1
|
Hurt RT, Mohamed Elfadil O, Edakkanambeth Varayil J, Bonnes SL, Salonen BR, Mundi MS. Optimizing Intravenous Access for Long-Term Parenteral Nutrition. Curr Nutr Rep 2024; 13:323-330. [PMID: 38696073 DOI: 10.1007/s13668-024-00534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Securing safe and effective intravenous (IV) access is of utmost importance for administering parenteral nutrition (PN). Sustaining this access can indeed pose challenges, especially when dealing with the risk of complications associated with long-term PN. This review emphasizes best practices to optimize intravenous access and reviews the current evidence-based recommendations and consensus guidelines. RECENT FINDINGS An individualized approach when selecting central venous catheters (CVC) is recommended, considering the estimated duration of need for IV access and the number of lumens needed. Established and novel approaches to minimize complications, including infection and thrombosis, are recognized. These include placement and positioning of the catheter tip under sonographic guidance and the use of antimicrobial lock therapies. Moreover, when possible, salvaging CVCs can reduce the risk of vascular access loss. CVC selection for patients requiring PN depends on several factors. Carefully reviewing an individual patient's clinical characteristics and discussing options is important. Given the increased infection risk, CVC lumens should be minimized. For long-term PN beyond 6 months, using CVCs with skin barriers and larger diameters should be considered.
Collapse
Affiliation(s)
- Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA.
- Program Director, Home Parenteral Nutrition Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | | | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
2
|
Su E, Bhargava V, Gil DV, Bavare A. The Path to Durable Access in Critically Ill Children; Not a Straight Line. Pediatr Crit Care Med 2023; 24:969-972. [PMID: 37916880 DOI: 10.1097/pcc.0000000000003362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Erik Su
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Vidit Bhargava
- Divison of Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Danny V Gil
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Aarti Bavare
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
3
|
Wan R, Gu L, Yin B, Cai S, Zhou R, Yang W. A six-year study of complications related to peripherally inserted central catheters: A multi-center retrospective cohort study in China. Perfusion 2022; 38:689-697. [PMID: 35236188 DOI: 10.1177/02676591221076287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Peripherally inserted central catheters (PICCs), the most frequent central venous catheter, are used to provide medical treatments, although long-term PICC-related adverse outcomes are unknown in China. This study systematically investigated PICC-related complications in four Chinese hospitals. METHODS Between January 2014 and January 2020, we analyzed the results of 3550 patients with PICC who were referred to four Chinese hospitals. All patients underwent PICC treatment in four Chinese hospitals. Patient-reported signs and symptoms of a putative PICC-related complication or functional were studied. Long-term outcomes and hospitalization costs were also evaluated. RESULTS An aggregate of 3285 patients were enrolled in the analytic cohort. 58.6% were females and 41.4% were males. The most common reasons for PICC placement included oncologic malignancy and critically ill patients. The majority of PICCs had valved systems (90.7%) and were implanted in the right side (85.5%) and into the basilic vein (87.7%). At least one potential PICC-related problem or adverse effects (AEs) was reported by 67.3% of patients. Central line-associated bloodstream infection (28.1%) and symptomatic deep vein thrombosis (20.7%) were the most common complications. The majority of PICCs were removed for causes other than AEs, with just 723 reported AEs accounting for 22.0% of all PICC removals. The most reasons for PICCs removal were occlusion (425, 12.9%) and exit-site infections (189, 5.8%). CONCLUSIONS This study is the first retrospective study in our country to explore PICC-related complications. While living with a PICC, more than 67.3% of patients report signs and symptoms of at least one PICC-related problem or adverse impacts, such as difficulties with PICC use and poor effects on physical and social function. In this group, PICCs are safe and effective, although the danger of PICC-related problems should not be disregarded.
