Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE Trial)

Claire Rickard1,2, 3, Nicole Marsh1,2, Joan Webster1,2, Naomi Runnegar1,3, Emily Larsen1,2, Fiona Fullerton1,3, Md Abu Choudhury1, E Geoffrey Playford1,3.

1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan, QLD 4111, c.rickard@griffith.edu.au
2 Royal Brisbane and Women’s Hospital, Bowen Bridge Road, Herston, QLD 4006.
3 Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102.


BACKGROUND: Two billion peripheral intravenous catheters (PIVCs) are used globally each year, but optimal dressing and securement methods are not well established. We compared three alternative approaches to standard non-bordered polyurethane dressings.

METHODS: Pragmatic, open, parallel, superiority, randomised controlled trial in two hospitals. Adults (≥18 years) with PIVCs of expected use >24 hours were randomly assigned (1:1:1:1) to (i) Tissue Adhesive with Polyurethane dressing, (ii) Bordered Polyurethane dressing, (iii) Securement Device with Polyurethane dressing, or (iv) Polyurethane dressing (controls). Randomisation was centralised, computer-generated, stratified, with concealed allocation. The primary outcome was PIVC failure (composite of dislodgement, occlusion, phlebitis, primary bloodstream, local infection). Participants and clinicians were not masked but infections were blind-adjudicated. Analysis was intention to treat. Trial registration: ACTRN12611000769987.

FINDINGS: Of 1807 randomised patients, 1697 (94%) had the primary endpoint available. PIVC failure was: 163/427 (38%) Tissue Adhesive with Polyurethane (absolute risk difference [ARD] -4∙5%, 95% CI -11∙1–2∙1%, p=0∙19); 169/423 (40%) Bordered Polyurethane (ARD -2∙7%, 95% CI -9∙3%–3∙9%, p=0∙44); 176/425 (41%) Securement Device with Polyurethane (ARD -1∙2%, 95% CI -7∙9%­–5∙4%, p=0∙73); and 180/422 (43%) Polyurethane controls. There were three primary bloodstream infections (3/1697, 0.18%), of which one was PIVC-related (1/1697, 0.06%), and 2% (34/1697) of participants had adverse skin reactions. Total costs were not significantly different between groups. Overall, 66% (1130/1709) PIVCs required dressing reinforcement.

INTERPRETATION: Current dressing and securement methods are commonly associated with PIVC failure, adverse events, and poor durability, with simultaneous use of multiple products commonly required. Innovation is urgently needed.

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