Dressed for success: A pilot study of central venous access device securement and dressing effectiveness in the PICU

Abstract

Aims & Objectives: Central venous access devices (CVADs) are used to provide reliable vascular access during critical illness, however 25% fail before completion of treatment. Failure is frequently attributed to inadequate securement and dressing. This study aimed to establish the feasibility of an efficacy randomised control trial (RCT) of current and new technologies to secure paediatric CVADs. Methods A single centre, parallel, superiority, pilot RCT of 179 paediatric patients with non-tunnelled CVADs admitted to the PICU at Lady Cilento Children's Hospital, Australia. Participants were randomised to receive CVAD dressing and securement: 1. Standard care: Bordered polyurethane dressing, with sutures and chlorhexidine gluconate (CHG) disc; 2. Tissue adhesive (Histoacryl®): with standard care; 3. Engineered securement dressing: (SorbaView SHIELD®): with sutures and CHG disc. Outcomes: Primary: Feasibility (including effect estimates); Secondary: CVAD failure, complication; family/ staff acceptability, skin damage and dressing performance Results Feasibility criteria were achieved as suitable recruitment rates, low rates of attrition and good protocol adherence were achieved. Family members and staff reported comparable acceptability for intervention arms, however tissue adhesive was most difficult to apply. There were low rates of failure within all the study arms with 2% (1/56) in engineered dressing, 6% (3/54) in standard care, and 10% (6/59) in tissue adhesive. Non-routine dressing changes were lower in the engineered dressing (13%) and tissue adhesive (10%) groups, in comparison to standard care (28%). Conclusions It is feasible to conduct an efficacy RCT of the studied interventions. Further research is required to definitively identify clinical, cost-effective securement methods to prevent CVAD failure.L6238158602018-09-13 <br />