The PISCES Trial: Improvements needed in catheter use with cancer patients

Improving the experience for cancer patients undergoing treatments such as chemotherapy or a blood transfusion is the focus of new Griffith research which has received $1.1m in National Health and Medical Research Council (NHMRC) funding.

Cancer treatment often requires a peripherally inserted central catheter (PICC) to remain in a large vein for these treatments, as well as for the intake of medicines, fluids, nutrition and blood sampling.

Current PICC dressing and securement products are not preventing the 30% of PICCs that develop infection, occlusion, thrombosis or dislodgement, says Professor Claire Rickard from Griffith's Menzies Health Institute Queensland, therefore this trial will aim to reduce the incidence of PICC failure and test new dressings for their effectiveness, costs, comfort and practicality.

A world leading researcher in the area of intravenous catheters, Professor Rickard says that new products are now available on the market that may reduce complications.

"Australian cancer patients use 10,000 PICCs each year to receive chemotherapy and other anti-cancer agents, transfusions, hydration, nutrition, and for repeated blood tests.

"PICCs remain in place for weeks to many months, but complications are common - 30% of PICCs fail before treatment is complete, and this is likely due in part to inadequate dressing and securement. PICC failure includes infection, occlusion, thrombosis, and dislodgement.

"Such complications delay treatment, cause pain, prolong hospitalisation, significantly increase healthcare costs and workloads, and catheter associated bloodstream infections (CABSIs) can be fatal."

Run in collaboration with the Royal Brisbane and Women's, Princess Alexandra, and Lady Cilento Children's Hospitals and other universities around Australia, the nursing-led study is multi-centre and will compare four types of dressing and securement combinations a combination separate securement device plus standard dressing versus an 'all in one' securement dressing, and a chlorhexidine antiseptic sponge versus plain dressing alone.

The effectiveness and cost-effectiveness of these treatments will be tested and it is expected that the new approaches can prevent half of all CABSIs, and one quarter of all PICC failures.

"We believe that the results will prevent 1,000 PICC failures including 400 CABSIs in Australia each year. This will save $8 million, 4,000 hospital days, avoid 1,000 replacement PICC insertions, avoid treatment interruptions, reduce workload, and improve the patient experience of cancer treatment," says Professor Claire Rickard.

As Principal Director of the Griffith based Alliance for Vascular Access Teaching and Research (AVATAR), Professor Rickard leads the largest research group in the world looking at intravascular access. And the success of its research can be measured in hundreds of millions of dollars of reduced health care costs world-wide, as well as improved patient comfort and health outcomes.

"It doesn't matter what health issues you have; whether you are treated in an ambulance or a hospital; whether you have cancer treatment in the community setting, or you need hydration or antibiotics; whenever you need sustained access to a blood vessel to provide treatment, a catheter must be inserted into a vein or artery," Professor Rickard said.
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