Highlights
- •Bundled dressing and securement interventions for PIVCs are feasible and acceptable.
- •In this small sample, no significant differences were found in PIVC failure.
- •These bundled interventions should now be tested in a definitive trial.
- •They may be an innovative solution to the currently high PIVC failure rates.
Abstract
Background
Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however
failure rates are unacceptably high, with around half failing before prescribed treatment
is complete. The most effective dressing and securement option to prolong PIVC longevity
is unclear.
Objectives
To determine feasibility of conducting a definitive randomized controlled trial (RCT)
investigating evidence-based securement bundles (medical adhesive tapes and supplementary
securement products) to reduce PIVC failure.
Methods
In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized
to Standard care (bordered polyurethane dressing plus non-sterile tape over extension
tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard
care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed
until study entry. Exclusions: laboratory-confirmed positive blood culture, current/high-risk
of skin tear, or study product allergy. Primary outcome: feasibility (eligibility,
recruitment, retention, protocol fidelity, participant/staff satisfaction). Secondary
outcomes: PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and
cost.
Results
Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes
were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34)
for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence
rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1
(95% confidence interval [CI] 0.4–2.7) and 2.1 (95% CI 0.9–5.1) for Bundles 1 and
2, respectively.
Conclusions
A large RCT testing securement bundles is feasible, with adjustment to screening processes.
Innovative dressing and securement solutions are needed to reduce unacceptable PIVC
failure rates.
Trial registration ACTRN12619000026123.
Keywords
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Article info
Publication history
Published online: August 27, 2022
Accepted:
July 28,
2022
Received in revised form:
July 25,
2022
Received:
February 24,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
