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Özalp Gerçeker G, Yıldırım BG, Önal A, Ören H, Olgun HN, Bektaş M. The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study. Eur J Oncol Nurs 2023; 67:102430. [PMID: 37879193 DOI: 10.1016/j.ejon.2023.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications. METHOD This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed. RESULTS The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication. CONCLUSIONS The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population. CLINICALTRIALS GOV IDENTIFIER NCT05769452.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Büşra Güliz Yıldırım
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Ayşe Önal
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hatice Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
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Knowledge and practice of intravenous infusion among nurses in university of Calabar teaching hospital. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns3.6132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed at assessing the knowledge and practice of intravenous infusion among nurses in University of Calabar Teaching Hospital. Two (2) objectives with the corresponding research questions were formulated. A descriptive research design was adopted for the study. The population and sample comprised of 160 registered nurses working in University of Calabar Teaching Hospital. Convenient sampling technique was employed to select 114 nurses to form the sample for this study. A self-developed and structured questionnaire was used to obtain data and analyzed using simple frequency and percentage tables. Findings of Results in table 2 reveals that majority 87(76.3) of the respondents said yes that As a nurse I know that intravenous infusion is carried out in most hospital by both doctors and nurses while 27(23.7%) said no. 114(100) of the respondents said yes that As a nurse I know that most management in the hospital do not allow nurses to carryout intravenous infusion on their patients for fear of replacement.
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Nickel B. Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care? Crit Care Nurse 2021; 41:e1-e21. [PMID: 34851379 DOI: 10.4037/ccn2021818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. OBJECTIVE To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. RESULTS Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. DISCUSSION Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. CONCLUSIONS Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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Exploring healthcare worker attitudes to peripheral vascular catheter management to facilitate policy implementation. J Hosp Infect 2021; 116:99-100. [PMID: 34418525 DOI: 10.1016/j.jhin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022]
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Lulie M, Tadesse A, Tsegaye T, Yesuf T, Silamsaw M. Incidence of peripheral intravenous catheter phlebitis and its associated factors among patients admitted to University of Gondar hospital, Northwest Ethiopia: a prospective, observational study. Thromb J 2021; 19:48. [PMID: 34256784 PMCID: PMC8276507 DOI: 10.1186/s12959-021-00301-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlebitis, inflammation of tunica intima of venous wall, occurred in 13-56% of hospitalized patients. It is characterized by pain, erythema, swelling, palpable venous cord, and pussy discharge at catheter site. Cannula-related blood stream infection (CRBSI) is recognized complication of phlebitis. Adverse outcomes of phlebitis embrace patient discomfort, longer hospital stay and higher health care cost. This study aimed to determine the incidence and associated factors of peripheral vein phlebitis among hospitalized patients. METHODS A hospital-based prospective, observational study was conducted between April 1 and August 31, 2020 at University of Gondar hospital, Northwest Ethiopia. A consecutive sampling method was used to recruit 384 patients. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients' records. Presence and severity of phlebitis was identified by Jackson's Visual Infusion Phlebitis (VIP) Scoring System. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with occurrence of phlebitis. P-value < 0.05 was used to declare significant association. RESULT A total of 384 study subjects were included in the study. The mean age of study subjects was 46 years, with a range of 19 to 96 years. The incidence of phlebitis was 70% among study subjects. Mid-stage (grade 3) and advanced-stage (grade 4) phlebitis were noticed in 136/268 (51%) and 89/268 (33%) respectively. Odds of developing phlebitis were twofold higher in patients with catheter-in situ > 96 h (AOR = 2.261, 95% CI 1.087-4.702, P-value = 0.029) as compared to those with catheter dwell time < 72 h. Female patients were 70% (AOR = 0.293, 95% CI 0.031-0.626, P-value = 0.002) lower than male patients with risk of developing phlebitis. Patients who use infusates were 53% (AOR = 0.472, 95% CI 0.280-0.796, P-value = 0.005) less likely to develop phlebitis as compared to those who didn't use infusates. CONCLUSION The cannula must be reviewed on daily basis, and it should be removed if it stayed later than 96 h.
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Affiliation(s)
- Mulugeta Lulie
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Yesuf
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Evaluation of the Duration of Peripheral Venous Catheter in Vein in Hospitalized Children. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.855374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021; 25:557-565. [PMID: 34177176 PMCID: PMC8196366 DOI: 10.5005/jp-journals-10071-23818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim and objective To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. Materials and methods The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as “IV line insertion and maintenance bundle” included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the “incidence of phlebitis and infiltration” was outcome measures while “scores on checklist of IV line insertion and IV line maintenance and administration of drugs” were process measures. Result The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles. Conclusion Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success. How to cite this article Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557–565.
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Affiliation(s)
- Neelima Singh
- Department of Nursing, Vardhman Mahavir, Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetanjli Kalyan
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sukhwinder Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Teuben MPJ, Pfeifer R, Teuber H, De Boer LL, Halvachizadeh S, Shehu A, Pape HC. Lessons learned from the mechanisms of posttraumatic inflammation extrapolated to the inflammatory response in COVID-19: a review. Patient Saf Surg 2020; 14:28. [PMID: 32665786 PMCID: PMC7346848 DOI: 10.1186/s13037-020-00253-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
Up to 20% of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients develop severe inflammatory complications with diffuse pulmonary inflammation, reflecting acute respiratory distress syndrome (ARDS). A similar clinical profile occurs in severe trauma cases. This review compares pathophysiological and therapeutic principles of severely injured trauma patients and severe coronavirus disease 2019 (COVID-19). The development of sequential organ failure in trauma parallels deterioration seen in severe COVID-19. Based on established pathophysiological models in the field of trauma, two complementary pathways of disease progression into severe COVID-19 have been identified. Furthermore, the transition from local contained disease into systemic and remote inflammation has been addressed. More specifically, the traumatology concept of sequential insults ('hits') resulting in immune dysregulation, is applied to COVID-19 disease progression modelling. Finally, similarities in post-insult humoral and cellular immune responses to severe trauma and severe COVID-19 are described. To minimize additional 'hits' to COVID-19 patients, we suggest postponing all elective surgery in endemic areas. Based on traumatology experience, we propose that immunoprotective protocols including lung protective ventilation, optimal thrombosis prophylaxis, secondary infection prevention and calculated antibiotic therapy are likely also beneficial in the treatment of SARS-CoV-2 infections. Finally, rising SARS-CoV-2 infection and mortality rates mandate exploration of out-of-the box treatment concepts, including experimental therapies designed for trauma care.
