A Randomized, Noninferiority, Comparative Evaluation of Vascular Securement Devices: Cost and Clinical Analysis
Peripheral intravenous catheter placement is the most common medical procedure worldwide. Choice of securement is important to minimize cost, improve patient satisfaction. Objective and sound, quality assurance projects provide relevant data to make decisions. Annual cost savings were achieved (>$1 million), with predicted savings at other centers. Peripheral intravenous catheters (PIVCs) are a near universal element of modern medicine with nearly 2 billion PIVCs placed annually worldwide. Virtually all PIVC complications are related to stabilization. Recent innovations in dressings and securement have sought to minimize these complications; however, evidence is lacking in determining superiority of devices and selecting one product over another. In this quality assurance evaluation, we attempted to select a more cost-effective and optimal product for use in our large, tertiary-referral academic institution. A randomized, noninferiority, comparative evaluation was undertaken to compare an integrated securement device (ISD) new to our institution to our institution’s current standard adhesive securement device (ASD). Patients were selected for randomization based on likelihood of a >5-day postoperative inpatient stay, allowing for prolonged daily follow up and survey of both patients and nurses. Results showed that the ISD outperformed the ASD in terms of efficiency of application, adhesive quality, stability, overall satisfaction, and patient comfort. Additionally, the ISD demonstrated a lower rate of complications than the ASD. Cost analysis revealed that the ISD was 28% less expensive than the ASD, resulting in significant cost savings and fewer venipunctures. Intravenous catheter placement is the most common procedure performed annually in hospitalized patients. Given the large volume of PIVC insertions each year and associated costs, combined with the frequency of complications, it is imperative to identify a more adequate and cost-effective device. Our quality improvement project, at a high-volume, tertiary care referral center, provides the groundwork for similar studies at other institutions and supports a more cost-effective and potentially safe delivery.Highlights
Abstract
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Frequency of maximum dwell time by device.
(a) Peripheral intravenous catheter (PIVC) insertion site frequency, adhesive securement device (ASD). (b) PIVC insertion site frequency, integrated securement device (ISD).
Insertion survey results by device.
Insertion and postinsertion patient comfort rating by device.
Postinsertion survey results by device.
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