Preventing harm associated with arterial catheters in intensive care
Critically ill patients in intensive care frequently need an arterial catheter, which is a small hollow plastic tube inserted into an artery to facilitate continuous monitoring (e.g. blood-pressure) and blood sampling. Unfortunately, these tubes are associated with significant harm like local clotting and inflammation, plus infection and anaemia. Many of these arterial catheter-related complications could be avoided with more consideration of arterial catheter appropriateness and evidence implementation. This research aims to improve clinician decision making related to arterial catheter insertion and use. Outcomes will improve patient safety and care in intensive care.
Our VISION is to prevent arterial catheter-related harm in intensive care by transforming the way clinicians decide when and how to insert and use arterial catheters in critically ill patients.
AIMS and OBJECTIVES:
- Develop evidence-based criteria for arterial catheter appropriateness, through evidence review and expert consensus (n=15 multidisciplinary and consumer panel) using RAND/UCLA modified Delphi technique to determine appropriateness criteria for arterial catheter insertion/use in ICU
- Optimise appropriate arterial catheter placement, through a national, multi-site, hybrid effectiveness-implementation study (12 ICU sites, n=5000). We will evaluate impact of arterial catheter appropriateness criteria on arterial catheter insertion/removal and harm reduction, plus utility of implementation strategies.
- Optimise appropriate arterial catheter use, through a multi-site implementation trial (6 sites, n=1530). We will explore barriers and enablers to recommended blood sampling practice in ICU, co-design strategies to overcome these, and implement and evaluate the impact of these and the evidence-based bundle on implementation into practice and reduction in blood sample losses and associated harm (e.g. anaemia and transfusion use).
Anticipated OUTCOMES include new knowledge to reduce arterial catheter-related harm for critically ill patients, and the sustained translation of advanced interdisciplinary arterial catheter use/care in ICU. Additionally, this research will enable clinician-researcher development and embed a pathway for supportive care clinical trials and implementation science across Australian critical care nursing.