The game-changing research that will help IV catheters become safer

A new type of research method is helping to identify best practice around intravascular (IV) catheter usage, in a bid to drive down the 3500 cases of bloodstream infection (BSI) that occur annually in Australia.

Each year, more than two billion central and peripheral IV catheters are used around the world, with the devices accounting for 35% of all healthcare-associated BSIs.

While a large volume of research has already explored the issue, much of the literature has focused on single aspects of catheter usage, such as product type or method of insertion.

In contrast, this new research method, known as a platform trial, can measure multiple variables at speed and provide a more holistic picture, explained lead researcher Professor Claire Rickard, Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland.

“Studies that look at isolated aspects of catheter usage can generate really good-quality data, but the problem is there are just so many things that need testing: antimicrobial products, nursing and medical procedures, etc. It can take years to amass enough data and, by that time, more questions have likely arisen, so we are never getting the full, current picture of best practice.

“With a platform trial, we can answer multiple questions at once and get the guidance we need more efficiently,” she told Hospital + Healthcare.

How does it work?

The platform trial method involves ongoing data collection, using the same dataset, but with different research questions. “Essentially, we are just swapping in and out the different experimental interventions,” Rickard said.

The method proved particularly useful throughout COVID-19, during which time there were lots of rapidly changing treatment questions. “We didn’t have 20 years to work out the answers — we needed them asap; and a platform trial enabled researchers to do that.”

While it is an efficient method, Rickard admitted it can be challenging to execute.

“Platform trials are quite ambitious and complex. They require us to step up new statistical methods and work with other groups who have worked in this space before” she said.

Product evaluation is especially important

Rickard’s IV Care Platform Trial will be particularly beneficial in the realm of product evaluation, given that the Therapeutic Goods Administration (TGA) has already approved more than 3500 IV products for use in Australia.

“Unlike pharmaceutical products, health device manufacturers are not required to provide efficacy data for their products; and there is no formal R&D section within the health system that evaluates products in use.

“There is a huge economic imperative to figure out which work best — and it is largely up to collaborative research groups to do that,” Rickard said.

While Rickard admitted clinicians often have their own preferences for products, she said statistical data remains crucial.

“Clinicians are only working with what they have got access to — and their workplace will have purchased those products based on their own criteria. Oftentimes, decisions are made on a cost basis.

“It’s really important to test the full breadth of products available and see which deliver the statistically best outcomes for patients. Moreover, you need that real-world testing in the hospital environment that includes patients with multiple drugs and disease processes.”

Unexpected results

Rickard and team have already uncovered some surprising results, with certain, less expensive, brands sometimes outperforming those at the higher end of the market.

“It is certainly not always the case that expensive products are best. Some we find are, but in our recent study, a simple design of catheter securement was just as effective as some of the complex varieties out there.”

Sustainability has also emerged as an important factor in product selection, with single-use devices taking a financial toll on hospitals.

“Ten years ago, sustainability didn’t raise a mention, but now hospitals are taking more interest. It makes sense from a financial perspective: if you can reduce throw away items, it will save you money on purchase and disposal.

“Obviously the main aim is to prevent infection, but if two products work just as well than sustainability might be the deciding factor — so we need data around that.”

The IV Care Platform Trial is ongoing and funded by the Australian National Health and Medical Research Council until 2027.

Image credit: iStockphoto.com/Hispanolistic