Prolonged use of intravenous administration sets: a randomised controlled trial.
Rickard, Claire (2004) Prolonged use of intravenous administration sets: a randomised controlled trial. PhD thesis, Queensland University of Technology.
The purpose of this research study was to improve the nursing care of intravenous
catheters by providing evidence on the effects of prolonged duration of intravenous
administration set use.
Intravenous therapy is a vital part of modern health care. However, its invasive nature
can result in infection, with high associated morbidity and mortality. The highest infection rates are displayed in intensive care patients with central venous catheters. The duration of intravenous administration set use may have an impact on infection rates,however the current practice usage and the optimum duration of use is unknown. Previous studies of central venous catheters have reported equal infection rates with 1 to 4 days of administration set use; however few patients have been evaluated with
administration sets used beyond this time. Previous research has been limited by the
inadequacy of available definitions for Catheter-Related Infection.
A prospective, randomised, controlled clinical trial was performed to assess the infection risk of using administration sets for prolonged periods. In the developmental phase prior to the clinical trial; definitions of Catheter-Related Bloodstream Infection (CRBSI) were developed; a nursing practice survey was undertaken to establish the current duration of administration set use; and laboratory experiments were executed to assess the impact of prolonged use on administration set physical integrity and
Central venous catheters were randomised to have their administration sets used for 4
days (n = 203) or 7 days (n = 201).
Percutaneous central venous catheters were enrolled into the study from two adult
intensive care units at a metropolitan, tertiary-referral, teaching hospital. Catheters were
multiple-lumen, chlorhexidine-gluconate and silver-sulphadiazine coated lines, both inserted and removed in the intensive care unit.
Catheters were cultured for microbial colonisation on removal using the Maki roll-plate
technique. Patients were assessed for CRBSI using the developed definitions consisting
of categories: definite, probable (type I and II), possible and absent. Prior to the clinical
trial, a practice survey questionnaire was administered, and laboratory experimentation
Normality of distribution for continuous variables was assessed using the Kolmogorov-
Smirnov statistic. The distribution between groups of variables considered risk factors
for Catheter-Related Infection were tested to assess for bias using Chi-square and T-test.
Logistic regression modelling was performed to analyse the influence of potentially
confounding variables. The incidence of catheter colonisation and CRBSI was tested between groups using Kaplan-Meier survival curve with Log-rank test. Paired T-tests were performed to test for difference in programmed and delivered volumes of
administration sets. A general linear model (ANOVA)± a Scheffe post hoc test to isolate difference was fitted to the standardised values of delivered volumes to determine the effects of day of measurement and volume delivery rate on the accuracy of volume delivery.
There were 10 colonised tips in the intervention group and 19 in the control group. This
difference was not statistically significant (Kaplan Meier survival analysis, Log Rank =
0.87, df = 1, p = 0.35). There were 3 cases of CRBSI per group and the difference in survival from CRBSI was not statistically significant (Kaplan Meier with Log Rank test, p = 0.86). The pre-clinical trial phases of the research programme established that current clinical practice was 3 to 7-day use of administration sets; that administration sets were physically intact and delivered clinically accurate volumes after 7 days of use; and developed useful definitions of CRBSI.
Prolonged intravenous administration set use of 7 days was found to have no significant
impact on patient infection indicators or physical performance of the sets. This finding is
congruent with previous research and trends in current clinical practice.
In conclusion, the research findings support the use of intravenous administration sets
for 7 days.
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|Item Type:||QUT Thesis (PhD)|
|Supervisor:||Courtney, Mary& Webster, Joan|
|Keywords:||Infusions, intrvenous, catheterisation, central venous, sepsis, septicaemia, infusion pumps, infection control, clinical nursing research, clinical trails, randomised controlled trials, questionnaires|
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health|
Current > Schools > School of Nursing
|Department:||Faculty of Health|
|Institution:||Queensland University of Technology|
|Copyright Owner:||Copyright Claire Rickard|
|Deposited On:||03 Dec 2008 13:54|
|Last Modified:||29 Oct 2011 05:41|
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