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dc.contributor.authorKeogh, Samantha
dc.contributor.authorShelverton, Caroline
dc.contributor.authorFlynn, Julie
dc.contributor.authorMihala, Gabor
dc.contributor.authorMathew, Saira
dc.contributor.authorDavies, Karen M
dc.contributor.authorMarsh, Nicole
dc.contributor.authorRickard, Claire M
dc.date.accessioned2020-10-06T04:07:59Z
dc.date.available2020-10-06T04:07:59Z
dc.date.issued2020
dc.identifier.issn1741-7015
dc.identifier.doi10.1186/s12916-020-01728-1
dc.identifier.urihttp://hdl.handle.net/10072/398117
dc.description.abstractBackground: Peripheral intravenous catheters (PIVCs) are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing. The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on short PIVC maintenance had on patient outcomes. Methods: This single-centre, incomplete, stepped wedge, cluster randomised trial with an implementation period was undertaken at a quaternary hospital in Queensland, Australia. Eligible patients were from general medical and surgical wards, aged ≥ 18 years, and requiring a PIVC for > 24 h. Wards were the unit of randomisation and allocation was concealed until the time of crossover to the implementation phase. Patients, clinicians, and researchers were not masked but infections were adjudicated by a physician masked to allocation. Practice during the control period was standard care (variable practice with manually prepared flushes of 0.9% sodium chloride). The intervention group received education reinforcing practice guidelines (including administration with manufacturer-prepared pre-filled flush syringes). The primary outcome was all-cause PIVC failure (as a composite of occlusion, infiltration, dislodgement, phlebitis, and primary bloodstream or local infection). Analysis was by intention-to-treat. Results: Between July 2016 and February 2017, 619 patients from 9 clusters (wards) were enrolled (control n = 306, intervention n = 313), with 617 patients comprising the intention-to-treat population. PIVC failure was 91 (30%) in the control and 69 (22%) in the intervention group (risk difference - 8%, 95% CI - 14 to - 1, p = 0.032). Total costs were lower in the intervention group. No serious adverse events related to study intervention occurred. Conclusions: This study demonstrated the effectiveness of post-insertion PIVC flushing according to recommended guidelines. Evidence-based education, surveillance and products for post-insertion PIVC management are vital to improve patient outcomes. Trial registration: Trial submitted for registration on 25 January 2016. Approved and retrospectively registered on 4 August 2016. Ref: ACTRN12616001035415 .
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.relation.ispartofissue1
dc.relation.ispartofjournalBMC Medicine
dc.relation.ispartofvolume18
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchcode32
dc.subject.fieldofresearchcode3202
dc.subject.keywordsCatheter-related infection
dc.subject.keywordsEvidence-based practice
dc.subject.keywordsFlushing
dc.subject.keywordsPeripheral intravenous catheter
dc.subject.keywordsRandomised trial
dc.titleImplementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationKeogh, S; Shelverton, C; Flynn, J; Mihala, G; Mathew, S; Davies, KM; Marsh, N; Rickard, CM, Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial., BMC Medicine, 2020, 18 (1), pp. 252-
dcterms.dateAccepted2020-07-31
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2020-10-06T03:49:28Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2020 The Authors. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
gro.hasfulltextFull Text
gro.griffith.authorMihala, Gabor


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