IMPORTANCE: Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes.
OBJECTIVE: To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure.
DESIGN, SETTING, AND PARTICIPANTS: A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024.
INTERVENTIONS: Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient.
MAIN OUTCOMES AND MEASURES: Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs.
RESULTS: A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P = .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups.
CONCLUSIONS AND RELEVANCE: In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This is a new method to this reviewer. It is a novel idea with potential that requires more study including looking at infection rates.
Physician rater
This RCT evaluated the effectiveness of devices that secure peripheral IVs to reduce PIV failure. The design is a 3-arm parallel group superiority RCT at 2 different centers. The authors included 383 patients aged 6 months to 8 years. Patients were randomized 1:1:1 to standard care, integrated securement dressing, and integrated securement dressing with tissue adhesive. Failure was lowest in the securement dressing with adhesive group, as were direct costs. PIV longevity and intervention acceptability were similar in all groups. Ultimately, this study suggests that using tissue adhesive with a securement dressing reduces PIV failure.
Physician rater
In this RCT, using tissue adhesive with an integrated securement device (to secure the intravenous cannula) significantly reduced failure rates. This is an important observation as IV access and maintenance in children is very often an issue. The only concern is the time needed of 30 seconds after applying the liquid adhesive and the dressing. This may not be easy, especially in a crying struggling infant.
, McMaster University