Authors' objectives:

To examine the clinical and cost-effectiveness of image-guided Hickman line insertions versus blind Hickman line insertions undertaken by nurses in adult cancer patients at Christie Hospital NHS Trust. To explore whether or not experienced nurses can transfer skills to trainee operators via a short but intensive training programme.

Authors' results and conclusions: When comparing image-guided with blind Hickman line insertions, no statistically significant difference was found between the mean cost per patient (464.57 versus 440.40 GBP, respectively) in the two arms of the trial. The only statistically significant difference in clinical outcomes was the frequency of catheter tip misplacement; this was higher in the blind arm of the trial. In the blind arm, 14% of patients had misplaced catheter tips whereas in the image-guided arm only 1% of patients had misplaced catheter tips. Consequently, incremental cost-effectiveness analysis was undertaken and the incremental cost per misplaced catheter tip avoided was 183.22 GBP. Sensitivity analysis demonstrated that the cost of the interventional X-ray suite charge might have an impact on the preferred method of insertion. At very low costs, the image-guided approach dominates the blind approach as fewer costs and greater benefits are incurred. Based on the clinical evidence from the trial, it is evident that nurses previously inexperienced in the procedure can be trained to insert Hickman lines successfully both at the bedside and under image guidance within a 3-month period. The only statistically significant difference identified when comparing the skill level of the three nurses was that the trainer was less likely to call for assistance from another healthcare professional during the procedure than the trainees.

Authors' recommendations: This report indicates that nurse insertion of Hickman lines in the majority of adult cancer patients at Christie Hospital NHS Trust is both safe and effective. However, there are a select group of patients for whom image-guided insertion may be preferred. The results reveal that skills and expertise can be transferred from trainer to trainee through a relatively short but intensive training course. From the patient satisfaction evidence available, it is evident that patients support nurse insertion. Nurse insertions can free up clinical resources in a safe and effective manner at a time of unprecedented pressure within the NHS.

Authors' methods: Randomised controlled trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/1068

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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