Midline pilot randomised controlled trial: Managing peripheral intravenous devices among adult hospital patients with limited vascular access or prolonged therapy trial
Prof Nicole Marsh1,2,3,5, Ms Emily Larsen1,3, Ms Catherine O’Brien1,3, Prof Robert Ware4, Ms Tricia Kleidon1,3,6, Mr Peter Groom1, Ms Barbara Hewer1, Dr Evan Alexandrou3,7,8, Dr Julie Flynn3,5, Ms Kaylene Woollett1, Prof Claire Rickard1,2,3
1Nursing & Midwifery Research Centre; Surgical and Perioperative Services; Herston Infectious Diseases Institute; Royal Brisbane and Women’s Hospital, Herston, Australia
2School of Nursing, Midwifery and Social Work, The University of Queensland, UQCCR Herston, Australia
3Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland; School of Nursing and Midwifery; Griffith University, Brisbane, Australia
4School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
5School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
6Queensland Children’s Hospital, South Brisbane, Australia
7Liverpool Hospital, Department of Intensive Care, Liverpool, Australia
8South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute, Herston, Australia
Introduction: Hospitalised patients frequently require antibiotics administered through a peripheral intravenous catheters (PIVCs). However, half of PIVCs fail prematurely interrupting optimal therapy delivery. Midline catheters (MC) are a longer device, inserted in the upper arm. This study aimed to test protocol feasibility and efficacy of MC to PIVCs.
Methods: Single center, parallel group, pilot randomised controlled trial. Medical/Surgical patients ≥18 years, with difficult access (≤ 2palpable veins) and/or requiring ≥5 days intravenous therapy were randomised to a PIVC or MC.
Results: Feasibility criterion were met except eligibility (>80%) with 143/231 (62%) patients eligible for inclusion. MCs had less failed device insertions; 9/70 (13%) versus 11/69 (16%) PIVCs (relative risk (RR) 0.81; 95% confidence interval (CI) 0.36 to 1.82; p=0.61). Post-insertion failure was significantly (p=0.004) lower for MCs (n=19; 31%) versus PIVCs (n=34; 59%) (RR 0.53; 95% CI, 0.34 to 0.82). MC dwell time (117 hours) was double that of PIVCs (61 hours), with a median difference of 55 hours (95% CI, 22.5-87.6; p=0.001). Infiltration/extravasation was the most common PIVC complication (n=13; 22.4%), however no episodes were reported for MCs. Phlebitis (n=14; 21.1%) and occlusion (n=5; 8.6%) in PIVCs were higher than for MCs (phlebitis: n=6; 9.8%, p=0.05) (occlusion: n=1; 1.6%). Thrombosis was present in 2 MCs and no PIVCs. There were no device-related infections.
Conclusion: MCs are a promising device with less insertion and post-insertion failure compared to PIVCs, potentially reducing interruption to administration of crucial antibiotics. Although not designed to provide conclusions about efficacy, post-insertion failure was statistically significant.
Biography:
Dr Nicole Marsh’s research is focused on improving patient outcomes and decreasing complications associated with vascular access across the acute clinical care and community setting.
In addition, she has been a Clinical Trial Co-ordinator for more than 30 single and multi-centre clinical trials. She also has over 25 years’ experience in nursing with specialist qualifications in Neurosurgical Nursing.