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Trial registered on ANZCTR
Registration number
ACTRN12621001012864
Ethics application status
Approved
Date submitted
9/06/2021
Date registered
2/08/2021
Date last updated
19/10/2023
Date data sharing statement initially provided
2/08/2021
Type of registration
Prospectively registered
Titles & IDs
Public title
Securing jugular central venous catheters with dressings fixed to a liquid adhesive (Mastisol) in an Intensive Care Unit population: a randomised controlled trial re-thinking evidence-based care delivery
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Scientific title
Effect of securing jugular central venous catheters with dressings fixed to a liquid adhesive (Mastisol) on dressing failure in an Intensive Care Unit population: a randomised controlled trial re-thinking evidence-based care delivery
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Secondary ID [1]
303912
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Nil known.
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Universal Trial Number (UTN)
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Trial acronym
STICKY
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Central venous catheter dressing and securement
321495
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Condition category
Condition code
Anaesthesiology
319249
319249
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0
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Other anaesthesiology
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Mastisol liquid adhesive (MLA) in addition to 'standard' central venous catheter dressing and securement products as per hospital policy. MLA will be applied to the skin around the CVC insertion site as per manufacturer’s instructions after skin decontamination and securement placement (if used) and before dressing application.
At each CVC dressing change, existing MLA will be removed using adhesive remover wipes and re-applied by the bedside nurse/clinician at every CVC dressing change for the duration of the CVC dwell.
Participants and their dressings will be inspected daily by the research team to monitor dressing adherence and adverse events.
In a subset of participants (convenience sample), skin swabs will be taken by research staff to assess skin flora at the CVC insertion sites at the time of CVC removal.
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Intervention code [1]
320217
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Prevention
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Comparator / control treatment
'Standard' central venous catheter dressing and securement products (as per hospital policy)
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Control group
Active
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Outcomes
Primary outcome [1]
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'Dressing failure' defined as requirement for initial internal jugular central venous catheter dressing to be replaced due to the dressing lifting at the edges, prior to scheduled dressing change (scheduled dressing changes are every 7 days). This outcome will be assessed through daily visualisation of the dressing, and notes from the patient's medical records.
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Assessment method [1]
327125
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Timepoint [1]
327125
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From time of central venous catheter (CVC) insertion to CVC removal.
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Secondary outcome [1]
393870
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'All-cause central venous catheter failure' defined as a composite of failure resulting from pain, infiltration/extravasation, blockage/occlusion (with or without leakage), fracture, thrombosis, dislodgement (complete or partial), or haematoma.
This outcome will be assessed through daily visualisation of the CVC, and notes from the patient's medical records.
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Assessment method [1]
393870
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Timepoint [1]
393870
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From time of central venous catheter (CVC) insertion to CVC removal.
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Secondary outcome [2]
393871
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'Individual central venous catheter (CVC) failure' defined as pain, infiltration/extravasation, blockage/occlusion (with or without leakage), fracture, thrombosis, or dislodgement (complete or partial).
This outcome will be assessed through daily visualisation of the CVC, and notes from the patient's medical records.
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Assessment method [2]
393871
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Timepoint [2]
393871
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From time of central venous catheter (CVC) insertion to CVC removal.
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Secondary outcome [3]
393872
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'Central line associated bloodstream infection' defined as a laboratory-confirmed bloodstream infection (BSI) where an eligible BSI organism is identified that is un-related to an infection at another site, the patient exhibits at least one of fever (>38.0°C), chills or hypotension (National Healthcare Safety Network (NHSN) common commensal organisms only), and an eligible central line is present on the day of or day before the event.
This outcome will be assessed by collating data from daily visual inspections and from patient medical records, which will then be assessed by an infectious disease specialist blinded to treatment allocation to confirm infectious outcome.
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Assessment method [3]
393872
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Timepoint [3]
393872
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From CVC insertion to 48 hours after CVC removal.
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Secondary outcome [4]
393873
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'Primary BSI' defined as a laboratory-confirmed BSI where an eligible BSI organism is identified that is un-related to an infection at another site, the patient exhibits at least one of fever (>38.0°C), chills or hypotension (NHSN common commensal organisms only).
This outcome will be assessed by collating data from patient medical records, which will then be assessed by an infectious disease specialist blinded to treatment allocation to confirm infectious outcome.
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Assessment method [4]
393873
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Timepoint [4]
393873
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From CVC infection to 48 hours after CVC removal.
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Secondary outcome [5]
393874
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‘Local infection’ as defined by the CDC/NHSN ‘Arterial or venous infection’ criteria: 1) Purulent drainage from vascular site, 2) Patient has at least one of fever, pain, erythema or heat at the vascular site with no other recognised source AND more than 15 CFU cultured from the catheter tip without corresponding bloodstream infection.