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Affiliation(s)
- Michel P. J. Teuben
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland
- Department of Spine- Neuro- and Special orthopedic Surgery, Rhein-Maas Klinikum Würselen, Aachen, Germany
| | - Roman Pfeifer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland
| | - Henrik Teuber
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
- Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Leonard L. De Boer
- Imperial College London, London, UK
- The Francis Crick Institute, London, UK
| | - Sascha Halvachizadeh
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland
| | - Alba Shehu
- Department of Trauma and Orthopedic Surgery, Marienhospital, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopedic Research, Zurich, Switzerland
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Vidal Santos S, Souza Ramos FR, Costa R, da Cunha Batalha LM. Evidências sobre prevenção de lesões de pele em recém-nascidos: revisão integrativa. ESTIMA 2019. [DOI: 10.30886/estima.v17.787_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: identificar estratégias para a prevenção de lesões de pele em recém-nascidos (RN) hospitalizados, publicadas em periódicos científicos no período de 2013 a 2018. Método: revisão integrativa de literatura realizada em dois momentos de busca em bases de dados, sendo selecionados 37 estudos publicados entre os anos de 2013 e 2018. Resultados: termorregulação, uso de antisséptico, uso de emolientes e limpeza do coto umbilical foram as recomendações mais encontradas. Entre as práticas baseadas em evidência, destacam-se as que previnem o risco de hipotermia, como o uso de saco de polietileno e o contato pele a pele, que respaldam a assistência e que garantem segurança no cuidado do paciente neonatal. Conclusão: a prevenção de lesões de pele é um tema relevante, entretanto, existe escassez de evidências robustas para sustentar, com segurança, as práticas de cuidados com o RN. Observa-se ainda que as evidências são insuficientes para englobar o universo do tema, demonstrando que o cuidado com a pele é um tema que demanda investimentos e mais pesquisas.
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Vidal Santos S, Souza Ramos FR, Costa R, da Cunha Batalha LM. Evidence on prevention of skin lesions in newborns: integrative review. ESTIMA 2019. [DOI: 10.30886/estima.v17.787_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To identify strategies for the prevention of skin lesions in hospitalized newborns (NBs), published in scientific journals from 2013 to 2018. Method: Integrative literature review performed in two moments of database search, selecting 37 studies published between 2013 and 2018. Results: Thermoregulation, use of antiseptic, use of emollients and cleaning of the umbilical stump were the most commonly found recommendations. Among the evidence-based practices, we highlight those that prevent the risk of hypothermia, such as the use of a polyethylene bag and skin-to-skin contact, which support the assistance and ensure safety in the care of the neonatal patient. Conclusion: The prevention of skin lesions is a relevant topic. However, there is a scarcity of robust evidence to safely sustain NB care practices. It is also observed that the evidence is insufficient to encompass the universe of the theme, demonstrating that skin care is a theme that requires investment and more research.
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Ruiz-Giardin JM, Ochoa Chamorro I, Velázquez Ríos L, Jaqueti Aroca J, García Arata MI, SanMartín López JV, Guerrero Santillán M. Blood stream infections associated with central and peripheral venous catheters. BMC Infect Dis 2019; 19:841. [PMID: 31615450 PMCID: PMC6794764 DOI: 10.1186/s12879-019-4505-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. Methods This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. Results In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4%), p < 0.001. The accuracy was greater for PB (75%) than for CB (66. 2%), Coagulase-negative staphylococci were the most frequent microorganisms in both groups but occurred 1.57 times more frequently in CB (64.1%/40.6%) (p = 0.004), while Staphylococcus aureus (23. 4%/9.5%) (p = 0.02) and Enterobacteriae species (15.6%/6. 3%) (p = 0.003) were 2.5 times more frequent in PB. The CB patients stayed at the hospital for an average of 7.44 days longer than did the PB patients; more CB patients had active neoplasia (70. 4%/32.8%), more had surgery in the previous week (29. 2%/8. 3%), and fewer received adequate empirical treatment (53.9%/ 62.5%). Catheter was not removed in 8. 2% of CB and 3.7% of PB. On the other hand, the CB and PB patients had similar Pitt scores at blood extraction (median 0.89 versus 0.84 points, respectively; p = 0.8) and similar survival rates at hospital discharge (91.1% versus 90. 2%; p = 0.81). Conclusions Central catheters were more frequent sources of bacteraemias than were peripheral catheters. There were important differences in the microbiological aetiology as well. PB patients received correct empirical antibiotic treatment more frequently and had a higher initial rate of correct determination of the suspected source of bacteraemia. Differences in the microbiological aetiology and empirical antibiotic treatment received, and probably catheter removal and time to catheter removal could explain why CB and PB patients had similar survival rates .
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Affiliation(s)
- Jose Manuel Ruiz-Giardin
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Iciar Ochoa Chamorro
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Laura Velázquez Ríos
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Jeronimo Jaqueti Aroca
- Clinical Analysis Department, Microbiology Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Maria Isabel García Arata
- Clinical Analysis Department, Microbiology Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Juan Víctor SanMartín López
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Marta Guerrero Santillán
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
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Wei T, Li XY, Yue ZP, Chen YY, Wang YR, Yuan Z, Lin Q, Tan Y, Peng SY, Li XF. Catheter dwell time and risk of catheter failure in adult patients with peripheral venous catheters. J Clin Nurs 2019; 28:4488-4495. [PMID: 31410906 DOI: 10.1111/jocn.15035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/04/2019] [Accepted: 08/04/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. BACKGROUND Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. DESIGN Prospective, observational study. We have complied with the STROBE checklist of items. METHODS This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. RESULTS A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. CONCLUSIONS The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. RELEVANCE TO CLINICAL PRACTICE The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.
