Victoria Gibson’s research while affiliated with The University of Queensland and other places


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Publications (29)


Analysis processes. CFIR, Consolidated Framework for Implementation Research; ERIC, Expert Recommendations for Implementation Change.
Implementation contexts and strategies for alternative peripherally inserted central catheter material and design selection: A qualitative exploration using CFIR/ERIC approach
  • Article
  • Full-text available

July 2024

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23 Reads

Journal of Advanced Nursing

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Rachel M. Walker

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Victoria Gibson

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[...]

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Samantha Keogh

Aim To explore the implementation contexts and strategies that influence the uptake and selection of alternative peripherally inserted central catheter (PICC) materials and design. Design Qualitative evaluation of end user perspectives within a randomized control trial of different PICC materials and design. Methods Semi‐structured interviews with key stakeholders were undertaken via an adapted, rapid‐analytic approach using the Consolidated Framework for Implementation Research. Outcomes were mapped against the Expert Recommendations for Implementing Change (ERIC) tool for strategies to guide innovation in PICC practice. Results Participants (n = 23) represented a combination of users and inserters/purchasers, from adult and paediatric settings. Dominant themes included intervention characteristics (intervention source), inner setting (structural characteristics) and individuals involved (self‐efficacy). Strategies emerging to support a change from ERIC mapping (n = 16) included promotion of intervention adaptability, inclusion of staff and consumer perspectives and sufficient funding. Implementation contexts such as inner setting and individuals involved equally impacted PICC success and implementation effectiveness and enabled a greater understanding of barriers and facilitators to intervention implementation in this trial. Conclusion Trial evidence is important, but healthcare decision‐making requires consideration of local contexts especially resourcing. Implementation contexts for Australian healthcare settings include a practical, strategic toolkit for the implementation of alternative PICC materials and designs. Reporting Method This study adhered to COREQ guidelines. Patient or Public Contribution No patient or public contribution.

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Figure 2. Kaplan-Meier Curve of Any Dislodgement During Device Dwell
Patient and Device Characteristics (continued)
Primary and Secondary Outcomes
Securement to Prevent Noncuffed Central Venous Catheter Dislodgement in Pediatrics: The SECURED Superiority Randomized Clinical Trial

July 2024

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44 Reads

Importance Catheter dislodgement is a common complication for children with tunneled or peripherally inserted noncuffed central venous catheters (CVCs). A subcutaneous anchor securement system (SASS) may reduce this risk compared with traditional adhesive securement. Objective To compare dislodgement of noncuffed CVCs secured with SASS with dislodgement of noncuffed CVCs secured with sutureless securement devices (SSDs). Design, Setting, and Participants The SECURED (Securing Central Venous Catheters to Prevent Dislodegment) trial was a pragmatic, multicenter, superiority randomized clinical trial with an internal pilot and was conducted from August 5, 2020, to August 30, 2022, at 2 Australian quaternary pediatric hospitals. Data analysis was performed in January 2023. Patients aged 0 to 18 years requiring a noncuffed CVC (≥3F catheter) were eligible for inclusion. Follow-up duration was 8 weeks or until device removal. Interventions Patients were randomly assigned 1:1 to receive an SASS or SSD, stratified by hospital and catheter type. Only 1 catheter was studied per patient. Main Outcomes and Measures The primary outcome was dislodgement (partial or total), defined as movement of the catheter tip by greater than 1 cm (change in external catheter length) at any point during catheter dwell. Dislodgement, reported as a risk ratio (RR), was estimated using a generalized linear model with binomial family and log link. Secondary outcomes were reported as incidence rate ratios and were analyzed using Poission regression. Outcomes reported as mean differences (MDs) were analyzed using linear regression. Results Of 310 randomized patients, 175 patients (56.5%) were male and median (IQR) patient age was 48 (16-120) months. A total of 307 patients had a catheter device inserted, of which 153 (49.8%) were SASS and 154 (50.2%) were SSD, and were included in the intention-to-treat (ITT) analysis. Device dislodgement was lower with SASS (8 dislodgements in 153 patients [5.2%]) compared with SSD (35 dislodgements in 154 patients [22.7%]) (RR, 0.23; 95% CI, 0.11-0.48; P < .001). The per-protocol analysis was consistent with the ITT analysis. Partial dislodgement accounted for most dislodgement events, including 6 partial dislodgements in the SASS group (3.9%) and 30 partial dislodgements in the SSD group (19.5%) (RR, 0.18; 95% CI, 0.08-0.42). This contributed to fewer complications during dwell in the SASS group (37 reported complications [24.2%]) vs the SSD group (60 reported complications [39.0%]) (RR, 0.62; 95% CI, 0.44-0.87). Staff reported greater difficulty removing devices anchored with SASS vs SSD (mean [SD], 29.1 [31.3] vs 5.3 [17.0], respectively; MD, 23.8; 95% CI, 16.7-31.0). However, use of SASS resulted in reduced per-participant health care costs of A36.60(9536.60 (95% credible interval, 4.25-68.95; US 24.36; 95% credible interval, 2.83-45.89). Conclusions and Relevance In the SECURED trial, noncuffed CVCs secured with SASS had fewer dislodgements compared with SSDs, with a lower cost per patient and an acceptable safety profile. Future efforts should be directed at SASS implementation at the health service level. Trial Registration anzctr.org.au Identifier: ACTRN12620000783921