This outcome will be assessed by collating data from daily visual inspections of the CVC insertion site and from patient medical records, which will then be assessed by an infectious disease specialist blinded to treatment allocation to confirm infectious outcome.
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Assessment method [5]
393874
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Timepoint [5]
393874
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From CVC infection to 48 hours after CVC removal.
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Secondary outcome [6]
393875
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'Loss of dressing integrity' defined as lifting at edges or lifting at edges requiring re-enforcement (all dressings per patient).
This outcome will be assessed through daily visualisation of the dressing, and notes from the patient's medical records.
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Assessment method [6]
393875
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Timepoint [6]
393875
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From CVC insertion to CVC removal.
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Secondary outcome [7]
393876
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'Dressing dwell time' in days (all dressings per patient, from application to removal)
This outcome will be assessed through daily visualisation of the dressing, and notes from the patient's medical records.
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Assessment method [7]
393876
0
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Timepoint [7]
393876
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From dressing application to dressing removal.
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Secondary outcome [8]
393877
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'Premature dressing removal' defined as before seven days from dressing application (all dressings per patient).
This outcome will be assessed through daily visualisation of the dressing, and notes from the patient's medical records.
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Assessment method [8]
393877
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Timepoint [8]
393877
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From dressing application to dressing removal.
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Secondary outcome [9]
393883
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Number of dressing changes (from first application to last removal; all dressings per patient).
This outcome will be assessed through daily visualisation of the dressing, and notes from the patient's medical records.
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Assessment method [9]
393883
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Timepoint [9]
393883
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From CVC insertion to CVC removal.
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Secondary outcome [10]
393885
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Device dwell-time (time from insertion to removal, in hours).
This outcome will be assessed through daily visualisation of the CVC, and notes from the patient's medical records.
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Assessment method [10]
393885
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Timepoint [10]
393885
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From CVC insertion to CVC removal.
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Secondary outcome [11]
393886
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Serious adverse events (composite outcome of mortality, central line associated bloodstream infection and medical adhesive related skin injury),
Each SAE will be assessed and graded as per the Common Terminology for Adverse Events (version 5.0) by both the principal investigator at each recruiting site, and also the coordinating principal investigator.
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Assessment method [11]
393886
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Timepoint [11]
393886
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From time of CVC insertion to 48 hours after CVC removal.
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Secondary outcome [12]
396686
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Adverse skin events relating to medical adhesive-related skin injury (MARSI) (e.g. pain, itch, erythema, skin stripping, blister, skin tear, irritant contact dermatitis, maceration, folliculitis or infection).
This outcome will be assessed through daily visualisation of the skin around the CVC insertion site underneath the dressing, and notes from the patient's medical records.
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Assessment method [12]
396686
0
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Timepoint [12]
396686
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From time of CVC insertion to 48 hours after CVC removal.
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Secondary outcome [13]
396688
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Cost (cost and number of products used, cost of treating complications, staff time).
Number of products used will be totalled from CVC insertion to CVC removal as per information gained via visual inspections of the dressings and patient medical records.
Cost of products used will be based on standard hospital costs.
Costs of treating complications will be determined using a micro-costing approach with detailed resource use recorded in terms of procedures/treatments to rectify dressing-related complications.
Staff time will be calculated using local staffing wage rates (per hour), multiplied by time required to change dressings and number of dressing changes required.
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Assessment method [13]
396688
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Timepoint [13]
396688
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From CVC insertion to CVC removal (plus the duration of any complications that arise from the CVC dwell).
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Secondary outcome [14]
396689
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Staff satisfaction on dressing application and removal (0 = not at all satisfied to 10 = completely satisfied).
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Assessment method [14]
396689
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Timepoint [14]
396689
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At CVC insertion, dressing changes and CVC removal.
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Secondary outcome [15]
396690
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Skin colonisation, a composite measure of both organism and colony forming units.
This outcome will be assessed through qualitative/quantitative analysis of skin swabs of skin underneath the CVC dressing at the time of CVC removal by specialist pathology staff blinded to the intervention allocation.
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Assessment method [15]
396690
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Timepoint [15]
396690
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Swabs will be taken in a subset of 10 patients per arm at the time of CVC removal.
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Secondary outcome [16]
398251
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Patient satisfaction of dressing application and removal (0 = not at all satisfied to 10 = completely satisfied).
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Assessment method [16]
398251
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Timepoint [16]
398251
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At CVC insertion, dressing changes and CVC removal.
