1
|
Bahl A, Gibson SM, Walton A. Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening. Ther Clin Risk Manag 2024; 20:559-566. [PMID: 39247171 PMCID: PMC11380876 DOI: 10.2147/tcrm.s479846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/26/2024] [Indexed: 09/10/2024] Open
Abstract
Objective Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture. Methods This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow. Results Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P<0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P<0.001). Conclusion In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Alexis Walton
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| |
Collapse
|
2
|
Spencer TR, Imbriaco G, Bardin-Spencer A, Mahoney KJ, Brescia F, Lamperti M, Pittiruti M. Safe Insertion of Arterial Catheters (SIA): An ultrasound-guided protocol to minimize complications for arterial cannulation. J Vasc Access 2024; 25:1403-1408. [PMID: 37265235 DOI: 10.1177/11297298231178064] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Direct puncture and cannulation of peripheral arteries is frequently performed in critical care and in emergency settings, mainly for hemodynamic monitoring and blood sampling. While there is abundant literature on peripheral arterial cannulation in children and adults, there is still scope for clinical improvements which may impact on patient safety. Although the radial artery is the most frequently utilized access site today, due to its superficial proximity, ease of access, and low risk of adverse events, other sites are sometimes chosen. The authors propose the Safe Insertion of Arterial Catheters (SIA) protocol, an ultrasound-guided insertion bundle applying a systematic approach to arterial cannulation, with a focus on improving insertion practices, reducing procedural complications, increasing the patient safety profile, and improving device performance.
Collapse
|
3
|
Hadaway L, Gorski LA. Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review. JOURNAL OF INFUSION NURSING 2024; 47:324-346. [PMID: 39250768 DOI: 10.1097/nan.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.
Collapse
Affiliation(s)
- Lynn Hadaway
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| | - Lisa A Gorski
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| |
Collapse
|
4
|
Gibson SM, Sarlabous J, Adair L, Bahl A. Operation STICK Improves Vascular Access Outcomes in a Specialty Team: A Quasi-Experimental Study. J Nurs Care Qual 2024:00001786-990000000-00157. [PMID: 39151043 DOI: 10.1097/ncq.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Education and training may improve outcomes within an experienced vascular access team. PURPOSE The purpose of this study was to measure the impact of a standardized peripheral intravenous catheter insertion educational program (Operation STICK) on vascular access outcomes. METHODS A quasi-experimental study design was used. Adult inpatients with difficult intravenous access (DIVA) requiring ultrasound-guided insertion by a vascular access specialty team were eligible. Data were collected before and 7 months after the educational training program. RESULTS A total of 54 subjects were included (24 pre- and 30 post-implementation). Significant improvements were found for mean peripheral intravenous catheter dwell time (3.62 to 14.97 days, P < .001), completion of therapy (58.3% to 96.7%, P = .001), and first-stick success rate (79.2% to 100%, P = .013). Catheter-to-vein ratio significantly decreased (P = .007). CONCLUSIONS Standardized education/training in vascular access focusing on best practices yields favorable outcomes for DIVA patients within an established specialty team.
Collapse
Affiliation(s)
- Steven Matthew Gibson
- Author Affiliations: Vascular Access Specialty Nurse, Vascular Access Consulting, Henderson, Kentucky (Mr Gibson); Vascular Access Specialty Nurse, Baptist Hospital, Miami, Florida (Ms Sarlabous and Ms Adair); and Professor of Emergency Medicine, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan (Dr Bahl)
| | | | | | | |
Collapse
|
5
|
Bahl A, Johnson S, Hijazi M, Mielke N, Chen NW. Cost effectiveness of ultrasound-guided long peripheral catheters in difficult vascular access patients. J Vasc Access 2024; 25:1204-1211. [PMID: 36789955 DOI: 10.1177/11297298231154297] [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] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Peripheral intravenous catheter (PIVC) placement is a routinely performed invasive procedure in hospital settings with an unacceptably high failure rate that can result in significant costs. This investigation aimed to determine the cost-effectiveness of using long peripheral catheters (LPC) versus standard short peripheral catheters (SPC) in the difficult vascular access (DVA) population. METHODS A secondary analysis was performed of a randomized control trial that compared a 20-gauge 4.78 cm SPC to a 20-gauge 6.35 cm SPC for the endpoint of survival. This study assessed cost-effectiveness of the comparative interventions. Costs associated with increased hospitalization length of stay due to PIVC failure, including labor, materials, equipment, and treatment delays were estimated by utilizing healthcare resource utilization data. Cost-effectiveness of the LPC was analyzed through the incremental cost-effectiveness ratio, the cost-effectiveness acceptability curve, and the incremental net benefit. A sensitivity analysis was conducted to evaluate the robustness of the results during the time interval of PIVC insertion. RESULTS Among the 257 patients, the average total cost for therapy was lower in the LPC group compared to the SPC group ($400 vs $521; mean difference -$121, 95% bootstrapped CI -$461 to $225). A marginally significant absolute difference of complication averted was found for LPC versus SPC (10.8%, p = 0.07). The estimated incremental cost-effectiveness ratio (ICER) for LPC as compared with SPC was -$1123 (95% bootstrapped CI -$8652 to $5964) per complication averted. In a willingness to pay (WTP) analysis, as WTP = $0, the incremental net benefit (INB) $121 was positive, indicating LPC was less costly. Analysis of PIVCs that survived ⩽48 h (n = 134) demonstrated a lower average total cost for therapy among the LPC group ($418 vs $531; mean difference -$113, 95% bootstrapped CI -$507 to $282). Forty-seven of 66 (71.2%) LPCs did not experience a complication, compared with 37 of 68 (54.4%) SPCs, resulting in a significant absolute difference of complication adverted of 16.8% (p = 0.04). In addition, with a positive slope, the INB $113 was positive as WTP = $0, indicating LPC was estimated to be cost-effective. CONCLUSIONS When using ultrasound guidance for vascular access, LPCs are potentially a cost-effective strategy for reducing PIVC complications in DVA patients compared to SPCs. Given this finding, ultrasound-guided LPCs should be routinely considered as first-line among the DVA population in order to improve their overall care and wellbeing.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Steven Johnson
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Mahmoud Hijazi
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nai-Wei Chen
- Research Institute, Beaumont Hospital, Royal Oak, MI, USA
| |
Collapse
|
6
|
Cao Q, Wang Y. Effectiveness of nanoparticle-based antimicrobial agents in the prevention and treatment of Central Venous Catheter-Associated Bloodstream Infections. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38945158 DOI: 10.1080/10255842.2024.2310076] [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: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND In healthcare settings, Central Venous Catheter-Associated Bloodstream Infections (CVC-BSIs) present a serious problem since they raise morbidity, mortality, and medical expense rates. The management of these illnesses is made more challenging by the development of antimicrobiotic resistance. Nanotechnology has attracted interest recently as a viable method for creating new antimicrobial agents. By putting antibacterial nanomaterials onto the catheter's appear, that may reduce the likelihood of getting sick by stopping germs from adhering and growing. Antimicrobial additives can be released gradually finishes, protecting over time through bioengineering sectors. To prevent and treat CVC-BSIs, this study will assess the efficacy of antimicrobial medicines based on nanoparticles. METHODS In the network Meta-Analyses (MA) and Systematic Review (SR), we looked for studies published from January 2010 to September 2021 using the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAHL, and Web of Science databases. Ten papers in all were included in the review following the screening of the publications using inclusion and exclusion criteria. RESULTS In contrast to conventional catheters, the implementation of Antimicrobial Catheters (AC) and the use of chlorhexidine (CHG) or Silver Sulfadiazine (SS) demonstrated notably reduced occurrences of Central Venous Catheter-Associated Bloodstream Infections (CVC-BSIs) per 1000 Catheter Days (CD) (with Odds Ratios (ORs) and 95% Credibility Intervals (CrIs) of 0.66 and 0.54, respectively) by bioengineering sectors. Moreover, these interventions were linked to the lowest rate of Catheter Colonization (CC), with ORs as well as 95% CrIs of 0.45 and 0.31, respectively, underscoring their potential as effective strategies for minimizing the risk of infections associated with catheter use as well as bioengineering sectors innovations. CONCLUSIONS As a result, CVC-BSI has shown significant promise for prevention and treatment with nanoparticle-based antimicrobial medicines. Due to their special characteristics and modes of action, they are strong candidates for improving the security and effectiveness of central venous catheter use in clinical settings. Due to ongoing research and development in this area, nanoparticle-based coatings and therapies may be used to lessen the impact of CVC-BSIs and enhance patient outcomes.
