Standard versUs peRForated peripheral intravenous catheter. The SURF trial: a pilot randomised controlled trial

Other than the study intervention, (type of peripheral intravenous catheter (PIVC) inserted), all other aspects of PIVC management will be as per local clinical guidelines (Royal Brisbane and Women’s Hospital, 000259: Peripheral Intravenous Cannulation and Infusion Management – Adult and Paediatrics). Hand hygiene is required prior to and throughout the insertion procedure. Skin will be prepped and decontaminated using a large swab or swab stick containing 2% Chlorhexidine Gluconate with 70% isopropyl alcohol. The antiseptic must be allowed to dry prior to inserting the IV catheter. Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained. If the health professional needs to re-establish the identification of the vein, the site should be re-prepped with the antiseptic solution and allowed to thoroughly dry. It is more efficient to assess the patient’s veins at the outset, determine degree of difficulty of insertion and then risk assess to ascertain if it may be more effective to wear sterile gloves to enable palpating of the cleansed area thereby maintaining Aseptic Non-Touch Technique (ANTT®). Site selection will be determined by inserter following assessment of the patient’s vessel health and in consultation with radiographer/radiologist about procedure and infusion protocol. Study and control PIVCs will be inserted by trained clinicians (either clinical staff or research nurses), who are existing skilled or competent intravenous inserters. Pre-trial they will have training and simulated practice inserting the study PIVC, until they feel confident that their skills match their competence for control PIVC insertion. If ultrasound is used to guide insertion, this will be recorded. Weekly checks by Research Nurse (ReN) for protocol fidelity will be conducted. A sterile transparent, semi-permeable, self-adhesive IV dressing must be placed over the insertion site (as per manufacturer recommendations). The PIVC is removed when prescribed therapy is complete or as clinically indicated. Participants allocated to the Intervention group will have a 20g or 22g (as per clinician preference and assessment), 31.75mm BD NexivaTM DiffusicsTM catheter inserted and used for infusion of contrast. This device has both side and end hole exit points at the distal tip, as opposed a single end hole exit point in standard (control) catheter. Pre-packs of allocated products will be kept in storeroom and monitored daily by the research nurse, who will also confirm time and reason for replacements with nursing staff.