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Eligibility
Key inclusion criteria
• 18 years or over
• Patient expected to require IJ CVC for greater or equal to 72 hours
• Requiring greater or equal to 24 hours treatment in the ICU
• Within 12 hours of CVC insertion
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• Emergency CVC insertion
• Bloodstream infection in 24 hours prior to CVC insertion (as defined by National Health and Safety Network)
• Pre-existing concurrent CVC expected to dwell for >24 hours
• Patient receiving end-of-life care
• Previous enrolment in this study
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/09/2021
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Actual
13/09/2021
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Date of last participant enrolment
Anticipated
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Actual
3/02/2023
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Date of last data collection
Anticipated
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Actual
13/02/2023
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Sample size
Target
160
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Accrual to date
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Final
160
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Recruitment in Australia
Recruitment state(s)
NSW,QLD
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Funding & Sponsors
Funding source category [1]
308299
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Commercial sector/Industry
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Name [1]
308299
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Eloquest Healthcare
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Address [1]
308299
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780 West Eight Mile Road,
Ferndale, Michigan, 48220
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Country [1]
308299
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United States of America
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Primary sponsor type
University
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Name
University of Queensland
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Address
St Lucia, Queensland, 4072
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Country
Australia
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Secondary sponsor category [1]
309717
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None
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Name [1]
309717
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Address [1]
309717
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Country [1]
309717
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
308275
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Royal Brisbane and Women's Hospital HREC
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Ethics committee address [1]
308275
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Royal Brisbane and Women's Hospital Butterfield Street, Herston, Queensland, 4029
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Ethics committee country [1]
308275
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Australia
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Date submitted for ethics approval [1]
308275
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Approval date [1]
308275
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21/05/2021
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Ethics approval number [1]
308275
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HREC/2021/QRBW/73896
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Ethics committee name [2]
308716
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University of Queensland HREC
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Ethics committee address [2]
308716
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St Lucia, Queensland, 4072
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Ethics committee country [2]
308716
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Australia
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Date submitted for ethics approval [2]
308716
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Approval date [2]
308716
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08/06/2021
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Ethics approval number [2]
308716
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2021/HE001361
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Summary
Brief summary
Central venous catheters (CVCs) placed in the internal jugular vein have been associated with increased risk of central line-associated infection and CVC failure compared to subclavian CVCs. Effective dressing and securement of internal jugular CVCs can reduce the risk of such complications, but dressing and securement is often inadequate due to 'drag' of infusion lines on the CVC and intermittent 'catching' of the CVC lines on other objects. Dressing failure also increases the risk of medical adhesive-related skin injury and central line-associated bloodstream infection due to repeated dressing changes. Mastisol Liquid Adhesive (MLA) is a non-water-soluble gum mastic liquid adhesive designed to improve dressing adherence and integrity. MLA has been shown to not increase bacterial growth and improve dressing adhesion in small studies, but has not been rigorously tested in a randomised controlled trial. The aim of this study is to investigate the effectiveness of MLA in reducing dressing changes, adverse events (e.g. device failure, infection and MARSI), clinician workload and costs associated with IJ CVCs. It is hypothesised that dressings secured with MLA will required changes less frequently, and therefore be associated with less adverse events, lower clinician workload and costs.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
110154
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Dr Nicole Marsh
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Address
110154
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Level 2, Building 34 (Centre for Clinical Nursing)
Royal Brisbane and Women's Hospital
Butterfield Street,
Herston, Queensland, Australia, 4029
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Country
110154
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Australia
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Phone
110154
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+61 7 3646 8590
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Fax
110154
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Email
110154
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[email protected]
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Contact person for public queries
Name
110155
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Catherine O'Brien
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Address
110155
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Level 2, Centre for Clinical Nursing, Royal Brisbane and Women's Hospital
Butterfield Street, Herston, Queensland, 4029
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Country
110155
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Australia
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Phone
110155
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+61 7 3646 8725
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Fax
110155
0
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Email
110155
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[email protected]
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Contact person for scientific queries
Name
110156
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Nicole Marsh
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Address
110156
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Level 2, Building 34 (Centre for Clinical Nursing)
Royal Brisbane and Women's Hospital
Butterfield Street,
Herston, Queensland, Australia, 4029
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Country
110156
0
Australia
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Phone
110156
0
+61 7 3646 8590
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Fax
110156
0
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Email
110156
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
De-identified patient data underlying published results only
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When will data be available (start and end dates)?
Beginning 3 months and ending 5 years following main results publication
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Available to whom?
Only researchers who provide a methodologically sound proposal and at the discretion of the Principal Investigator
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Available for what types of analyses?
For IPD meta-analyses
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How or where can data be obtained?
Data can be obtained from the Principal Investigator (Dr Nicole Marsh,
[email protected]
)
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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