Catheter-Related Infections
Conditions
Keywords
Midlines
Brief summary
The administration of medication, fluid resuscitation, or even nutrition in intensive care unit (ICU) patients, requires one or more infusion lines which can be peripheral or central. Midline catheter is a 10 to 20 cm long peripheral venous catheter, which can be used for up to 28 days. These features make it a good alternative to central venous and conventional peripheral venous catheters. Midlines are routinely used in the ICU of Lorient Hospital, currently inserted by doctors. In association with the Regional Health Agency, the investigators are currently implementing a project of task delegation to ICU nurses, so that they could insert Midlines' catheters. The aim of the study is to increase the use of Midlines in the unit to reduce the exposure to central venous catheters and their complications, such as infections or thrombosis. The investigators propose to conduct a prospective monocentric study to compare the frequency of Midlines'use, before and after the task delegation. The primary objective is to compare the duration of exposure to central venous catheters between the two periods. Secondary objectives are to compare the duration of exposure to peripheral venous catheters and Midlines, and the catheter-related infections and thrombosis.
Detailed description
The administration of medication, fluid resuscitation, or even nutrition in intensive care unit (ICU) patients, requires one or more infusion lines which can be peripheral or central. Although central venous catheters (CVC) are often mandatory in ICU, the risk of catheter-related infections should lead to consider the insertion of peripheral venous catheters. However in ICU patients, presence of edema or poor venous condition may not allow placement of peripheral venous catheter. Midline catheter is a 10 to 20 cm long peripheral venous catheter, which can be used for up to 28 days (according to manufacturer recommendations). These features make it a good alternative to central venous and conventional peripheral venous catheters. They are placed at the bedside, peripherally into the cephalic or basilic vein, with the tip reaching the axillary vein. Midlines are routinely used in the ICU of Lorient Hospital, currently inserted by doctors. Studies have shown the feasibility and the safety of delegating to nurses placement of CVC and Midlines. In association with the Regional Health Agency, the investigators are currently implementing a project of task delegation to ICU nurses, so that they could insert Midlines' catheters. Midlines' implementation has been associated with a decrease in the use of CVC and catheter-related infections. To our knowledge, no study investigated the placement of Midlines by nurses in the ICU. The investigators propose to conduct a prospective monocentric study to compare the frequency of Midlines' use, before and after the task delegation. The primary objective is to compare the duration of exposure to central venous catheters between the two periods. Secondary objectives are to compare the duration of exposure to peripheral venous catheters and Midlines, and the catheter-related infections and thrombosis. Complications related to Midlines' placement would also be recorded.
Interventions
None listed
Sponsors
Groupe Hospitalier de Bretagne Sud
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients hospitalized in ICU for more than 48 hours
Exclusion criteria
* Patient under 18 years old * Patient under legal guardianship * Absence of health insurance in France * Refusal of the patient or his next-of-kin * Patient with a decision of withholding or withdrawing of life sustaining therapy * Patient with a subcutaneous central venous port * Impossibility of infusion on the upper limbs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of exposure to central venous catheter | ICU discharge (usually seven days) | Duration of exposure to central venous catheter (catheter-days per patient-day) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of exposure to Midline | ICU discharge (usually seven days) | Duration of exposure to Midline (catheter-days per patient-day) |
| Number of catheter-related infections | ICU discharge (usually seven days) | Number of catheter-related infections (number of events per 1000 catheter days) |
| Number of catheter-related thrombosis | ICU discharge (usually seven days) | Number of catheter-related thrombosis (number of events per 1000 catheter days) |
| Number of pneumothorax and arterial punctures | ICU discharge (usually seven days) | Number of pneumothorax and arterial punctures (for each catheter inserted, percentage) |
| Duration of exposure to peripheral venous catheter | ICU discharge (usually seven days) | Duration of exposure to peripheral venous catheter (catheter-days per patient-day) |
| Description of the events associated with Midlines' insertion : Number of punctures | ICU discharge (usually seven days) | Number of punctures (per Midline inserted) |
| Description of the events associated with Midlines' insertion : Duration of the procedure | ICU discharge (usually seven days) | Duration of the procedure (in minutes) |
| Description of the events associated with Midlines' insertion : Failure rate | ICU discharge (usually seven days) | Failure rate (percentage) |
| Number of patients discharged from the ICU with a central venous catheter | ICU discharge (usually seven days) | Number of patients discharged from the ICU with a central venous catheter (percentage) |
Countries
France
Outcome results
None listed