Dislodged Catheter
Conditions
Keywords
skin glue, dermabond, randomized controlled trial, intravenous catheter
Brief summary
Intravenous (IV) catheter placement is the most common medical procedure in emergency department settings. IVs are used to deliver medications, fluids and blood products to patients. At the Children's Hospital of Eastern Ontario, approximately three-quarters of children admitted to hospital have an IV inserted while they are in the emergency department. However, a challenge associated with IVs is that they sometimes stop working or fall out before treatment has been completed (this is known as IV failure). When IVs fail, a new IV often needs to be placed. Children rank IV placement as one of the leading causes of pain in the hospital setting. The investigators are interested in understanding whether there are strategies that can help keep IVs in place longer for children admitted to hospital. Previous studies investigating whether certain types of bandages over IV sites are helpful in keeping IVs in longer found all bandages performed about the same. However, a recent study of adult patients showed that using medical-grade skin glue to secure the IV significantly reduced IV failure rates when compared to usual care. There have been no similar studies in children. The objective of this study is to understand whether placement of skin glue at IV insertion sites is effective in decreasing IV failure rates in children. This study will take place in the emergency department at Children's Hospital of Eastern Ontario (CHEO). Consenting children will be randomly assigned to receive IV placement either with or without skin glue (one drop at the IV insertion site and another drop under the hub of the catheter), along with otherwise standard securement with a transparent dressing. The investigators will look at the numbers of children in each group whose IVs fail before their intended treatment course is complete. This study has the potential to improve patient and family satisfaction, decrease nursing workload and reduce healthcare costs.
Interventions
DEVICECyanoacrylate glue
One drop of cyanoacrylate glue will be applied to the intravenous (IV) insertion site and another drop under the hub of the IV catheter
OTHERTransparent polyurethane dressing
The IV will be secured in the usual manner with tape and a transparent dressing.
Sponsors
The Physicians' Services Incorporated Foundation
Children's Hospital of Eastern Ontario
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Age 0 days to 18 years 2. Patient must require a PIVC as part of their management plan 3. Patient must be physically in the ED at the time of PIVC insertion
Exclusion criteria
1. At the time of insertion, the treating physician anticipates the patient will likely be discharged from the ED (with or without the PIVC in place) 2. Known allergy to skin glue, glue removal wipe, or standard catheter securement materials 3. Active infection at site of PIVC insertion 4. Insurmountable language barrier (patient's parent/guardian is unable to understand English or French well enough to give informed consent and participate in follow-up) 5. Previous enrolment in the trial 6. PIVC is expected to be used for chemotherapy (note: these are changed every 4 days even with good blood return) 7. Life-threatening or critical presentation in which consent is unable to be obtained
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PIVC failure before the intended intravenous treatment course is complete. | Measured at the point at which the PIVC fails, up to 14 days | PIVC failure is defined by a composite of dislodgement, occlusion, signs of infection, and phlebitis. Dislodgement is defined as subcutaneous extravasation, accidental removal by patient or staff, or history that the PIVC fell out. Occlusion is defined as an inability to flush the catheter with 2-3ccs of normal saline or history that the PIVC was not working. Infection is defined as presence of pus, erythema, pain, and/or swelling around the PIVC site in keeping with a clinical suspicion of infection or cellulitis. Phlebitis is defined as a painful, palpable, cord-like vein.If the PIVC fails (as per the above definition) before an order is written to discontinue the PIVC, it will be determined the device failed before the treatment course was complete. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to PIVC failure | Time from PIVC insertion to either a) PIVC failure or b) when PIVC is not longer needed for treatment, up to 14 days | Time from PIVC insertion to failure (measured in hours) |
| PIVC failure or removal as a result of each of the following: a) dislodgement, b) occlusion, c) infection, and d) phlebitis | End of study period, up to 14 days | Numerator: number of PIVCs that fail; Denominator: Total number of PIVCs inserted |
| Pain on PIVC removal as experienced by the patient or observed by the caregiver | Measured at the time of PIVC removal, up to 14 days | Measured using the Visual Analogue Scale |
| Difficulty of PIVC removal | Measured at the time of PIVC removal, up to 14 days | measured by the bedside nurse using a 4-point Likert scale |
Countries
Canada
Outcome results
None listed