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Privitera D, Geraneo A, Li Veli G, Parravicini G, Mazzone A, Rossini M, Sanfilippo M, Gubertini A, Airoldi C, Capsoni N, Busca E, Bassi E, Langer T, Dal Molin A. Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03651-2. [PMID: 38805082 DOI: 10.1007/s11739-024-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata Rome, Rome, Italy.
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Greta Li Veli
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Parravicini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Sanfilippo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Gubertini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Busca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
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Jiménez-Martínez E, Adamuz J, González-Samartino M, Muñoz-Carmona MA, Hornero A, Martos-Martínez MP, Membrive-Martínez R, Juvé-Udina ME. Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study. PLoS One 2024; 19:e0303152. [PMID: 38722995 PMCID: PMC11081384 DOI: 10.1371/journal.pone.0303152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. METHODS A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. RESULTS Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74). CONCLUSION About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.
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Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | - Jordi Adamuz
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maribel González-Samartino
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria Antonia Muñoz-Carmona
- Nursing Knowledge Management and Information Systems Department, Viladecans Hospital, Viladecans (Barcelona), Barcelona, Spain
| | - Ana Hornero
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | | | - Remedios Membrive-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria-Eulàlia Juvé-Udina
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
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Lissy Ben B, Yeshwanth Peela S, Gopi K, Nelson A, Thakkar S, Sri Sai Jeevana M. Assessment of the Peripheral Venous Cannulation in a Teaching Hospital: A Prospective Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S283-S285. [PMID: 38595624 PMCID: PMC11000971 DOI: 10.4103/jpbs.jpbs_493_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction In today's healthcare environment, peripheral venous cannulations are frequently performed procedures. Bloodstream infections could occur as a result of the intrusive operation. Peripheral venous cannulas should be inserted and managed according to specific rules. This study compared these standards to the peripheral venous cannulation procedure and results at a teaching hospital institution. Materials and Methods This study investigated the procedure and results of peripheral venous cannulation in a teaching center using a prospectively completed audit loop study. The "Royal College of Nursing's criteria for infusion therapy" is one such set of recommendations. After the first phase of the observations, the audit was conducted. Later, after 4 months based on the recommendations, the personnel received training on a variety of cannulation-related topics and the second set of observations for the cannulations was performed. Both observations were made and compared for significance that was considered at. 05 using the ANOVA. Results During the first phase of the research, 212 cannulations were made, and 314 were made for the second phase to be audited. In the reaudit compared with the initial audit, there was a statistically substantial surge in documentation, cannula cleansing, glove use, suitable site selection, and hand cleanliness, according to comparative exploration. Moreover, there was a statistically substantial decline in recannulations. Conclusion Even though peripheral intravenous cannulation is a straightforward process, if done incorrectly, it might have serious side effects. Such techniques' auditing reveals performance flaws. Reaudit results reveal a noticeable increase in performance and outcome following proper personnel retraining.
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Affiliation(s)
- Bella Lissy Ben
- Department of General and Laparoscopic Surgery, Sree Ayyappa Medical College and Research Foundation, Vadasserikkara, Pathanamthitta, Kerala, India
| | | | - Kodali Gopi
- Department of General Surgery, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh, India
| | - Anish Nelson
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral and Maxillofacial Surgery, Mangalore, Karnataka, India
| | - Smit Thakkar
- Shri M P Shah Government Medical College, Gujarat, India
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Torné-Ruiz A, Reguant M, Sanromà-Ortiz M, Piriz M, Roca J, García-Expósito J. Assessment, Treatment, and Follow-Up of Phlebitis Related to Peripheral Venous Catheterisation: A Delphi Study in Spain. Healthcare (Basel) 2024; 12:378. [PMID: 38338263 PMCID: PMC10855708 DOI: 10.3390/healthcare12030378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Phlebitis related to peripheral venous catheters (PVCs) is a common complication in patients who require these devices and can have important consequences for the patients and the healthcare system. The management and control of the PVC-associated complications is related to nursing competency. The present study aims to determine, at the national level in Spain, the consensus on the assessment, treatment, and follow-up of PVC-related phlebitis and the importance of the actions taken. METHOD A three-round Delphi technique was used with clinical care nurses who are experts in the field of in-hospital intravenous treatment in Spain. For this, an online questionnaire was developed with three open-ended questions on the dimensions of phlebitis assessment, treatment, and follow-up. For the statistical analysis of the results, frequencies and percentages were used to determine consensus, and the measures of central tendency (mean, standard deviation, and the coefficient of variation) were used to rank importance. The coefficient of variation was set as acceptable at ≤30%. RESULTS The final sample was 27 expert nurses. At the conclusion of round 3, actions were ranked according to their importance, with six items included in the PVC-related phlebitis assessment (symptomatology/observation, redness, the Maddox scale, induration, temperature, and pain), two in treatment (catheter removal, pentosan polysulphate sodium ointment + application of cold), and just one in follow-up (general monitoring + temperature control). CONCLUSIONS There is a major disparity in relation to the PVC-related phlebitis assessment, treatment, and follow-up actions. More clinical studies are therefore needed to minimise the complications associated with the use of PVCs, given their impact on the quality of care and patient safety and their economic cost.
