Deimplementing CXR After CVC (DRAUP) in the ICU

The Washington University

Status: Enrolling

Conditions: Implementation Science; Behavior and Behavior Mechanisms

Treatments: Behavioral: adapted DRAUP strategy bundle

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06146348

202312113

5K01HL161026-02 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This study proposes adapting and testing an innovative, behavioral theory-driven deimplementation program called DRAUP in two intensive care units for proof of concept and support that the program can help providers and hospital organizations address context determinants of deimplementation. Study data will be used to optimize the intervention for a subsequent larger trials.

Full description

There are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. Previously, we developed and initiated a successful evidence-based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We now move to adapt the deimplementation bundle in the new environment of the Intensive Care Unit (ICU) with hopeful continued success.

In experiment 1, qualitative analysis will be employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit and implementation outcomes as well as cost will be evaluated. In experiment 3, mixed methods will be used to evaluate the mechanism of impact of the refined program in the new environment.

Enrollment: 100 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

-Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs

Inclusion Criteria for DRAUP training:

(1) ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners

• ICU inclusion for DRAUP program:
• Availability of ultrasound machines with archiving capability (DICOM)
• A minimum of 100 supradiaphragmatic CVC insertions annually in adult patients (age >18)
• Capacity to access digital archiving (PICOM)
• Patient inclusion for DRAUP program:
• supradiaphragmatic CVC placed
• Patient exclusion for DRAUP program:
• severe instability (cardiac arrest, severe shock) where CVC would be used without CXR,
• level 1 trauma;
• burn patients with no viable skin surface for imaging

Trial design

Primary purpose: Other

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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100 participants in 2 patient groups

CVC confirmed by DRAUP

Experimental group

Description:

new mode of CVC confirmation for correct location and excluding pneumothorax

Treatment:

Behavioral: adapted DRAUP strategy bundle

CVC confirmed by CXR

Experimental group

Description:

traditional mode of CVC confirmation for correct location and excluding pneumothorax

Treatment:

Behavioral: adapted DRAUP strategy bundle