Study interventions
Preventing adverse events during paediatric cancer treatment: protocol for a multi-site hybrid randomised controlled trial of catheter lock solutions (the CLOCK trial)

July 2024

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28 Reads

BMJ Open

Introduction Central venous access devices (CVADs) are commonly used for the treatment of paediatric cancer patients. Catheter locking is a routine intervention that prevents CVAD-associated adverse events, such as infection, occlusion and thrombosis. While laboratory and clinical data are promising, tetra-EDTA (T-EDTA) has yet to be rigorously evaluated or introduced in cancer care as a catheter lock. Methods and analysis This is a protocol for a two-arm, superiority type 1 hybrid effectiveness-implementation randomised controlled trial conducted at seven hospitals across Australia and New Zealand. Randomisation will be in a 3:2 ratio between the saline (heparinised saline and normal saline) and T-EDTA groups, with randomly varied blocks of size 10 or 20 and stratification by (1) healthcare facility; (2) CVAD type and (3) duration of dwell since insertion. Within the saline group, there will be a random allocation between normal and heparin saline. Participants can be re-recruited and randomised on insertion of a new CVAD. Primary outcome for effectiveness will be a composite of CVAD-associated bloodstream infections (CABSI), CVAD-associated thrombosis or CVAD occlusion during CVAD dwell or at removal. Secondary outcomes will include CABSI, CVAD-associated-thrombosis, CVAD failure, incidental asymptomatic CVAD-associated-thrombosis, other adverse events, health-related quality of life, healthcare costs and mortality. To achieve 90% power (alpha=0.05) for the primary outcome, data from 720 recruitments are required. A mixed-methods approach will be employed to explore implementation contexts from the perspective of clinicians and healthcare purchasers. Ethics and dissemination Ethics approval has been provided by Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (HREC/22/QCHQ/81744) and the University of Queensland HREC (2022/HE000196) with subsequent governance approval at all sites. Informed consent is required from the substitute decision-maker or legal guardian prior to participation. In addition, consent may also be obtained from mature minors, depending on the legislative requirements of the study site. The primary trial and substudies will be written by the investigators and published in peer-reviewed journals. The findings will also be disseminated through local health and clinical trial networks by investigators and presented at conferences. Trial registration number ACTRN12622000499785.


An mHealth application for chronic vascular access: A multi-method evaluation

February 2024

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8 Reads

Journal of Clinical Nursing

Background Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose. Aim In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long‐term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport. Design Multi‐site, parallel, multi‐method, prospective cohort study. Methods A multi‐site, multi‐method study was carried out in 2020–2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months. Results Overall, utility rates were acceptable, with 78.3% ( N = 36) using the IV Passport over the follow‐up period, with high rates of planned future use for those still active in the project ( N = 21; 73%), especially in the child/family cohort ( N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5–10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality. Conclusion Several recommendations were made to improve the end‐user experience including ‘how to’ instructions; and scheduling functionality for routine care. Implications for the Profession and/or Patient Care The IV Passport can be safely and appropriately integrated into healthcare, to support consumers. Impact Patient‐/parent‐reported feedback suggests the Intravenous Passport is a useful tool for record‐keeping, and positive communication between patients/parents, and clinicians. Reporting Method Not applicable. Patient Contribution Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months.