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Affiliation(s)
- Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Hospital Fundació Althaia, Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Mercedes Reguant
- Department of Research Methods and Diagnosis in Education, University of Barcelona, 08035 Barcelona, Spain;
| | - Montserrat Sanromà-Ortiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Blanquerna School of Health Science, Ramon Llull University, 08025 Barcelona, Spain
| | - Marta Piriz
- Infectious Diseases Division, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Judith García-Expósito
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Group Preving, 03003 Alicante, Spain
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Somavarapu H, Kamala Kant Rakesh K, Roy G, Navkar VK, Pinto N, Muchhala S, Daultani PM, Mittal R. A Multicentric, Prospective, Observational, Single-Arm Registry Study to Assess the Clinical Safety and Effectiveness of Thrombophob Ointment (Heparin Sodium + Benzyl Nicotinate) in Indian Patients With Thrombophlebitis. Cureus 2024; 16:e54436. [PMID: 38510884 PMCID: PMC10951742 DOI: 10.7759/cureus.54436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose Thrombophlebitis is a frequent intravenous (IV) therapy consequence. Topical heparin for seven days is used as a treatment for thrombophlebitis. This study was performed to evaluate the clinical safety and effectiveness of the combination of heparin sodium & benzyl nicotinate (Thrombophob Ointment, manufactured by Zydus Healthcare Ltd., Ahmedabad, India) in thrombophlebitis patients in India. Methods A study carried out by 118 Indian doctors examined 2002 thrombophlebitis patients from 2016-2023, prescribing ointment containing heparin sodium and benzyl nicotinate. Patients were followed up on day three and day seven after starting the treatment, and safety and effectiveness were recorded, including adverse events. Result A total of 2002 patients were included in the study and males were predominant (58.15%). IV fluids (60.58%) were the leading cause of thrombophlebitis. The study found notable improvements in key markers of venous health over time. Compared to baseline, patients experienced significantly reduced severity of phlebitis, shorter venous lesion lengths, and lower pain and tenderness scores by both day 3 and day 7 (p<0.001 for all comparisons). Furthermore, these improvements continued between day 3 and day 7, indicating sustained positive effects (p<0.001 for all comparisons). After the application of the ointment, very few patients experienced adverse effects (0.25% on day three and 0.05% on day seven). Treatment effectiveness was excellent in 72% of patients, and treatment safety was excellent in 93% of patients. Conclusion The ointment containing heparin sodium and benzyl nicotinate was well tolerated and efficacious in the treatment of thrombophlebitis in Indian patients.
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Affiliation(s)
- Harsha Somavarapu
- Orthopaedic and Spine Surgery, Tejaswi Ortho & Trauma Hospital, Tenali, IND
| | | | | | | | | | | | | | - Ravindra Mittal
- New Product Development, Zydus Healthcare Ltd., Ahmedabad, IND
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Privitera D, Bassi E, Airoldi C, Capsoni N, Innocenti G, Santomauro I, Molin AD. Effectiveness of short peripheral intravenous catheter educational programmes to improve clinical outcomes protocol for a systematic review. MethodsX 2023; 11:102352. [PMID: 37705570 PMCID: PMC10495618 DOI: 10.1016/j.mex.2023.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
The placement of a short peripheral intravenous catheter (sPIVC) is the most common invasive clinical procedure for patients requiring fluid infusion and multiple blood draws. Phlebitis and infiltration represent the most common catheter-related complications. Occlusions, dislocations, and infections are less frequent. Insufficient knowledge and skills may increase the risk of these complications. This review aims to evaluate the effectiveness of training programmes to reduce sPIVC failure amongst hospitalised patients. We will search PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Vascular Specialized Register through the Cochrane Register of Studies, and Google Scholar. We defined the search query using the PICO framework (Participants: health professionals; Intervention: training programme; Comparison: No training programme; Outcomes: all-cause catheter failure). We will include experimental studies evaluating an educational programme to reduce early sPIVC failure amongst hospitalised patients. Two reviewers will independently screen studies for inclusion, extract data, and perform the risk of bias assessment using the Cochrane Effective Practice and Organisation of Care Risk of Bias tool for randomised controlled trials. This review will highlight important perspectives for future studies on the effectiveness of educational programmes focused on reducing the rate of sPIVC complications.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gloria Innocenti
- Centro Documentazione Biomedica, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Isabella Santomauro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Health Professions’ Direction, Maggiore della Carità Hospital, Novara, Italy
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Nwafor D, Goeckeritz J, Hasanpour Z, Davidson C, Lucke-Wold B. Nutritional Support Following Traumatic Brain Injury: A Comprehensive Review. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2023; 8:236-247. [PMID: 37795213 PMCID: PMC10550050 DOI: 10.14218/erhm.2022.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traumatic brain injury (TBI) can contribute to extensive dysbiosis of the gastrointestinal system, leading to worsened outcomes. The importance of nutrition in recovery is underappreciated but highly important. In this focused review, we discuss the timing of nutritional interventions with supporting data. We highlight routes of administration that are important given the extent of injury often seen in TBI. The increased energy demands can be met through these approaches. Furthermore, patients need increased vitamins, minerals, and supplements. These interventions are constantly being refined. The current standards are reviewed with an emphasis on evidence-based practices.
