None listed
Conditions
Brief summary
Peripheral Intravenous Catheters (PIVCs) are the most frequently used vascular access device in Australia, with Queensland Health spending $41 million purchasing over 2.6 million PIVCs in 2016 alone. Currently, peripheral intravenous (IV) device choice consistently defaults to short-PIVCs (<4cms) to meet most patients’ IV treatment needs. This is largely due to the current workforce model in which most PIVC inserters are doctors and nurses (generalist) inserting PIVCs within their existing roles. Over the last decade, PIVC insertion teams made up of Vascular Access Specialists (VAS) have been disbanded in many hospitals due to budgetary constraints. The ‘generalist’ approach has been adopted instead putting pressure on already-stretched frontline clinicians, particularly junior medical officers in the after-hours space. Inherent inefficiencies in the current generalist workforce model are not sustainable. More efficient, innovative service provision is urgently needed. Our research project aims to compare the clinical effectiveness of peripheral intravenous device selection and insertion by (i) VAS compared with (ii) generalist model (standard practice). We will conduct a single-centre, two-arm, parallel, randomised controlled trial recruiting 196 patients who are 18 years of age or older and requiring IV therapy for 24hrs or more. All participants enrolled in this trial will be randomly allocated (by chance) to have their IV device inserted by either a VAS or a generalist inserter. Daily follow up checks will then be carried out by a (blinded) Research Nurse until the time of device removal. We the investigators hypothesise that devices selected and inserted by a VAS, compared to those inserted by a generalist inserter, will result in: • Reduced peripheral IV device failure and complications • Fewer attempts to achieve successful peripheral IV device placement • Fewer devices to complete the prescribed peripheral IV therapy • Improved patient satisfaction and less self-reported pain on insertion
Interventions
Intervention arm:
Device selection and insertion (with or without ultrasound guidance) by a Vascular Access Specialist (VAS) of either a short or long-Peripheral Intravenous Catheter (PIVC); Midline catheter (MC) or recommendation/referral for a Peripherally Inserted Central Catheter (PICC).
VAS defined as a clinician with advanced knowledge in vascular access insertion, management, device selection, intravenous therapy management (e.g., treatment duration, peripheral and drug compatibility)
Intervention arm: Device selection and insertion (with or without ultrasound guidance) by a Vascular Access Specialist (VAS) of either a short or long-Peripheral Intravenous Catheter (PIVC); Midline catheter (MC) or recommendation/referral for a Peripherally Inserted Central Catheter (PICC). VAS defined as a clinician with advanced knowledge in vascular access insertion, management, device selection, intravenous therapy management (e.g., treatment duration, peripheral and drug compatibility) and technology guidance (e.g., ultrasound). Prior to randomisation, all participants will be individually assessed by the VAS to determine the most appropriate IV device for their needs. The VAS will make an expert decision on the type of peripheral intravenous device that would be best suited, keeping the decision confidential. The VAS will then randomise the patient. If the patient is randomised to “VAS” for device selection and insertion (intervention), the VAS will insert the pre-decided peripheral intravenous device as per their assessment (with or without the use of ultrasound guidance). If, based on the VAS assessment they recommend a PICC as the best option for the patient’s treatment needs, the VAS would make this recommendation to the treating team and assist in the PICC referral process as appropriate. If the patient is randomised to “generalist” (control), the patient will have an IV device selected and inserted as per current hospital practice by a credentialed clinician or service. These decisions are made at the discretion of the generalist inserter (e.g., bedside nurse or medical team). All device insertion data will be collected regardless of study allocation (e.g., device type, device location, inserting clinician and number of attempts).
Sponsors
Griffith University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
18 years of age or older Requiring peripherally-compatible IV therapy for 24 hours or longer Informed written consent
Exclusion criteria
Patient receiving end-of-life care Limited English, without appropriate interpreter Previous study enrolment
Outcome results
None listed