Securement bundles to prevent peripheral intravenous catheter failure – the SECURE-PIVC trial: A pilot randomised controlled trial

Introduction: Around half of peripheral intravenous catheters (PIVCs) fail before treatment completion. Effective PIVC securement reduces failure but optimal ways to achieve this is unclear. We tested the feasibility of two securement bundles against standard care to prevent PIVC failure in a pilot randomised controlled trial (RCT). Methods: In adult medical-surgical wards, we tested standard care (bordered polyurethane dressing plus non-sterile tape) against two securement bundles (Bundle 1: standard care plus two sterile tape strips over PIVC hub; Bundle 2: Bundle 1 plus tubular bandage). Patients >18yrs requiring a PIVC for >24 hours were eligible; those with laboratory-confirmed positive blood cultures within 24hrs of screening were excluded. Sample size for feasibility outcomes was 35 per arm. Central randomisation was computer-generated with allocation concealment. Primary outcome was study feasibility with results reported descriptively. Secondary outcomes included PIVC failure. A substudy of PIVC and site colonisation was performed. Results: 104 participants were included in the analysis. Feasibility outcomes were met, except the eligibility criterion (79%) therefore screening should be streamlined. Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for standard care. Incidence rate ratio for PIVC failure/1000 catheter days was 1.1 (95% Confidence Interval 0.4-2.7) for Bundle 1 and 2.1 (0.9-5.1) for Bundle 2. No PIVC or site colonisation was detected. Conclusion: A definitive RCT testing securement bundles to reduce PIVC failure is feasible, with adjustments to screening processes. Innovative solutions need to be rigorously tested to address unacceptable rates of PIVC failure. ; No Full Text