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Published on: July 13, 2019
Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical
Brooke Charters1,2,3, Kelly Foster3, Benjamin Lawton1
1Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia.
Insights
New securement methods for peripheral intravenous catheters (PIVCs) in children significantly reduce catheter failure. Integrated securement dressings with tissue adhesive offer the most effective PIVC securement, improving patient outcomes and reducing costs.
Area of Science:
- Pediatric emergency medicine
- Medical device securement
- Clinical trial methodology
Background:
- Peripheral intravenous catheters (PIVCs) are crucial for pediatric treatment but frequently fail.
- Developing effective PIVC securement strategies is essential to improve patient outcomes and reduce healthcare costs.
Purpose of the Study:
- To evaluate the clinical effectiveness of novel PIVC securement technologies in children.
- To compare the failure rates and complications of different PIVC securement methods.
Main Methods:
- A 3-arm, parallel-group, superiority randomized clinical trial involving 383 children aged 6 months to 8 years.
- Participants received standard care, integrated securement dressing, or integrated securement dressing with tissue adhesive.
- Primary outcome was PIVC failure; secondary outcomes included complications, longevity, acceptability, and costs.
Main Results:
- PIVC failure was lowest with integrated securement dressing plus tissue adhesive (12%) compared to integrated securement dressing (21%) and standard care (34%).
- The integrated securement dressing with tissue adhesive group showed significantly lower direct costs associated with device failure.
- PIVC longevity and intervention acceptability were comparable across all groups.
Conclusions:
- Integrated securement dressings with tissue adhesive significantly reduce PIVC failure in hospitalized children compared to standard care or bordered polyurethane dressings.
- These findings suggest that this novel securement method is a valuable option for improving PIVC reliability in pediatric emergency departments.
- Further research is recommended for implementation in inpatient settings for prolonged intravenous access needs.
Importance:
Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes.
Objective:
To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure.
Design, Setting, And Participants:
A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024.
Interventions:
Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient.
Main Outcomes And Measures:
Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs.
Results:
A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P ≤ .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups.
Conclusions And Relevance:
In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed.
Trial Registration:
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