Pediatric Central Venous Access Device Lock Solutions: A Network Meta-analysis

January 2024

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83 Reads

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3 Citations

PEDIATRICS

CONTEXT Central venous access device (CVAD) locks are routine interventions used to prevent and treat complications, such as infection, thrombosis, and catheter occlusion. OBJECTIVE To compare and rank lock-solutions for prevention or treatment of complications in pediatrics. Design Systematic review and network meta-analysis. DATA SOURCES Five databases and 2 clinical trial registries were searched. STUDY SELECTION Published and unpublished randomized controlled trials that enrolled pediatric patients with a CVAD and compared the effectiveness of lock-solutions. DATA EXTRACTION Data extraction was conducted by 2 reviewers. Odds ratio (OR) for prevention or treatment of CVAD-associated bloodstream infection (BSI), thrombosis, occlusion, CVAD-failure, and mortality were calculated, with point estimates ranking lock-solutions. RESULTS Twenty-nine studies were included. Chelating agents and antibiotic locks given as prevention were associated with lower odds (OR: 0.11; 95% confidence interval [CI]: 0.02–0.67; moderate-quality; OR: 0.19; 95% CI: 0.05–0.79, high-quality, respectively) of CVAD-associated BSI compared with heparinized saline (reference). Preventative thrombolytic agents had lower odds (OR: 0.64, 95% CI: 0.44–0.93; low-quality) of CVAD occlusion, whereas ethanol had higher odds (OR: 2.84, 95% CI: 1.31–6.16; high-quality) compared with heparinized saline (reference). No lock solution had effects on thrombosis prevention or treatment, CVAD-failure, CVAD-associated BSI treatment failure, or mortality. LIMITATIONS There was substantial uncertainty around the point estimates because of the limited number of studies for outcomes and study heterogeneity. More high-quality studies are needed to confirm the efficacy of lock solutions. CONCLUSIONS Chelating agents and antibiotic locks may be effective for CVAD-associated BSI prevention in pediatrics. Thrombolytic agents can be an option for CVAD occlusion prevention, whereas ethanol may not be recommended.


Flow diagram of study selection.
Invasive device‐associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta‐analysis

Journal of Advanced Nursing

Aim This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. Design This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies. Data Sources MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Review Methods Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post‐insertion device‐associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device‐associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. Results This review synthesized 114 studies (30,782 devices; 1,635,649 device‐days). Skin complications were reported in 40 studies, but none exclusively reported individual device‐related pressure injuries. Mechanical dysfunctions were well‐reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. Conclusions This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device‐related complications, particularly for understudied device types. Device‐related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. Impact Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device‐related complications. Reporting Method MOOSE (Meta‐analyses Of Observational Studies in Epidemiology) Checklist. Patient or Public Contribution No Patient or Public Contribution.


Fig. 2 Process of patient selection (On arrival to the ward, the research assistants visited every odd or even numbered bed (according to the random allocation). *50% of patients were sampled, based on random allocation of odd or even bed numbers.
Device-related harm by device types across the audit period (N = 412 devices).
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Pediatric invasive device utility and harm: a multi-site point prevalence survey

January 2024

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27 Reads

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1 Citation

Pediatric Research

Background and aims Invasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals. Methods In 2022–2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics. Results Of the 285 patients audited, 78.2% had an invasive device ( n = 412 devices), with a median of 1 device-per-patient (interquartile range 1–2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices ( n = 223; 54.1%), followed by gastrointestinal devices ( n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices). Conclusions The study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings. Impact A high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient. The most common devices used in pediatric healthcare are vascular access devices ( n = 223; 54.1%), however, 16% ( n = 36) of these devices failed, and one-third had complications. The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.


Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis

January 2024

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41 Reads

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1 Citation

Abstract Context Indwelling invasive devices, inserted into the body for extended periods, whether through an orifice or the skin, are associated with infections. Objective This study aimed to estimate infection proportion and rates associated with indwelling invasive devices in pediatric healthcare. Data sources MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Study selection Cohort studies and trials published from January-2011 to June-2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) post-insertion infection complications, and (4) published in English, were included. Data extraction Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. Main outcomes and measures Device local, organ and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per 1000 device days per device type were reported. Results A total of 116 studies (61554 devices and 3632364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95%CI, 6-11; 50-studies) and incidence rate (IR) of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia (VAP) in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). Conclusions Although CVAD-BSI and VAP are well-documented, there is a scarcity of overall reporting on tissue and local organ infections. Standard international practice guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.


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Citations (17)


... 14 In a recent network meta-analysis of 29 studies, chelating agents and antibiotic locks given as prevention were associated with lower odds (OR 0.11; 95% CI 0.02 to 0.67; moderate quality; OR 0.19; 95% CI 0.05 to 0.79, high quality, respectively) of CVAD-associated BSI compared with heparinised saline. 23 ...

