Implementation of Ultrasound Guided Central Venous Catheter Confirmation Protocol (DRAUP)
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|ClinicalTrials.gov Identifier: NCT04324762|
Recruitment Status : Recruiting
First Posted : March 27, 2020
Last Update Posted : April 12, 2022
|Condition or disease||Intervention/treatment|
|Behavior Process, Acceptance Inertia of Accommodation||Behavioral: targetted implementation strategies|
The placement of central venous catheters (CVCs) is a common procedure performed in critically ill patients, with millions placed annually. The routine use of chest radiographs for CVC confirmation is outdated. Chest radiographs are associated with delays in initiating time-critical interventions and present an unexamined opportunity for improving resource utilization and associated costs. Radiography has been used for over 50 years for this purpose in the absence of other options. Emerging evidence suggests that a post-procedure chest radiographs are unnecessary when ultrasound is used to confirm catheter position and exclude pneumothorax (PCEP). Yet few in the medical community are likely aware of these data and even among those who are aware, chest radiographs continues to be the routine modality used for CVC PCEP.
The average 17 years it takes to translate clinical research into practice is too long and presents an opportunity to expedite implementation of innovations in critical care medicine. For the proposed project, "De-Implementation Of Routine Chest Radiographs After Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol (DRAUP)", the hypothesis is that identifying determinants of behavior for intervention development (Aim 1) will increase the likelihood of developing successful strategies that will yield faster clinical adoption. Understanding the behavioral adaptations that have to occur is key to developing strategies that increase the uptake of evidence into healthcare practice and improving health outcomes. These strategies (targeting adoption and substitution) will then be implemented in a local Emergency Department (Aim 2) to determine if these selected implementation strategies will increase provider adoption, fidelity, and organizational penetrance (Aim 3) of ultrasound-guided CVC PCEP. A good clinical outcome would be a decrease in provider dependence on chest radiographs after ultrasound-guided CVC PCEP.
|Study Type :||Observational|
|Estimated Enrollment :||120 participants|
|Official Title:||De-Implementation Of Routine Chest Radiographs After Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol|
|Actual Study Start Date :||December 9, 2019|
|Estimated Primary Completion Date :||April 30, 2022|
|Estimated Study Completion Date :||April 30, 2022|
- Behavioral: targetted implementation strategies
strategies at the individual and institutional level to promote implementation of an evidenced based innovation and de-implementation of an unnecessary, low value diagnostic test.
- Adoption [ Time Frame: 1 year ]Adoption will be measured by calculating the absolute number and proportion who utilize POCUS guided protocol and deimplement chest radiographs after central venous catheter placement
- De-adoption [ Time Frame: 1 year ]De-adoption will be measured by calculating the absolute number and proportion who do not obtain chest radiographs after central venous catheter placement
- Fidelity [ Time Frame: 1 year ]Fidelity will be measured by calculating the degree (%) to which the DRAUP algorithm was implemented as it was prescribed
- Effectiveness [ Time Frame: 1 year ]Effectiveness will be measured by calculating the sensitivity/specificity of POCUS guided CVC confirmation
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04324762
|Contact: Enyo Ablordeppey, MDfirstname.lastname@example.org|
|Contact: Richard Griffey, MDemail@example.com|
|United States, Missouri|
|Washington Unversity School Of Medicine||Recruiting|
|Saint Louis, Missouri, United States, 63110|
|Contact: Enyo Ablordeppey, MD 313-362-7021 firstname.lastname@example.org|
|Principal Investigator:||Enyo A Ablordeppey, MD||Washington University School of Medicine|