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

Raymond J. Chan, Sarah Northfield, Emily Larsen, Gabor Mihala, Amanda Ullman, Peter Hancock, Nicole Marsh, Nicole Gavin, David Wyld, Anthony Allworth, Emily Russell, Md Abu Choudhury, Julie Flynn, Claire M. Rickard

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17 Citations (Scopus)

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. Trial registration: Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415. Registered on 15 January 2016.

Original languageEnglish
Article number458
Number of pages13
JournalTrials
Volume18
DOIs
Publication statusPublished - 4 Oct 2017
Externally publishedYes

Keywords

  • Catheterization
  • Central venous
  • Complications
  • Dressing and securement methods
  • Peripherally inserted central catheter (PICC)
  • Randomised controlled trials
  • Vascular access devices

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