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Affiliation(s)
- Divine Nwafor
- Department of Neurosurgery, West Virginia University, Morgantown, USA
| | - Joel Goeckeritz
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Zahra Hasanpour
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Faris GO, Abdulkareem AG, Ismael NH, Qader DJ. Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq. BMC Nurs 2023; 22:188. [PMID: 37277836 DOI: 10.1186/s12912-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Obedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure's success. OBJECTIVES To determine the peripheral cannulation technique evaluation among nurses working in the emergency departments. METHODS This descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses' general characteristics and an observational checklist to assess the nurses' pre, during and post practices regarding peripheral cannulation technique. RESULTS According to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique. CONCLUSIONS Nurses were not practised peripheral cannulation technique appropriately; however, half of the nurses' had an average level of practice, although their practices were not followed the standard protocols.
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Affiliation(s)
- Gona Othman Faris
- Department of Maternal Neonate Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
| | - Awayi Ghazy Abdulkareem
- Department of Pediatric Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq.
| | - Niyan Hakim Ismael
- Department of Adult Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
| | - Delan Jamal Qader
- Department of Adult Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
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Stagg PL. The Adult Difficult Intravenous Access (DIVA) Cognitive Aid: An Evidence-Based Cognitive Aid Prototype for Difficult Peripheral Venous Access. Cureus 2023; 15:e37135. [PMID: 37153329 PMCID: PMC10159796 DOI: 10.7759/cureus.37135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Difficult intravenous access (DIVA) is common, with imperfect solutions. Cognitive aids are widespread in anaesthesia; however, a standard DIVA cognitive aid is lacking. This article describes a cognitive aid for DIVA. It has been developed using evidence-based techniques for DIVA. The effects of heuristics, biases, and automatic thinking on procedural decision-making are briefly discussed. While often useful, shortcut decision-making can impair the performance of apparently simple tasks. Cognitive aids may lead to better outcomes by providing choice architecture. This resource is intended as a cognitive aid prototype for difficult peripheral venous access, incorporating both modern behavioural psychology principles and evidence-based medicine. It may be used as both an educational tool, or as a cognitive aid to assist in situations where DIVA is encountered or expected. The adult DIVA cognitive aid is intended for use in both elective and emergency scenarios by practitioners adequately trained in ultrasound-guided or ultrasound-assisted vascular access and Seldinger-based techniques. Clinical implementation and audit of the adult DIVA cognitive aid, or similar locally developed cognitive aids based on this prototype are recommended.
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Miller C, Gibson JME, Jones S, Timoroska AM, Maley A, Romagnoli E, Chesworth BM, Watkins CL. How is hydration assessed and managed in acute stroke? A qualitative study of healthcare staff's knowledge, attitudes and experiences. J Clin Nurs 2023; 32:1089-1102. [PMID: 35437838 DOI: 10.1111/jocn.16332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration. BACKGROUND Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia. DESIGN A descriptive qualitative study reported following the COREQ guidelines. METHODS Semi-structured interviews, utilising patient vignettes, were conducted in 2018 (Apr-Oct) with a purposive sample of 30 multidisciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel. RESULTS The themes were mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external audit, other areas of post-stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out-of-hours working patterns, low priority given to hydration, patients' comorbidities and complex post-stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis. CONCLUSION Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed. RELEVANCE TO CLINICAL PRACTICE Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes 'everybody's and nobody's job'.
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Affiliation(s)
- Colette Miller
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | | | - Stephanie Jones
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | - Anne-Marie Timoroska
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Alex Maley
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, UK
| | - Elisa Romagnoli
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, UK
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Stagg PL. Micro-Stick to Rapid Infusion Catheter (RIC): Ultrasound-Guided Rapid Infusion Catheter Insertion Using a Micropuncture Kit. Cureus 2023; 15:e35813. [PMID: 37033508 PMCID: PMC10074745 DOI: 10.7759/cureus.35813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Ultrasound-guidance improves success for difficult intravenous access (DIVA), particularly when difficulty is anticipated. However, insertion of a wide-bore sheath, such as a rapid infusion catheter, is likely to pose additional problems and unique challenges in this context, despite ultrasound guidance. With the aid of a video clinical simulation, this article describes an ultrasound-guided technique for inserting a proprietary rapid infusion catheter (RIC) or similar wide-bore sheath using the micropuncture kit.
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Walker RM, Pires MPO, Ray-Barruel G, Cooke M, Mihala G, Azevedo SS, Peterlini MAS, Felipe MDAA, Álvarez CP, Quintanilla M, Corzo MC, Villareal GC, Cigarroa EN, Pedreira MLG, Rickard CM. Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study. Front Med (Lausanne) 2023; 9:1039232. [PMID: 36687407 PMCID: PMC9846050 DOI: 10.3389/fmed.2022.1039232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Peripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs. Methods In 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement. Results A total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8-72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant. Conclusion Given the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.