Reference:

Preventing adverse events during paediatric cancer treatment: protocol for a multi-site hybrid randomised controlled trial of catheter lock solutions (the CLOCK trial)
Pediatric Central Venous Access Device Lock Solutions: A Network Meta-analysis
  • Citing Article
  • January 2024

PEDIATRICS

... The rate of LCBIs identified in this study (2.54/1000 catheter days) is likely a better indicator of infection rate. This is much higher than rate of 0.96 per 1000 catheter days reported in recent metaanalysis of 50 studies of CVCs [12]. Further, the organisms responsible for LCBI are common harmful pathogens, prevalent throughout ICU [13]. ...

Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis
  • Citing Article
  • January 2024

... The latest guidelines for IV infusion management for children recommend that IV catheters do not need to be replaced as long as there are no complications; however, in practice, IV catheters are conwww.e-chnr.org stantly replaced for hospitalized children as they cannot be maintained for 72 hours due to blockage, infiltration, and swelling in more than half of children [6,7]. A previous study has reported that the mean IV catheter indwell time among hospitalized children was 51.3 hours, and the IV catheter indwell time was even shorter among younger children with lots of body movement [6]. ...

Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial
  • Citing Article
  • September 2023

... Research in the consumer experience of other vascular access devices in children and adults has found that both insertion and living with a device may be distressing and the psychological impact may not be appreciated by clinicians. [17,[41][42][43][44]. ...

Experiences of children with central venous access devices: a mixed-methods study

Pediatric Research

... Seven experts were selected using purposive sampling within the authors' networks, with selection based on research and clinical expertise in the fields of CVAD use, tool development, infection prevention, skin integrity and wound care, including representation across differing age groups (neonates, paediatric and adults). Several of these individuals (AU, FC, JC, CR) are experts on clinimetric studies and have experience in tool development (Barakat-Johnson et al. 2022;Broadhurst et al. 2017;Schults et al. 2021Schults et al. , 2022Ullman et al. 2020). The invitation to participate was sent via email to eight clinical or research experts to achieve acceptable CVI values of at least 0.83 (Lynn 1986;Polit, Beck, and Owen 2007). ...

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

BMC Health Services Research

... In duodenum an air-fluid level is visible, due to bowel occlusion (arrow) catheter placement, but they might not be clinically evident in patients with severe neutropenia [17]. Factors that contribute to the risk of catheter-related infections in oncologic pediatric patients include immunosuppression and neutropenia, long-term CVADs implantation, frequent manipulation, age < 4-6 years, and prolonged hospitalization [18,19]. Among the pathogens most frequently isolated from cultures are Gram-positive bacteria, such as methicillin-resistant Staphylococcus Aureus (MRSA) and coagulase-negative staphylococci (CoNS), as well as Candida species [17,20]. ...

Pediatric central venous access devices: practice, performance, and costs

Pediatric Research

... Ten studies had multiple CVAD devices included. 17,[34][35][36][37][38][39][40][41][42] Five studies used lock solutions to treat CVAD-BSI. 17,34,35,40,43 No studies used a lock solution for rescuing occlusion and thrombosis. ...

Routine Catheter Lock Solutions in Pediatric Cancer Care: A Pilot Randomized Controlled Trial of Heparin vs Saline

Cancer Nursing

... [7,15,17], and in children, it was significantly higher at 2.43 (95% CI ¼ 1.16e5.09) [27]. Low heterogeneity was observed across the trials (I 2 ¼ 0%), as shown in Figure 2. ...

Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial

Pediatric Anesthesia

... The second is CVCs (8.39%). Most CVCs used in our hospital are made of ordinary polyurethane, which irritates the endothelium of the blood vessels [35]. CVCs are thick and are primarily double-or triple-lumen catheters, which have a great effect on blood flow rate, resulting in slow blood flow and thrombus formation. ...

Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol

BMJ Open

... studies included all malignancies [5,24,. Studies were conducted across Asia and Pacific [40,43,45,48,51], North America [28,30,34,38,47,53,58,61,62], South America [46], Africa [60], and Europe [5, 24-26, 29, 31-33, 36, 37, 39, 41, 42, 44, 49, 50, 52, 54-57, 59, 63]. ...

Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study
  • Citing Article
  • August 2020

Journal of Paediatrics and Child Health