Standard versUs peRForated peripheral intravenous catheter: a pilot randomised controlled trial. (The SURF trial)
Cancer care patients are 'high end users' of PIVCs and other vascular devices necessary to receive both anti-cancer and adjunct treatments. However, current failure rates of PIVCs are unacceptably high (40-50%). Intravenous (IV) cytotoxic chemotherapy, rapid injection of radiopaque contrast, in addition to other drugs and infusates are frequently required to be delivered via peripheral vascular access in cancer care services. These substances are known to be highly irritant to veins and frequently cause localised inflammation and sclerosis which results in the loss of accessible veins. Consequently, difficult venous access during later stages of treatment and readmission are experienced by a significant proportion of patients.
Other than the PIVC's polymeric formulation, the invasive segment of the catheter has not changed in the last few decades. Traditional PIVCs are designed with a single hole at the distal tip of the catheter in which medications and intravenous fluids were administered. A relatively new innovative catheter has recently become available which offers additional micro perforations on the side of the catheter (BD NexivaTM DiffusicsTM). It was originally developed to facilitate high pressure contrast injection within the Medical Imaging setting. However, the perforated design of the catheter tip may hold the key to reducing PIVC failure more widely through its 'diffusive' action at the catheter tip in vivo, minimising endothelial and platelet activation from repeated injection and infusion from everyday use.
This study is supportive by a collaborative research grant between Metro North Hospitals and Health Service (MNHHS ) and Queensland University of Technology (QUT) and aims to test the feasibility of evaluating perforated versus non-perforated peripheral catheter design. Eighty patients (40 per treatment group) requiring injection of contrast via PIVC for a Computerised Tomography (CT) scan for diagnosis or staging of malignant oncology or haematology conditions, will be enrolled. In addition to feasibility outcomes, the impact on device failure and vessel integrity will be evaluated. The results will lay the foundation for follow on trial work and grant applications to support this.