title: A pilot trial of bordered polyurethane dressings, tissue adhesive and sutureless devices compared with standard polyurethane dressings for securing short-term arterial catheters.
abstract: OBJECTIVE
  To improve arterial catheter (AC) securement and reduce AC failure; to assess feasibility of a large randomised controlled trial.
  
  
  METHODS
  A four-arm, parallel, randomised, controlled, non-blinded pilot trial with 195 intensive care patients taking part, in a tertiary referral hospital in Brisbane, Australia from May to November 2012.
  
  
  METHODS
  Standard polyurethane (SPU) dressing (controls); bordered polyurethane (BPU) + SPU dressing; tissue adhesive (TA) + SPU dressing; and sutureless securement device (SSD) + SPU dressing (no sutures used).
  
  
  METHODS
  AC failure, ie, complete dislodgement, occlusion (monitor failure, inability to infuse or fluid leaking), pain or infection (local or blood).
  
  
  RESULTS
  Median AC dwell time was 26.2 hours and was comparable between groups. AC failure occurred in 26/195 patients (13%). AC failure was significantly worse with SPU dressings (10/47 [21%]) than with BPU + SPU dressings (2/ 43 [5%]; P = 0.03), but not significantly different to TA + SPU (6/56 [11%]; P = 0.18) or SSD + SPU (8/49 [16%]; P = 0.61). The dressing applied at AC insertion lasted until AC removal in 68% of controls; 56% of BPU + SPU dressings; 73% of TA + SPU dressings; and 80% of SSD + SPU dressings (all P > 0.05). There were no infections or serious adverse events. Patient and staff satisfaction with all products was high. Median costs (labour and materials) for securement per patient were significantly higher in all groups compared with the control group (SPU, $3.48 [IQR, $3.48-$9.79]; BPU + SPU, $5.07 [IQR, $5.07-$12.99]; SSD + SPU, $10.90 [IQR, $10.90-$10.90]; TA + SPU, $17.70 [IQR, $17.70-$38.36]; all P < 0.01).
  
  
  CONCLUSIONS
  AC failure occurred significantly less often with BPU + SPU dressings than with SPU dressings. TA + SPU and SSD + SPU dressings should be further investigated and compared with BPU + SPU dressings as controls. The novel approach of TA + SPU dressings appeared safe and feasible.
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. melannie.edwards@health.qld.gov.au.
authors.forename: Melannie
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
authors.affiliation: Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Rapchuk
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Corley
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Marsh
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Spooner
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia.
authors.forename: Gabor
authors.initials: G
authors.lastname: Mihala
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D001158:Arteries; D001458:Bandages / Q000191:economics; D002404:Catheterization / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011140:Polyurethanes; D013997:Time Factors; D014014:Tissue Adhesives / Q000191:economics
chemical_list: D011140:Polyurethanes; D014014:Tissue Adhesives