A pilot randomised controlled trial of dressing and securement methods to prevent arterial catheter failure in intensive care |
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| Authors: | Emily N. Larsen Amanda Corley Marion Mitchell India Lye Madeleine Powell Sheena Tom Gabor Mihala Amanda J. Ullman Victoria Gibson Nicole Marsh Tricia M. Kleidon Ivan L. Rapchuk Claire M. Rickard |
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| Affiliation: | 1. Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia;2. School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia;3. The Royal Brisbane and Women''s Hospital, Brisbane, Queensland, Australia;4. The Prince Charles Hospital, Brisbane, Queensland, Australia;5. The Princess Alexandra Hospital, Brisbane, Queensland, Australia;6. School of Medicine, Griffith University, Queensland, Australia;7. Centre for Applied Health Economics, Menzies Health Institute, Queensland, Australia;8. Queensland Children''s Hospital, Brisbane, Queensland, Australia;9. The University of Queensland, Brisbane, Queensland, Australia;1. Gold Coast Health, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia;2. Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, 4222, Australia;3. School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, University of the Sunshine Coast, 90, Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia;1. Longgang Central Hospital of Shenzhen, Guangdong, China;2. Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, United Kingdom;3. The Second People''s Hospital of Shenzhen, Guangdong, China;1. Alfred Intensive Care Unit, Alfred Health, 55 Commercial Road, Melbourne, 3181, Victoria, Australia;2. La Trobe University, Alfred Clinical School of Nursing, 99 Commercial Road, Melbourne, 3004, Victoria, Australia;3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia;1. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, VIC, Australia;2. Nutrition Department, The Alfred Hospital, Melbourne, VIC, Australia;3. Department of Intensive Care, The Queen Elizabeth Hospital, Woodville South, SA, Australia;1. Department of Critical Care Medicine, The Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China;2. School of Nursing, Peking University, Beijing, 100191, China;3. Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, 100191, China;4. Department of Nursing, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China |
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| Abstract: | BackgroundCritically ill patients in an intensive care setting often require arterial catheters for blood pressure monitoring and arterial blood collection. Arterial catheter failure, which manifests in both mechanical and infective forms, remains common. Dressing and securement inadequacies may impact this failure; however, the best method for dressing and securing arterial catheters is yet to be determined.ObjectivesThe objective of this study was to establish the feasibility of a definitive randomised controlled trial comparing methods for dressing and securing arterial catheters and to prevent device failure in an adult intensive care setting.MethodsA pilot, parallel-group, randomised controlled trial was conducted between April 2017 and June 2018. Patients receiving treatment in two adult intensive care units (Queensland, Australia) were eligible for inclusion and were allocated to receive either (i) an integrated securement dressing or (ii) a simple polyurethane dressing (with gauze/foam), applied to their newly inserted arterial catheters.Main outcome measuresPrimary outcomes were (i) feasibility (defined by pre-established criteria: patient eligibility, consent, protocol adherence, retention, and staff acceptability) and (ii) all-cause arterial catheter failure (a composite of local and bloodstream infection, occlusion, dislodgement, infiltration/extravasation, arterial inflammation, thrombosis, and/or inaccurate trace). Secondary outcomes included: failure type, dwell time, dressing adhesion, adverse event profiles, and staff acceptability.ResultsIn total, 109 patients were studied (n = 53 integrated securement dressing; n = 56 simple polyurethane). The feasibility criterion was met by most patients (including rates of consent [86%], protocol adherence [93%], and retention [100%]); however, the criteria for patient eligibility were not met (73%). All-cause device failure did not differ significantly between the integrated securement device group (n = 12/53, 23%) and the simple polyurethane group (n = 6/56, 11%) (hazard ratio = 2.39, 95% confidence interval = 0.89–6.37, p = 0.083).ConclusionsFindings indicate a larger study is feasible, with minor alterations to recruitment methods required. Arterial catheter failure remains unacceptably common; further research to determine optimal dressing/securement practices is urgently needed. |
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| Keywords: | Arterial Catheter Dressing Feasibility Randomised Securement Trial |
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