Indwelling vs Intermittent Catheterization Pilot Study (PEE)
Hip Fracture Patient and the Use of IndwElling vs IntermittEnt Catheterization Pilot Study
調査の概要
状態
詳細な説明
The primary aim of the proposed pilot feasibility is to determine whether it is feasible to recruit patients with a hip fracture into a prospective study and randomize them to either indwelling or intermittent catheterization.
The study hypothesis is that the investigators would be able to show that this study can be incorporated into clinical practice, with satisfactory rate of patient recruitment and retention. Thus, the investigators would be able to compete this vanguard trial and proceed towards a multi-center trial.
Secondary objectives would be related to safety and patient activity that would be important endpoints for the definitive, large scale trial. These would include the following:
- Is short term indwelling catheter use associated with reduced incidence of UTI compared to clean intermittent catheterization in patients with hip fracture.
- How does patient experience compare between these two forms of treatment?
Eligible patients will be approached for consent at admission and, if willing to participate, will be randomized into Group A or Group B using a web-based, computer-generated randomization with permuted blocks of varying sizes.
Data Collection will include:
- Urinary symptoms at admission, pre-fracture
- Date and time of catheter insertion (indwelling or not)
- Date and time of surgery
- Type of anesthesia used
- Date and time of catheter removal
- Number of catheterizations performed during hospital stay
- Type of Antibiotic cover during per-operative period (typically 3 doses provided perioperatively)
A clinical research coordinator (CRC) will oversee study recruitment and assess number of study participants to the total number of patients admitted with a hip fracture which will allow for documentation of ability to recruit into the study. Furthermore, the CRC will prospectively record each patent's journey to assess whether enrolled patients are receiving the treatment they are randomized to. All enrolled patients will be asked to fill in a patient satisfaction score that has been in use already at our institution.
A CRC, blinded to the arm patients were randomized to, will be responsible for recording all outcome measures of interest prospectively in the study's database from the participant's electronic medical records. Validity of data extraction will be tested for a randomly selected 10% of the cohort by a second evaluator (CRC not previously involved in the study).
Data analyses will include:
Descriptive Statistics: Given the feasibility purpose of the vanguard trial, descriptive statistics will be used to summarize demographics and baseline prognostic factors of participants allocated to the two trial arms.
Analysis of Primary Outcome: Our primary endpoint is the rate of enrolment to ensure the ability to undertake a larger multi-centered trial. An average rate of 10 patients/month or greater will be considered as ideal for establishing feasibility. An enrollment of less than 5 patients/month will likely jeopardize the ability to feasibly recruit for the larger trial. Whereas, average monthly enrolment of 5 to 10 patients will require a re-evaluation of our recruitment strategy, intervention specifications, and/or eligibility criteria to improve enrolment.
Analysis of Secondary Outcomes: Given the vanguard nature of this trial, the investigators will not undertake inferential analyses of our secondary outcomes but rather these patients will be carried forward into the larger trial.
研究の種類
入学 (予想される)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前:Isabel Horton
- 電話番号:73032 613-737-8899
- メール:ihorton@ohri.ca
研究連絡先のバックアップ
- 名前:George Grammatopoulos, MD
- メール:ggrammatopoulos@toh.ca
研究場所
-
-
Ontario
-
Ottawa、Ontario、カナダ、K1H 8L6
- The Ottawa Hospital
-
コンタクト:
- Isabel S Horton
- 電話番号:73032 6137378899
- メール:ihorton@ohri.ca
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Hip fracture (intertrochanteric, femoral neck, femoral head, sub-trochanteric) confirmed by imaging
- Age ≥50 years
- Operative treatment planned
- Admitted under Orthopaedic Surgery
- Willing and able to sign consent (substitute decision maker)
Exclusion Criteria:
- Periprosthetic hip fracture
- Polytrauma
- Multiple fractures of the lower limbs
- Previous lower urinary tract surgery
- Known (past or current) urogenital cancer (prostate, bladder)
- Urinary tract infection prior to randomization
- Indwelling catheter present on admission (chronic or placed at previous acute setting)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:他の
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:Indwelling
Foley catheterization upon admission and removed the morning following surgery.
|
Patients in the experimental group will receive foley catheter upon admission, aseptically.
The catheter will be discontinued on the morning following surgery.
