A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients

Abstract

(200)PurposeMid-trial, due to safety, the TA+SPU intervention was replaced with a Suture+TA+SPU group.Results: 221 patients were randomised with two post-randomisation exclusions. CVAD failure was

Building a central vascular access device registry in an adult intensive care unit: feasibility study

“…The CLABSI rate (0.33 per 1000 days) was lower than a previous meta-analysis of PICC-related CLABSI (1.0-2.1 per 1000 catheter days) 26 and slightly lower than previously published registry data (0.44/1,000 days) from 2015-2016 22 . A previous pilot RCT conducted at the same facility reported no CLABSI or local infection 27 , which supports this low CLABSI rate. It was also revealed that 33 PICCs were removed due to suspected catheter infection compared with only one confirmed CLABSI, suggesting that a significant number of PICCs were removed unnecessarily or that diagnostic approaches were not adequate.…”

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

“…The multivariable analysis identified two significant factors (male gender, and three or more comorbidities) associated with PICC failure. Male gender may increase risk due to men being more hirsute, which can disrupt dressing adhesiveness [ 36 ] and having more muscle movement. In spite of the non-modifiable nature of these two risk factors, clinicians should pay additional attention in ensuring best insertion, monitoring and maintenance practice in men, and those with three or more comorbidities.…”

Securement for vascular access devices: looking to the future

“…However, while Yamamoto et al (2002) demonstrated SSD significantly reduced PICC-related bloodstream infections (n=170; SSD 2%; suture 12%; p=0.032), there was no significant reduction in accidental dislodgement (SSD 12%; suture 14%; p>0.05). A recent trial by Rickard et al (2016) examining a different type of SSD in non-tunnelled jugular CVADs in intensive care found no difference in accidental dislodgement between sutures (4%) and SSD (7%; p= not provided). Pilot studies in peripheral VAD found SSDs safe and feasible to apply (Marsh et al, 2015a, Edwards et al, 2014, with a large, efficacy study soon to be published (Rickard et al, 2015).…”

“…Another potential product to assist with VAD security is tissue adhesive, which is a medical grade 'superglue' (cyanoacrylate) used previously to close skin lacerations and soft tissue wounds as an alternative to sutures or staples (Singer andThode, 2004, Aukerman et al, 2005). Tissue adhesive used in small amounts (only 1-2 drops at the insertion site and under the hub) has been successfully applied to prevent failure for PIVC (Bugden et al, 2016, Marsh et al, 2015a, peripheral arterial catheters (Reynolds et al, 2015), and non-tunnelled CVAD (Rickard et al, 2016). Tissue adhesive also has haemostatic properties that reduce post insertion bleeding and haematomas; which is advantageous for CVADs immediately post-insertion.…”