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Affiliation(s)
- Rachel M. Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maria Paula Oliveira Pires
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,*Correspondence: Maria Paula Oliveira Pires,
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Silvia Schoenau Azevedo
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Cirlia Petrona Álvarez
- Infection Control Service, Asociación de Terapia de Infusión y Seguridad del Paciente (ATISPA), Buenos Aires, Argentina
| | | | | | - Gabriela Cortez Villareal
- National Institute of Cardiology Ignacio Chávez, Directorate of Quality and Health Education of the Ministry of Health of Mexico, Ciudad de México, Mexico
| | - Eliazib Nataren Cigarroa
- Dr. Jesús Gilberto Gómez Maza Hospital, Health Services of the State of Chiapas, Tuxtla Gutiérrez, Mexico
| | - Mavilde L. G. Pedreira
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| | - Claire M. Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
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Shivani S, Joseph HB. Effectiveness of reinforcement program on adherence toward short peripheral catheter (SPC) care guidelines among registered nurses working in pediatric wards of a tertiary care hospital. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:359. [PMID: 36618482 PMCID: PMC9818619 DOI: 10.4103/jehp.jehp_511_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Short peripheral catheterization is the common procedure performed in every hospital with patients' admittance. It becomes challenging when it comes to children and requires more knowledge and skills. The aim of the current study was to assess the effectiveness of the reinforcement program on adherence to short peripheral catheter (SPC) care guidelines among registered nurses. MATERIALS AND METHODS A quasi-experimental study was conducted among 44 registered nurses by observing 96 SPC care events before and after the reinforcement program in pediatric wards of a tertiary care hospital in Eastern India. The study was conducted in a tertiary care public hospital in Eastern India in 2019, and the data collection tool included children's and nurses' socio-demographic data and an observation checklist on intravenous catheterization care. Descriptive statistics were used to explain the participant characteristics, and McNemar's test was used to identify the adherence to SPC care guidelines. RESULTS There was a statistically significant improvement in most steps, such as hand washing, gloving, tray preparation, documentation initiation, maintenance, and removal (P = 0.001). A statistically significant reduction in the early stage of phlebitis was found from 66.7% in pre-intervention to 37.5% in post-intervention (P = 0.027). CONCLUSIONS The majority of nurses adhered to SPC care guidelines after the reinforcement program. From the study findings, it is recommended that regular reinforcement related to peripheral catheter care acts as a stimulant to adhere to SPC care guidelines. The nursing administration should take initiative by conducting in-service training for the nurses, which motivates them toward practicing quality nursing care.
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Affiliation(s)
- S Shivani
- Nursing Tutor, Maharaja Agrasen Nursing College, New Delhi, India
| | - Hepsi Bai Joseph
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Chen CY, Chen WC, Chen JY, Lai CC, Wei YF. Comparison of clinically indicated replacement and routine replacement of peripheral intravenous catheters: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2022; 9:964096. [PMID: 36035414 PMCID: PMC9411788 DOI: 10.3389/fmed.2022.964096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background It is unknown whether clinically indicated replacement of peripheral intravenous catheters (PIVCs) increases the risks of PIVC-associated complications and infections compared to routine replacement of PIVCs. Methods We searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) that compare the safety outcomes of routine replacement and clinically indicated replacement of PIVCs were included for meta-analysis. The primary outcome was the incidence of phlebitis, and secondary outcomes included the risks of occlusion, local infection, infiltration, catheter-related bloodstream infection (CRBSI), and accidental removal of the PIVC. Results A total of 9 RCTs involving 10 973 patients were included in this meta-analysis, of whom 5,546 and 5,527 were assigned to the study group (clinically indicated replacement of PIVCs) and control group (routine replacement of PIVCs every 72–96 h), respectively. The incidence of phlebitis in the study group was significantly higher than that in the control group [risk ratio (RR), 1.20; 95% confidence interval (CI), 1.01–1.44, P = 0.04, I2 = 49%]. In addition, the study group was associated with a higher risk of occlusion (RR, 1.45; 95% CI, 1.08–1.95, P = 0.01, I2 = 82%) and infiltration (fluid leaks) (RR, 1.27; 95% CI, 1.06–1.53, P = 0.01, I2 = 72%) than the control group. However, no significant differences were observed in the risks of local infection (RR, 1.75; 95% CI, 0.38–8.16, P = 0.48, I2 = 0%) and CRBSI (RR, 0.61; 95% CI, 0.08–4.68, P = 0.64, I2 = 0%) between the study and control groups. Conclusion The clinically indicated replacement of PIVCs may increase the risks of PIVC-associated phlebitis, infiltration, and occlusion compared to the routine replacement of PIVCs, but did not increase the risk of PIVC-associated infections. Based on these findings, routine replacement of PIVCs every 72–96 h maybe a preferred option than clinically indicated replacement of PIVCs. Systematic review registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022302021].
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Affiliation(s)
- Ching-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Wang-Chun Chen
- Department of Pharmacy, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jung-Yueh Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- *Correspondence: Chih-Cheng Lai,
| | - Yu-Feng Wei
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
- Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Yu-Feng Wei,
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15
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Buetti N, Abbas M, Pittet D, Chraiti MN, Sauvan V, De Kraker MEA, Boisson M, Teixeira D, Zingg W, Harbarth S. Lower risk of peripheral venous catheter-related bloodstream infection by hand insertion. Antimicrob Resist Infect Control 2022; 11:80. [PMID: 35659775 PMCID: PMC9164319 DOI: 10.1186/s13756-022-01117-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Little is known about the bloodstream infection (BSI) risk associated with short-term peripheral venous catheters (PVCs) and no large study investigated the insertion site-related risk for PVC-BSI. METHODS We performed a cohort study at the University of Geneva Hospitals using the prospective hospital-wide BSI surveillance database. We analyzed the association between insertion site and risk of PVC-BSI on the upper extremity using univariable and multivariable marginal Cox models. RESULTS Between 2016 and 2020, utilization of 403'206 peripheral venous catheters were prospectively recorded in a 2000-bed hospital consortium with ten sites. Twenty-seven percent of PVC (n = 109'686) were inserted in the hand. After adjustment for confounding factors, hand insertion was associated with a decreased PVC-BSI risk (adjusted hazard ratio [HR] 0.42, 95% CI 0.18-0.98, p = 0.046) compared to more proximal insertion sites. In a sensitivity analysis for PVCs with ≥ 3 days of dwell time, we confirmed a decreased PVC-BSI risk after hand insertion (HR 0.37, 95% CI 0.15-0.93, p = 0.035). CONCLUSION Hand insertion should be considered for reducing PVC infections, especially for catheters with an expected dwell time of more than 2 days.
