Impact of a Task Delegation to ICU Nurses for Midlines' Placement

Study Overview
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Brief Summary
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The administration of medication, fluid resuscitation, or even nutrition in intensive care unit (ICU) patients, requires one or more infusion lines which can be peripheral or central. Midline catheter is a 10 to 20 cm long peripheral venous catheter, which can be used for up to 28 days. These features make it a good alternative to central venous and conventional peripheral venous catheters. Midlines are routinely used in the ICU of Lorient Hospital, currently inserted by doctors. In association with the Regional Health Agency, the investigators are currently implementing a project of task delegation to ICU nurses, so that they could insert Midlines' catheters. The aim of the study is to increase the use of Midlines in the unit to reduce the exposure to central venous catheters and their complications, such as infections or thrombosis. The investigators propose to conduct a prospective monocentric study to compare the frequency of Midlines'use, before and after the task delegation. The primary objective is to compare the duration of exposure to central venous catheters between the two periods. Secondary objectives are to compare the duration of exposure to peripheral venous catheters and Midlines, and the catheter-related infections and thrombosis.

Detailed Description
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The administration of medication, fluid resuscitation, or even nutrition in intensive care unit (ICU) patients, requires one or more infusion lines which can be peripheral or central. Although central venous catheters (CVC) are often mandatory in ICU, the risk of catheter-related infections should lead to consider the insertion of peripheral venous catheters. However in ICU patients, presence of edema or poor venous condition may not allow placement of peripheral venous catheter. Midline catheter is a 10 to 20 cm long peripheral venous catheter, which can be used for up to 28 days (according to manufacturer recommendations). These features make it a good alternative to central venous and conventional peripheral venous catheters. They are placed at the bedside, peripherally into the cephalic or basilic vein, with the tip reaching the axillary vein. Midlines are routinely used in the ICU of Lorient Hospital, currently inserted by doctors. Studies have shown the feasibility and the safety of delegating to nurses placement of CVC and Midlines. In association with the Regional Health Agency, the investigators are currently implementing a project of task delegation to ICU nurses, so that they could insert Midlines' catheters. Midlines' implementation has been associated with a decrease in the use of CVC and catheter-related infections. To our knowledge, no study investigated the placement of Midlines by nurses in the ICU. The investigators propose to conduct a prospective monocentric study to compare the frequency of Midlines' use, before and after the task delegation. The primary objective is to compare the duration of exposure to central venous catheters between the two periods. Secondary objectives are to compare the duration of exposure to peripheral venous catheters and Midlines, and the catheter-related infections and thrombosis. Complications related to Midlines' placement would also be recorded.

Official Title
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Impact of a Task Delegation to ICU Nurses for Midlines' Placement on the Duration of Exposure to Central Venous Catheters

Conditions
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Catheter-Related Infections

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients hospitalized in ICU for more than 48 hours Exclusion Criteria: Patient under 18 years old Patient under legal guardianship Absence of health insurance in France Refusal of the patient or his next-of-kin Patient with a decision of withholding or withdrawing of life sustaining therapy Patient with a subcutaneous central venous port Impossibility of infusion on the upper limbs

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Phase 1 group<br>During phase 1, Midlines are inserted only by doctors. | |
| Phase 2 group<br>During Phase 2, Midlines are preferentially inserted by ICU nurses, and if needed, by doctors. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of exposure to central venous catheter | Duration of exposure to central venous catheter (catheter-days per patient-day) | ICU discharge (usually seven days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of exposure to peripheral venous catheter | Duration of exposure to peripheral venous catheter (catheter-days per patient-day) | ICU discharge (usually seven days) | 
| Duration of exposure to Midline | Duration of exposure to Midline (catheter-days per patient-day) | ICU discharge (usually seven days) | 
| Number of catheter-related infections | Number of catheter-related infections (number of events per 1000 catheter days) | ICU discharge (usually seven days) | 
| Number of catheter-related infections | Number of catheter-related infections (number of events per 1000 catheter days) | Hospital discharge (usually two weeks) | 
| Number of catheter-related thrombosis | Number of catheter-related thrombosis (number of events per 1000 catheter days) | ICU discharge (usually seven days) | 
| Number of catheter-related thrombosis | Number of catheter-related thrombosis (number of events per 1000 catheter days) | Hospital discharge (usually two weeks) | 
| Number of pneumothorax and arterial punctures | Number of pneumothorax and arterial punctures (for each catheter inserted, percentage) | ICU discharge (usually seven days) | 
| Number of patients discharged from the ICU with a central venous catheter | Number of patients discharged from the ICU with a central venous catheter (percentage) | ICU discharge (usually seven days) | 
| Description of the events associated with Midlines' insertion : Number of punctures | Number of punctures (per Midline inserted) | ICU discharge (usually seven days) | 
| Description of the events associated with Midlines' insertion : Duration of the procedure | Duration of the procedure (in minutes) | ICU discharge (usually seven days) | 
| Description of the events associated with Midlines' insertion : Failure rate | Failure rate (percentage) | ICU discharge (usually seven days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Midlines