番茄社区

Peripheral intravenous catheters (PIVCs) secured with integrated securement dressings and tissue adhesive failed significantly less than those with standard-of-care bordered polyurethane, a randomized clinical trial of 383 kids found.

Among the participants who were admitted to the hospital from the emergency department, PIVC failure was lowest (12%) among participants randomized to those secured with both (adjusted HR 0.47 versus usual care, 95% CI 0.26-0.84, P=0.01), reported Brooke Charters, BN, of Gold Coast Health in Southport, Australia, and colleagues.

PIVCs secured with integrated securement dressings alone had numerically but not statistically significantly less failure than standard bordered polyurethane dressing (21% vs 34%, aHR 0.78, 95% CI 0.47-1.28, P=0.32), they noted in .

"Despite their widespread use, devices often fail (33% to 69%), resulting in reinsertion and/or escalation of invasive devices (e.g., insertion of a central venous catheter)," Charters and colleagues wrote.

Though a pilot randomized controlled trial in pediatrics showed of these securement dressings in general pediatric settings, no studies had addressed the clinical and cost-effectiveness of these interventions alone or in combination in pediatrics.

Charters, though, had a more personal reason to want to research better solutions -- "the empathy for the families and children I felt post a PIVC being accidentally dislodged."

These children often required a further PIVC inserted, "which in turn becomes a burden on waiting time and personnel required for PIVC insertion," Charters told 番茄社区 in an email. "The experience is often traumatic relating to poor first experience of hospital for children and with incomplete treatment."

Direct costs, explored as a secondary outcome, were also significantly lower for PIVCs secured with both methods or with integrated securement dressings alone than with standard of care, Charters and colleagues noted. Median costs in Australian dollars were $312 (interquartile range [IQR] $302-$380) and $303 (IQR $294-$465), respectively, compared with $341 (IQR $297-$592, P≤0.002) when including the economic burden related to failure of devices.

The study "has set the stage for a shift in securement practice likely to improve outcomes and result in more cost-effective care for hospitalized children with PIVCs," Amanda Bettencourt, PhD, APRN, of the University of Pennsylvania in Philadelphia, and colleagues reported in an accompanying the study. "However, publication of their findings is only the first step in the process of institutionalizing this practice."

"What is most urgently needed now is guidance for how hospitals around the world can make implementing this practice change minimally burdensome to adopt and sustain in routine care," they added. "Applying approaches from implementation science holds great promise to bridge the current evidence-to-practice gap, making it stick."

The study was conducted at two regional Australian hospitals from Feb. 5, 2020, to Jan. 14, 2022. Children ages 6 months to 8 years who were expected to require admission with a PIVC for at least 24 hours were eligible for inclusion; 134 were randomized to standard of care with a bordered polyurethane dressing (Tegaderm), 131 were randomized to PIVCs secured with both integrated securement dressings (SorbaView Shield) and tissue adhesive (a drop of Secureport IV at the PIVC skin site and another under the PIVC hub 30 seconds prior to dressing application), and 118 were randomized to PIVCs secured with the dressings alone.

Baseline characteristics between the groups were balanced, Charters and colleagues noted, with participants predominantly admitted for medical reasons (72%) and with good skin integrity (92%). PIVCs were most commonly inserted in the cubital fossa (48%) or dorsum of the hand (42%) using landmark insertion (97%).

PIVC failure was defined as the PIVC ceasing to function for any reason prior to the end of planned treatment during the entirety of the patient admission.

Secondary measures examined by Charters and colleagues including PIVC longevity, complications, and intervention acceptability were similar across groups.

Study limitations included impacts from COVID-19 related to admissions, recruitment, and workforce, Charters and colleagues noted.

Additionally, the study was "not designed to look at the impact of failures related to the use of PIVCs, such as medication and fluid management, which could be further explored," they added.

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