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المؤلفون: Emily Larsen, Peter Hancock, Raymond Javan Chan, David Wyld, Nicole Gavin, Abu Choudhury, Emily Russell, Sarah Northfield, Amanda J. Ullman, Nicole Marsh, Julie Flynn, Claire M. Rickard, Anthony M. Allworth, Gabor Mihala
المصدر: Trials, Vol 18, Iss 1, Pp 1-13 (2017)
Trialsمصطلحات موضوعية: Catheter Obstruction, Male, Time Factors, Complications, medicine.medical_treatment, Polyurethanes, Medicine (miscellaneous), Peripherally inserted central catheter (PICC), Pilot Projects, law.invention, Central venous, 0302 clinical medicine, Catheters, Indwelling, Randomized controlled trial, law, Acute care, Medicine, Central Venous Catheters, Pharmacology (medical), 030212 general & internal medicine, Treatment Failure, lcsh:R5-920, Chlorhexidine, Equipment Design, Middle Aged, Catheter, Patient Satisfaction, 030220 oncology & carcinogenesis, Female, Vascular access devices, Queensland, lcsh:Medicine (General), Adult, medicine.medical_specialty, Catheterization, Central Venous, Attitude of Health Personnel, Randomised controlled trials, Peripherally inserted central catheter, Catheterization, 03 medical and health sciences, Patient satisfaction, Catheterization, Peripheral, Humans, Device Removal, Aged, Inpatients, Dressing and securement methods, business.industry, Research, Bandages, Surgery, Clinical trial, Intravenous therapy, Catheter-Related Infections, Anti-Infective Agents, Local, Feasibility Studies, Tissue Adhesives, business, Complication
الوصف: Background Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure. Methods This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged ≥ 16 years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU + SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL + Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA + SPU). All groups except TA + SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected. Results PICC failure incidence was: PAL + CHG + Tape (1/5; 20%; 17.4/1000 days), SPU + SSD + CHG (control) (4/39; 10%; 9.0/1000 days), TA + SPU (3/35; 9%; 9.6/1000 days), and CSD + CHG (3/42; 7%; 9.4/1000 days). Recruitment to PAL + CHG + Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD + CHG, TA + SPU (TA applied only at PICC insertion time), and control treatments were acceptable to patients and health professionals. Conclusion A large RCT of CSD + CHG and TA + SPU (but not PAL + CHG + Tape) versus standard care is feasible. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415 . Registered on 15 January 2016.
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المؤلفون: Samantha Keogh, Nicole Gavin, Julie Flynn
المصدر: European Journal of Oncology Nursing. 19:694-700
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, media_common.quotation_subject, Population, Risk Assessment, Asepsis, Cohort Studies, Hygiene, Blood-Borne Pathogens, medicine, Central Venous Catheters, Humans, Hospitals, Teaching, education, Bone Marrow Transplantation, Retrospective Studies, media_common, Cross Infection, education.field_of_study, Chi-Square Distribution, Oncology (nursing), business.industry, Medical record, Sterilization, Retrospective cohort study, General Medicine, Middle Aged, Surgery, Disinfection, Exact test, Catheter, Treatment Outcome, Needles, Catheter-Related Infections, Anti-Infective Agents, Local, Female, Queensland, Aseptic processing, business, Follow-Up Studies
الوصف: Purpose The aim of this study was to determine whether a variation in practice from an aseptic non-touch technique (ANTT) to a sterile technique when changing needleless connectors on central venous access devices (CVAD) was associated with any change in catheter related bloodstream infection (CRBSI) rates in the bone marrow transplant (BMT) population. Methods A two group comparative study without concurrent controls using a retrospective cohort was conducted in a large metropolitan hospital in Brisbane, Australia. Inclusion criteria: haematological malignancy, Hickman catheter inserted, age ≥18. A tool was developed to extract historical data from medical records and pathology results. Primary outcome: CRBSI. Secondary outcomes: laboratory confirmed bloodstream infection, mucosal barrier injury laboratory confirmed bloodstream infection and skin contaminants. Results One hundred and fifty patients were assessed, 73/150 (49%) in the ANTT group. Demographics: males 95/150 (63%), with 71/150 (47%) receiving an autologous BMT. No difference in CRBSI rates between groups was observed (ANTT n = 3 (4%) vs Sterile n = 1 (2.7%), p = 0.357 Fishers Exact Test). Infection by skin contaminants were identified in a similar number of cases across both groups (ANTT n = 9 (12.3%) vs Sterile n = 6 (7.8%)). Conclusions No causal effect can be deduced from this small study; nevertheless results imply that an ANTT was not associated with increased CRBSI. Poor hand hygiene and ANTT were perceived across both groups. Quality and consistent ANTT is a safe method for managing intravascular devices, however education and awareness of pathogen transfer from healthcare worker and patient to their device is required.
