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Trial registered on ANZCTR
Registration number
ACTRN12613000471785
Ethics application status
Approved
Date submitted
16/04/2013
Date registered
26/04/2013
Date last updated
29/04/2013
Type of registration
Retrospectively registered
Titles & IDs
Public title
A randomised control trial to determine whether “tapping” on a vein improves perceived ease of venous cannulation, and rate of successful cannulation in patients undergoing elective surgery.
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Scientific title
A randomised control trial to determine whether “tapping” on a vein improves perceived ease of venous cannulation, and rate of successful cannulation in patients undergoing elective surgery.
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Secondary ID [1]
282352
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pre operative peripheral venous cannulation
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Condition category
Condition code
Anaesthesiology
289262
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0
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Other anaesthesiology
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Peripheral venous cannulation by an experienced anaesthetic registrar prior to admission to theatre/surgery. This will be timed and recorded as successful or unsuccessful by the assistant. The registrar is blinded to the intervention.
The assistant lightly taps on the dorsum of the patient's hand, over the previously rated vein (by anaesthetic registrar) for 20 seconds. This occurs only once prior to reassessment of the vein and cannulation by the anaesthetic registrar.
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Intervention code [1]
286975
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Other interventions
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Comparator / control treatment
Assistant to tap on her own hand instead of patient's chosen vein for the control treatment
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Control group
Placebo
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Outcomes
Primary outcome [1]
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The primary outcome to be evaluated will be whether or not the treatment (tapping) reduces the number of attempts to cannulate a patient undergoing elective surgery.
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Assessment method [1]
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Timepoint [1]
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Direct measurement of number of attempts and time taken (usually within 5 minutes)
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Secondary outcome [1]
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Time to venous cannulation
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Assessment method [1]
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Timepoint [1]
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As for the Primary time point - time measured with a stopwatch.
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Secondary outcome [2]
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Improvement of perceived ease of cannulation is rated immediately in front of the patient once the intervention (tapping/no tapping) has occured. The vein is rated prior to cannulation and then compared to the rating after the intervention.
This was rated using the prevalidated scale by:
Lenhardt R, Seybold T, Kimberger O, Stoiser B, Sessler D. Local warming and insertion of peripheral venous cannulation: single blinded prospective randomised controlled trial BMJ: 2002; volume 325 pp 409
The details of the scale used:
Veins were classified as
(1) clearly visible and easily palpable
(2) veins visible and palpable
(3) veins barely visible and palpable,
(4) veins viable but not palpable
(5) veins neither visible or palpable
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Assessment method [2]
302377
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Timepoint [2]
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Using the prevalidated scale above, assessment occurs before and after each intervention/no intervention (in front of the patient).
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Eligibility
Key inclusion criteria
Inclusion criteria –
All patients admitted to Day of Surgery Admission Unit (DOSA) for same-day elective surgery who require a venous cannula.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria –
Patients will be excluded if they are premedicated, unable to communicate in English, intellectually impaired, age<18 yr or recently ingested analgesic medication
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
This is a prospective, randomized, single blinded study to be conducted in Day of Admissions Unit (DOSA) at the Royal Adelaide Hospital.
Admission of patients will be as per normal DOSA procedure. Informed consent will be obtained from patients awaiting same-day elective surgery who require a venous cannula.
Patients will be randomised into two groups, tapping (group T) and non-tapping (group NT) using pre-arranged random number generator, independent of the two study investigators.
Allocation is concealed by sealed opaque envelopes, only opened 10s prior to patient intervention by the assistant.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Method used for allocation to intervention in this randomised controlled trial is simple randomisation using a computerised sequence generator.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
As no pilot study was conducted, the sample size was calculated based on previous similar studies attempting to identify differences in interventions for ease of peripheral cannulation. [previously referenced Ledhart paper] We calculated that a total of 120 subjects were required to detect a 20% difference in mean time to perform a cannulation between the groups with a power of 0.80 and a type 1 error rate of 0.05 .
Our initial aim was to recruit 120 patients, however due to time and resource constraints, we limited our recruitment to 100 participants.
Intention to treat analysis to occur.
For the primary outcome of ‘successful cannulation on first attempt’, a logistic regression model was used to explore the association between randomization group and whether first attempt cannulation was successful.
For the secondary outcome of ‘time to successful cannulation’ a linear regression model was used.
For the secondary outcome of ‘improvement of perceived ease of cannulation’,
a Wilcoxon signed rank sum test was performed to analyse the difference between paired rankings across the two groups.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
18/01/2013
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Actual
18/01/2013
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Date of last participant enrolment
Anticipated
5/02/2013
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Actual
5/02/2013
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
120
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
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The Royal Adelaide Hospital - Adelaide
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
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Country [1]
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Primary sponsor type
Individual
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Name
Lok Yin Evelyn Cheng
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Address
Royal Adelaide Hospital
North Terrace
Adelaide SA 5000
Australia
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
285890
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Royal Adelaide Hospital Research Ethics Committee
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Ethics committee address [1]
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Royal Adelaide Hospital North Terrace Adelaide, SA 5000 Australia
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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12/11/2012
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Ethics approval number [1]
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(Protocol Number 12107)
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Summary
Brief summary
Peripheral intravenous cannulation is a commonly performed procedure. The insertion of an intravenous cannula is usually uncomplicated, however it can be difficult in certain patients, including hypovolemic or critically ill patients, IV drug users, patients having repeated courses of chemotherapy, and obese patients. Perceived ease and efficiency of cannulation is related to the experience of the cannulator. It has been shown that, when certain manoeuvres are performed, for example, warming the skin prior to insertion of a peripheral venous cannula, both the time taken for insertion and number of attempts required for cannulation are reduced. A randomised controlled trial evaluated ultrasound guided peripheral venous cannulation in patients with a history of difficult intravenous cannulation, however it found no significant difference between the two groups in time to successful cannulation, number of attempts or number of subjects in whom IV cannulation was successful on the first attempt. It is common practice for health professionals to tap a vein, prior to cannulation, on the assumption that it will improve the perceived ease of cannulation and therefore the likelihood of successful cannulation. This assumption is based on anecdotal evidence and a rigorous investigation of the effect of tapping of the vein on the time taken and the number of attempts required to cannulate has not been undertaken. The optimisation of conditions is important for this commonly performed procedure. Failed attempts at cannulation can lead to fear induced vasoconstriction by activation of the sympathetic nervous system, resulting in subsequent attempts being more difficult. Multiple attempts at cannulation are also unpleasant for the patient. We investigated whether or not tapping of a selected vein prior to cannulation improved the perceived ease of cannulation and the success of cannulation.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Lok Yin Evelyn Cheng
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Address
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Department of Anaesthesia
Royal Adelaide Hospital
North Terrace, Adelaide
South Australia 5000
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Country
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Australia
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Phone
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+61402709829
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Jonathan Dutt-Gupta
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Address
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Department of Anaesthesia
Royal Adelaide Hospital
North Terrace, Adelaide
South Australia 5000
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Country
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Australia
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Phone
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+61 8 8222 4000
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Anna Marria Carrera
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Address
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Department of Anaesthesia
Royal Adelaide Hospital
North Terrace, Adelaide
South Australia 5000
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Country
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Australia
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Phone
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+61 8 8222 5858
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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