Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial
Abstract Background Central venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current co...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-017-3606-9 |
| _version_ | 1818322855598751744 |
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| author | Amanda J. Ullman Tricia Kleidon Victoria Gibson Craig A. McBride Gabor Mihala Marie Cooke Claire M. Rickard |
| author_facet | Amanda J. Ullman Tricia Kleidon Victoria Gibson Craig A. McBride Gabor Mihala Marie Cooke Claire M. Rickard |
| author_sort | Amanda J. Ullman |
| collection | DOAJ |
| description | Abstract Background Central venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current complication rates suggest customary practices are inadequate. The aim of this study was to evaluate the feasibility of launching a full-scale randomized controlled efficacy trial of innovative dressing and securement products for pediatric tunneled CVAD to prevent complication and failure. Methods An external, pilot, four-group randomized controlled trial of standard care (bordered polyurethane dressing and suture), in comparison to integrated securement-dressing, suture-less securement device, and tissue adhesive was undertaken across two large, tertiary referral pediatric hospitals in Australia. Forty-eight pediatric participants with newly inserted tunneled CVADs were consecutively recruited. The primary outcome of study feasibility was established by elements of eligibility, recruitment, attrition, protocol adherence, missing data, parent and healthcare staff satisfaction and acceptability, and effect size estimates for CVAD failure (cessation of function prior to completion of treatment) and complication (associated bloodstream infection, thrombosis, breakage, dislodgement or occlusion). Dressing integrity, product costs and site complications were also examined. Results Protocol feasibility was established. CVAD failure was: 17% (2/12) integrated securement-dressing; 8% (1/13) suture-less securement device; 0% tissue adhesive (0/12); and, 0% standard care (0/11). CVAD complications were: 15% (2/13) suture-less securement device (CVAD associated bloodstream infection, and occlusion and partial dislodgement); 8% (1/12) integrated securement-dressing (partial dislodgement); 0% tissue adhesive (0/12); and, 0% standard care (0/11). One CVAD-associated bloodstream infection occurred, within the suture-less securement device group. Overall satisfaction was highest in the integrated securement-dressing (mean 8.5/10; standard deviation 1.2). Improved dressing integrity was evident in the intervention arms, with the integrated securement-dressing associated with prolonged time to first dressing change (mean days 3.5). Conclusions Improving the security and dressing integrity of tunneled CVADs is likely to improve outcomes for pediatric patients. Further research is necessary to identify novel, effective CVAD securement to reduce complications, and provide reliable vascular access for children. Trial registration ACTRN12614000280606 ; prospectively registered on 17/03/2014. |
| first_indexed | 2024-12-13T11:03:26Z |
| format | Article |
| id | doaj.art-228e39546bfd459a917dcf818ee65ceb |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-13T11:03:26Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-228e39546bfd459a917dcf818ee65ceb2022-12-21T23:49:10ZengBMCBMC Cancer1471-24072017-08-0117111210.1186/s12885-017-3606-9Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trialAmanda J. Ullman0Tricia Kleidon1Victoria Gibson2Craig A. McBride3Gabor Mihala4Marie Cooke5Claire M. Rickard6School of Nursing and Midwifery, Griffith UniversityAlliance for Vascular Access Teaching and Research Group, Menzies Health Institute QueenslandAlliance for Vascular Access Teaching and Research Group, Menzies Health Institute QueenslandAlliance for Vascular Access Teaching and Research Group, Menzies Health Institute QueenslandAlliance for Vascular Access Teaching and Research Group, Menzies Health Institute QueenslandSchool of Nursing and Midwifery, Griffith UniversitySchool of Nursing and Midwifery, Griffith UniversityAbstract Background Central venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current complication rates suggest customary practices are inadequate. The aim of this study was to evaluate the feasibility of launching a full-scale randomized controlled efficacy trial of innovative dressing and securement products for pediatric tunneled CVAD to prevent complication and failure. Methods An external, pilot, four-group randomized controlled trial of standard care (bordered polyurethane dressing and suture), in comparison to integrated securement-dressing, suture-less securement device, and tissue adhesive was undertaken across two large, tertiary referral pediatric hospitals in Australia. Forty-eight pediatric participants with newly inserted tunneled CVADs were consecutively recruited. The primary outcome of study feasibility was established by elements of eligibility, recruitment, attrition, protocol adherence, missing data, parent and healthcare staff satisfaction and acceptability, and effect size estimates for CVAD failure (cessation of function prior to completion of treatment) and complication (associated bloodstream infection, thrombosis, breakage, dislodgement or occlusion). Dressing integrity, product costs and site complications were also examined. Results Protocol feasibility was established. CVAD failure was: 17% (2/12) integrated securement-dressing; 8% (1/13) suture-less securement device; 0% tissue adhesive (0/12); and, 0% standard care (0/11). CVAD complications were: 15% (2/13) suture-less securement device (CVAD associated bloodstream infection, and occlusion and partial dislodgement); 8% (1/12) integrated securement-dressing (partial dislodgement); 0% tissue adhesive (0/12); and, 0% standard care (0/11). One CVAD-associated bloodstream infection occurred, within the suture-less securement device group. Overall satisfaction was highest in the integrated securement-dressing (mean 8.5/10; standard deviation 1.2). Improved dressing integrity was evident in the intervention arms, with the integrated securement-dressing associated with prolonged time to first dressing change (mean days 3.5). Conclusions Improving the security and dressing integrity of tunneled CVADs is likely to improve outcomes for pediatric patients. Further research is necessary to identify novel, effective CVAD securement to reduce complications, and provide reliable vascular access for children. Trial registration ACTRN12614000280606 ; prospectively registered on 17/03/2014.http://link.springer.com/article/10.1186/s12885-017-3606-9Central venous catheterDressingRandomized controlled trialEvidence-based carePediatrics |
| spellingShingle | Amanda J. Ullman Tricia Kleidon Victoria Gibson Craig A. McBride Gabor Mihala Marie Cooke Claire M. Rickard Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial BMC Cancer Central venous catheter Dressing Randomized controlled trial Evidence-based care Pediatrics |
| title | Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial |
| title_full | Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial |
| title_fullStr | Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial |
| title_full_unstemmed | Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial |
| title_short | Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial |
| title_sort | innovative dressing and securement of tunneled central venous access devices in pediatrics a pilot randomized controlled trial |
| topic | Central venous catheter Dressing Randomized controlled trial Evidence-based care Pediatrics |
| url | http://link.springer.com/article/10.1186/s12885-017-3606-9 |
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