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Affiliation(s)
- Tao Wei
- Nursing Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xu-Ying Li
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Zhi-Ping Yue
- Nursing Department, Nin Xiang Traditional Chinese Medical Hospital, Ningxiang, China
| | - Yong-Yi Chen
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Yi-Ren Wang
- Department of Epidemiology and Statistics, School of Public Health, Central south University, Changsha, China
| | - Zhong Yuan
- Vascular Access Center, Hunan cancer hospital, Changsha, China
| | - Qin Lin
- Vascular Access Center, Hunan cancer hospital, Changsha, China
| | - Yan Tan
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Si-Yi Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xing-Feng Li
- Nursing Department, Hunan cancer hospital, Changsha, China
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A Model of Phlebitis Associated with Peripheral Intravenous Catheters in Orthopedic Inpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183412. [PMID: 31540024 PMCID: PMC6765841 DOI: 10.3390/ijerph16183412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/24/2022]
Abstract
Phlebitis leads to increased discomfort for patients, longer hospital stays, and higher healthcare costs. This study aimed to identify predictive factors of peripheral phlebitis related to intravenous injection among orthopedic inpatients, develop a prediction model, and evaluate the goodness-of-fit of the prediction model. This study included 270 orthopedic patients who were hospitalized in the orthopedic ward of a general hospital. A peripheral intravenous injection-related questionnaire based on previous studies and the modified Infusion Nurses Society scale were used to collect data. Phlebitis risk factors were identified, and a prediction model was developed using the Bayesian regression model. Vein quality, contrast medium use, hygiene duration, and period of nursing clinical experience were significant based on their 95% confidence intervals. The prediction model exhibited good discrimination. The prediction model developed in this study can be used for screening high-risk patients for peripheral intravenous catheter-related phlebitis and for providing basic data for developing interventions for the prevention and management of peripheral intravenous catheter-related phlebitis.
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Osti C, Khadka M, Wosti D, Gurung G, Zhao Q. Knowledge and practice towards care and maintenance of peripheral intravenous cannula among nurses in Chitwan Medical College Teaching Hospital, Nepal. Nurs Open 2019; 6:1006-1012. [PMID: 31367425 PMCID: PMC6650670 DOI: 10.1002/nop2.288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
AIM The study is mainly concerned about the care and maintenance of peripheral intravenous cannulation: to determine the knowledge and practice of nurses towards care and maintenance of IV cannula and to find out the obstacles encountered in caring and maintaining IV cannula. Intravenous cannulation is a common procedure performed by nurses in every hospital and closely associated with the risk of nosocomial infections if standard care is not provided. DESIGN A descriptive cross-sectional study design was carried out. METHODS Nurses' knowledge and practice towards care and maintenance of peripheral intravenous cannula were assessed using a validated semi-structured self-administered questionnaire through the census method. Data were analysed through SPSS program. The comparison was done between knowledge and practice. RESULTS The findings revealed that 84.72% respondents were doing correct practices despite the fact that only 82.47% respondents had proper knowledge. Most nurses have good knowledge of caring and maintaining peripheral intravenous cannulation but there were some without proper knowledge and practice. This could be a potential risk factor for patient safety.
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Affiliation(s)
- Chadani Osti
- Department of NursingChongqing Medical University First Affiliated HospitalChongqingChina
| | - Menuka Khadka
- Department of NursingKathmandu Valley HospitalKathmanduNepal
| | - Deepa Wosti
- College of NursingChitwan Medical CollageBharatpurNepal
| | - Ganga Gurung
- College of NursingChitwan Medical CollageBharatpurNepal
| | - Qinghua Zhao
- Department of NursingChongqing Medical University First Affiliated HospitalChongqingChina
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Webster J, Osborne S, Rickard CM, Marsh N. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019; 1:CD007798. [PMID: 30671926 PMCID: PMC6353131 DOI: 10.1002/14651858.cd007798.pub5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection. Costs associated with routine replacement may be considerable. This is the third update of a review first published in 2010. OBJECTIVES To assess the effects of removing peripheral intravenous catheters when clinically indicated compared with removing and re-siting the catheter routinely. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 18 April 2018. We also undertook reference checking, and contacted researchers and manufacturers to identify additional studies. SELECTION CRITERIA We included randomised controlled trials that compared routine removal of PIVC with removal only when clinically indicated, in hospitalised or community-dwelling patients receiving continuous or intermittent infusions. DATA COLLECTION AND ANALYSIS Three review authors independently reviewed trials for inclusion, extracted data, and assessed risk of bias using Cochrane methods. We used GRADE to assess the overall evidence certainty. MAIN RESULTS This update contains two new trials, taking the total to nine included studies with 7412 participants. Eight trials were conducted in acute hospitals and one in a community setting. We rated the overall certainty of evidence as moderate for most outcomes, due to serious risk of bias for unblinded outcome assessment or imprecision, or both. Because outcome assessment was unblinded in all of the trials, none met our criteria for high methodological quality.Primary outcomesSeven trials (7323 participants), assessed catheter-related bloodstream infection (CRBSI). There is no clear difference in the incidence of CRBSI between the clinically indicated (1/3590) and routine change (2/3733) groups (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.08 to 4.68), low-certainty evidence (downgraded twice for serious imprecision).All trials reported incidence of thrombophlebitis and we combined the results from seven of these in the analysis (7323 participants). We excluded two studies in the meta-analysis because they contributed to high heterogeneity. There is no clear difference in the incidence of thrombophlebitis whether catheters were changed according to clinical indication or routinely (RR 1.07, 95% CI 0.93 to 1.25; clinically indicated 317/3590; 3-day change 307/3733, moderate-certainty evidence, downgraded once for serious risk of bias). The result was unaffected by whether the infusion was continuous or intermittent. Six trials provided thrombophlebitis rates