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Affiliation(s)
- Niccolò Buetti
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.508487.60000 0004 7885 7602UMR 1137, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Mohamed Abbas
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Didier Pittet
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Marie-Noëlle Chraiti
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Valérie Sauvan
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Marlieke E. A. De Kraker
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Matthieu Boisson
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Daniel Teixeira
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Walter Zingg
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.412004.30000 0004 0478 9977Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Harbarth
- grid.150338.c0000 0001 0721 9812Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Service PCI, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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16
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Larsen EN, Ray-Barruel G, Takashima M, Marsh N, Friese CR, Chopra V, Alexandrou E, Rickard CM. Peripheral intravenous catheters in the care of oncology and haematology patients. THE AUSTRALIAN JOURNAL OF CANCER NURSING 2022; 23:16-22. [PMID: 35854857 PMCID: PMC9288653 DOI: 10.33235/ajcn.23.1.16-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Aim To determine peripheral intravenous catheter (PIVC) characteristics, complications and risk factors among patients in cancer units. Methods A secondary analysis of a global, cross-sectional study (127 hospitals in 24 countries). Participants (≥18 years) admitted to cancer units were assessed once for PIVC characteristics and the presence of complications. Variables included patient demographics, device characteristics, treatment details, and device and/or site complications. PIVC characteristics were presented using qualitative descriptors; mixed-effects logistic regression models determined risk factors for PIVC complications. Results In total, 1,807 participants (1,812 PIVCs) were included; 12% (n=215) of PIVCs presented with complications. Risk factors included: insertion by doctors; insertion in ED and ambulance/other locations; poor PIVC dressing integrity; dwell time ≥49 hours; and administration of colloids/blood products and antiemetics. Conclusions At least one in ten PIVCs in cancer units present with complications; regular PIVC assessment and improved dressing integrity is likely to reduce risk and improve outcomes.
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Affiliation(s)
- Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- Corresponding author:
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, QLD, Australia
| | - Mari Takashima
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Christopher R Friese
- School of Nursing and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Vineet Chopra
- Department of Medicine, University of Colorado, Denver, Colorado 80204, USA
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
- Liverpool Hospital, Sydney, NSW, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, QLD, Australia
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Inflammatory, Mechanical and Infectious Complications Associated with Peripheral Intravenous Catheters in Dogs and Cats: A Risk Factor Analysis. Vet Sci 2022; 9:vetsci9030118. [PMID: 35324846 PMCID: PMC8954030 DOI: 10.3390/vetsci9030118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
The placement of peripheral intravenous catheters (PIVC) is potentially associated with complications that negatively impact healthcare. Our study investigated factors associated with the occurrence of PIVC-related complications in dogs and cats at a Veterinary Teaching Hospital. The second aim was to determine the prevalence of PIVC bacterial colonization. A total of 76 dogs and 40 cats with PIVCs were evaluated for the occurrence of phlebitis and mechanical complications. The devices were removed when they ceased to be functional or when complications occurred, and the content was submitted for bacterial cultures and antimicrobial susceptibility tests. Both multivariable linear regression models and ROC analysis were employed. Complications were recorded in 46.6% of cases, and 20.7% of catheters yielded a positive culture. Among the isolates, 45% were classified as multi-resistant. In dogs, a ≥36-h indwelling time was associated with an increased risk of complications. Male cats seem more prone to developing complications, while the insertion of PIVCs under sedation may represent a protective factor in this species. In conclusion, PIVC-associated complications were frequently observed, and the high rate of positive culture for PIVCs, together with the presence of multi-resistant isolates, is a cause of concern in a hospital setting.
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Najari F, Khoshnevis J, Javaheri Z, Najari D, Mirzaei S. Maim, death cases following the installation of vascular access devices filed with specialized forensic medicine commissions of Tehran, Iran, 2013-2018, (A descriptive study). CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:689-692. [PMID: 36420346 PMCID: PMC9659835 DOI: 10.22088/cjim.13.4.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implantation of vascular access devices is of great importance in critically ill patients or those vulnerable to clinical worsening. The aim of this study was to identify the complications of implantation of vascular access leading to complaints from patients, in the forensic medicine commissions of Tehran. METHODS The present descriptive-cross sectional study was performed on all cases that died from implantation of vascular access devices and complaints about permanent local complications caused by this procedure, filed with the forensic medicine commissions of Tehran in period of 2013-2018, based on selected variables, and the results were statistically analyzed using the chi-square and Fisher exact tests in SPSS Version 18. A p-value of <0.01 was considered statistically significant. RESULTS All alleged deaths were due to implantation of central venous port placed in a large vein in the neck, and most organ failure cases were attributed to anterior forearm deformity. The most common cause of death was acute cardiac death; internal bleeding was observed in 14% of them. Most complaints of death were filed against general surgery and anesthesia assistants, and most complaints about peripheral venipuncture were against trainee nurses. The present study findings were significantly different in terms of cannulation site, age, cause of death, type of local complication (p<0.01). CONCLUSION This study shows, as patients become more aware, complaints from physicians about implantation of vascular access, in the judicial authority are also on the rise. Therefore, in choosing these patients, Venice should be treated more carefully.
