Central venous Access device SeCurement And Dressing Effectiveness in the ICU: the CASCADE ICU Trial

About 500,000 Australians need a Central Venous Access Device (CVAD) each year for intravenous administration of medicines, chemotherapy and fluids. Insertion of these devices poses great procedural risk and complications are common during subsequent use. Between 20 and 50% of CVADs fail prior to treatment being complete. This includes CVADs becoming partially or wholly dislodged, occluded, thrombosis of the vein, fractured catheters, severe pain, or a bloodstream infection. These complications are associated with patient suffering, prolonged hospitalisation, more expensive healthcare costs and increased mortality. Two key factors in preventing complications are (i) securement - that CVADs are adequately secured to the skin, and (ii) dressings - that the incision is covered to prevent infection. CVAD securement has traditionally been via sutures, with a simple polyurethane dressing. This approach (sutures plus simple polyurethane) has been dominant since the 1980s, despite significant evidence of increased bloodstream infections. New alternative securement and dressing options have become available that may be superior to suture and simple polyurethane dressings for preventing complications, but these have not yet been adequately tested for efficacy or cost-effectiveness. CVAD securement and dressings cost the Australian health system millions of dollars each year, yet there is currently no high quality evidence from independent trials to guide decision making and practice on this topic. The proposed study is a high quality, pilot randomised controlled trial, designed to assess the feasibility of undertaking a full-scale efficacy randomised controlled trial, and provide preliminary data for an NHMRC project grant application. The full study would aim identify clinically- and cost-effective securement and dressing approaches that prevent CVAD failure. The 4 group trial will test 3 alternatives to standard care, a novel product – tissue adhesive (medical super-glue), and two commercial alternatives. This design will efficiently and rapidly test numerous treatments. The trial will additionally evaluate the acceptability of products to patients and clinicians, and apply an integrated approach to knowledge translation.