by number of device days (32,709 device days). There is no clear difference between groups (RR 0.90, 95% CI 0.76 to 1.08; clinically indicated 248/17,251; 3-day change 236/15,458; moderate-certainty evidence, downgraded once for serious risk of bias).One trial (3283 participants), assessed all-cause blood stream infection (BSI). We found no clear difference in the all-cause BSI rate between the two groups (RR 0.47, 95% CI 0.15 to 1.53; clinically indicated: 4/1593 (0.02%); routine change 9/1690 (0.05%); moderate-certainty evidence, downgraded one level for serious imprecision).Three trials (4244 participants), investigated costs; clinically indicated removal probably reduces device-related costs by approximately AUD 7.00 compared with routine removal (MD -6.96, 95% CI -9.05 to -4.86; moderate-certainty evidence, downgraded once for serious risk of bias).Secondary outcomesSix trials assessed infiltration (7123 participants). Routine replacement probably reduces infiltration of fluid into surrounding tissues compared with a clinically indicated change (RR 1.16 (95% CI 1.06 to 1.26; routine replacement 747/3638 (20.5%); clinically indicated 834/3485 (23.9%); moderate-certainty evidence, downgraded once for serious risk of bias).Meta-analysis of seven trials (7323 participants), found that rates of catheter failure due to blockage were probably lower in the routine-replacement group compared to the clinically indicated group (RR 1.14, 95% CI 1.01 to 1.29; routine-replacement 519/3733 (13.9%); clinically indicated 560/3590 (15.6%); moderate-certainty evidence, downgraded once for serious risk of bias).Four studies (4606 participants), reported local infection rates. It is uncertain if there are differences between groups (RR 4.96, 95% CI 0.24 to 102.98; clinically indicated 2/2260 (0.09%); routine replacement 0/2346 (0.0%); very low-certainty evidence, downgraded one level for serious risk of bias and two levels for very serious imprecision).One trial (3283 participants), found no clear difference in the incidence of mortality when clinically indicated removal was compared with routine removal (RR 1.06, 95% CI 0.27 to 4.23; low-certainty evidence, downgraded two levels for very serious imprecision).One small trial (198 participants) reported no clear difference in device-related pain between clinically indicated and routine removal groups (MD -0.60, 95% CI -1.44 to 0.24; low-certainty evidence, downgraded one level for serious risk of bias and one level for serious imprecision).The pre-planned outcomes 'number of catheter re-sites per patient', and 'satisfaction' were not reported by any studies included in this review. AUTHORS' CONCLUSIONS There is moderate-certainty evidence of no clear difference in rates of CRBSI, thrombophlebitis, all-cause BSI, mortality and pain between clinically indicated or routine replacement of PIVC. We are uncertain if local infection is reduced or increased when catheters are changed when clinically indicated. There is moderate-certainty evidence that infiltration and catheter blockage is probably lower when PIVC are changed routinely; and moderate-certainty evidence that clinically indicated removal probably reduces device-related costs. The addition of two new trials for this update found no further evidence to support changing catheters every 72 to 96 hours. Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. This would provide significant cost savings, spare patients the unnecessary pain of routine re-sites in the absence of clinical indications and would reduce time spent by busy clinicians on this intervention. To minimise PIVC-related complications, staff should inspect the insertion site at each shift change and remove the catheter if signs of inflammation, infiltration, occlusion, infection or blockage are present, or if the catheter is no longer needed for therapy.
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Affiliation(s)
- Joan Webster
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- The University of QueenslandSchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
- Royal Brisbane and Women's HospitalNursing and Midwifery Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Sonya Osborne
- Queensland University of TechnologySchool of Public Health and Social Work, Institute of Health and Biomedical InnovationKelvin Grove Campus69 Musk AveBrisbaneQueenslandAustralia4059
| | - Claire M Rickard
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustraliaQueensland 4029
| | - Nicole Marsh
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
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Elective replacement of intravenous cannula in neonates-a randomised trial. Eur J Pediatr 2018; 177:1719-1726. [PMID: 30191302 DOI: 10.1007/s00431-018-3234-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
Peripheral intravenous cannula (PIVC) insertion is one of the most common invasive procedures performed in neonates and is frequently associated with adverse events. There are no studies in the neonatal population looking at the possibility of reducing the risk of PIVC-related complications by elective replacement of PIVC. A randomised, non-blinded, control trial was conducted in a tertiary level neonatal unit in Melbourne, Australia, to examine rates of extravasation in neonates with elective replacement of PIVC as compared to standard practice. Neonates born at 32 weeks of gestation or more were randomly assigned to have their PIVC replaced electively (every 72-96 h) or when clinically indicated in a 1:1 allocation ratio after parental consent. Primary outcome studied was rate of extravasation. Secondary outcomes included rates of phlebitis, leakage or spontaneous dislodgement of PIVC. One hundred thirteen infants were enrolled. Extravasation was noted in 33 (60%) of standard practice group vs. 28 (48.3%) of elective replacement (RR 0.80, CI 0.57-1.13, p = 0.21) infants. Time to first extravasation was similar between the groups (hazard ratio 0.69, CI 0.42-1.15). Extravasation events per 1000 IV hours were also similar between groups. Similar results were seen by both intention to treat and per protocol analyses. There was an increase in leaking rates (HR1.98, CI 1.03-3.81, p = 0.04) in the elective group, while phlebitis and spontaneous dislodgement rates were similar to standard group.Conclusion: Elective replacement of PIVC in neonates is not associated with reduction in extravasation rates.Trial registration: This trial has been registered with the Australian and New Zealand Clinical Trials Register. Identifier: ACTRN12615000827538. What is Known: • The reported incidence of extravasation injury is as high as 70% in the neonatal and paediatric population and has an association with cannula dwell time. • Adult studies have done to look at the possibility of reducing intravenous cannula-related complications with routine replacement of the cannulas but no similar studies have been done in the neonatal population. What is New: • Routine replacement of intravenous cannula in neonates between 72 and 96 h of use does not reduce the rate of extravasation injuries. • There might be some added complications associated with such a practice.