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Affiliation(s)
- Fares Najari
- Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence: Fares Najari, Tajrish Square, Shahrdari St., Shohada-ye-Tajrish Teaching Hospital, Department of Forensic Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: , Tel: 0098 2122713333, Fax: 0098 2122719014
| | - Jalaluddin Khoshnevis
- Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Javaheri
- Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Najari
- Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Mirzaei
- Clinical Research Development Center of Shohada-ye-Tajrish Hospital, Vice- Chancellor in Research Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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20
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Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z, Zhang F, Lyu Y, Lin F. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. J Clin Nurs 2021; 31:2959-2970. [PMID: 34779070 DOI: 10.1111/jocn.16129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. BACKGROUND Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. DESIGN A multisite randomised controlled trial. METHODS The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. RESULTS The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients' first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. CONCLUSIONS In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. RELEVANCE TO CLINICAL PRACTICE In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.
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Affiliation(s)
- Jing Li
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Peking University School of Nursing, Beijing, China
| | - Peiying Zhang
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, China.,Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | | | - Yang Lyu
- Beijing Chao-Yang Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia.,School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
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21
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Pires-Júnior JF, Chianca TCM, Borges EL, Azevedo C, Simino GPR. Medical adhesive-related skin injury in cancer patients: A prospective cohort study. Rev Lat Am Enfermagem 2021; 29:e3500. [PMID: 34755780 PMCID: PMC8584878 DOI: 10.1590/1518-8345.5227.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: to estimate the incidence of medical adhesive-related skin injury in the
peripheral venous catheter fixation region in critical cancer patients, to
identify risk factors, and to establish a risk prediction model for its
development. Method: a prospective cohort study with a sample of 100 adult and aged patients
hospitalized in an intensive care unit. The data were analyzed using
descriptive, bivariate and multivariate statistics with Cox regression. Results: the incidence of medical adhesive-related skin injury was 31.0% and the
incidence density was 3.4 cases per 100 people-days. The
risk factors were as follows: alcoholism, smoking habit, hospitalization due
to deep vein thrombosis, acute respiratory failure, immediate postoperative
period, heart disease, dyslipidemia, use of antiarrhythmics, blood
transfusion, friction injury, pressure injury, turgor, edema, hematoma,
petechiae, low values in the Braden scale, clinical severity of the patient,
elasticity, moisture, texture and color. The predictive model consisted in
the following: decreased skin turgor, presence of hematoma and edema. Conclusion: medical adhesive-related skin injury at the peripheral venous catheter
insertion site has a high incidence in critical cancer patients and is
associated with decreased turgor, presence of hematoma and edema, evidence
that can support the clinical practice.
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Affiliation(s)
| | | | - Eline Lima Borges
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
| | - Cissa Azevedo
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
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22
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Buetti N, Abbas M, Pittet D, de Kraker MEA, Teixeira D, Chraiti MN, Sauvan V, Sauser J, Harbarth S, Zingg W. Comparison of Routine Replacement With Clinically Indicated Replacement of Peripheral Intravenous Catheters. JAMA Intern Med 2021; 181:1471-1478. [PMID: 34533191 PMCID: PMC8561330 DOI: 10.1001/jamainternmed.2021.5345] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events. OBJECTIVE To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement. DESIGN, SETTING, AND PARTICIPANTS This institution-wide, observational cohort study evaluated all patients hospitalized at a large university-affiliated hospital with 10 sites in Western Switzerland with a PVC insertion between January 1, 2016, and February 29, 2020. EXPOSURES Peripheral intravenous catheters were routinely replaced every 96 hours until March 31, 2018 (baseline period). Between April 1, 2018, and October 15, 2019, PVCs were replaced if clinically indicated (intervention period). From October 16, 2019, PVCs were again routinely replaced every 96 hours (reversion period). MAIN OUTCOMES AND MEASURES The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period. RESULTS A total of 412 631 PVCs with documented catheter duration were included (164 331 patients; median [interquartile range] patient age, 51 [33-72] years; 88 928 [54.1%] female): 241 432 PVCs at baseline, 130 779 at intervention, and 40 420 at reversion. Eleven PVC-BSIs were observed during the baseline period, 46 during the intervention, and 4 during the reversion period. Although the monthly number of PVC-days remained stable during all study periods, the number of monthly inserted PVCs decreased during the intervention period. The number of PVCs still in place more than 4 or more than 7 days was higher during the intervention period compared with the baseline and reversion periods. A significantly increased IRR of PVC-BSIs was observed for the intervention period (IRR, 7.20; 95% CI, 3.65-14.22; P < .001) compared with baseline, whereas during the reversion period there was no significant increase (IRR, 1.35; 95% CI, 0.30 6.17; P = .69). CONCLUSIONS AND RELEVANCE The results of this cohort study using a large, prospective surveillance database suggest that replacement of PVCs only when clinically indicated may be associated with an increased risk of PVC-BSI compared with routine replacement. Even if PVC-associated BSI is a rare event, the use of PVCs in most patients makes this outcome relevant.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Unité Mixte de Recherche ( UMR ) 1137 , Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM, Université de Paris, Paris, France
| | - Mohamed Abbas
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlieke E A de Kraker
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Teixeira
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Noëlle Chraiti
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Valérie Sauvan
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Julien Sauser
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Walter Zingg
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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23
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Bonsignore M, Tafelski S, Schwegmann K, Meier-Hellmann A, Witzke O, Nachtigall I. Risk Factors for Vascular Catheter Infections-Findings of a Point-Prevalence Study in 78 Hospitals. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:503-504. [PMID: 34526213 PMCID: PMC8476827 DOI: 10.3238/arztebl.m2021.0204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/21/2020] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sascha Tafelski
- Charité—Universitätsmedizin Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Germany; statistician accredited by the doctoral committee
| | | | | | - Oliver Witzke
- West German Department of Infectious Diseases, Duisburg-Essen, Essen, Germany
| | - Irit Nachtigall
- Charité—Universitätsmedizin Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Germany; statistician accredited by the doctoral committee
- HELIOS Hospital Ost and Bad Saarow, Germany
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24
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Guanche-Sicilia A, Sánchez-Gómez MB, Castro-Peraza ME, Rodríguez-Gómez JÁ, Gómez-Salgado J, Duarte-Clíments G. Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective. Healthcare (Basel) 2021; 9:healthcare9050611. [PMID: 34069674 PMCID: PMC8160666 DOI: 10.3390/healthcare9050611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 12/03/2022] Open
Abstract
The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.