Collapse
Affiliation(s)
- Qianqian Cao
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yun Wang
- Northern Jiangsu People's Hospital, Yangzhou, China
| |
Collapse
|
7
|
Kamata M. Required volume for color flow injection test to confirm the intravascular placement of a peripheral venous catheter. J Vasc Access 2024:11297298241258625. [PMID: 38855976 DOI: 10.1177/11297298241258625] [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: 06/11/2024] Open
Abstract
BACKGROUND Confirmation of adequate peripheral intravenous catheter placement is essential before using venous catheters. The color flow injection test has been reported as a method with high sensitivity and specificity for this purpose. The technique involves administrating saline through the peripheral venous route to observe changes in the color flow pattern around the same vein at a more central location. However, the required volume of saline remains uncertain. This study aims to determine the appropriate dosage for conducting the test in pediatric patients and explore any potential correlations between dosage and patient characteristics. METHODS A prospective study was conducted in children under 6 years of age with American Society of Anesthesiologists Physical Status 1-2 presenting for general anesthesia. After an intravenous cannula was placed in the forearm under general anesthesia, normal saline was injected at a speed of approximately 1 mL/s while the axillary artery and vein were observed with color flow Doppler imaging. The volume of normal saline required to induce a change in the color flow pattern around the vessels was measured. Measurements were performed twice and averaged for comparison with patient characteristics and other factors. RESULTS The study cohort included 30 patients aged from 0.3 to 5.5 (2.6 ± 1.6) years. The change in color flow Doppler imaging was noted in all the patients, and the average volume was 1.40 ± 0.36 mL (95% confidence interval (CI), 1.27-1.54; p < 0.001), which was significantly correlated with age, with a correlation coefficient of 0.435 (95% CI, 0.09-0.69; p = 0.02). CONCLUSIONS The required volume for the color flow injection test is small; therefore, the test is easy to perform and minimally invasive in pediatric patients.
Collapse
Affiliation(s)
- Mineto Kamata
- Department of Anesthesiology, Saitama International Medical Center, Saitama, Japan
| |
Collapse
|
8
|
Hansen ØM, Solbakken R. Experiences and perceptions of critical care nurses on the use of point-of-care ultrasound (POCUS) to establish peripheral venous access in patients with difficult intravenous access: a qualitative study. BMJ Open 2024; 14:e078106. [PMID: 38834329 PMCID: PMC11163595 DOI: 10.1136/bmjopen-2023-078106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES This study aims to explore and describe critical care nurses' (CCNs') experiences and perceptions of using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with difficult intravenous access (DIVA). DESIGN A qualitative design with a hermeneutic approach was chosen for this study. From May to August 2022, data were collected using individual, face-to-face, and digital semistructured interviews and analysed using Braun and Clarke's reflexive thematic analysis. SETTING The study were conducted in six intensive care units in both Norway and Sweden. PARTICIPANTS Nine CCNs experienced in using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with DIVA were recruited. RESULTS Data analysis led to the construction of the overarching theme: 'POCUS simplifies a complicated procedure' based on the following five subthemes: 'Sharing the experience', 'Seeing inside the body', 'Independent in establishing difficult intravenous access', 'Using POCUS to increase action readiness', and 'Appreciating an expanded role as critical care nurses'. CONCLUSION Ultrasound-guided peripheral intravenous access can become a valuable skill for CCN's caring for patients with DIVA in the intensive care unit. This practice can potentially reduce patient suffering, improve patient outcomes, enable the CCN to provide high-quality care, improve action readiness, time management and job satisfaction for the nurses.
Collapse
Affiliation(s)
- Øystein Myrlund Hansen
- Faculty of Nursing and Health Sciences, Nord University, Bodo, Norway
- Medical Department, Nordland Hospital, Bodo, Norway
| | - Rita Solbakken
- Faculty of Nursing and Health Sciences, Nord University, Bodo, Norway
| |
Collapse
|
9
|
Slosse C, Hossu G, Micard E, Hani H, Ambroise-Grandjean G, Bouaziz H. Influential factors on the echogenicity of peripheral venous catheters: Insights from an experimental phantom study. J Vasc Access 2024:11297298241254675. [PMID: 38801000 DOI: 10.1177/11297298241254675] [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: 05/29/2024] Open
Abstract
INTRODUCTION Ultrasound-guided placement of peripheral venous catheters requires appropriate equipment. Among the devices used, peripheral venous catheters have different structure and properties. This study aimed to define the impact of these different factors on the echogenicity of peripheral venous catheters. METHOD An open comparative study was conducted from September 2022 to May 2023. Thirteen devices were introduced in a standardized manner along the longitudinal and transverse axes with the help of guides into a phantom at different angles. Two criteria defined the echogenicity of these devices: the surface occupied by the device in the image (composite criterion: length and diameter of the device and angle of insertion) and its brightness (average of the pixel intensity of gray). Sixty-five ultrasound images were recorded and postprocessed twice (blinded to the previous measurement) by an expert operator, for reproducibility purposes. RESULTS The intra-observer reproducibility of all measurements was excellent, with an intra-class coefficient of >0.90 over the entire dataset. On the longitudinal axis, echogenicity was significantly influenced by insertion angle (p = 0.009), device length (p = 0.006), and the interaction of cannula component and insertion angle (p = 0.007). On the transverse axis, no factors significantly influenced the device's echogenicity. DISCUSSION The echogenicity of a device is an essential component of successful ultrasound-guided peripheral venous catheter placement. Optimizing catheter intrinsic factors such as components of the cannula and length, and extrinsic factor like the insertion angle should be considered in their design and use to reduce puncture failure rates.
