title: A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients.
abstract: To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility.
  
  
  
  Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU; control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU). Midtrial, due to safety, the TA+SPU intervention was replaced with a suture + TA+SPU group.
  
  
  
  A total of 221 patients were randomized with 2 postrandomization exclusions. Central venous access device failure was as follows: suture + BPU controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56 (0.26/1000 hours, P=.560); SSD+SPU, 4 (7%) of 55 (1.04/1000 hours, P=.417); TA+SPU, 4 (17%) of 23 (2.53/1000 hours, P=.049); and suture + TA+SPU, 0 (0%) of 30 (P=.263; intention-to-treat, log-rank tests). Central venous access device failure was predicted (P<.05) by baseline poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval, 1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2; 95% confidence interval, 3.0-68.4).
  
  
  
  Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia. Electronic address: c.rickard@griffith.edu.au.
authors.forename: C M
authors.initials: CM
authors.lastname: Rickard
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: melannie.edwards@health.qld.gov.au.
authors.forename: M
authors.initials: M
authors.lastname: Edwards
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: amy.spooner@health.qld.gov.au.
authors.forename: A J
authors.initials: AJ
authors.lastname: Spooner
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Meadowbrook, 4131, Queensland, Australia. Electronic address: g.mihala@griffith.edu.au.
authors.forename: G
authors.initials: G
authors.lastname: Mihala
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, 4006, Queensland, Australia. Electronic address: nicole.marsh@health.qld.gov.au.
authors.forename: N
authors.initials: N
authors.lastname: Marsh
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: jessica.best@health.qld.gov.au.
authors.forename: J
authors.initials: J
authors.lastname: Best
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: tameka.wendt@health.qld.gov.au.
authors.forename: T
authors.initials: T
authors.lastname: Wendt
authors.affiliation: Department of Anaesthesia, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: ivan.rapchuk@health.qld.gov.au.
authors.forename: I
authors.initials: I
authors.lastname: Rapchuk
authors.affiliation: Cardiac Surgery Research Unit, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: sarah.gabriel@health.qld.gov.au.
authors.forename: S
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Department of Cardiac Surgery, The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: bruce.thomson@health.qld.gov.au.
authors.forename: B
authors.initials: B
authors.lastname: Thomson
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: amanda.corley@health.qld.gov.au.
authors.forename: A
authors.initials: A
authors.lastname: Corley
authors.affiliation: AVATAR Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Queensland, Australia; Critical Care Research Group, The University of Queensland and The Prince Charles Hospital, Chermside, 4032, Queensland, Australia. Electronic address: john.fraser@health.qld.gov.au.
authors.forename: J F
authors.initials: JF
authors.lastname: Fraser
mesh_terms: D000368:Aged; D001458:Bandages; D006348:Cardiac Surgical Procedures; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D010865:Pilot Projects; D011140:Polyurethanes; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D011140:Polyurethanes
keywords: Occlusive dressings; Randomized controlled trial; Securement device; Tissue adhesives; Vascular access devices