National data shows 70% of paediatric patients admitted will require a PIVC, or cannula, with rates of failure at one in four. This situation is costly to the health system and causes pain, stress, and trauma to young patients and their loved ones, undermining the confidence of healthcare workers. The burden of PIVC failure is not only procedural and economical, but also psychological.
National and international studies report that children require significantly more repeat PIVC insertion attempts compared to their adult counterparts. Paediatric PIVC insertion is also a resource-intensive procedure, requiring multiple personnel, consumables, and an average of 41 minutes per procedure.
Having seen first-hand how often cannulas used in treating children were failing and needed to be reinserted, paediatric emergency nurse Brooke Charters welcomed the opportunity to find a solution.
“I had just come off a shift where this happened when the statewide research manager told me the EMF research funding had opened up to nurses and she was looking for applications,” Ms Charters said.
She applied for EMF funding and was the first nurse to become a Principal Investigator on an EMF Queensland Research Program grant when it was opened to nurses as lead clinician-researchers in 2018.
Using a three-arm, randomised controlled trial, Ms Charters and her research team recruited 383 paediatric patients at two regional EDs: Logan Hospital and Ipswich Hospital.
Children were randomised to receive PIVCs secured by standard care, advanced dressing, or medical grade superglue and advanced dressing. The primary outcome demonstrated that using medical grade superglue and advanced dressing successfully reduced PIVC failure.
The impact of the grant from EMF is primarily the positive effect on patient care and followed by cost savings to the health system.
“The main outcome of this trial looked at PIVC failure, with other important questions surrounding cost effectiveness and patient comfort also explored,” she said.
“Improvements to patient care are the biggest benefits and what motivated me to do the study. The children’s experience is so much better if you don’t have to reinsert the cannula.
“We were able to decrease the pain from multiple insertions and reduce the anxiety that was driven by so many cannulations. The families liked the product, they were happy.”
She says the change in practice has been well received by clinicians at the local sites who immediately requested the dressings as their preferred option. This will benefit younger patients by reducing the number of cannula insertions in children due to failure and leading to fewer complications. This in turn will decrease staff time and the use of extra products, resulting in overall cost savings for the health system.
“The only way that I could have done a study this large is through financial support to put the team together, get this study rolling and complete it,” Ms Charters said.
The team has published the main results in the Journal of the American Medical Association Pediatrics , one of the top paediatric journals and rolled out changes at Gold Coast University Hospital and Robina Hospital. They are now exploring further translation of the research into practice in Queensland and around Australia.