Collapse
Affiliation(s)
- Côme Slosse
- CHRU-Nancy, Département d'anesthésie et réanimation, Nancy, France
- Université de Lorraine, Inserm, IADI, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, IADI, Nancy, France
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, Nancy, France
| | - Emilien Micard
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, Nancy, France
| | - Hind Hani
- Université de Lorraine, Centre Universitaire d'Enseignement par Simulation (CUESIM), Nancy, France
| | - Gaëlle Ambroise-Grandjean
- Université de Lorraine, Inserm, IADI, Nancy, France
- CHRU-Nancy, Département d'obstétrique, Nancy, France
- Université de Lorraine, Département de maïeutique, Nancy, France
| | - Hervé Bouaziz
- CHRU-Nancy, Département d'anesthésie et réanimation, Nancy, France
| |
Collapse
|
10
|
Godfrey J, Gallipoli L. Introducing an ultrasound-guided longer length peripheral IV catheter for patients with difficult venous access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S4-S8. [PMID: 38700139 DOI: 10.12968/bjon.2024.33.7.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
AIM Insertion of a peripheral intravenous catheter (PIVC) is one of the most common procedures carried out in hospitals worldwide, but failure rates are unacceptably high. This local quality improvement project aimed to assess improvements in first-stick success rate, dwell time and overall catheter success rate when implementing a longer-length peripheral intravenous catheter (LPIVC) under ultrasound guidance for patients with difficult venous access (DVA). METHODS Data were collected from 386 DVA patients requiring a PIVC at one hospital. Number of catheter insertion attempts, catheter dwell time and reason for catheter removal were recorded for each patient. To implement the new DVA catheterisation pathway, registered nurses undertook a training programme comprising workshops and ultrasound-guided cannulation technique practice on phantoms. Costs and waste weights associated with LPIVC insertion, compared with midline insertion, were calculated. RESULTS First-stick success rate was 95.0% using the LPIVC under ultrasound guidance. Dwell time ranged from 1 to 80 days, with a large proportion of those dwelling <1 day being placed in day-case patients. Treatment success rate with the LPIVCs was 83.6%. Equipment costs for an LPIVC insertion were £89.22 lower than for a midline insertion, and the weight of waste generated per procedure was 1 kg lower for LPIVCs. CONCLUSIONS First-stick success rate of LPIVCs, aided by improved purchase in the vein and visualisation with ultrasound guidance, was very high, superior to rates reported in other studies. The procedure provides a better patient experience as successful first attempts avoid unnecessary further insertion attempts. Other benefits are increased nursing time efficiency, a reduction in clinical waste and the lower cost of the equipment required.
Collapse
Affiliation(s)
- Julie Godfrey
- Lead Vascular Access Consultant Nurse, Mid and South Essex NHS Foundation Trust
| | - Luigi Gallipoli
- PICC and Vascular Access Clinical Nurse Specialist, Mid and South Essex NHS Foundation Trust
| |
Collapse
|
11
|
Ray-Barruel G, Pather P, Schults JA, Rickard CM. Handheld Ultrasound Devices for Peripheral Intravenous Cannulation: A Scoping Review. JOURNAL OF INFUSION NURSING 2024; 47:75-95. [PMID: 38422403 DOI: 10.1097/nan.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is recommended for patients with difficult intravenous access, but access to ultrasound equipment is often limited to specialty departments. Compact, affordable handheld ultrasound devices are available, but the extent of their clinical adoption and impact on patient outcomes is unknown. This scoping review aimed to explore evidence regarding handheld and pocket ultrasound devices for PIVC insertion. Databases were searched for studies published in English between January 2000 and January 2023 evaluating handheld or pocket ultrasound devices weighing ≤3 kg for PIVC insertion. Data were extracted using standardized forms and summarized using descriptive statistics. Seventeen studies reporting the use of handheld or pocket ultrasound devices were identified. Most studies were conducted in adult inpatient facilities; 3 included pediatrics, and 2 reported out-of-hospital use. Participants with difficult intravenous access featured in 9 studies. Ultrasound training programs were described in 12 studies, with competency defined by number of successful PIVC insertions. Five studies reported clinician and/or patient perspectives. Ultrasound for PIVC insertion is not widely accessible in nonspecialist areas, but more compact and affordable handheld models could provide a solution, especially for patients with difficult access. More research evidence using handheld ultrasound is needed.
Collapse
Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Priscilla Pather
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Jessica A Schults
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| |
Collapse
|
12
|
Bahl A, Millard M, Hijazi M, Chen NW. Predictors of ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing trial data. J Vasc Access 2024; 25:519-525. [PMID: 36113061 DOI: 10.1177/11297298221122118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Ultrasound-guided (US) peripheral intravenous catheters (PIVC) have a high failure rate with many failing prior to completion of therapy. Risk factors associated with catheter failure are poorly delineated. This study aimed to assess risk factors related to catheter failure including patient, procedure, catheter, and vein characteristics to further elucidate which variables may impact catheter longevity. METHODS This was a secondary analysis using an existing trial dataset that primarily compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. Adult emergency room patients with difficult intravenous access at a tertiary care suburban academic center were study participants. Kaplan-Meier was employed to estimate the median catheter survival time. Cox regression univariable and multivariable analyses were used to evaluate the primary outcome of catheter survival. RESULTS Among 257 subjects, 63% of PIVCs survived until completion of therapy. In a multivariable Cox regression model, length of catheter in vein >2.75 cm (adjusted hazard ratio [aHR] 0.58, 95% confidence interval [CI] 0.37-0.90, p = 0.01) was associated with improved survival. First stick success decreased the risk of catheter failure (aHR 0.68, 95% CI 0.44-1.06, p = 0.09) but was not statistically significant. Factors associated with the increased risk of catheter failure included: depth of vein >1.2 cm (aHR 1.68, 95% CI 1.06-2.66, p = 0.03) and PIVC placement in right extremity (aHR 1.64, 95% CI 1.07-2.51, p = 0.02). CONCLUSIONS This study demonstrated that catheter length in vein (>2.75 cm) was associated with improved US PIVC survival highlighting the value of longer catheters in US PIVC survival. Choosing targets in the non-dominant extremity with shallower depths (⩽1.2 cm) may also increase catheter survival.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Mahmoud Hijazi
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nai-Wei Chen
- Beaumont Health Research Institute, Royal Oak, MI, USA
| |
Collapse
|
13
|
Bahl A, Mielke N, Xing Y, DiLoreto E, Zimmerman T, Gibson SM. A standardized educational program to improve peripheral vascular access outcomes in the emergency department: A quasi-experimental pre-post trial. J Vasc Access 2024:11297298231219776. [PMID: 38183178 DOI: 10.1177/11297298231219776] [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: 01/07/2024] Open
Abstract
