty
Faculty/School / Institute/Centre: No Faculty
Date Deposited: 10 Dec 2021 01:35
Last Modified: 11 Dec 2021 03:49
Uncontrolled Keywords: Catheterization; Central venous; Complications; Dressing and securement methods; Peripherally inserted central catheter (PICC); Randomised controlled trials; Vascular access devices
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
11 Medical and Health Sciences > 1110 Nursing > 111099 Nursing not elsewhere classified
Fields of Research (2020): 42 HEALTH SCIENCES > 4205 Nursing > 420506 Sub-acute care
42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care
42 HEALTH SCIENCES > 4205 Nursing > 420599 Nursing not elsewhere classified
Identification Number or DOI: https://doi.org/10.1186/s13063-017-2207-x
URI: http://eprints.usq.edu.au/id/eprint/44664

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