Edwards Melannie, Rickard Claire M, Rapchuk Ivan, Corley Amanda, Marsh Nicole, Spooner Amy J, Mihala Gabor, Fraser John F
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, QLD, Australia.
Crit Care Resusc. 2014 Sep;16(3):175-83.
To improve arterial catheter (AC) securement and reduce AC failure; to assess feasibility of a large randomised controlled trial.
DESIGN, SETTING AND PARTICIPANTS: A four-arm, parallel, randomised, controlled, non-blinded pilot trial with 195 intensive care patients taking part, in a tertiary referral hospital in Brisbane, Australia from May to November 2012.
Standard polyurethane (SPU) dressing (controls); bordered polyurethane (BPU) + SPU dressing; tissue adhesive (TA) + SPU dressing; and sutureless securement device (SSD) + SPU dressing (no sutures used).
AC failure, ie, complete dislodgement, occlusion (monitor failure, inability to infuse or fluid leaking), pain or infection (local or blood).
Median AC dwell time was 26.2 hours and was comparable between groups. AC failure occurred in 26/195 patients (13%). AC failure was significantly worse with SPU dressings (10/47 [21%]) than with BPU + SPU dressings (2/ 43 [5%]; P = 0.03), but not significantly different to TA + SPU (6/56 [11%]; P = 0.18) or SSD + SPU (8/49 [16%]; P = 0.61). The dressing applied at AC insertion lasted until AC removal in 68% of controls; 56% of BPU + SPU dressings; 73% of TA + SPU dressings; and 80% of SSD + SPU dressings (all P > 0.05). There were no infections or serious adverse events. Patient and staff satisfaction with all products was high. Median costs (labour and materials) for securement per patient were significantly higher in all groups compared with the control group (SPU, $3.48 [IQR, $3.48-$9.79]; BPU + SPU, $5.07 [IQR, $5.07-$12.99]; SSD + SPU, $10.90 [IQR, $10.90-$10.90]; TA + SPU, $17.70 [IQR, $17.70-$38.36]; all P < 0.01).
AC failure occurred significantly less often with BPU + SPU dressings than with SPU dressings. TA + SPU and SSD + SPU dressings should be further investigated and compared with BPU + SPU dressings as controls. The novel approach of TA + SPU dressings appeared safe and feasible.
改善动脉导管（AC）固定并减少AC故障；评估一项大型随机对照试验的可行性。
设计、设置和参与者：2012年5月至11月在澳大利亚布里斯班一家三级转诊医院进行的一项四臂、平行、随机、对照、非盲法试点试验，有195名重症监护患者参与。
标准聚氨酯（SPU）敷料（对照组）；带边框聚氨酯（BPU）+SPU敷料；组织粘合剂（TA）+SPU敷料；以及无缝合固定装置（SSD）+SPU敷料（未使用缝线）。
AC故障，即完全移位、堵塞（监测故障、无法输注或液体渗漏）、疼痛或感染（局部或血液感染）。
AC的中位留置时间为26.2小时，各组之间具有可比性。195名患者中有26名（13%）发生AC故障。使用SPU敷料时AC故障情况（10/47 [21%]）明显比使用BPU + SPU敷料时（2/43 [5%]；P = 0.03）更糟，但与TA + SPU敷料时（6/56 [11%]；P = 0.18）或SSD + SPU敷料时（8/49 [16%]；P = 0.61）无显著差异。在AC插入时应用的敷料在AC拔除前一直有效的比例在对照组中为68%；BPU + SPU敷料组为56%；TA + SPU敷料组为73%；SSD + SPU敷料组为80%（所有P>0.05）。未发生感染或严重不良事件。患者和工作人员对所有产品的满意度都很高。与对照组相比，所有组每位患者固定的中位成本（人工和材料）显著更高（SPU，3.48美元[四分位距，3.48 - 9.79美元]；BPU + SPU，5.07美元[四分位距，5.07 - 12.99美元]；SSD + SPU，10.90美元[四分位距，10.90 - 10.90美元]；TA + SPU，17.70美元[四分位距，17.70 - 38.36美元]；所有P<0.01）。
使用BPU + SPU敷料时AC故障的发生率明显低于使用SPU敷料时。TA + SPU和SSD + SPU敷料应进一步研究，并与BPU + SPU敷料作为对照进行比较。TA + SPU敷料这种新方法似乎安全可行。
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