Catheter Securement And Dressing Effectiveness: the CASCADE Trial
Central Venous Devices (CVADs), or commonly “central lines”, are small plastic tubes inserted into major veins (most frequently in the chest, neck or groin) to administer fluid, nutrients, medications, blood products, withdraw blood for analysis and to monitor central blood pressure. CVAD insertion is one of the most common invasive procedure performed in hospitals with ~ 150 million used in the USA each year and ~ 14 million in Australia.
The study is a multi-centre, parallel group randomised controlled trial (RCT) with four arms: three experimental groups and one control. Adult and paediatric patients who require an intravenous catheter with expected use that is greater than 24 hours are included in this study. We hypothesise a difference (reduced failure rate) of each of three alternative treatments against control. The first experimental group have CVADs secured with tissue adhesive, the second group with bordered polyurethane; the third experimental group with sutureless securement devices. The control group will have usual care CVAD securement. There will be a 3-year recruitment of patients, from hospitals in South-East QLD. Comprehensive assessment of effectiveness, cost-effectiveness, and acceptability will be performed in line with the MRC model for evaluating complex interventions
CVADs are foreign objects placed within the body, with the external component requiring securement to the skin. Dressings/securements must ensure CVADs do not dislodge and fall out, or move out of the vein and into surrounding tissue. This can occur via movement/pressure on the external CVAD: ‘drag’ from infusion tubing, ‘catching’ on environmental structures e.g. clothing or bedclothes. Securement also minimises micro-motion in the vessel, which irritates the vein wall, causing inflammation presenting as pain, swelling and CVAD occlusion. Effective securement must also prevent infection by stopping bacteria entering the CVAD wound (bacteria may travel from the skin/environment down the CVAD tract, into the bloodstream). Micro-motion or ‘pistoning’ of the device may further encourage bacterial entry.