Prof. Nicole Marsh1,2,3, Ms. Emily Larsen1,3, Professor Amanda Ullman2,4, Dr Gillian Ray-Barruel2,5, Professor Robert Ware3, Ms. India Pearse6, Professor Fiona Coyer1,2, Mr. Marhashi Patel3, Professor Claire Rickard2,5, Associate Professor Patrick Harris1, Professor Kevin Laupland1, Dr Amanda Corley1,2
1Royal Brisbane and Women's Hospital, Nathan, Australia, 2University of Queensland, St Lucia, Australia, 3Griffith University, Nathan, Australia, 4Children's Health Queensland Hospital and Health Service, South Brisbane, Australia, 5Herston Infection Disease Institute, Metro North Health, Herston, Australia, 6The Prince Charles Hospital, Chermside, Australia
Biography:
Professor Nicole Marsh is the Nursing and Midwifery Director for Research at the Royal Brisbane and Women’s Hospital. Her program of research is focused on improving patient outcomes and decreasing complications associated with vascular access across the acute care and community setting. She is currently leading a team who are investigating the clinical and economic benefit of different workforce models for vascular access device insertion to improve patient outcomes. In recognition of her expertise in the field, she was invited to advise on the Australian Commission on Safety and Quality in Healthcare’s 2021 Peripheral Intravenous Catheter Clinical Care Standard.
Abstract:
Introduction
Central venous catheters (CVC) are necessary to provide treatment to intensive care unit (ICU) patients. However, CVCs are vulnerable to failure, in part, from inadequate dressing and securement, which causes treatment delays and increased healthcare-costs. This study evaluated the efficacy of medical liquid adhesive (MLA) for improving CVC dressing adhesion.
Methods
A multicentre randomised controlled trial comparing standard care dressings with standard care plus MLA (intervention) was undertaken in four ICUs between September 2021 and February 2023. Eligible patients were: ≥18years, within 12hours of CVC insertion, requiring CVC for ≥72hours, and in ICU ≥24hours. The primary endpoint was dressing failure (lifting at edges). Secondary outcomes included first dressing dwell-time, local infection, central line associated bloodstream infection (CLABSI), CVC failure and skin-injury.
Results
160 participants (82 control; 78 intervention) were enrolled. Dressing failure was significantly lower in the intervention group compared to the control (Risk difference -22%, 95% confidence interval (CI) -0.37 – -0.07, p=0.005). The MLA group had longer first dressing dwell (median difference and interquartile range 43.3 hours [16.4, 70.3], p=0.002) compared to standard care. There were two local infections in the MLA group, and no CLABSI in either group. CVC failure was similar (IRR 1.44; 95% CI 0.36 – 5.79, p=0.607) and three skin injuries occurred, two in standard care (maceration and skin tear) and one in the MLA group (blister).
Conclusions
MLA is significantly associated with decreased jugular CVC dressing failure and longer dressing dwell. MLA should be considered when applying jugular CVC dressings in ICU.