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Marsh N, Larsen E, Genzel J, Mihala G, Ullman AJ, Kleidon T, Cadigan S, Rickard CM. A novel integrated dressing to secure peripheral intravenous catheters in an adult acute hospital: a pilot randomised controlled trial. Trials 2018; 19:596. [PMID: 30376880 PMCID: PMC6208178 DOI: 10.1186/s13063-018-2985-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of peripheral intravenous catheter (PIV) failure has been as high as 69%. This is in part due to inadequate stabilisation or securement to the skin, which allows micro-motion of the catheter within the vein. METHODS A pilot open randomised controlled trial of 300 patients was conducted in the medical and surgical wards of a large tertiary hospital. A superiority parallel pragmatic design was used. Eligible patients over the age of 16 years were randomised using a centralised service (randomly varied block sizes and 1:1 ratio) to have PIV dressings of either (i) a bordered polyurethane dressing (BPU, standard care) or (ii) the integrated securement device (ISD). Allocation was concealed until entry. The primary outcome of feasibility addressed eligibility, consent, protocol adherence and retention rates. All-cause PIV failure was an additional primary outcome. This was a composite of infection (laboratory-confirmed local or bloodstream infection), occlusion or infiltration, dislodgement, phlebitis and thrombosis. Group comparisons were by proportions, incidence rates per 1000 PIV days and hazard ratios. Secondary outcomes were local or bloodstream infection, occlusion or infiltration, dislodgement, phlebitis, thrombosis, PIV dwell time, safety and adverse events and patient satisfaction with study products. Analysis was by intention to treat and the patient was the unit of measurement. Multivariable modelling was undertaken. RESULTS Feasibility outcomes were 91% of screened patients were eligible, 98% of invited patients consented, 100% of randomised participants received the allocated intervention on insertion and 1/300 (< 1%) were lost to follow-up. In total, 792 PIV days were studied. PIV failure occurred in 43/150 BPU patients (29%) and 40/150 ISD patients (27%) (119 vs 93 per 1000 PIV days; incidence rate ratio 0.78, 95% confidence interval, CI 0.50-1.23). In the multivariate model, ISD (hazard ratio 0.51, 95% CI 0.29-0.89) and admission for a surgical emergency were significantly associated with decreased failure, while female gender, wound, hand insertion and more frequent PIV use were significantly associated with increased PIV failure. CONCLUSION ISDs were significantly associated with decreased failure in the multivariable modelling. Feasibility outcomes were supportive of the need to undertake a larger trial to confirm these results. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000984493 . Registered 27 July 2016.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Emily Larsen
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Jodie Genzel
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Amanda J. Ullman
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Sue Cadigan
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
| | - Claire M. Rickard
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
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18
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Short-Term Peripheral Venous Catheter-Related Bloodstream Infections: Evidence for Increasing Prevalence of Gram-Negative Microorganisms from a 25-Year Prospective Observational Study. Antimicrob Agents Chemother 2018; 62:AAC.00892-18. [PMID: 30126952 DOI: 10.1128/aac.00892-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to describe the etiology and outcome of short-term peripheral venous catheter (PVC)-related bloodstream infections (PVCRBSI) in a 25-year period (1992 to 2016) and to identify predictive factors of Gram-negative PVCRBSI. This was a prospective observational study including all episodes of PVCRBSI. A multivariate logistic regression model adjusted for calendar year was built to explore factors associated with a Gram-negative bacterial etiology. Over the study period, 711 episodes of PVCRBSI were identified. Incidence rate of PVCRBSI increased from 0.06 to 0.13 episodes/1,000 patient-days. A Gram-negative bacterial etiology was demonstrated in 162 (22.8%) episodes. There was a significant increase in the proportion of Gram-negative infections (22.6% in 1992 to 1996 versus 33.2% in 2012 to 2016). Independent predictive factors of Gram-negative PVCRBSI were the following: being in the hospital for more than 7 days with a catheter in situ for more than 3 days (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI], 1.20 to 2.69), surgery in the previous month (aOR, 2.39; 95% CI, 1.40 to 4.09), and antimicrobial treatment with beta-lactams (aOR, 1.80; 95% CI, 1.16 to 2.78). In conclusion, we reported an increase in the prevalence of Gram-negative PVCRBSI over the last 25 years. Factors associated with a Gram-negative bacterial etiology were being in the hospital for more than 7 days with a catheter in situ for more than 3 days, having undergone surgery, and having received antimicrobial treatment with beta-lactams.
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Mohanty M, Lawal OD, Skeer M, Lanier R, Erpelding N, Katz N. Medication errors involving intravenous patient-controlled analgesia: results from the 2005-2015 MEDMARX database. Ther Adv Drug Saf 2018; 9:389-404. [PMID: 30364852 PMCID: PMC6199682 DOI: 10.1177/2042098618773013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the current magnitude and characteristics of intravenous patient-controlled analgesia (IV-PCA) errors, and to identify opportunities for improving the PCA modality. METHODS We conducted a descriptive analysis of IV-PCA medication errors submitted to the MEDMARX database. Events were restricted to those occurring in inpatient hospital settings between 1 January 2005 and 31 December 2015. IV-PCA errors were classified by error category, cause of error, error type, level of care rendered, and actions taken. RESULTS A total of 1948 IV-PCA errors were identified as potential errors (3.9%), nonharmful errors (89.5%), or harmful errors (6.7%) based on the National Coordinating Council for Medication Error Reporting and Prevention taxonomy for categorizing medication errors. Of these, 19.1% required a clinical intervention to address the deleterious effects of the error, indicating an underestimation of the risks associated with IV-PCA errors. The most frequent types of errors were improper dose/quantity (43.2%) and omission errors (19.9%). While human performance deficit was the leading cause of error (50.2%), other common causes included failure to follow procedure and protocol (42.2%) and improper use of the pump (22.7%). Although remedial actions were often taken to prevent error recurrence, actions were taken to rectify the systemic deficits that led to errors in only a minority of cases (11.8%). CONCLUSION Preventable errors continue to pose unnecessary risks to patients receiving IV-PCA. Multimodal analgesic regimens and novel PCA systems that reduce human error are needed to prevent errors while preserving the advantages of PCA for the management of acute pain.