Collapse
Affiliation(s)
- Rong Wan
- Department of Nursing, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Lilei Gu
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Bi Yin
- Department of Physical Examination, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Shengwei Cai
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Rengui Zhou
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Weilin Yang
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| |
Collapse
|
4
|
Simonetti G, Bersani A, Tramacere I, Lusignani M, Gaviani P, Silvani A. The role of body mass index in the development of thromboembolic events among cancer patients with PICCs: a systematic review. JOURNAL OF VASCULAR NURSING 2022; 40:11-16. [DOI: 10.1016/j.jvn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
|
5
|
Laird CT, Cox S, Nakayama DK. Vascular access: Centuries of progress. Semin Pediatr Surg 2021; 30:151118. [PMID: 34930588 DOI: 10.1016/j.sempedsurg.2021.151118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chris T Laird
- Division of Pediatric General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
| | - Sharon Cox
- Division of Paediatric Surgery, University of Cape Town, Cape Town, South Africa
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, United States
| |
Collapse
|
6
|
Krein SL, Harrod M, Weston LE, Garlick BR, Quinn M, Fletcher KE, Chopra V. Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study. BMJ Qual Saf 2021; 30:628-638. [PMID: 33361343 PMCID: PMC8222389 DOI: 10.1136/bmjqs-2020-011987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. METHODS We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to conduct semistructured interviews completed between August 2018 and January 2019. Study sites included five Veterans Affairs Medical Centres, two with vascular access teams (VATs), two with PICC insertion primarily by interventional radiology (IR) and one without on-site PICC insertion capability. Interview participants were healthcare personnel (n=56), including physicians, bedside and vascular access nurses, and IR clinicians. Data collection focused on four PICC domains: use and decision-making process, insertion, in-hospital management and patient discharge education. We used rapid analysis and a summary matrix to compare practices across sites within each domain. RESULTS Our findings highlight the benefits of dedicated VATs across all PICC-related process domains, including implementation of criteria to guide PICC placement decisions, timely PICC insertion, more robust management practices and well-defined patient discharge education. We also found areas with potential for improvement, such as clinician awareness of PICC appropriateness criteria and alternative devices, deployment of VATs and patient discharge education. CONCLUSION Vascular access nurses play critical roles in all aspects of PICC-related care. There is variation in PICC decision-making, care and maintenance, and patient education across hospitals. Quality and safety improvement opportunities to reduce this variation are highlighted.
Collapse
Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly Harrod
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lauren E Weston
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Brittani R Garlick
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Martha Quinn
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathlyn E Fletcher
- Internal Medicine, Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vineet Chopra
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
7
|
Gavin NC, Kleidon TM, Larsen E, O'Brien C, Ullman A, Northfield S, Mihala G, Runnegar N, Marsh N, Rickard CM. A comparison of hydrophobic polyurethane and polyurethane peripherally inserted central catheter: results from a feasibility randomized controlled trial. Trials 2020; 21:787. [PMID: 32928286 PMCID: PMC7489010 DOI: 10.1186/s13063-020-04699-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. Methods This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants (n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external clamp (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. Results All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group (p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group (p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. Conclusions This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12616001578493. Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
Collapse
Affiliation(s)
- Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia. .,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia. .,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia. .,Institute of Health and Biomendical Institute to Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Children's Hospital Queensland, South Brisbane, Queensland, 4101, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Sarah Northfield
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, 4102, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, 4111, Australia
| |
Collapse
|
8
|
Krein SL, Saint S, Trautner BW, Kuhn L, Colozzi J, Ratz D, Lescinskas E, Chopra V. Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study. BMJ Qual Saf 2019; 28:574-581. [PMID: 30683751 PMCID: PMC6593651 DOI: 10.1136/bmjqs-2018-008726] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/06/2018] [Accepted: 11/11/2018] [Indexed: 01/07/2023]
Abstract
Objective Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation. Design Prospective cohort study. Setting Inpatient medical units at four US hospitals in two states. Participants Consecutive sample of patients who had a new PICC placed during a hospital stay between August 2015 and May 2017. Main outcome(s) Patient-reported signs and symptoms of a possible PICC-related complication or functional issues. Results Of the 438 patients in the analytic cohort (91.4% of those consented), two-thirds were male with a mean age of 56 years. The most common reason for PICC placement was long-term antibiotic therapy (43.4%). During the 70-day follow-up period, 61.4% of patients reported signs of at least one complication, including potentially serious complications, such as bloodstream infection (17.6%) and deep vein thrombosis (30.6%). Correspondence of these reported events with medical record documentation of the complication was generally low. More than one-quarter (27.9%) of patients reported minor complications, such as insertion site redness, discomfort or difficult removal. While the PICC was in place, 26.0% reported restrictions in activities of daily living, 14.4% social activity restrictions and 19.2% had difficulty with flushing or operating the PICC. Conclusion Over 60% of patients report signs or symptoms of a possible complication or adverse effect after PICC placement. Bothersome complications from the patient perspective are clearly more common than those that typically rise to the level of healthcare provider attention or concern. Understanding the patient experience is critical for providing safe and effective care.