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Affiliation(s)
- Aitana Guanche-Sicilia
- University Hospital Nuestra Señora de Candelaria, Canary Islands Health Service, 38010 Tenerife, Spain;
| | - María Begoña Sánchez-Gómez
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
| | - María Elisa Castro-Peraza
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 092301 Guayaquil, Ecuador
- Correspondence: ; Tel.: +34-959219700
| | - Gonzalo Duarte-Clíments
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
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25
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Lin SW, Chen SC, Huang FY, Lee MY, Chang CC. Effects of a Clinically Indicated Peripheral Intravenous Replacement on Indwelling Time and Complications of Peripheral Intravenous Catheters in Pediatric Patients: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3795. [PMID: 33916497 PMCID: PMC8038579 DOI: 10.3390/ijerph18073795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
Peripheral intravenous catheters (PVCs) are common treatment modalities for pediatric patients, and may cause infection, infiltration, occlusion, and phlebitis. The purpose of this study was to evaluate the effect of a clinically indicated peripheral intravenous replacement (CIPIR) on PVC indwelling time and complication rates in pediatric patients. This study used a randomized, pre- and post-repeated measures design. A total of 283 participants were randomly assigned to an experimental group (n = 140) and a control group (n = 143). The experimental group received CIPIR and the control group received usual care with routine PVC replacement every three days. The insert sites of PVC were assessed every day until the signs of infiltration, occlusion, or phlebitis were presented. Patients in the experimental group had significantly longer PVC indwelling times compared to those in the control group (t = -18.447, p < 0.001). No significant differences were noted between groups in infiltration (χ2 = 2.193, p = 0.139), occlusion (χ2 = 0.498, p = 0.481), or phlebitis (χ2 = 3.865, p = 0.050). CIPIR can prolong the PVC indwelling time in pediatric patients with no increase in the rate of adverse events.
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Affiliation(s)
- Su-Wen Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-W.L.); (M.-Y.L.)
| | - Shu-Ching Chen
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
- Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Fang-Yi Huang
- Department of Nursing, New Taipei Municipal Tucheng Hospital Chang Gung Memorial Hospital, New Taipei 236, Taiwan;
| | - Ming-Ying Lee
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-W.L.); (M.-Y.L.)
| | - Chun-Chu Chang
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-W.L.); (M.-Y.L.)
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
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26
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Laney JA, Friedman J, Fisher AD. Sternal Intraosseous Devices: Review of the Literature. West J Emerg Med 2021; 22:690-695. [PMID: 34125048 PMCID: PMC8202990 DOI: 10.5811/westjem.2020.12.48939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased. Methods The authors conducted a limited review, searching PubMed and Google Scholar databases for “sternal IO,” “sternal intraosseous,” and “intraosseous” without specific date limitations. A total of 47 articles were included in this review. Results Sternal IOs are currently FDA approved for ages 12 and older. Sternal IO access offers several anatomical, pharmacokinetic, hemodynamic, and logistical advantages over peripheral intravenous and other IO points of access. Sternal IO use carries many of the same risks and limitations as the humeral and tibial sites. Sternal IO gravity flow rates are sufficient for transfusing blood and resuscitation. In addition, studies demonstrated they are safe during active CPR. Conclusion The sternal IO route remains underutilized in civilian settings. When considering IO vascular access in adults or older children, medical providers should consider the sternum as the recommended IO access, particularly if the user is a novice with IO devices, increased flow rates are required, the patient has extremity trauma, or administration of a lipid soluble drug is anticipated.