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Affiliation(s)
| | | | - Margie Skeer
- Associate Professor of Public Health and
Community Medicine, Tufts University School of Medicine, Boston, MA,
USA
| | | | | | - Nathaniel Katz
- Analgesic Solutions, LLC, 321 Commonwealth Road,
Suite 204, Wayland, MA 01778, USA
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20
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Ray-Barruel G, Cooke M, Mitchell M, Chopra V, Rickard CM. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study. BMJ Open 2018; 8:e021290. [PMID: 29866733 PMCID: PMC5988165 DOI: 10.1136/bmjopen-2017-021290] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice. METHODS AND ANALYSIS The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published. TRIAL REGISTRATION NUMBER ANZCTR: 12617000067370; Pre-results.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Division of Hospital Medicine, Patient Safety Enhancement Program, Michigan Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Castillo MI, Larsen E, Cooke M, Marsh NM, Wallis MC, Finucane J, Brown P, Mihala G, Carr PJ, Byrnes J, Walker R, Cable P, Zhang L, Sear C, Jackson G, Rowsome A, Ryan A, Humphries JC, Sivyer S, Flanigan K, Rickard CM. Integrated versus nOn-integrated Peripheral inTravenous catheter. Which Is the most effective systeM for peripheral intravenoUs catheter Management? (The OPTIMUM study): a randomised controlled trial protocol. BMJ Open 2018; 8:e019916. [PMID: 29764876 PMCID: PMC5961612 DOI: 10.1136/bmjopen-2017-019916] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) are frequently used in hospitals. However, PIVC complications are common, with failures leading to treatment delays, additional procedures, patient pain and discomfort, increased clinician workload and substantially increased healthcare costs. Recent evidence suggests integrated PIVC systems may be more effective than traditional non-integrated PIVC systems in reducing phlebitis, infiltration and costs and increasing functional dwell time. The study aim is to determine the efficacy, cost-utility and acceptability to patients and professionals of an integrated PIVC system compared with a non-integrated PIVC system. METHODS AND ANALYSIS Two-arm, multicentre, randomised controlled superiority trial of integrated versus non-integrated PIVC systems to compare effectiveness on clinical and economic outcomes. Recruitment of 1560 patients over 2 years, with randomisation by a centralised service ensuring allocation concealment. Primary outcomes: catheter failure (composite endpoint) for reasons of: occlusion, infiltration/extravasation, phlebitis/thrombophlebitis, dislodgement, localised or catheter-associated bloodstream infections. SECONDARY OUTCOMES first time insertion success, types of PIVC failure, device colonisation, insertion pain, functional dwell time, adverse events, mortality, cost-utility and consumer acceptability. One PIVC per patient will be included, with intention-to-treat analysis. Baseline group comparisons will be made for potentially clinically important confounders. The proportional hazards assumption will be checked, and Cox regression will test the effect of group, patient, device and clinical variables on failure. An as-treated analysis will assess the effect of protocol violations. Kaplan-Meier survival curves with log-rank tests will compare failure by group over time. Secondary endpoints will be compared between groups using parametric/non-parametric techniques. ETHICS AND DISSEMINATION Ethical approval from the Royal Brisbane and Women's Hospital Human Research Ethics Committee (HREC/16/QRBW/527), Griffith University Human Research Ethics Committee (Ref No. 2017/002) and the South Metropolitan Health Services Human Research Ethics Committee (Ref No. 2016-239). Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000089336.
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Affiliation(s)
- Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marianne C Wallis
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Peter Brown
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Rachel Walker
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Prudence Cable
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Candi Sear
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Gavin Jackson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anna Rowsome
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Ryan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Julie C Humphries
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Susan Sivyer
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Kathy Flanigan
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Guzmán Ramos PJ, Fernández Pérez C, Ayllón Santiago T, Baquero Artigao MR, Ortiz‐Díez G. Incidence of and associated factors for bacterial colonization of intravenous catheters removed from dogs in response to clinical complications. J Vet Intern Med 2018; 32:1084-1091. [PMID: 29602241 PMCID: PMC5980313 DOI: 10.1111/jvim.15118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/21/2017] [Accepted: 02/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infection rate associated with intravenous (IV) catheter placement is emerging as an important issue in small animal veterinary medicine, mostly because of the economic costs associated with these infections. Identification of possible associated factors may provide useful information for the surveillance and prevention of such infections. OBJECTIVES To determine the incidence of positive bacterial cultures obtained from IV catheters used in dogs hospitalized for at least 48 hours and removed because of clinical complication. To identify the bacteria involved and factors associated with bacterial colonization. ANIMALS One-hundred eighty-two dogs that underwent IV catheterization from January 2015 to July 2015 at the Veterinary Teaching Hospital of Alfonso X el Sabio University of Madrid were enrolled in the study. RESULTS The bacterial colonization rate of all IV catheters removed in response to clinical complications was 39.6%, the cumulative proportion of catheters that remained in place at 24, 48, and 72 hours after placement was 89.5, 78, and 59.4%, respectively. Multivariable Cox proportional hazards regression indicated significant associations for staff who performed catheterization (junior, P = .002; student, P = .034) and use of steroidal anti-inflammatory drugs (P = .036). The most frequently isolated bacterium was Acinetobacter spp. (21.7%). CONCLUSIONS AND CLINICAL IMPORTANCE The bacterial colonization incidence related to IV catheter placement was slightly higher than the incidence described in other veterinary studies. Associated factors not previously described in veterinary medicine were found. The most frequently isolated organism was Acinetobacter spp., indicating its importance as an emerging pathogen in catheter colonization.
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Affiliation(s)
- Pedro Jose Guzmán Ramos
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
| | - Cristina Fernández Pérez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Universitario Clínico San Carlos (Servicio de Medicina Preventiva), Universidad Complutense de MadridMadridSpain
| | - Tania Ayllón Santiago
- Instituto Nacional de Infectología Evandro Chagas, Núcleo Operacional Centinela de Mosquitos Vetores FiocruzRío de JaneiroBrazil
- Departamento de Microbiología de la Universidad Alfonso X el SabioMadridSpain
| | | | - Gustavo Ortiz‐Díez
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
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Kirtil I, Akyuz N. Precautions Taken by Nurses about the Prevention of Hospital-Acquired Infections in Intensive Care Units. Pak J Med Sci 2018; 34:399-404. [PMID: 29805416 PMCID: PMC5954387 DOI: 10.12669/pjms.342.14610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the precautions that nurses take for avoiding hospital-acquired infections in intensive care units of a State University Medical Faculty Hospital in Istanbul. Methods The research data were collected by a questionnaire developed by the authors. The study was conducted in intensive care units of a medical faculty hospital of a state university in Istanbul province. 85 nurses working in different various intensive care units and providing informed consent participated in the study. Results Intravenous catheterization, urinary catheterization, ventilator-associated infections and surgical site infections were assessed. The questionnaire was scored by applying a conversion of 100 to the total scores obtained, with the highest score being 100 and lowest score being 0. The percentage of nurses that practised all of the approaches about preventing hospital-acquired infections was estimated to be 8.2% for catheter-related bloodstream infections, 67.1% for surgical site infections, 72.9% for catheter-associated urinary tract infections, 27.1% for ventilator-associated infections, 29.4% for isolation preventions and 62.5% for attempts related to sterilization/disinfection of the medical devices. Conclusion It was seen that nurses use most of the effective measures in order to prevent hospital-acquired infections. The guidelines generated for intensive care units should be updated according to international standards as needed. These guidelines should be used effectively; the differences between intensive care units should be resolved and all nurses should be trained at certain intervals.
