Amanda J Ullman 1, Deanne August 2, Tricia M Kleidon3 Rachel M Walker 4 Nicole Marsh5 Andrew C Bulmer 6 Ben Pearch 7 Naomi Runnegar 8 Joanne Leema 9 Paul Lee-Archer 10 Cathy Biles 11 Victoria Gibson 12 Ruth Royle 13 Katrina Southam 14 Joshua Byrnes 15 Vineet Chopra 16 Alan Coulthard 17 Peter Mollee 18 Claire M Rickard 19 Patrick N A Harris 20 Robert S Ware 21
1 The University of Queensland, Centre for Children’s Health Research, South Brisbane, QLD, 4101 a.ullman@uq.edu.au, 2 The University of Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD, 4006 d.august@uq.edu.au, 3 Queensland Children’s Hospital, South Brisbane, QLD, 4101 tricia.kleidon@health.qld.gov.au, 4 Griffith University, Nathan, QLD 4111 r.walker@griffith.edu.au, 5 Royal Brisbane and Women’s Hospital, Herston, QLD, 4006 nicole.marsh@health.qld.gov.au, 6 Griffith University, Southport, QLD 4215 a.bulmer@griffith.edu.au, 7 Princess Alexandra Hospital, Woolloongabba, QLD, 4102 benjamin.pearch@health.qld.gov.au, 8 Princess Alexandra Hospital, Woolloongabba, QLD, 4102 naomi.runnegar@health.qld.gov.au, 9 Princess Alexandra Hospital, Woolloongabba, QLD, 4102 joanne.leema@health.qld.gov.au, 10 Queensland Children’s Hospital, South Brisbane, QLD, 4101 paul.lee-archer@health.qld.gov.au, 11 Princess Alexandra Hospital, Woolloongabba, QLD, 4102 cathy.biles@health.qld.gov.au, 12 Queensland Children’s Hospital, South Brisbane, QLD, 4101 victoria.gibson@health.qld.gov.au, 13 Griffith University, Nathan, QLD 4111 r.royle@griffith.edu.au, 14 Royal Brisbane and Women’s Hospital, Herston, QLD, 4006 katrina.southam@health.qld.gov.au, 15 Griffith University, Nathan, QLD 4111 j.byrnes@griffith.edu.au, 16 University of Colorado School of Medicine, Denver, United States vineet.chopra@cuanschutz.edu, 17 Royal Brisbane and Women’s Hospital, Herston, QLD, 4006 alan.coulthard@health.qld.gov.au, 18 Princess Alexandra Hospital, Woolloongabba, QLD, 4102 peter.mollee@health.qld.gov.au, 19 The University of Queensland, Metro North Health, Herston, QLD, 4006 c.rickard@uq.edu.au, 20 The University of Queensland, Herston, QLD, 4006 p.harris@uq.edu.au, 21 Griffith University, Nathan, QLD 4111 r.ware@griffith.edu.au
Abstract:
Background
New catheter materials promise to decrease infectious, thrombotic and catheter occlusion events associated with peripherally inserted central catheters (PICCs). We aimed to rigorously assess the clinical effectiveness of novel PICC technology versus standard polyurethane in a real-world setting.
Methods
The trial was a three-arm, parallel group, superiority randomised controlled trial conducted in three tertiary hospitals in Brisbane, Australia. Adults and children requiring ≥4Fr PICC were randomly assigned (1:1:1) to a novel technology (Hydrophobic PICC or Chlorhexidine PICC), or standard care (standard PICC), and followed for eight weeks. The primary outcome was device failure. Trial registration: ANZCTR619000022167.
Findings
From 2019 to 2022 1,098 patients were recruited and assigned. PICC failure occurred in 21 (5·9%) Hydrophobic, 36 (9·9%) Chlorhexidine and 22 (6·1%) standard care participants (odds ratio (OR) 0·95 [95% CI 0·52-1·77, p 0·88] and OR 1.69 [0·97-2·93], p 0·06] respectively). The most common complication was catheter occlusion (Hydrophobic 17·0% [n=61]; Chlorhexidine 33·6% [n=122]; standard care 14·2% [n=51]). Symptomatic venous thrombosis was lower in Hydrophobic (3·1%; n=11) than standard care (6·4%, n=23; OR 0·46 [0·22-0·96]), which was the primary driver of estimated cost savings for hydrophobic PICCs ($298·57 [$87·62 to $509·52]). No significant adverse events were attributable to interventions.