Impact of a Task Delegation to ICU Nurses for Midlines' Placement

NCT04155723 | Completed

• 1 other identifier: GHBretagneSud
• Study Type: observational
• Target: 310
• Locations: 1 country
• Sites: 1

Brief Summary

The administration of medication, fluid resuscitation, or even nutrition in intensive care unit (ICU) patients, requires one or more infusion lines which can be peripheral or central. Midline catheter is a 10 to 20 cm long peripheral venous catheter, which can be used for up to 28 days. These features make it a good alternative to central venous and conventional peripheral venous catheters. Midlines are routinely used in the ICU of Lorient Hospital, currently inserted by doctors. In association with the Regional Health Agency, the investigators are currently implementing a project of task delegation to ICU nurses, so that they could insert Midlines' catheters. The aim of the study is to increase the use of Midlines in the unit to reduce the exposure to central venous catheters and their complications, such as infections or thrombosis. The investigators propose to conduct a prospective monocentric study to compare the frequency of Midlines'use, before and after the task delegation. The primary objective is to compare the duration of exposure to central venous catheters between the two periods. Secondary objectives are to compare the duration of exposure to peripheral venous catheters and Midlines, and the catheter-related infections and thrombosis.

Conditions

Catheter-Related Infections

Keywords

Midlines

Outcome Measures

Primary Outcomes (1)

• Duration of exposure to central venous catheter

  Duration of exposure to central venous catheter (catheter-days per patient-day)

  ICU discharge (usually seven days)

Secondary Outcomes (11)

• Duration of exposure to peripheral venous catheter

  ICU discharge (usually seven days)

• Duration of exposure to Midline

  ICU discharge (usually seven days)

• Number of catheter-related infections

  ICU discharge (usually seven days)

• Number of catheter-related infections

  Hospital discharge (usually two weeks)

• Number of catheter-related thrombosis

  ICU discharge (usually seven days)

Study Arms (2)

Phase 1 group

During phase 1, Midlines are inserted only by doctors.

Phase 2 group

During Phase 2, Midlines are preferentially inserted by ICU nurses, and if needed, by doctors.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients hospitalized in ICU for more than 48 hours

You may qualify if:

• Adult patients hospitalized in ICU for more than 48 hours

You may not qualify if:

• Patient under 18 years old
• Patient under legal guardianship
• Absence of health insurance in France
• Refusal of the patient or his next-of-kin
• Patient with a decision of withholding or withdrawing of life sustaining therapy
• Patient with a subcutaneous central venous port
• Impossibility of infusion on the upper limbs

Sponsors & Collaborators

• Groupe Hospitalier de Bretagne Sud: lead

Study Sites (1)

Groupe Hospitalier Bretagne Sud

Lorient, 56100, France

Location

Related Publications (6)

• O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011 May;39(4 Suppl 1):S1-34. doi: 10.1016/j.ajic.2011.01.003. No abstract available.

  PMID: 21511081 BACKGROUND

• Pathak R, Patel A, Enuh H, Adekunle O, Shrisgantharajah V, Diaz K. The Incidence of Central Line-Associated Bacteremia After the Introduction of Midline Catheters in a Ventilator Unit Population. Infect Dis Clin Pract (Baltim Md). 2015 May;23(3):131-134. doi: 10.1097/IPC.0000000000000237.

  PMID: 25972725 BACKGROUND

• Pathak R, Gangina S, Jairam F, Hinton K. A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital. Ther Clin Risk Manag. 2018 Aug 21;14:1453-1456. doi: 10.2147/TCRM.S171748. eCollection 2018.

  PMID: 30174427 BACKGROUND

• Xu T, Kingsley L, DiNucci S, Messer G, Jeong JH, Morgan B, Shutt K, Yassin MH. Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center. Am J Infect Control. 2016 Dec 1;44(12):1458-1461. doi: 10.1016/j.ajic.2016.09.010.

  PMID: 27908432 BACKGROUND

• Shokoohi H, Boniface K, McCarthy M, Khedir Al-tiae T, Sattarian M, Ding R, Liu YT, Pourmand A, Schoenfeld E, Scott J, Shesser R, Yadav K. Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients. Ann Emerg Med. 2013 Feb;61(2):198-203. doi: 10.1016/j.annemergmed.2012.09.016. Epub 2012 Nov 7.

  PMID: 23141920 BACKGROUND

• Alexandrou E, Spencer TR, Frost SA, Mifflin N, Davidson PM, Hillman KM. Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates--a report from 13 years of service*. Crit Care Med. 2014 Mar;42(3):536-43. doi: 10.1097/CCM.0b013e3182a667f0.

  PMID: 24145843 BACKGROUND

MeSH Terms

Conditions

Catheter-Related Infections

Condition Hierarchy (Ancestors)

Infections

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: October 25, 2019
• First Posted: November 7, 2019
• Study Start: November 6, 2019
• Primary Completion: December 31, 2022
• Study Completion: June 1, 2023
• Last Updated: July 12, 2023

Record last verified: 2023-07

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)