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Affiliation(s)
- Inci Kirtil
- Inci Kirtil, M.Sc. Research Assistant, Marmara University Faculty of Health Sciences, Department of Surgical Nursing, Başıbüyük Mah. Maltepe Başıbüyük Yolu Sk. Sağlık Bilimleri Kampüsü No:9/4/1 Maltepe, Istanbul, Turkey
| | - Nuray Akyuz
- Nuray Akyuz, RN, PhD. Associate Professor, Istanbul University Florence Nightingale, Faculty of Nursing Abide-i Hürriyet Cad. 34381 Şişli, Istanbul, Turkey
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Carr PJ, Higgins NS, Cooke ML, Mihala G, Rickard CM. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev 2018; 3:CD011429. [PMID: 29558570 PMCID: PMC6353147 DOI: 10.1002/14651858.cd011429.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Most people admitted to hospitals worldwide require a vascular access device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes. OBJECTIVES To compare the use of the vascular access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, device failure, and cost-effectiveness. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018. SELECTION CRITERIA We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management. MAIN RESULTS We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication. AUTHORS' CONCLUSIONS This systematic review failed to locate relevant published RCTs to support or refute the assertion that vascular access specialist teams are superior to the generalist model. A vascular access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of vascular access devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for vascular access devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a vascular access specialist team approach for vascular access device insertion and care for the prevention of failure.
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Affiliation(s)
- Peter J Carr
- School of Medicine, The University of Western AustraliaEmergency Medicine2nd Floor, R Block, QE11 Medical CentreNedlandsAustralia6009
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
| | - Niall S Higgins
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Queensland University of Technology & Royal Brisbane and Women's Hospital, Metro North Hospital and Health ServiceSchool of NursingVictoria Park RoadKelvin GroveBrisbaneQueenslandAustralia4059
| | - Marie L Cooke
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneAustralia
| | - Gabor Mihala
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- School of Medicine, Griffith UniversityCentre for Applied Health Economics, Menzies Health Institute QueenslandUniversity DriveMeadowbrookQueenslandAustralia4131
| | - Claire M Rickard
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneAustralia
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25
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Paladini A, Chiaretti A, Sellasie KW, Pittiruti M, Vento G. Ultrasound-guided placement of long peripheral cannulas in children over the age of 10 years admitted to the emergency department: a pilot study. BMJ Paediatr Open 2018; 2:e000244. [PMID: 29637197 PMCID: PMC5887829 DOI: 10.1136/bmjpo-2017-000244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Most children admitted to the emergency department (ED) require peripheral venous access (PVA), which is often difficult to perform or is unsuccessful. Ultrasound guidance helps with the placement of peripheral short cannulas (SC), but it has a limited cannula duration and a high risk of developing complications. The aim of this study was to compare success rates, dwell times and complications of peripheral venous long cannulas (LCs) inserted under ultrasound guidance with those of SCs in children. METHODS We prospectively studied all children older than 10 years of age admitted to our paediatric ED requiring PVA for an expected therapy of more than 5 days. In children with difficult intravenous access (DIVA), after two unsuccessful attempts of 'blind' placement of SCs, LCs (20 G, 8 cm) were inserted in the deep veins of arms using ultrasound guidance and the direct Seldinger technique. RESULTS LC placement (n=20) was successful in 100% of the cases. LC dwell time was 9.2±6.0 days, and most catheters were electively removed because they were no longer indicated. SC (n=20) placement showed a shorter dwell time duration, 3.2±2.1 days (p<0.0001), with complications occurring in 70% of the cases compared with 25% of cases in patients with LC (p=0.002). No local or major infectious complications were reported with LC placement. CONCLUSIONS Ultrasound-guided placement of LC was associated with a low risk of catheter failure and complications compared with the 'blind' placement of SC. LC placement may be considered a valid option in patients with DIVA requiring PVA in paediatric ED or in children who are candidates for infusion therapy expected to last longer than 5 days.
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Affiliation(s)
- Angela Paladini
- Institute of Pediatrics and Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Chiaretti
- Institute of Pediatrics and Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | | | - Mauro Pittiruti
- Department of Emergency Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Institute of Pediatrics and Neonatology, Catholic University of Sacred Heart, Rome, Italy
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26
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Ben Abdelaziz R, Hafsi H, Hajji H, Boudabous H, Ben Chehida A, Mrabet A, Boussetta K, Barsaoui S, Sammoud A, Hamzaoui M, Azzouz H, Tebib N. Peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study. BMC Pediatr 2017; 17:208. [PMID: 29258474 PMCID: PMC5735659 DOI: 10.1186/s12887-017-0965-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
Background Peripheral venous catheterization (PVC) is frequently used in children. This procedure is not free from potential complications. Our purpose was to identify the types and incidences of PVC complications in children and their predisposing factors in a developing country. Methods We conducted a prospective observational multicenter study in five pediatric and pediatric surgery departments over a period of 2 months. Two hundred fifteen PVC procedures were conducted in 98 children. The times of insertion and removal and the reasons for termination were noted, and the lifespan was calculated. Descriptive data were expressed as percentages, means, standard deviations, medians and interquartile ranges. The Chi2 test or the Fisher test, with hazard ratios and 95% confidence intervals (CI95%), as well as Student’s t test or the Mann-Whitney U test were used to compare categorical and quantitative variables, respectively, in groups with and without complications. The Spearman test was used to determine correlations between the lifespan and the quantitative variables. The Kruskal Wallis test was used to test for differences in the median lifespan within 3 or more subgroups of a variable. Linear regression and logistic binary regression were used for multivariate analysis. A p-value <0.05 was considered significant. Results The mean lifespan was 68.82 ± 35.71 h. A local complication occurred in 111 PIVC (51.9%) cases. The risk factors identified were a small catheter gauge (24-gauge) (p = 0.023), the use of a volume-controlled burette (p = 0.036), a longer duration of intravenous therapy (p < 0.001), a medical diagnosis of respiratory or infectious disease (p = 0.047), the use of antibiotics (p = 0.005), including cefotaxime (p = 0.024) and vancomycin (p = 0.031), and the use of proton pump inhibitors (p = 0.004).The lifespan of the catheters was reduced with the occurrence of a complication (p < 0.001), including the use of 24-gauge catheters (p = 0.001), the use of an electronic pump or syringe(p = 0.036) and a higher rank of the intravenous device in each patient (p = 0.010). Conclusions PVC complications were frequent in our pediatric departments and are often associated with misuse of the device. These results could engender awareness among both doctors and nurses regarding the need for rationalization of the use of PVC and better adherence to the recommendations for the use of each drug and each administration method.
