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A Pilot Randomized Controlled Trial of Novel Dressing and Securement Techniques in 101 Pediatric Patients
Tricia M Kleidon1, Amanda J Ullman2, Victoria Gibson1
1Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Children's Health Queensland, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, Queensland 4101, Australia.
Insights
This study found that integrated securement dressings (ISDs) and tissue adhesive (TA) are safe and acceptable alternatives to standard care for peripherally inserted central catheter (PICC) lines. Securement dressings may reduce dressing changes and complications, warranting further research into cost-effective methods.
Area of Science:
- Pediatric nursing
- Vascular access devices
- Clinical trials
Background:
- Peripherally inserted central catheters (PICCs) are crucial for pediatric care.
- Complications and failure of PICCs can significantly impact patient outcomes.
- Standard dressing and securement techniques require evaluation for optimal performance.
Purpose of the Study:
- To assess the feasibility of a clinical trial comparing different PICC dressing and securement methods.
- To evaluate the efficacy of tissue adhesive (TA) and integrated securement dressings (ISDs) against standard care.
- To identify methods that prevent PICC complications and failure.
Main Methods:
- A pilot, 3-armed randomized controlled trial involving 101 pediatric participants.
- Comparison of standard care (bordered polyurethane dressing, sutureless securement) with TA and ISDs.
- Primary outcome: trial feasibility and PICC failure; Secondary outcomes: complications, dressing performance, and satisfaction.
Main Results:
- Protocol feasibility was confirmed.
- PICC failure rates were low across all groups (3-6%).
- Tissue adhesive (TA) reduced bleeding and prolonged dressing change intervals; Integrated Securement Dressings (ISDs) showed highest parent and staff satisfaction.
Conclusions:
- Different securement dressings (TA, ISD) are safe and acceptable for PICCs compared to standard care.
- Securement dressings may decrease the frequency of dressing changes.
- Further research is needed to establish cost-effective strategies for preventing PICC failure.
Purpose:
To evaluate feasibility of an efficacy trial comparing peripherally inserted central catheter (PICC) dressing and securement techniques to prevent complications and failure.
Materials And Methods:
This pilot, 3-armed, randomized controlled trial was undertaken at Royal Children's Hospital and Lady Cilento Children's Hospital, Brisbane, Australia, between April 2014 and September 2015. Pediatric participants (N = 101; age range, 0-18 y) were assigned to standard care (bordered polyurethane [BPU] dressing, sutureless securement device), tissue adhesive (TA) (plus BPU dressing), or integrated securement dressings (ISDs). Average PICC dwell time was 8.1 days (range, 0.2-27.7 d). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were PICC complications, dressing performance, and parent and staff satisfaction.
Results:
Protocol feasibility was established. PICC failure was 6% (2/32) with standard care, 6% (2/31) with ISD, and 3% (1/32) with TA. PICC complications were 16% across all groups. TA provided immediate postoperative hemostasis, prolonging the first dressing change until 5.5 days compared with 3.5 days and 2.5 days with standard care and ISD respectively. Bleeding was the most common reason for first dressing change: standard care (n = 18; 75%), ISD (n = 11; 69%), TA (n = 4; 27%). Parental satisfaction (median 9.7/10; P = .006) and staff feedback (9.2/10; P = .002) were most positive for ISD.
Conclusions:
This research suggests safety and acceptability of different securement dressings compared with standard care; securement dressings may also reduce dressing changes after insertion. Further research is required to confirm clinically cost-effective methods to prevent PICC failure.
