118 - SEcuring Central venous catheters Using a subcutaneously anchored secuRement system to prevent cathEter Dislodgment in children: the SECURED randomised controlled trial
Professor and Chair The University of Queensland and Childrens Health Queensland South Brisbane, Queensland, Australia
Background: Optimal securement for central venous catheters (CVC) is vital to reduce catheter dislodgement which can interrupt therapy delivery, increase infection risk, and prolong hospitalization. We aimed to compare the effectiveness of a novel subcutaneous anchored securement system (SASS) with a sutureless securement device (SSD) to prevent CVC dislodgement in pediatrics. Objective: To determine clinical and cost-effectiveness of novel, SASS compared to standard dressing and securement for children requiring insertion of PICC or tunnelled CVC. Design/Methods: A multi-centre randomized controlled trial (June 2020 to July 2022) at two Australian quaternary paediatric hospitals. Patients aged neonatal to 18 years requiring a peripherally inserted or tunnelled, non-cuffed CVC were included. Randomization was 1:1, stratified by device type. The primary outcome was dislodgement. Secondary outcomes included partial or complete dislodgment, catheter- associated skin impairment, dwell time, patient, and staff satisfaction.
Prospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12620000783921, Hospital (HREC/20/QCHQ/62034) and University (2020/368) ethics approval. Results: Of 310 randomized patients, 306 had a device inserted (SASS n=153; SSD n=153). Device dislodgement was lower in SASS (5.2% 8/153; incident rate (IR) 2.0 per 1,000 catheter days [95% confidence interval (CI)1.0–4.0]) than SSD (22.9%; 35/153; IR 9.8 per 1,000 catheter days [95% CI 7.0-16.6]; incidence rate ratio (IRR) 4.8 [95% CI 2.2–10.3]; p = < 0.001). Complete dislodgement was similar, but partial dislodgement was lower in SASS (3.9%; 6/153) than SSD (21.6%; 33/153; IRR 6.7; [95% CI 2.7-16.5]; p=0.001). No difference in catheter dwell, patient and staff satisfaction or catheter-associated skin injury was observed.
Conclusion(s): Use of SASS significantly reduced catheter dislodgement and potentially the clinical sequalae. Further research should focus on implementation of this new technology to improve patient and clinician satisfaction.