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Affiliation(s)
- Rim Ben Abdelaziz
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia. .,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia. .,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia. .,Department of Pediatrics, La Rabta Hospital Jabbari, 1007, Tunis, Tunisia.
| | - Habiba Hafsi
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia
| | - Hela Hajji
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia
| | - Hela Boudabous
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Amel Ben Chehida
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Ali Mrabet
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics B, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Khadija Boussetta
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics A, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Sihem Barsaoui
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics C, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Azza Sammoud
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatric Surgery A, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Mourad Hamzaoui
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Department of Pediatrics, La Rabta Hospital Jabbari, 1007, Tunis, Tunisia
| | - Hatem Azzouz
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Néji Tebib
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
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27
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Rupp ME, Majorant D. Prevention of Vascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am 2017; 30:853-868. [PMID: 27816140 DOI: 10.1016/j.idc.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) are responsible for significant morbidity, mortality, and excess health care costs. It is increasingly evident that many CRBSI can be prevented with current knowledge and techniques. Preventive measures can be broadly grouped into clinical practice-based interventions and technologic innovations. Clinical practice-based interventions require changes in human behavior and can be subdivided into interventions before and at the time of insertion and postinsertion. Despite recent successes with prevention of CRBSI, pertinent questions regarding pathogenesis and prevention remain unanswered and work on improved surveillance, devices less prone to infection, and more effective prevention techniques are needed.
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Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Denisa Majorant
- Division of Infectious Diseases, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198, USA
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28
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Rossini FDP, Andrade DD, Santos LCDS, Ferreira AM, Tieppo C, Watanabe E. Microbiological testing of devices used in maintaining peripheral venous catheters. Rev Lat Am Enfermagem 2017; 25:e2887. [PMID: 28513768 PMCID: PMC5465976 DOI: 10.1590/1518-8345.1528.2887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 02/21/2017] [Indexed: 11/21/2022] Open
Abstract
Objective to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. Methods this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. Results all external surfaces, 40% of lumens, and 86.7% of dressing presented bacterial growth. The main species isolated in the lumen were 50% coagulase-negative Staphylococcus, 14.3% Staphylococcus aureus, and 14.3% Pseudomonas aeruginosa. Fifty nine percent of multidrug-resistant bacteria were isolated of the three-way stopcocks, 42% of the lumens, and 44% of the dressing with a predominance of coagulase-negative Staphylococcus resistant to methicillin. Besides, 18% gram-negative bacteria with resistance to carbapenems were identified from multidrug-resistant bacteria on the external surfaces of the three-way stopcocks. Conclusion it is important to emphasize the isolation of coagulase-negative Staphylococcus and gram-negative bacteria resistant to methicillin and carbapenems in samples of devices, respectively, which reinforces the importance of nursing care in the maintenance of the biologically safe environment as well as prevention and infection control practices.
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Affiliation(s)
- Fernanda de Paula Rossini
- PhD, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Denise de Andrade
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Lissandra Chaves de Sousa Santos
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Adriano Menis Ferreira
- PhD, Associate Professor, Universidade Federal do Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | - Caroline Tieppo
- Pharmacy-Biochemistry, Hospital Regional do Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - Evandro Watanabe
- PhD, Professor, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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Affiliation(s)
- Sanjay A Patel
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Michael M Alebich
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Leonard S Feldman
- Departments of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Meeder AM, van der Steen MS, Rozendaal A, van Zanten ARH. Phlebitis as a consequence of peripheral intravenous administration of cisatracurium besylate in critically ill patients. BMJ Case Rep 2016; 2016:bcr-2016-216448. [PMID: 27698008 DOI: 10.1136/bcr-2016-216448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This case report series describes 3 cases of cisatracurium besylate associated phlebitis after an infusion period of 14-20 hours. No similar cases have been reported in the literature. Association of phlebitis with another neuromuscular blocking agent, atracurium, has been described in the literature. The acidity of atracurium is thought to be the main cause. It is recommended that atracurium is administered only via central venous catheters when indicated to infuse over prolonged periods of time due to the acidity. Cisatracurium is a stereoisomer of atracurium and as such has the same molecular weight. Although cisatracurium also has a similar acidity as atracurium, a recommendation concerning infusion via a central venous catheter is lacking. We suggest prolonged administration of cisatracurium besylate only via centrally placed venous catheters or if not possible to careful monitor relevant peripheral intravenous sites to diminish the risks of phlebitis and associated complications or other cutaneous reactions.
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Affiliation(s)
- Annelijn M Meeder
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | - Annemieke Rozendaal
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands
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31
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Serane T, Kothendaraman B. Incidence and risk factors of infections associated with peripheral intravenous catheters. J Infect Prev 2016; 17:115-120. [PMID: 28989466 DOI: 10.1177/1757177416631415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/10/2016] [Indexed: 11/16/2022] Open
Abstract
AIM To study the incidence and risk factors of bacterial colonisation of peripheral venous catheters during the early neonatal period. DESIGN Prospective observational clinical study. SETTING Level II neonatal intensive care unit. PATIENTS Consecutive neonates in whom peripheral catheter was inserted were recruited. METHODS The insertion site was cleaned with isopropyl alcohol and chlorhexidine for 30 s consecutively. A needleless catheter access device was attached to peripheral catheters. A dedicated observer reviewed the catheter sites regularly for complications. On removal, the tip of the catheter was cut under sterile conditions and sent to the laboratory for culture. Only catheters indwelling for >12 h were sent for culture. FINDINGS Bacteria were isolated from 22 out of 154 catheter tips. Methicillin-sensitive Staphylococcus aureus (n = 13) was the most common organism constituting more than 50% of isolates. In five out of 22 isolates, the organism from the catheter tip was identical to the one from the skin. Systemic sepsis at enrolment was positively associated with colonisation of peripheral catheter. None of the neonates developed peripheral catheter-related bloodstream infection. CONCLUSION When proper infection control measures are in place, risk of peripheral venous catheter-related infection appears extremely low in spite of frequent colonisation of the catheter.
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Affiliation(s)
- Tiroumourougane Serane
- Canvij Neonatal Services, A.G. Padmavati's Hospital, Arumparthapuram, Pondicherry, India
| | - Bhuvaneswari Kothendaraman
- Department of Medicine, Indira Gandhi Medical College and Research Institute, Kathirkamam, Pondicherry, India
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32
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Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A. Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.62008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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