OBJECTIVE Difficult intravenous access (DIVA) patients are known to have disproportionately poorer vascular access outcomes. The impact of education and training on vascular access outcomes in this vulnerable population is unclear. We aim to demonstrate the success of a program (Operation (O) STICK) on improving vascular access outcomes in DIVA patients. METHODS This was a quasi-experimental pre-post interventional study conducted at a tertiary care emergency department (ED) with 120,000 annual visits and 1100 hospital beds. Adult patients requiring an ultrasound-guided (US) peripheral intravenous catheter (PIVC) in the ED were eligible participants. Traditional (palpation method) insertions were excluded. Using multivariable linear regression and inverse probability weighted (IPW) linear regression, the standard group inclusive of PIVCs inserted by staff without formalized OSTICK training were compared to the interventional group inclusive of PIVCs inserted by staff with training and competency in the OSTICK training model. RESULTS Data were collected over two time intervals: 4/1/21-9/30/21 (pre; non-OSTICK) and 10/1/22-3/31/23 (post; OSTICK). 2375 DIVA patients included 1035 (43.6%) non-OSTICK and 1340 (56.4%) OSTICK PIVCs. Overall, OSTICK PIVCs had a higher proportion of upper arm or forearm placements (94.6% vs 57.4%; p < 0.001), 20 gauge catheters (97.1% vs 92.3%; p < 0.001), and left-sided placements (54.4% vs 43.5%; p < 0.001). 62.7% of OSTICK PIVCs were placed by ED technicians, compared to 25.5% in the non-OSTICK group (p < 0.001). OSTICK PIVCs were placed on the first attempt 86.2% of the time and by the second attempt 95.4% of the time. In a subanalysis of 1343 hospitalized patients (689 (51.3%) OSTICK vs 654 (48.7%) non-OSTICK), OSTICK PIVCs survived for a median of 92% of the patient's hospital length of stay, compared to non-OSTICK PIVCs at 74% (p < 0.001). CONCLUSIONS Formalized vascular access training in the ED leads to improved adherence to best practices for PIVC insertion, high success of cannulation with minimal attempts, and improved PIVC functionality during hospitalization for DIVA patients. Importantly, these outcomes are sustainable as they were captured 12 months after implementation of the program.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Todd Zimmerman
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | | |
Collapse
|
14
|
Blanco P, Abdo-Cuza A, Palomares EA, Díaz CM, Gutiérrez VF. Ultrasonography and procedures in intensive care medicine. Med Intensiva 2023; 47:717-732. [PMID: 38035918 DOI: 10.1016/j.medine.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/20/2023] [Indexed: 12/02/2023]
Abstract
The use of point-of-care ultrasonography (POCUS) is not limited to the diagnosis and/or monitoring of critically ill patients. Further, ultrasound guidance is of paramount relevance to aid in successfully and safely performing several procedures in the intensive care unit (ICU). In this article, we review the role of POCUS as a procedural guidance in the ICU. Core procedures include, but are not limited to, vascular cannulation, pericardiocentesis, thoracentesis, paracentesis, aspiration of soft-tissue collections/arthrocentesis and lumbar puncture. With time, the procedures performed by intensivists may extend beyond the core competencies depicted in this review. Ultrasound guidance should be part of the intensivist's competencies, for which appropriate training should be achieved.
Collapse
Affiliation(s)
- Pablo Blanco
- High Dependency Unit, Hospital "Dr. Emilio Ferreyra", Necochea, Argentina.
| | | | | | - Cristina Martínez Díaz
- Intensive Care Unit, Hospital Universitario "Príncipe de Asturias Alcalá de Henares", Madrid, Spain
| | | |
Collapse
|
15
|
Moreta JA. Longer length peripheral catheters in sickle cell treatment: a more efficient and cost-effective care pathway. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S14-S19. [PMID: 37883315 DOI: 10.12968/bjon.2023.32.19.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Patients with sickle cell disease require frequent venous access for red blood cell exchange transfusions to manage their condition. Such frequent access can lead to scar tissue formation, increased pain on insertion, and difficult vascular access for the patients. Previous attempts at achieving successful venous access for patients with difficult venous access has been made with central venous lines, usually femoral lines, which required a large amount of nursing input and resulted in anxiety and pain on insertion for patients. In this article, the author reports on a new pathway with a longer-length peripheral intravenous catheter that reduces the nursing time burden during line insertion, requires less equipment and, crucially, results in a less painful procedure for patients. The increased efficiency of the pathway resulted in a cost saving of £149 per insertion, and patient feedback revealed that the longer-length catheter was preferred over femoral lines.
Collapse
Affiliation(s)
- Jenniferth Aviles Moreta
- Clinical Nurse Specialist, OPAT and Vascular Access Service, Homerton Healthcare NHS Foundation Trust, London
| |
Collapse
|
16
|
Huang D, Winter L, Macauley E, Alterman T, Renouard B, Wilson JL, Leon LN. Difficult Intravenous Access Requiring Ultrasound in the Emergency Department: Associations With Delays in Care and Areas for Quality Improvement. Cureus 2023; 15:e44960. [PMID: 37822433 PMCID: PMC10564258 DOI: 10.7759/cureus.44960] [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: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
Background Patients with difficult intravenous access (DIVA) requiring ultrasound-guided intravenous (USGIV) access have been associated with delays in treatment, imaging, and disposition in academic emergency department (ED) patient populations. Our objective in this study was to characterize differences in time to intravenous access, imaging, and disposition between patients with DIVA versus those without DIVA requiring USGIV access in a community ED while also assessing for DIVA-associated comorbidities. Methods A cross-sectional, observational analysis was performed on admitted ED patients evaluated from September 2 to September 31, 2022, at a community ED. Patients with DIVA were defined as patients with two failed attempts at traditional intravenous placement. These patients require USGIV placement per institutional protocol. Patients younger than 18 years of age, trauma admissions, repeated visits from the same patient, patients with missing data, and direct hospital admissions were excluded. Continuous variables were recorded with medians and included ED throughput measures of time to vascular access, contrast CT imaging, and disposition. Differences in median times between DIVA patients versus non-DIVA patients were assessed with the Mann-Whitney U-test. Categorical data involving comorbidities were reported as percentages, and differences in proportions between DIVA versus non-DIVA patients were assessed via chi-square tests. Multivariate logistic regression analysis evaluated for correlations between DIVA and times to access, contrast CT imaging, disposition, and significant covariates while adjusting for demographic information. Results A total of 1250 patients were included in this investigation (5.8% associated with DIVA requiring USGIV access). The median age of all subjects was 69 (interquartile range = 58, 79) with no significant difference between the DIVA and non-DIVA groups. Patients with DIVA were more likely to be female in comparison to patients without DIVA (65.3% and 51.2%, respectively, p < 0.05). Patients with a history of end-stage renal disease (ESRD) (p < 0.001), intravenous drug use (IVDU) (p < 0.001), and venous thromboembolism (p < 0.05) had statistically significant associations with DIVA. On regression analysis, patients with DIVA were more likely to have a history of ESRD with an odds ratio (OR) of 3.56 (95% confidence interval (CI): 1.62-7.81) and a history of IVDU with an OR of 14.29 (95% CI: 5.17-39.54). Patients with DIVA were associated with statistically significant greater median times to vascular access, contrast CT imaging, and disposition (p < 0.001 for time to access and disposition and p < 0.01 for time to contrast CT imaging). Conclusion In this study, DIVA cases requiring USGIV access were positively associated with significantly longer times to access, contrast CT imaging, and disposition compared to patients without DIVA at our community ED. Comorbidities such as IVDU and ESRD had statistically significant associations with DIVA requiring USGIV access.