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Affiliation(s)
- Jared A Laney
- Texas A&M University College of Medicine, Bryan, Texas
| | | | - Andrew D Fisher
- Medical Command, Texas Army National Guard, Austin, Texas.,University of New Mexico School of Medicine, Department of Surgery, Albuquerque, New Mexico
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27
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Chaudhary MK, Dhakaita SK, Ray R, Baruah TD. Local complications of intravenous access - an often underestimated entity. J Family Med Prim Care 2020; 9:6073-6077. [PMID: 33681043 PMCID: PMC7928085 DOI: 10.4103/jfmpc.jfmpc_1649_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 12/01/2022] Open
Abstract
Context: Obtaining intravenous (IV) access is one of the very frequent invasive procedures performed in hospital care settings. This has several complications some of which are serious in nature. However, the incidence and seriousness of these complications as well as the burden of this complication on patient management are often underestimated. Identification of susceptible patients and the risk factors are important to ensure better outcomes. Aims: The aim of this study was to document the various local complications of intravenous access and to identify the risk factors associated with it. Settings and Design: Prospective observational study with three hundred and one surgical patients. Study duration of 1 year. Methods and Material: Indication of IV access, site, size of IV cannula used, category of personnel involved as well as local complications at access site were documented. Dressing at cannula site were changed every 72 h or earlier. Cannula and site of access were changed in case of any complication. Statistical Analysis Used: Results analysed using SPSS software (IBM Inc). Frequency calculated as average and percentage. Chi-square test used for statistical significance. Relative risk calculated. Results: Females, overweight, diabetics and smokers were found at more risk. Requirement of major surgery, IV access by paramedical personnel, IV access over joints and when kept beyond 3 days were found to have more complications. 5.7% of patients had serious complications requiring surgical intervention. Conclusions: Our study shows that local complications at IV access site are very common with occurrence in more than fifty percent patients. Several risk factors are identified. Not all demographic and clinical risk factors are readily modifiable. However many of the complications can easily be minimized by following basic precautions.
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Affiliation(s)
- Manoj Kr Chaudhary
- Department of General Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - S K Dhakaita
- R D Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Rubik Ray
- Department of General Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Tridip Dutta Baruah
- Department of General Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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28
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Stanley AK, Barnett-Vanes A, Reed MJ. Peripheral Intravenous Cannula Usage in the Emergency Department. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.9205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.
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29
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Blanco-Mavillard I, Parra-García G, Fernández-Fernández I, Rodríguez-Calero MÁ, Personat-Labrador C, Castro-Sánchez E. Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines. PLoS One 2020; 15:e0240086. [PMID: 33007001 PMCID: PMC7531784 DOI: 10.1371/journal.pone.0240086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. Aim To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. Methods We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. Conclusions Our findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital Manacor, Manacor, Spain
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- * E-mail:
| | | | | | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Servei de Salut de les Illes Balears, Palma, Spain
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30
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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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31
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Blanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control 2019; 8:124. [PMID: 31367345 PMCID: PMC6647274 DOI: 10.1186/s13756-019-0581-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices among inpatients. Catheter-related bloodstream infections (CRBSI) are serious yet preventable events for patients. Although the contribution of PIVCs towards these infections is gradually being recognised, its role in the Spanish setting is yet to be determined. We aimed to estimate the rate and incidence of PIVC failure at Manacor hospital (Spain) as baseline within a wider quality improvement initiative. Methods Tips from all PIVC removed during December 2017 and January 2018 in hospital wards were cultured semiquantitatively. The study population included all PIVCs inserted in adult patients admitted to any of three medical and one surgical wards, emergency department, critical care unit and operating rooms. Clinical, microbiological and ward information was collected by clinical researchers for each PIVC from insertion to removal on the study sites. CRBSI was defined per international guidelines (i.e., Centers for Disease Control and Prevention, USA). Data was analysed descriptively. Results Seven hundred and eleven tips were cultured, with 41.8% (297/711) reported as PIVC failure. The PIVC failure rate density-adjusted incidence for hospital length of stay (HLOS) was 226.2 PIVC failure/1000 HLOS. 5.8% (41/711) tips yielded positive isolates, with most frequent microorganisms Staphylococcus spp (S. epidermidis 29/41, 70.7%, S. aureus 2/41, 4.9%, S. hominis 2/41, 4.9%), and Acinetobacter baumannii (1/41, 2.4%). One S. aureus isolate was methicillin-resistant. 53.6% (22/41) positive cultures were obtained from patients with local signs and symptoms compatible with catheter-related infection (CRI), 2.4% (1/41) were compatible with CRBSI type 2 and that clinical signs improve within 48 h of catheter removal (density-adjusted incidence for hospital stays of 16.7 PIVC-CRI/1000 hospital-stays and 0.76 PVC-BSI/1000 hospital-stays respectively) and no patients were diagnosed CRBSI type 3 with a bacterial growth concordant in tip and blood cultures. Most cases responded favourably to catheter removal and management. Conclusions Our findings show that almost 42% PIVCs resulted in unplanned removal, amplifying the importance in terms of morbidity, mortality and patient safety. A high number of positive tip cultures without clinical signs and symptoms was observed. We underpin the importance to remove unnecessary PIVCs for the prevention of CRBSI.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- 2Servei de Salut de les Illes Balears, Palma, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Joan de Pedro-Gómez
- 3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | | | - Ismael Fernández-Fernández
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain
| | - Enrique Castro-Sánchez
- 6NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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Aldakauskienė I, Tamelienė R, Marmienė V, Rimdeikienė I, Šmigelskas K, Kėvalas R. Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial. ACTA ACUST UNITED AC 2019; 55:medicina55040082. [PMID: 30925739 PMCID: PMC6524051 DOI: 10.3390/medicina55040082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.
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Affiliation(s)
- Ilona Aldakauskienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Rasa Tamelienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Vitalija Marmienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Inesa Rimdeikienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Kastytis Šmigelskas
- Department of Health Psychology, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
- Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
| | - Rimantas Kėvalas
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
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