The RESPECT trial–Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: A randomized, controlled, non-inferiority trial

Vendramim, Patrícia; Avelar, Ariane Ferreira Machado; Rickard, Claire M; Peterlini, Maria Angélica Sorgini

doi:10.1016/j.ijnurstu.2019.103504

Cited by 32 publications

(35 citation statements)

References 29 publications

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“…Research within vascular access has focused on the reduction of infection; however, the scale and implications of PIVC failure have only recently been acknowledged. This trial is one of the few recently published studies addressing the maintenance phase of the PIVC [20,29,30]. It has provided important information on the effectiveness of post-insertion PIVC maintenance, specifically, optimising patency through flushing.…”

Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

Keogh

Shelverton

Flynn

et al. 2020

BMC Med

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Background Peripheral intravenous catheters (PIVCs) are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing. The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on short PIVC maintenance had on patient outcomes. Methods This single-centre, incomplete, stepped wedge, cluster randomised trial with an implementation period was undertaken at a quaternary hospital in Queensland, Australia. Eligible patients were from general medical and surgical wards, aged ≥ 18 years, and requiring a PIVC for > 24 h. Wards were the unit of randomisation and allocation was concealed until the time of crossover to the implementation phase. Patients, clinicians, and researchers were not masked but infections were adjudicated by a physician masked to allocation. Practice during the control period was standard care (variable practice with manually prepared flushes of 0.9% sodium chloride). The intervention group received education reinforcing practice guidelines (including administration with manufacturer-prepared pre-filled flush syringes). The primary outcome was all-cause PIVC failure (as a composite of occlusion, infiltration, dislodgement, phlebitis, and primary bloodstream or local infection). Analysis was by intention-to-treat. Results Between July 2016 and February 2017, 619 patients from 9 clusters (wards) were enrolled (control n = 306, intervention n = 313), with 617 patients comprising the intention-to-treat population. PIVC failure was 91 (30%) in the control and 69 (22%) in the intervention group (risk difference − 8%, 95% CI − 14 to − 1, p = 0.032). Total costs were lower in the intervention group. No serious adverse events related to study intervention occurred. Conclusions This study demonstrated the effectiveness of post-insertion PIVC flushing according to recommended guidelines. Evidence-based education, surveillance and products for post-insertion PIVC management are vital to improve patient outcomes. Trial registration Trial submitted for registration on 25 January 2016. Approved and retrospectively registered on 4 August 2016. Ref: ACTRN12616001035415.

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Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

Keogh

Shelverton

Flynn

et al. 2020

BMC Med

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“…[7] Similarly, there was no difference in phlebitis or catheter-related bloodstream infection between the 2 removal approaches. [6] Additional large RCTs from China and Brazil had consistent findings [8,9] and a global observational study of over 40,000 PIVCs found PIVC dwell was not associated with phlebitis. [10]…”

Section: Introductionmentioning

confidence: 83%

“…Another may have been reluctance to generalize results of Australian trials to other health systems, although recent confirmatory trials have been undertaken elsewhere. [8,9] Finally, no published framework exists to guide implementation of clinically indicated removal policy, suggesting hospitals need guidance to overcome the barriers to change that exist at the patient, clinician, organizational, and outer regulatory body level. [15] Implementation using the CFIR framework…”

Section: Implementation Into Practicementioning

confidence: 99%

An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters

2021

Journal of Nursing Care Quality

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“…Trata-se de um estudo caracterizado como análise post hoc de um ensaio clínico randômico controlado (ECRC) de não inferioridade sobre a influência do modo de retirada do CIP na ocorrência de flebite, denominado "Remoção de cateteres intravenosos periféricos a cada 96 horas ou segundo indicação clínica: estudo clínico, randômico e de não inferioridade" e representado pelo acrônimo ResPeCt advindo do título do estudo na língua inglesa (Removal of Peripheral Intravenous Catheters according to clinical signs or every 96 hours: A randomized, controlled and non-inferiority study) (15) . O Estudo ResPeCt, um estudo clínico, randômico, controlado e de não inferioridade, teve como objetivo verificar se a remoção do CIP mediante indicação clínica não era inferior à remoção programada a cada 96 horas quanto à ocorrência de flebite e comparar a gravidade da flebite, tempo de permanência do CIP e outras complicações de terapia intravenosa entre os grupos de estudo.…”

Section: Desenho Do Estudounclassified

“…A taxa de incidência de flebite/1000 CIP-dia foi 14,9 no grupo indicação clínica e 23,8 no grupo remoção a cada 96 horas (p = 0,006). O estudo evidenciou que a retirada segundo indicação clínica não foi inferior à retirada a cada 96 horas quanto à ocorrência de flebite (15) . O estudo primário foi incluído em revisão sistemática Cochrane sobre ocorrência de flebite associada a cateteres intravenosos periféricos, sendo considerado robusto para sustentar tal revisão (14) .…”

Section: Desenho Do Estudounclassified

Fatores de risco para flebite relacionada ao uso de cateteres intravenosos periféricos em pacientes adultos

Simões

Vendramim

Peterlini

2022

Rev. esc. enferm. USP

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RESUMO Objetivo: Identificar fatores de risco para flebite relacionada a cateteres intravenosos periféricos em pacientes adultos. Método: Estudo de análise post hoc de ensaio clínico randômico, totalizando 1.319 pacientes. Pesquisaram-se variáveis demográficas, clínicas, relacionadas à terapia e à flebite. Para análise de dados, calcularam-se frequências, medidas de tendência central e dispersão, e utilizaram-se os testes Qui-quadrado de Pearson e Exato de Fisher, implementando-se regressão logística, curva ROC e cálculo de Odds Ratio (intervalo de confiança 95%; nível de significância 5%). Resultados: Dos 1.319 participantes, 80 (6,1%) desenvolveram flebite. Associaram-se à ocorrência de flebite mobilidade reduzida (p = 0,015), história familiar de trombose venosa profunda (p = 0,05), cateterização de veias do dorso da mão (p = 0,012), dor (p < 0,01), Amoxicilina-Clavulanato de Potássio (p = 0,015) e Omeprazol sódico (p = 0,029). Conclusão: Os fatores de risco para flebite envolveram fatores intrínsecos e extrínsecos ao paciente, indicando intervenções de enfermagem preventivas, como promover a mobilidade do paciente, não cateterizar veias do arco dorsal da mão, infusão cautelosa de fármacos de risco e valorizar a queixa de dor.

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The RESPECT trial–Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: A randomized, controlled, non-inferiority trial

Cited by 32 publications

References 29 publications

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters

Fatores de risco para flebite relacionada ao uso de cateteres intravenosos periféricos em pacientes adultos

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