Collapse
Affiliation(s)
- Derrick Huang
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Lucas Winter
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Emily Macauley
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Thomas Alterman
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Bryson Renouard
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - James L Wilson
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Leoh N Leon
- Emergency Medicine, University of Central Florida, Ocala, USA
| |
Collapse
|
17
|
Smith E, Irimia V. Evaluation of extended-length cannula inserted using ultrasound guidance in patients with difficult IV access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S14-S20. [PMID: 37495414 DOI: 10.12968/bjon.2023.32.14.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways.
Collapse
Affiliation(s)
- Emily Smith
- Vascular Access Lead Nurse, Aintree Hospital, Liverpool Hospitals NHS Foundation Trust
| | - Valentin Irimia
- Clinical Interventions Nurse Specialist, Clatterbridge Cancer Centre Liverpool, was an IV Access Clinical Nurse Specialist at Aintree Hospital at the time of the evaluation
| |
Collapse
|
18
|
Feinsmith SE, Amick AE, Feinglass JM, Sell J, Davis EM, Spencer TR, Koepke L, Pastoral J, Wayne DB, Barsuk JH. Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention. J Vasc Access 2023; 24:630-638. [PMID: 34524038 DOI: 10.1177/11297298211044363] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PROBLEM Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures. AIMS The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses. METHODS The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure. RESULTS A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan-Meier survival probabilities than PIVs (p < 0.001). CONCLUSIONS The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.
Collapse
Affiliation(s)
| | - Ashley E Amick
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jordan Sell
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Evan M Davis
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy R Spencer
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lydia Koepke
- Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Diane B Wayne
- Dr. John Sherman Appleman Professor of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Feinberg School of Medicine, Departments of Medicine and Medical Education, Northwestern University, Chicago, IL, USA
| |
Collapse
|
19
|
Malik A, Dewald O, Gallien J, Favot M, Kasten A, Reed B, Wells R, Ehrman RR. Outcomes of Ultrasound Guided Peripheral Intravenous Catheters Placed in the Emergency Department and Factors Associated with Survival. Open Access Emerg Med 2023; 15:177-187. [PMID: 37228359 PMCID: PMC10204754 DOI: 10.2147/oaem.s405692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
Background Patients with difficult peripheral intravenous (IV) access are common in emergency departments (EDs). Ultrasound-guided peripheral intravenous catheters (USIVs) are frequently used in this population; however, information regarding the effect of patient and IV characteristics on the dwell time (DT) and survival probability (SP) of USIVs is limited. Objective Our study aimed to evaluate for associations between patient or IV characteristics and the DT and SP of USIVs. Methods Retrospective analysis was performed on a database from an ED nurse (RN) USIV training program at an urban, academic hospital. Patients over 18 years with an USIV placed during the study period were included. Subject demographics, history, IV characteristics, insertion, and removal times were collected. Data were analyzed using descriptive statistics and univariable and multivariable Cox regression. USIV survival times for variates of interest were estimated using Kaplan-Meier curves for three censoring points. Results The final analysis cohort was 388 patients. Mean age was 56.6 years, 66.5% were female, mean BMI was 29.9 kg/m2, and 42.5% were obese (BMI ≥30). Median DT was 40.3 hours in admitted patients (N=340). SP for USIVs at 96 hours was 87.8%. A total of 21 of 340 (6.2%) USIVs failed. USIV location conferred a difference on DT in obese patients when dichotomized into upper arm versus antecubital fossa and forearm together (38.6 hours vs 44.6 hours, p=0.03). No factors were associated with a difference in USIV SP. Conclusion Median USIV DT of 40.3 hours for admitted patients was higher than in previous studies. Only 7% of USIVs in our study failed. Overall, catheters survived longer than expected.
Collapse
Affiliation(s)
- Adrienne Malik
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, MO, 66160, USA
| | - Olga Dewald
- Department of Emergency Medicine, Sparrow Hospital, Lansing, MI, 48912, USA
| | - John Gallien
- Department of Emergency Medicine, DMC Detroit Receiving Hospital, Detroit, MI, 48201, USA
| | - Mark Favot
- Department of Emergency Medicine, DMC Detroit Receiving Hospital, Detroit, MI, 48201, USA
| | - Adam Kasten
- Department of Emergency Medicine, DMC Harper Hospital, Detroit, MI, 48201, USA
| | - Brian Reed
- Department of Emergency Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Robert Wells
- Department of Emergency Medicine, DMC Harper Hospital, Detroit, MI, 48201, USA
| | - Robert R Ehrman
- Department of Emergency Medicine, DMC Sinai Grace Hospital, Detroit, MI, 48235, USA
| |
Collapse
|
20
|
Corley A, O'Brien C, Larsen E, Peach H, Rickard C, Hewer B, Pearse I, Fenn M, Cocksedge R, Marsh N. Does longer peripheral intravenous catheter length optimise antimicrobial delivery? Protocol for the LEADER study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S24-S30. [PMID: 37027419 DOI: 10.12968/bjon.2023.32.7.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Hospitalised patients receiving intravenous antimicrobial therapy require a reliable device through which this is delivered. Short peripheral intravenous catheters (PIVCs) are the default device for antimicrobial therapy but up to half fail before therapy completion, leading to suboptimal drug dosing, patient distress from repeated insertions, and increased healthcare costs. This study will investigate the use of long PIVCs to determine if they are more reliable at delivering antimicrobial therapy. METHODS A two-arm, parallel randomised controlled trial of hospitalised adults requiring at least 3 days of peripherally compatible intravenous antimicrobials. Participants will be randomised to a short (<4 cm) or long (4.5-6.4 cm) PIVC. After interim analysis ( n=70) for feasibility and safety, 192 participants will be recruited. Primary outcome is disruption to antimicrobial administration from all-cause PIVC failure. Secondary outcomes include: number of devices to complete therapy, patient-reported pain and satisfaction, and a cost analysis. Ethical and regulatory approvals have been received.
