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Charters B, Foster K, Lawton B, Lee L, Byrnes J, Mihala G, Cassidy C, Schults J, Kleidon TM, McCaffery R, Van K, Funk V, Ullman A. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:437-445. [PMID: 38558161 PMCID: PMC10985620 DOI: 10.1001/jamapediatrics.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Importance Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes. Objective To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure. Design, Setting, and Participants A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024. Interventions Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient. Main Outcomes and Measures Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs. Results A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P ≤ .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups. Conclusions and Relevance In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
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Affiliation(s)
- Brooke Charters
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Kelly Foster
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Benjamin Lawton
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Leonard Lee
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Corey Cassidy
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
- North West Regional Hospital, Cooee, Tasmania, Australia
| | - Jessica Schults
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Herston Infectious Disease Institute, Brisbane, Queensland, Australia
| | - Tricia M. Kleidon
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Ruth McCaffery
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Kristy Van
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Vanessa Funk
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Central West Hospital and Health Service, Glasson House, Longreach, Queensland, Australia
| | - Amanda Ullman
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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