Prof. Claire Rickard1,2,3, Ms Emily Larsen1,2, Prof Nicole Marsh1,2,3, A/Prof Matthew McGrail2,3, Prof Amanda Ullman1,2,3,4, Ms Tricia Kleidon2,3,4, Prof Ray Chan2,5, A/Prof Joshua Byrnes2, A/Prof Peter Mollee2,3,6, Prof David Paterson1,2,3, Dr Vineet Chopra2,7, Dr Leanne Stone2,6, Dr Doreen Tapsall2,6, Prof Samantha Keogh1,2,8, Dr Nicole Gavin1,2,8, Prof Sandie McCarthy2,3,6, Dr Evan Alexandrou2,9, Dr MA Choudhury2,10, Dr Amanda Corley1,2,3, Dr Jessica Schults1,2,3,4, Dr Gillian Ray-Barruel1,2,3, Prof E Geoffrey Playford2,3,6
1Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Cancer Care Services, Royal Brisbane and Women’s Hospital and Metro North Health, Herston, Australia
2Alliance for Vascular Access Teaching & Research (AVATAR), School of Nursing & Midwifery, and Centre for Applied Health Economics, Griffith University , Nathan, Australia
3School of Nursing Midwifery and Social Work, Rural Clinical School, and School of Medicine, The University of Queensland, Herston, 4059
4Queensland Children’s Hospital, South Brisbane, Australia
5Flinders University, Adelaide, Australia
6Princess Alexandra Hospital, Buranda, Australia
7University of Colorado , Denver, USA
8Queensland University of Technology, Kelvin Grove, Australia
9Western University of Sydney/Liverpool Hospital, Liverpool, Australia
10Uni of Canberra, Canberra, Australia
Introduction: The optimal dressing and securement for peripherally inserted central catheters (PICCs) is unclear with most evidence coming from other central venous catheter types. We aimed to compare the effectiveness of chlorhexidine gluconate (CHG) dressings to prevent catheter associated bloodstream infection (CABSI) and integrated securement devices (ISD) to prevent PICC failure.
Methods: This NHMRC-funded study was undertaken with cancer patients at 3 Australian adult/paediatric hospitals. There was a pragmatic, randomised, controlled, assessor masked, 2×2 factorial superiority design. Patients were randomised (centralised, stratified, blocked) to receive a PICC dressing with a CHG disc (intervention) or not (control), and to PICC securement with an ISD (intervention) or separate securement device (control). The primary outcomes were CABSI for the dressing comparison and all-cause PICC failure for the securement hypothesis.
Results: Between June 2016 and September 2020, 840 patients (1045 PICCs) were randomly assigned, with 1027 PICCs successfully inserted, and no attrition. PICCs were predominantly dual lumen, polyurethane non-valved catheters in the basilic vein. Median studied PICC dwell was 42 days. CABSI occurred in 23 of 491 (4.7%) CHG dressing PICCs, and 31 of 536 (5.8%) no-CHG dressing PICCs (Hazard Ratio [HR] 0.68, 95% confidence interval [CI] 0.40-1.17; p=0.16). PICC failure occurred in 107/510 (21.0%) of ISD secured PICCs and 108/517 (20.9%) separate securement device secured PICCs (HR 1.01, 95% CI 0.77-1.32; p=0.95).
Conclusion: Preliminary analysis identified no significant reduction in CABSI or PICC failure with the use of CHG dressings or ISD securement. Multivariate, economic and sensitivity analyses will further inform these results.
Biography: Claire Rickard is Professor of Infection Prevention & Vascular Access at The University of Queensland and Metro North Health. Her vision is complication-free vascular access devices, across healthcare settings. She founded the highly respected Alliance for Vascular Access Teaching and Research (AVATAR) and has mentored many clinician researchers.
Claire’s landmark trials published in The Lancet, have seen global change to assessment-based rather than time-based removal of peripheral IV catheters, informed better dressings and securements, and extended safe use of infusion sets for central venous and arterial catheter.
Claire was inducted into the International Nurse Researcher Hall of Fame in 2013.