HISTORICAL PERSPECTIVESFluid optimisation using a peripherally inserted central catheter (PICC) following proximal femoral fracture: Lessons learnt from a feasibility study
Section snippets
Background
Fluid depletion in older adults living with proximal femoral fracture is common. They are often dehydrated on arrival, frail and have poor venous access. Dehydration may be compounded by poor fluid management and inadequate monitoring of fluid balance (Cullum et al., 1999). Fluid optimisation for frail older people living with proximal femoral fracture is an under researched area. A systematic review identified that in perioperative studies of fluid optimisation this group of patients required
Aim
The aim of this randomised controlled trial was to test the feasibility of using PICCs in older people living with a proximal femoral fracture to enable fluid optimisation.
Design
The study design was a randomised controlled trial with three groups; one control and two intervention groups. The three groups were: (i) usual care, insertion of short peripheral intravenous cannulae and normal fluid prescription; (ii) PICC insertion by a vascular access specialist nurse and normal fluid prescription; (iii)
Discussion
Despite the rationale that these patients were likely to be under perfused and stand to gain most from having an adequate level of hydration there remains many barriers to the use of PICCs for fluid optimisation with frail older people. A significant aspect of this is the degree of frailty in this group of patients. Frailty is a complex concept encompassing many different facets but helps to identify health and life changes that differ from those expected from normal aging (Levers et al., 2006
Conclusions
This study has highlighted, with regard to this group of frail older people, the challenges of using PICCs as a means of fluid optimisation, the difficulty of using a randomised trial approach and the demands of introducing a different technology into a ward area. The feasibility of routinely using PICCs in this population for fluid optimisation is problematic due to their high degree of mental and physical frailty. Consenting older patients for randomised controlled trials in stressful
Acknowledgements
In addition to the authors, the research team that undertook this study were: Dr. James Price (Consultant Geriatrician and Chief Investigator), Helen Hamilton (Senior Nurse, Vascular Access Services), Professor Sallie Lamb (Kadoorie Professor of Trauma Rehabilitation), Debbie Langstaff (Matron), Professor Keith Willett (Professor of Orthopaedic Trauma Surgery).
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