Collapse
Affiliation(s)
- Amanda Corley
- Research Fellow (Clinician Researcher), School of Nursing and Midwifery, Griffith University, Nathan, Australia/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Catherine O'Brien
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Emily Larsen
- Research Fellow (Vascular Access), School of Nursing and Midwifery, Griffith University/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Hannah Peach
- Clinical Research Nurse, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia/Herston Infectious Diseases Institute, Metro North Health, Herston, Australia
| | - Barbara Hewer
- Clinical Nurse Consultant, Vascular Access and Surveillance and Education, Royal Brisbane and Women's Hospital
| | - India Pearse
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Mary Fenn
- Senior Research Assistant, School of Nursing and Midwifery, Griffith University
| | - Ruth Cocksedge
- Senior Research Assistant, School of Medicine and Dentistry, Griffith University
| | - Nicole Marsh
- Nursing and Midwifery Director, Research, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital/Professor, School of Nursing and Midwifery, Griffith University
| |
Collapse
|
21
|
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.
Collapse
|
22
|
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.
Collapse
|
23
|
Tada M, Yamada N, Matsumoto T, Takeda C, Furukawa TA, Watanabe N. Ultrasound guidance versus landmark method for peripheral venous cannulation in adults. Cochrane Database Syst Rev 2022; 12:CD013434. [PMID: 36507736 PMCID: PMC9744071 DOI: 10.1002/14651858.cd013434.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peripheral intravenous cannulation is one of the most fundamental and common procedures in medicine. Securing a peripheral line is occasionally difficult with the landmark method. Ultrasound guidance has become a standard procedure for central venous cannulation, but its efficacy in achieving peripheral venous cannulation is unclear. OBJECTIVES To evaluate the effectiveness and safety of ultrasound guidance compared to the landmark method for peripheral intravenous cannulation in adults. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 29 November 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which participants are systematically allocated based on data such as date of birth or recruitment) comparing the effects of ultrasound guidance to the landmark method for peripheral intravenous cannulation in adults. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were first-pass success of cannulation, overall success of cannulation, and pain. Our secondary outcomes were procedure time for first-pass cannulation, procedure time for overall cannulation, number of attempts, patient satisfaction, and overall complications. We used GRADE to assess the certainty of the evidence. Placing a peripheral intravenous line in individuals can be classed as 'difficult', 'moderate', or 'easy'. We use the terms 'difficult participants', 'moderate/moderately difficult participants' and 'easy participants' as shorthand to characterise the difficulty level in placing a peripheral line using the landmark method. We used the original studies' definitions of difficulty levels of peripheral intravenous cannulation with the landmark method. We analysed the results in these subgroups: 'difficult participants', 'moderate participants', and 'easy participants'. We did this because we expected the effect of ultrasound-guided peripheral venous cannulation to be largest in participants classed as 'difficult' and smaller in participants classed as 'moderate' and 'easy'. MAIN RESULTS: We included 14 RCTs and two quasi-RCTs involving 2267 participants undergoing peripheral intravenous cannulation. Participants were classed as 'difficult' in 12 studies (880 participants), 'moderate' in one study (401 participants), and 'easy' in one study (596 participants). Two studies (390 participants) did not restrict by landmark method difficulty level. The overall risk of bias assessments ranged from low to high. We judged studies to be at high risk of bias mainly because of concerns about blinding for subjective outcomes. In difficult participants, ultrasound guidance increased the first-pass success of cannulation (risk ratio (RR) 1.50, 95% confidence interval (95% CI) 1.15 to 1.95; 10 studies, 815 participants; low-certainty evidence), and the overall success of cannulation (RR 1.40, 95% CI 1.10 to 1.77; 10 studies, 670 participants; very low-certainty evidence). There was no clear difference in pain (mean difference (MD) -0.20, 95% CI -1.13 to 0.72; 4 studies, 323 participants; very low-certainty evidence; numerical rating scale (NRS) 0 to 10 where 10 is maximum pain). Ultrasound guidance increased the procedure time for first-pass cannulation (MD 119.9 seconds, 95% CI 88.6 to 151.1; 2 studies, 219 participants; low-certainty evidence), and patient satisfaction (standardised mean difference (SMD) 0.49, 95% CI 0.07 to 0.92; 5 studies, 333 participants; very low-certainty evidence; NRS 0 to 10 where 10 is maximum satisfaction). Ultrasound guidance decreased the number of cannulation attempts (MD -0.33, 95% CI -0.64 to -0.02; 9 studies, 568 participants; very low-certainty evidence). Ultrasound guidance showed no clear difference in the procedure time for overall cannulation (MD -24.9 seconds, 95% CI -323.1 to 273.3; 8 studies, 413 participants; very low-certainty evidence) and overall complications (RR 0.64, 95% CI 0.37 to 1.10; 5 studies, 431 participants; low-certainty evidence). In moderate participants, ultrasound guidance increased the first-pass success of cannulation (RR 1.14, 95% CI 1.02 to 1.27; 1 study, 401 participants; moderate-certainty evidence). No studies assessed the overall success of cannulation. There was no clear difference in pain (MD 0.10, 95% CI -0.47 to 0.67; 1 study, 401 participants; low-certainty evidence; NRS 0 to 10 where 10 is maximum pain). Ultrasound guidance increased the procedure time for first-pass cannulation (MD 95.2 seconds, 95% CI 72.8 to 117.6; 1 study, 401 participants; high-certainty evidence). Ultrasound guidance showed no clear difference in overall complications (RR 0.83, 95% CI 0.38 to 1.82; 1 study, 401 participants; moderate-certainty evidence). No studies assessed the procedure time for overall cannulation, number of cannulation attempts, or patient satisfaction. In easy participants, ultrasound guidance decreased the first-pass success of cannulation (RR 0.89, 95% CI 0.85 to 0.94; 1 study, 596 participants; high-certainty evidence). No studies assessed the overall success of cannulation. Ultrasound guidance increased pain (MD 0.60, 95% CI 0.17 to 1.03; 1 study, 596 participants; moderate-certainty evidence; NRS 0 to 10 where 10 is maximum pain). Ultrasound guidance increased the procedure time for first-pass cannulation (MD 94.8 seconds, 95% CI 81.2 to 108.5; 1 study, 596 participants; high-certainty evidence). Ultrasound guidance showed no clear difference in overall complications (RR 2.48, 95% CI 0.90 to 6.87; 1 study, 596 participants; moderate-certainty evidence). No studies assessed the procedure time for overall cannulation, number of cannulation attempts, or patient satisfaction. AUTHORS' CONCLUSIONS: There is very low- and low-certainty evidence that, compared to the landmark method, ultrasound guidance may benefit difficult participants for increased first-pass and overall success of cannulation, with no difference detected in pain. There is moderate- and low-certainty evidence that, compared to the landmark method, ultrasound guidance may benefit moderately difficult participants due to a small increased first-pass success of cannulation with no difference detected in pain. There is moderate- and high-certainty evidence that, compared to the landmark method, ultrasound guidance does not benefit easy participants: ultrasound guidance decreased the first-pass success of cannulation with no difference detected in overall success of cannulation and increased pain.