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المؤلفون: Nicole Gavin, Claire M. Rickard, Haitham Tuffaha, Marie Cooke, Joshua Byrnes, Joan Webster, Nicole Marsh
المصدر: Australian health review : a publication of the Australian Hospital Association. 43(5)
مصطلحات موضوعية: Health economics, business.industry, Total cost, Hospitals, Public, Health Policy, media_common.quotation_subject, 03 medical and health sciences, Schedule (workplace), Catheter, 0302 clinical medicine, Procurement, 030225 pediatrics, Health care, Economic evaluation, Humans, Operations management, 030212 general & internal medicine, Queensland, business, Welfare, health care economics and organizations, Vascular Access Devices, media_common
الوصف: Objective The aim of this study was to quantify the utilisation of vascular access devices in Queensland public hospitals and their associated cost. Methods Devices were broadly classified into peripheral intravenous catheters, central venous catheters and arterial lines. The number of catheters used was obtained from a central procurement department at Queensland Health and validated using Medicare Benefits Schedule (MBS) claims and/or hospital data from the Australian Institute of Health and Welfare for the same period. Resources consumed included equipment and staff time required to insert and remove catheters. Equipment costs were valued using negotiated hospital prices, and staff time was valued at the fixed industrial award wages in Australia or relevant MBS fees. Device maintenance costs (e.g. dressings) and costs of treating complications were excluded. Results Approximately 2.75 million vascular access devices were used in public hospitals in Queensland in 2016, at a total cost of A$59.14 million. This comprised a total equipment cost of around A$10.17 million and a total labour cost of A$48.85 million Conclusion Vascular access is an important component of healthcare expenditure. The present study is the first to characterise and cost vascular access devices in Queensland. Further research is needed on the costs of maintaining device function and of treating complications associated with vascular access. What is known about the topic? The cost of vascular access in Australia has previously been estimated from modelling, using various assumptions, or based on device utilisation in other countries. What does this paper add? For the first time, device utilisation for vascular access in Queensland has been quantified and costed. Results were obtained from reliable sources and validated against other databases. What are the implications for practitioners? Practitioners and managers may now provide accurate estimates about the cost of catheter failure, a potentially preventable problem that affects up to 50% of all catheters placed. Attaching costs to such failure may also stimulate research into how to reduce the problem.
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المؤلفون: Joan Webster, Glenn Gardner, Nicole Gavin, Kerrie Coleman, Catherine Nicholas
المصدر: Scopus-Elsevier
مصطلحات موضوعية: Male, medicine.medical_specialty, Risk Assessment, Predictive Value of Tests, Acute care, Health Status Indicators, Humans, Medicine, Outpatient clinic, Longitudinal Studies, Intensive care medicine, General Nursing, Aged, Pressure Ulcer, business.industry, Incidence (epidemiology), Reproducibility of Results, Emergency department, Confidence interval, Predictive value of tests, Cohort, Emergency medicine, Female, Queensland, business, Cohort study
الوصف: Aim: To assess the validity of the Waterlow screening tool in a cohort of internal medicine patients and to identify factors contributing to pressure injury. Method:A longitudinal cohort study design was used. A total of 274 patients (mean age 65.3 years) admitted through the emergency department or outpatient clinics of a tertiary hospital in Brisbane, Australia, and expected to remain in hospital for at least 3 days were screened on admission using the Waterlow screening tool. Their pressure ulcer status was monitored and recorded every second day. The main outcome measure was pressure ulcer incidence. Results: Fifteen participants (5.5%) had an existing pressure ulcer and a further 12 (4.4%) developed a pressure ulcer during their hospital stay. Sensitivity of the Waterlow scale was 0.67 (95% confidence interval [CI]: 0.35–0.88), specificity was 0.79 (95% CI: 0.73–0.85), positive predictive value was 0.13 (95% CI: 0.07–0.24) and negative predictive value was 0.98 (95% CI: 0.94–0.99). Conclusion: This study provides further evidence of the poor predictive validity of the Waterlow scale. A suitably powered, randomized controlled trial is urgently needed to provide definitive evidence about the usefulness of the Waterlow scale compared with other screening tools and with clinical judgment.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3263cf2d607c0c56693170d4e29f5b49
https://doi.org/10.12968/bjon.2010.19.sup2.47246
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