SEcuring Central venous catheters Using a subcutaneously anchored secuRement system to prevent cathEter Dislodgment in children: the SECURED randomised controlled trial

SEcuring Central venous catheters Using a subcutaneously anchored secuRement system to prevent cathEter Dislodgment in children: the SECURED randomised controlled trial

Tricia Kleidon^1,2,3,4, Jessica Schults^1,2,4, Derek Roebuck⁵, Victoria Gibson^1,2, Deborah Pierce⁵, Ruth Royle³, Robert Ware³, Joshua Byrnes³, Claire Rickard^1,2,3,4, Amanda Ullman^1,2,3,4, ,

¹Queensland Children’s Hospital, South Brisbane, Queensland, Australia
²University of Queensland, St Lucia, Queensland, Australia
³Griffith University, Nathan, Queensland, Australia
⁴Royal Brisbane and Women’s Hostpial, Herston, Queensland, Australia
⁵Perth Children’s Hospital, Perth, WA, Australia












Introduction
Optimal securement for central venous catheters (CVC) is imperative to reduce catheter dislodgement interrupting therapy delivery, increasing infection risk, and prolonging hospitalisation. We aimed to compare the effectiveness of subcutaneous anchored securement system (SASS) with a sutureless securement device (SSD) to prevent CVC dislodgement.

Methods
A Multi-centre randomised controlled trial (June 2020 to July 2022) at two Australian quaternary paediatric hospitals. Patients aged neonatal to 18 years requiring a peripherally inserted or tunnelled, non-cuffed CVC were included. Randomisation was 1:1, stratified by device type. The primary outcome was dislodgement. Secondary outcomes included partial or complete dislodgment, catheter- associated skin impairment, dwell time, patient, and staff satisfaction. Prospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12620000783921, Hospital (HREC/20/QCHQ/62034) and University (2020/368) ethics approval.

Results
Of 310 randomised patients, 306 had a device inserted (SASS n=153; SSD n=153). Device dislodgement was lower in SASS (n=8 (5.2%); incident rate (IR) 2.0 per 1,000 catheter days [95% confidence interval (CI)1.0–4.0]) than SSD (n=35 (22.9%); IR 9.8 per 1,000 catheter days [95% CI 7.0-13.6]; incidence rate ratio 0.21 [95% CI 0.10–0.45]). Complete dislodgement was similar between groups, but fewer partial dislodgements occurred in SASS than SSD (6 (3.9%) vs 33 (21.6%); odds ratio 0.15; [95% CI 0.06-0.37]). No difference in catheter dwell, patient and staff satisfaction or catheter-associated skin injury was observed.

Conclusion
Use of SASS significantly reduced catheter dislodgement and potentially the clinical sequalae. Further research should focus on implementation of this new technology to improve patient and clinician satisfaction.

Biography

Tricia is a Nurse Practitioner in Paediatric Vascular Assessment and Management at Queensland Children’s Hospital and Research Fellow at University of Queensland. Tricia is part of a dynamic clinical and research team that prides itself on achieving positive outcomes for patients and minimising vascular access related complications. She is currently enrolled in a PhD program of research entitled ‘Techniques and technologies to improve PIVC first time insertion success and reduce complications and failure’.