Innovation in Central Venous Access Device Security: A Pilot Randomized Controlled Trial in Pediatric Critical Care. Ullman, A. J, Long, D., Williams, T., Pearson, K., Mihala, G., Mattke, A. C, Macfarlane, F., & Rickard, C. M Pediatric Critical Care Medicine, 20(10):e480–e488, July, 2019.
Innovation in Central Venous Access Device Security: A Pilot Randomized Controlled Trial in Pediatric Critical Care [link]Paper  doi  abstract   bibtex   
Objectives: Central venous access devices enable many treatments during critical illness; however, 25% of pediatric central venous access devices fail before completion of treatment due to infection, thrombosis, dislodgement, and occlusion. This is frequently attributed to inadequate securement and dressing of the device; however, high-quality research evaluating pediatric central venous access device securement innovation to prevent central venous access device failure is scarce. This study aimed to establish the feasibility of a definitive randomized control trial examining the effectiveness of current and new technologies to secure central venous access devices in pediatrics. Design: Single-center, parallel group, superiority, pilot randomized control trial. Setting: Anesthetic and intensive care departments of a tertiary pediatric hospital Subjects: One-hundred eighty pediatric patients with nontunneled central venous access device Interventions: Participants were randomized to receive central venous access device securement via standard care (bordered polyurethane dressing, with prolene sutures, chlorhexidine gluconate disc), tissue adhesive (Histoacryl, B Braun, Melsungen, Germany) in addition to standard care; or integrated dressing securement (SorbaView SHIELD [Centurion Medical Products, Franklin, MA], with prolene sutures and chlorhexidine gluconate disc). Outcomes: Primary: Feasibility (including effect size estimates, acceptability); central venous access device failure; central venous access device complications; secondary: individual central venous access device complications, skin damage, dressing performance, and product cost. Measurements and Main Results: Feasibility criteria were achieved as recruitment occurred with acceptable eligibility, recruitment, missing data, and attrition rates, as well as good protocol adherence. Family members and staff-reported comparable levels of acceptability between study arms; however, tissue adhesive was reported as the most difficult to apply. Overall, 6% of central venous access devices failed, including 6% (3/54; incident rate, 13.2 per 1,000 catheter days) standard care, 2% (1/56; incident rate, 3.65 per 1,000 catheter days) integrated, and 8% (5/59; 25.0 per 1,000 catheter days) tissue adhesive. Conclusions: It is feasible to conduct an efficacy randomized control trial of the studied interventions. Further research is required to definitively identify clinical, cost-effective methods to prevent central venous access device failure by examining new dressing and securement technologies and techniques.
@article{ullman_innovation_2019,
	title = {Innovation in {Central} {Venous} {Access} {Device} {Security}: {A} {Pilot} {Randomized} {Controlled} {Trial} in {Pediatric} {Critical} {Care}},
	volume = {20},
	issn = {1529-7535},
	url = {http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=31274778&retmode=ref&cmd=prlinks},
	doi = {10.1097/pcc.0000000000002059},
	abstract = {Objectives: Central venous access devices enable many treatments during critical illness; however, 25\% of pediatric central venous access devices fail before completion of treatment due to infection, thrombosis, dislodgement, and occlusion. This is frequently attributed to inadequate securement and dressing of the device; however, high-quality research evaluating pediatric central venous access device securement innovation to prevent central venous access device failure is scarce. This study aimed to establish the feasibility of a definitive randomized control trial examining the effectiveness of current and new technologies to secure central venous access devices in pediatrics. Design: Single-center, parallel group, superiority, pilot randomized control trial. Setting: Anesthetic and intensive care departments of a tertiary pediatric hospital Subjects: One-hundred eighty pediatric patients with nontunneled central venous access device Interventions: Participants were randomized to receive central venous access device securement via standard care (bordered polyurethane dressing, with prolene sutures, chlorhexidine gluconate disc), tissue adhesive (Histoacryl, B Braun, Melsungen, Germany) in addition to standard care; or integrated dressing securement (SorbaView SHIELD [Centurion Medical Products, Franklin, MA], with prolene sutures and chlorhexidine gluconate disc). Outcomes: Primary: Feasibility (including effect size estimates, acceptability); central venous access device failure; central venous access device complications; secondary: individual central venous access device complications, skin damage, dressing performance, and product cost. Measurements and Main Results: Feasibility criteria were achieved as recruitment occurred with acceptable eligibility, recruitment, missing data, and attrition rates, as well as good protocol adherence. Family members and staff-reported comparable levels of acceptability between study arms; however, tissue adhesive was reported as the most difficult to apply. Overall, 6\% of central venous access devices failed, including 6\% (3/54; incident rate, 13.2 per 1,000 catheter days) standard care, 2\% (1/56; incident rate, 3.65 per 1,000 catheter days) integrated, and 8\% (5/59; 25.0 per 1,000 catheter days) tissue adhesive. Conclusions: It is feasible to conduct an efficacy randomized control trial of the studied interventions. Further research is required to definitively identify clinical, cost-effective methods to prevent central venous access device failure by examining new dressing and securement technologies and techniques.},
	number = {10},
	journal = {Pediatric Critical Care Medicine},
	author = {Ullman, Amanda J and Long, Debbie and Williams, Tara and Pearson, Kylie and Mihala, Gabor and Mattke, Adrian C and Macfarlane, Fiona and Rickard, Claire M},
	month = jul,
	year = {2019},
	pages = {e480--e488},
}
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