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  • Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial

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    Embargoed until: 2022-05-30
    File version
    Accepted Manuscript (AM)
    Author(s)
    Kleidon, Tricia M
    Schults, Jessica A
    Wainwright, Claire
    Mihala, Gabor
    Gibson, Victoria
    Saiyed, Masnoon
    Byrnes, Joshua
    Cattanach, Paula
    Macfarlane, Fiona
    Graham, Nicolette
    Shevill, Elizabeth
    Ullman, Amanda J
    Griffith University Author(s)
    Byrnes, Joshua M.
    Ullman, Amanda J.
    Mihala, Gabor
    Saiyed, Masnoon
    Schults, Jessica
    Shevill, Elizabeth
    Year published
    2021
    Metadata
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    Abstract
    BACKGROUND: The optimal intravenous device for antibiotic administration for children with respiratory disease is uncertain. We assessed the feasibility of a randomized controlled trial (RCT) comparing midline catheters with peripherally inserted central catheters (PICCs). METHODS: Prospective, 2-arm, feasibility RCT in an Australian tertiary, pediatric hospital. Random assignment of 110 children (< 18 years) to receive (i) midline catheter, (ii) PICC. Primary outcome was feasibility (eligibility, recruitment, retention, protocol adherence and acceptability), and the primary clinical outcome was general anesthesia requirement ...
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    BACKGROUND: The optimal intravenous device for antibiotic administration for children with respiratory disease is uncertain. We assessed the feasibility of a randomized controlled trial (RCT) comparing midline catheters with peripherally inserted central catheters (PICCs). METHODS: Prospective, 2-arm, feasibility RCT in an Australian tertiary, pediatric hospital. Random assignment of 110 children (< 18 years) to receive (i) midline catheter, (ii) PICC. Primary outcome was feasibility (eligibility, recruitment, retention, protocol adherence and acceptability), and the primary clinical outcome was general anesthesia requirement for intravenous catheter insertion. SECONDARY OUTCOMES: insertion time, treatment delays, infusion efficiency, device failure, complications, and cost. RESULTS: There was 80% recruitment, 100% retention, no missing data, and high patient/staff acceptability. Mean patient experience assessed on a 0-10 numeric rating scale was 8.0 (PICC) and 9.0 (midline catheters) respectively. Participant eligibility was not achieved (49% of screened patients) and moderate protocol-adherence across groups (89% PICC vs 76% midline catheter). Insertion of midline catheter for pulmonary optimisation reduced the requirement for general anesthesia compared to PICCs (10% vs 69%; odds ratio=0.01, 95% confidence interval: 0.00-0.09). Midline catheters failed more frequently (18.1 vs 5.5 PICCs per 1,000 catheter-days), however this reduced over trial duration. Midline catheter insertion compared to PICCs saved AUD$1,451 per pulmonary optimisation episode. CONCLUSION: An efficacy trial is feasible with expanded eligibility criteria and intensive staff training when introducing a new device. Midline catheter for peripherally compatible infusions is acceptable to patients and staff, might negate the need for general anesthesia and results in significant cost savings.
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    Journal Title
    Pediatric Anesthesia
    Publisher URI
    https://onlinelibrary.wiley.com/doi/abs/10.1111/pan.14229
    DOI
    https://doi.org/10.1111/pan.14229
    Copyright Statement
    © 2021 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial, Paediatric Anaesthesia, 2021, which has been published in final form at https://doi.org/10.1111/pan.14229. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
    Note
    This publication has been entered in Griffith Research Online as an advanced online version.
    Subject
    Health economics
    PICC
    anesthesia
    central venous catheterization
    cystic fibrosis
    general
    Publication URI
    http://hdl.handle.net/10072/404935
    Collection
    • Journal articles

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