At TOH most (>75%) hip fractures are treated within 48 hours of admission and 95% within 72 hours and hence the indwelling catheter is likely to stay in place for 3-4 days.
|
実験的:Intermittent
Intermittent catheterization when post-void residual volume is greater than 400 mL.
|
Patients randomized to the intermittent catheterization group will have their PVR monitored every 8 hours pre-operatively. If PVR>400 mL, an intermittent catheter will be used. If PVR> 400 mL greater than 3 times pre-operatively, an indwelling catheter will be placed the fourth time. The indwelling catheter will be removed the morning of post-op day 1. It is expected that a small percentage of patients in either group will not have a PVR>400 mL preoperatively. These patients will not be catheterized but will remain in the study. Post-operatively, both treatment groups will have their PVR monitored for 24 hours, or until PVR is less than 200 mL. If PVR>400 mL and the patient is not able to void further, intermittent catheterization will be done every six hours as needed. If post-operative PVR>400 mL greater than 3 times post-operatively, an indwelling catheter will be placed the fourth time. |
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Study Feasibility - Enrollment
時間枠:One year
|
Number of participants enrolled and willingness of participants to be randomized Comparing the Number of patients screened compared to the number of patients meeting eligibility criteria. Tracking crossover between the treatment groups, participant retention, and follow-up rates. |
One year
|
Study Feasibility - Screening
時間枠:One year
|
Number of patients screened and number meeting eligibility
|
One year
|
Study Feasibility - Retention
時間枠:One year
|
Participant retention rate in study
|
One year
|
Study Feasibility - Follow-up
時間枠:One year
|
Rates of participant follow-up
|
One year
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Safety-Related Outcomes - Rates of UTI
時間枠:30 days
|
Number of patients who present with a post-operative UTI within 30 days of catheterization
|
30 days
|
Safety-Related Outcomes - Rates of POUR
時間枠:30 days
|
Number of patients who present with post-operative POUR within 30 days of catheterization
|
30 days
|
patient experience questionnaire
時間枠:pre-operatively, and post-operative day six or at discharge
|
the patient experience questionnaire, created by the principal investigator of the study, will be used to assess patients level of urogenital pain and discomfort and satisfaction with catheterization.
|
pre-operatively, and post-operative day six or at discharge
|
協力者と研究者
捜査官
- 主任研究者:George Grammatopoulos, MD、The Ottawa Hospital
- 主任研究者:Steven Papp, MD、The Ottawa Hospital
出版物と役立つリンク
一般刊行物
- Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 Apr;31(4):319-26. doi: 10.1086/651091. No abstract available.
- Health Quality Ontario, M.o.H.a.L.-T.C., Quality Based Procedures Clinical Handbook for Hip Fracture. 2013.
- Dodd AC, Bulka C, Jahangir A, Mir HR, Obremskey WT, Sethi MK. Predictors of 30-day mortality following hip/pelvis fractures. Orthop Traumatol Surg Res. 2016 Oct;102(6):707-10. doi: 10.1016/j.otsr.2016.05.016. Epub 2016 Aug 3.
- Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L. Management of urinary retention after surgical repair of hip fracture. CMAJ. 1992 Apr 1;146(7):1185-9.
- Smith NK, Albazzaz MK. A prospective study of urinary retention and risk of death after proximal femoral fracture. Age Ageing. 1996 Mar;25(2):150-4. doi: 10.1093/ageing/25.2.150.
- Hedstrom M, Grondal L, Ahl T. Urinary tract infection in patients with hip fractures. Injury. 1999 Jun;30(5):341-3. doi: 10.1016/s0020-1383(99)00094-7.
- Kamdar A, Yahya A, Thangaraj L. Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures. Geriatr Gerontol Int. 2009 Jun;9(2):131-4. doi: 10.1111/j.1447-0594.2008.00490.x.
- Schneider MA. Prevention of catheter-associated urinary tract infections in patients with hip fractures through education of nurses to specific catheter protocols. Orthop Nurs. 2012 Jan-Feb;31(1):12-8. doi: 10.1097/NOR.0b013e3182419619.
- Thomas S, Harris N, Dobransky J, Grammatopoulos G, Gartke K, Liew A, Papp S. Urinary catheter use in patients with hip fracture: Are current guidelines appropriate? A retrospective review. Can J Surg. 2021 Nov 25;64(6):E630-E635. doi: 10.1503/cjs.014620. Print 2021 Nov-Dec.
- Excellence, N.I.f.H.a.C., Hip fracture: management. 2011.
研究記録日
主要日程の研究
研究開始 (予想される)
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
Indwelling Catheterの臨床試験
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Boston Scientific Corporation完了
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BrosMed Medical Co., LtdCCRF Inc., Beijing, Chinaわからない
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