Collapse
Affiliation(s)
- Masafumi Tada
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Department of Neurology, Emergency Medicine, Nagoya City University East Medical Center, Nagoya, Japan
| | - Naoki Yamada
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan
| | | | - Chikashi Takeda
- Department of Anesthesia, Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| |
Collapse
|
24
|
Midline Catheters: Could They Replace a Central Vascular Access Device? JOURNAL OF INFUSION NURSING 2022; 45:220-224. [PMID: 35820127 DOI: 10.1097/nan.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past 30 years, midline catheter use has grown rapidly. For several reasons, many providers and facilities are attempting to reduce the number of central venous catheters and subsequent central line-associated bloodstream infections (CLABSIs) by using midline catheters. Vessel preservation requires attention to all vascular access device (VAD)-associated complications and not only central line bloodstream infection. There is still much confusion about the appropriate tip location and the characteristics of fluids and medications that can safely be infused through a midline catheter residing in a peripheral vein. The Infusion Therapy Standards of Practice (the Standards) focuses on assessment of characteristics of infusion therapies that must be considered for VAD selection as an evidence-based list of fluids and medications for infusion through peripheral veins has yet to be established. This review of midline catheter studies evaluates the evidence regarding the substitution of a midline catheter for a central venous catheter. Many issues need to be addressed, such as studies that include an outcome list that mixes defined clinical complications (eg, thrombosis) with signs and symptoms of complications (eg, leaking). Another issue is basing a major change of clinical practice on retrospective chart reviews. Although a midline catheter may be appropriate for some patients, additional studies of a higher level of evidence are needed before this major practice change should occur.
Collapse
|
25
|
Imbrìaco G, Monesi A, Spencer TR. Preventing radial arterial catheter failure in critical care - Factoring updated clinical strategies and techniques. Anaesth Crit Care Pain Med 2022; 41:101096. [PMID: 35490863 DOI: 10.1016/j.accpm.2022.101096] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Radial artery catheterization is a frequently performed procedure for critically ill patients. The correct function of arterial catheters is essential to provide accurate and continuous hemodynamic monitoring, facilitating intermittent blood sampling and helping to optimize the workload for critical care nurses and physicians. However, they are not without their own problems. This narrative practice review discusses several clinical aspects that are not frequently considered but may contribute to enhanced catheter functionality, less device-related failure and more acceptable dwell times. Ultrasound has demonstrated unequivocal efficacies and safety with the procedure, improving first attempt success rates with children, the obese or patients with unstable clinical vital signs and shock. Moreover, anatomic variations of the radial artery are not rare, and ultrasound-guided catheterization reduces the incidence of insertion-related complications such as hematoma, posterior wall puncture, intimal dissection, and radial nerve injury. Ultrasound guidance offers several immediate benefits by enhancing the most appropriate insertion techniques, allows for the correct catheter to vessel ratio measurements to be performed and reduces the angle of insertion, which may affect catheter failure due to inappropriate catheter length. A deeper and more proximal cannulation site at least 4 cm from wrist joint, avoiding the area of wrist flexion, reduces mechanical complications related to patient movements and may improve catheter functionality and dwell along with a better area for stabilization and securement.
Collapse
Affiliation(s)
- Guglielmo Imbrìaco
- Centrale Operativa 118 Emilia Est (Prehospital Emergency Medical Dispatch Centre), Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy; Critical Care Nursing Course, University of Bologna, Bologna, Italy.
| | - Alessandro Monesi
- Critical Care Nursing Course, University of Bologna, Bologna, Italy; Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | | |
Collapse
|
26
|
Bahl A, Hijazi M, Chen NW. Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data. PLoS One 2022; 17:e0262793. [PMID: 35085318 PMCID: PMC8794136 DOI: 10.1371/journal.pone.0262793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose-related impact of these caustic medications on ultrasound-guided (US) PIVC survivorship. METHODS We performed a secondary analysis of a randomized control trial that compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. This study involved reviewing and recording all vesicants infusions through the PIVCs. Type and number of vesicants doses were extracted and characterized as one, two or multiple. The most commonly used vesicants were individually categorized for further analysis. The primary outcome was PIVC failure accounting for use and timing of vesicant infusates. RESULTS Between October 2018 and March 2019, 257 subjects were randomized with 131 in the UL group and 126 in the SL group. Vesicants were infused in 96 (37.4%) out of 257 study participants. In multivariable time-dependent extended Cox regression analysis, there was no significant increased risk of failure due to vesicant use [adjusted hazard ratio, aHR 1.71 (95% CI 0.76-1.81) p = 0.477]. The number of vesicant doses was not significantly associated with the increased risk of PIVC failure [(1 vs 0) aHR 1.20 (95% CI 0.71-2.02) p = 0.500], [(2 vs 0) aHR 1.51 (95% CI 0.67-3.43) p = 0.320] and [(≥ 3 vs 0) aHR 0.98 (95% CI 0.50-1.92) p = 0.952]. CONCLUSION Vesicant usage did not significantly increase the risk of PIVC failure even when multiple doses were needed in this investigation. Ultrasound-guided PIVCs represent a pragmatic option when vesicant therapy is anticipated. Nevertheless, it is notable that overall PIVC failure rates remain high and other safety events related to vesicant use should be considered when clinicians make vascular access decisions for patients.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan, United States of America
| | - Mahmoud Hijazi
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - Nai-Wei Chen
- Department of Biostatistics, Beaumont Hospital, Royal Oak, Michigan, United States of America
| |
Collapse
|
27
|
Kleidon TM, Schults J, Rickard CM, Ullman AJ. Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic Review and Meta-Analysis. J Hosp Med 2021; 16:742-750. [PMID: 34797998 DOI: 10.12788/jhm.3718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Insertion and function of pediatric peripheral intravenous catheters (PIVCs) present challenges. We systematically reviewed techniques and technologies to improve PIVC outcomes (first-time insertion success, overall insertion success, time to insertion, dwell time, failure, and complications). DATA SOURCES Cochrane Central Register of Controlled Trials (CONTROL), Cumulative Index to Nursing and Allied Health (CINAHL), US National Library of Medicine, and Embase. STUDY SELECTION English-language pediatric trials published post 2010 reporting PIVC outcomes. DATA EXTRACTION Following Cochrane standards, two authors screened, extracted, and critiqued study quality (Grading of Recommendations Assessment, Development and Evaluation approach) data, random effects analysis, results expressed as risk ratios (RR), mean differences (MD) and 95% CIs. RESULTS Twenty-one studies (3237 children; 3098 PIVCs) were included. First-time insertion success significantly increased with ultrasound guidance (compared with landmark insertion; RR, 1.60; 95% CI, 1.02-2.50). Use of ultrasound guidance (compared with landmark insertion) did not improve overall PIVC insertion success (RR, 1.10; 95% CI, 0.94-1.28). There was no evidence of an effect of near-infrared (compared with landmark) on first-time insertion success (RR, 1.21; 95% CI, 0.91-1.59) or number of attempts (MD, -0.65; 95% CI, -1.59 to 0.29); however, it significantly reduced PIVC insertion time (MD, -132.47; 95% CI, -166.68 to -98.26) and increased first-time insertion success in subgroup analysis of patients with difficult intravenous access (RR, 2.72; 95% CI, 1.02-7.24). LIMITATIONS Few studies per intervention, small sample sizes, and inconsistent outcome measures precluded definitive conclusions. CONCLUSIONS Ultrasound and near-infrared appear to improve pediatric PIVC insertion. High-quality studies examining the full extent of techniques and technologies are needed. Registration: CRD42020175314.