Collapse
Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Latoya Kuhn
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - John Colozzi
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Erica Lescinskas
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Vineet Chopra
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
9
|
Ullman AJ, Bulmer AC, Dargaville TR, Rickard CM, Chopra V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety. Expert Rev Med Devices 2018; 16:25-33. [PMID: 30513003 DOI: 10.1080/17434440.2019.1555466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Thrombotic complications associated with peripherally inserted central catheters (PICCs) are common, as most synthetic materials when placed in the presence of serum often result in platelet activation, fibrin deposition, thrombotic occlusion, and potentially embolization. A current innovation focus has been the development of antithrombogenic catheter materials, including hydrophilic and hydrophobic surfaces. These are being incorporated into PICCs in an attempt to prevent the normal thrombotic cascade leading to patient harm. AREAS COVERED This review focuses on the laboratory efficacy and clinical effectiveness of antithrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety. This synthesis was informed by a systematic identification of published and unpublished laboratory and clinical studies evaluating these technologies. EXPERT COMMENTARY A range of PICCs have been developed with antithrombogenic claims, using varying technologies. However, to date, there is no peer-reviewed laboratory research describing the individual PICCs' effectiveness. Despite promising early clinical trials, adequately powered trials to establish efficacy, effectiveness, efficiency, and safety of all of the individual products have not yet been undertaken.
Collapse
Affiliation(s)
- Amanda J Ullman
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,b School of Nursing and Midwifery , Griffith University , Nathan , Australia.,c Centre for Clinical Nursing , Royal Brisbane and Women's Hospital , Herston , Australia.,d Paediatric Critical Care Research Group , Queensland Children's Hospital , South Brisbane , Australia
| | - AndreW C Bulmer
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,e School of Medical Science , Griffith University , Gold Coast , Australia
| | - Tim R Dargaville
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,f Institute of Health and Biomedical Innovation, Science and Engineering Faculty , Queensland University of Technology , Brisbane , Australia
| | - Claire M Rickard
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,b School of Nursing and Midwifery , Griffith University , Nathan , Australia.,c Centre for Clinical Nursing , Royal Brisbane and Women's Hospital , Herston , Australia.,d Paediatric Critical Care Research Group , Queensland Children's Hospital , South Brisbane , Australia
| | - Vineet Chopra
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,g Division of Hospital Medicine , University of Michigan Health System , Ann Arbor , MI , USA
| |
Collapse
|
10
|
Hurt RT, Steiger E. Early History of Home Parenteral Nutrition: From Hospital to Home. Nutr Clin Pract 2018; 33:598-613. [DOI: 10.1002/ncp.10180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryan T. Hurt
- Division of General Internal Medicine; Mayo Clinic; Rochester Minnesota
- Division of Gastroenterology, Hepatology, and Nutrition; University of Louisville; Louisville Kentucky
| | - Ezra Steiger
- Digestive Disease & Surgery Institute; Cleveland Clinic; Cleveland Ohio
| |
Collapse
|