Specialized devices and dressings didn't significantly reduce rates of peripheral IV catheter (PIVC) failure, according to a recent study.
The trial was conducted in two hospitals in Queensland, Australia. Adult patients who were expected to require a PIVC for at least 24 hours were randomized to receive tissue adhesive with polyurethane dressing (n=446), bordered polyurethane dressing (n=454), a securement device with polyurethane dressing (n=453), or the control method, polyurethane dressing (n=454). Some patients ended up not requiring a PIVC, so the intention-to-treat population totaled 1,697 patients. Results were published by The Lancet on July 26.
The study's primary outcome of all-cause PIVC failure (a composite of complete dislodgement, occlusion, phlebitis, and primary bloodstream infection or local infection) occurred in 41% of patients. Rates of failure were similar between groups: 43% in the polyurethane group, 41% in the securement device with polyurethane group (absolute risk difference [RD], −1.2%; 95% CI, −7.9% to 5.4%; P=0.73), 40% in the bordered polyurethane group (RD, −2.7%; 95% CI, −9.3% to 3.9%; P=0.44), and 38% in the tissue adhesive with polyurethane group (RD, −4.5%; 95% CI, −11.1% to 2.1%; P=0.19). Skin adverse events occurred in 17 patients in the tissue adhesive with polyurethane group, eight patients in the securement device with polyurethane group, seven patients in the polyurethane group, and two patients in the bordered polyurethane group.
Total costs of the interventions did not differ significantly between groups, although the authors noted that if costs for infection were excluded, the mean cost per patient would be significantly lower for polyurethane than the other options.
“Two billion PIVCs are used globally each year, thus using polyurethane for all PIVC insertions instead of other securement devices and dressings could save $3.4–13.7 billion per year in products, staff time, and responses to PIVC failure (excluding infections),” they wrote.
The results suggested some potential benefit from tissue adhesive, but many patients who received it required additional dressing reinforcement (as did 67% of the overall study patient population), the authors said.
“When durable dressings are identified, tissue adhesive might be a useful adjunct in the future,” they wrote. “Innovations to achieve effective, durable dressings and securements, and randomised controlled trials assessing their effectiveness are urgently needed.” In the interim, cost should be the primary factor in the choice of a method to secure PIVCs, they said, noting that the CDC considers the optimal dressing and securement unresolved.