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03-05-2024 | Pediatric Emergency Medicine | Editor's Choice | News

Novel securement technique ‘significantly’ reduces intravenous catheter failure rates in children

Author: Shipra Verma

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medwireNews: Securing peripheral intravenous catheters (PIVCs) with integrated securement dressings (ISD) and tissue adhesive (TA) significantly reduces the likelihood of device failure in hospitalized children compared with traditional bordered polyurethane dressings, show findings of a randomized clinical trial.

The rate of PIVC failure, defined as premature cessation of PIVC function due to any reason before the completion of planned treatment, was lowest with ISD with TA (12%), highest with standard polyurethane dressings (34%), and intermediate with use of ISD alone (21%), say the investigators.

The trial collated information from 383 patients (51% females), aged between 6 months and 8 years (mean, 3 years), who were admitted for at least 24 hours of treatment with a PIVC in one of two regional hospitals in Queensland, Australia, between February 2020 and January 2022.

The participants were randomly assigned to receive an ISD with TA (n=131), standard care (n=134), or an ISD alone (n=118). Prior to trial commencement, the staff were trained on securement dressing application to ensure consistency and uniformity.

After considering covariables such as hospital, age, sex, reason for admission, and comorbidity, the adjusted hazard ratio for PIVC failure compared with usual care was a significant 0.47 for patients given ISD with TA and a nonsignificant 0.78 for ISD alone.

However, the researchers note that when assessing data for children aged at least 5 years versus those aged 23 months or less, the adjusted HR for PIVC failure was a significant 0.34 regardless of which type of dressing was used.

Overall, there was an absolute reduction in PIVC failure rates of 21 percentage points when using ISD plus TA versus standard care. This was “predominantly seen from a reduction in unintentional dislodgement,” which occurred in 1% and 12% of patients, respectively, report Brooke Charters (Gold Coast University Hospital, Southport, Queensland, Australia) and colleagues in JAMA Pediatrics.

Importantly, the longevity of PIVC was “comparable” across the groups, the researchers say, as were the rates and types of PIVC complications experienced, and the acceptability of interventions.

Charters et al therefore support the use of ISD plus TA to secure PIVCs for enhanced patient outcomes and cost reduction and write that “further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed.”

Amanda Bettencourt, from the University of Pennsylvania in Philadelphia, USA, and colleagues say in an accompanying editorial that “[n]ot only could improving PIVC securement reduce premature removal and potential traumatic and painful reinsertions, but could result in fewer interruptions and delays to intravenous therapy, improving outcomes such as medication therapy effectiveness, and hospital length of stay.”

However, recognizing barriers such as physician preference and high staff turnover can make it hard to “change deeply entrenched PIVC securement practices,” they pose the question: “[H]ow do clinicians integrate this evidence into routine pediatric care?”      

The editorialists conclude that “[w]hat is most urgently needed now is guidance for how hospitals around the world can make implementing this practice change minimally burdensome to adopt and sustain in routine care,” and suggest applying implementation science approaches could hold “great promise to bridge the current evidence-to-practice gap.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group.

JAMA Pediatr 2024; doi:10.1001/jamapediatrics.2024.0167        
JAMA Pediatr 2024; doi:10.1001/jamapediatrics.2024.0177

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