Collapse
Affiliation(s)
- Tricia M Kleidon
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Jessica Schults
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Claire M Rickard
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Amanda J Ullman
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| |
Collapse
|
28
|
Bahl A, Johnson S, Alsbrooks K, Mares A, Gala S, Hoerauf K. Defining difficult intravenous access (DIVA): A systematic review. J Vasc Access 2021; 24:11297298211059648. [PMID: 34789023 DOI: 10.1177/11297298211059648] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The term "difficult intravenous access" (DIVA) is commonly used but not clearly defined. Repeated attempts at peripheral intravenous catheter (PIVC) insertion can be a traumatic experience for patients, leading to sub-optimal clinical and economic outcomes. We conducted a systematic literature review (SLR) to collate literature definitions of DIVA, with the aim of arriving at an evidence-driven definition. METHODS The SLR was designed to identify clinical, cost, and quality of life publications in patients requiring the insertion of a PIVC in any setting, including studies on US-guidance and/or guidewire, and studies with no specific intervention. The search was restricted to English language studies published between 1st January 2010 and 30th July 2020, and the Ovid platform was used to search several electronic databases, in addition to hand searching of clinical trial registries. RESULTS About 121 studies were included in the SLR, of which 64 reported on the objectives relevant to this manuscript. Prevalence estimates varied widely from 6% to 87.7% across 19 publications, reflecting differences in definitions used. Of 43 publications which provided a definition of DIVA, six key themes emerged. Of these, themes 1-3 (failed attempts at PIV access using traditional technique; based on physical examination findings for example no visible or palpable veins; and personal history of DIVA) were covered by all but one publication. Following a failed insertion attempt, the most common number of subsequent attempts was 3, and it was frequently reported that a more experienced clinician would attempt to gain access after multiple failed attempts. CONCLUSIONS Considering the themes identified, an evidence-driven definition of DIVA is proposed: "when a clinician has two or more failed attempts at PIV access using traditional techniques, physical examination findings are suggestive of DIVA (e.g. no visible or palpable veins) or the patient has a stated or documented history of DIVA."
Collapse
Affiliation(s)
- Amit Bahl
- Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Steven Johnson
- Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Alicia Mares
- Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Smeet Gala
- Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Klaus Hoerauf
- Becton Dickinson and Co, Franklin Lakes, NJ, USA
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
29
|
Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
Collapse
Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| |
Collapse
|
30
|
Bahl A, Gibson SM. Catheter Length In-Vein Impacts Ultrasound-Guided Peripheral Intravenous Catheter Survival. J Emerg Nurs 2021; 47:843-845.e2. [PMID: 34294454 DOI: 10.1016/j.jen.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
|
31
|
Takeshita J, Tachibana K, Nakajima Y, Shime N. Bent peripheral venous catheter inserted using ultrasound-guided dynamic needle tip positioning. J Vasc Access 2020; 23:154-156. [PMID: 33349139 DOI: 10.1177/1129729820983158] [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] Open
Abstract
Herein, we report the case of a 2-year-old boy in whom a bent peripheral venous catheter was inserted using ultrasound-guided dynamic needle tip positioning via a short-axis out-of-plane approach. The peripheral venous catheter appeared to be successfully inserted into the cephalic vein in the forearm using dynamic needle tip positioning via a short-axis out-of-plane approach. However, after removing the inner needle, no blood return was confirmed. The removed catheter was noted to be bent at approximately one-third of the catheter length from the tip. A large change in the puncture angle during dynamic needle tip positioning for a deeply located vein might have caused this bend. Deeply located veins are not targeted when a blind puncture technique is used, as they are not visible and palpable. They can be visualized by ultrasonography and can be targeted using DNTP; however, the catheter may bend. Clinicians should be aware of this issue and, therefore, they are suggested to ensure that the puncture angle is not too steep and use a long length catheter; in addition, very deep veins should not be targeted.
Collapse
Affiliation(s)
- Jun Takeshita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
32
|
Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access 2020; 23:57-66. [PMID: 33302797 DOI: 10.1177/1129729820978124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PVCs) are widely used vascular access devices for infusion therapy; however, they are associated with relatively high failure rates. This study aimed to identify the incidence, risk factors and medical costs of PVC-induced complications in adult hospitalised adult patients in China. METHODS An observational, prospective study on 1069 patients lasting 5 months was conducted at a tertiary teaching hospital. RESULTS Infiltration ranked first among PVC complications with an incidence of 17.8%, followed by occlusion (10.8%) and phlebitis (10.5%). Most complications in phlebitis (88.4%) and infiltration (93.7%) were Grade 1. Catheters left in for over 96 h did not show a higher incidence of complications. Patients from the surgical department were more susceptible to infiltration, phlebitis and occlusion. The 26 gauge (Ga) catheters decreased the risk of phlebitis and occlusion, whereas 24Ga catheters increased infiltration rates. Infusing irritant drugs increased phlebitis and infiltration rates. The presence of comorbidities and non-use of needleless connectors were associated with occlusion. Compared with forearm insertion, the risk of occlusion nearly doubled with the dorsum of the hand insertion and the risk of infiltration tripled with antecubital fossa insertion. Medical treatment costs for PVC complications ranged from 0.3 to 140.0 CNY. CONCLUSIONS Infiltration is the most common PVC-related adverse event. Clinically-indicated instead of routine replacement of catheters is safe. More efforts are warranted to improve nurses' adherence to recent guidelines in terms of insertion site selection and needleless connector utilisation to reduce medical costs associated with catheter replacement.
Collapse
Affiliation(s)
- Congcong Liu
- Ward III, Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lin Chen
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Dong Kong
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Fangfang Lyu
- Department of Cardiac Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Linlin Luan
- Ward II, Department of Anesthesia Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| |
Collapse
|
33
|
Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:592. [PMID: 32998762 PMCID: PMC7526377 DOI: 10.1186/s13054-020-03305-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.
Collapse
|