A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center

Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study

PURPOSE

This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan.

METHODS

A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion.

RESULTS

Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis.

CONCLUSION

This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.

Peripherally inserted central catheter design and material for reducing catheter failure and complications

BACKGROUND

Peripherally inserted central catheters (PICCs) facilitate diagnostic and therapeutic interventions in health care. PICCs can fail due to infective and non-infective complications, which PICC materials and design may contribute to, leading to negative sequelae for patients and healthcare systems.

OBJECTIVES

To assess the effectiveness of PICC material and design in reducing catheter failure and complications.

SEARCH METHODS

The University of Queensland and Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the WHO ICTRP and ClinicalTrials.gov trials registers to 16 May 2023. We aimed to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, as well as relevant systematic reviews, meta-analyses, and health technology assessment reports. We contacted experts in the field to ascertain additional relevant information.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating PICC design and materials.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were venous thromboembolism (VTE), PICC-associated bloodstream infection (BSI), occlusion, and all-cause mortality. Secondary outcomes were catheter failure, PICC-related BSI, catheter breakage, PICC dwell time, and safety endpoints. We assessed the certainty of evidence using GRADE.

MAIN RESULTS

We included 12 RCTs involving approximately 2913 participants (one multi-arm study). All studies except one had a high risk of bias in one or more risk of bias domain. Integrated valve technology compared to no valve technology for peripherally inserted central catheter design Integrated valve technology may make little or no difference to VTE risk when compared with PICCs with no valve (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.19 to 2.63; I² = 0%; 3 studies; 437 participants; low certainty evidence). We are uncertain whether integrated valve technology reduces PICC-associated BSI risk, as the certainty of the evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Integrated valve technology may make little or no difference to occlusion risk when compared with PICCs with no valve (RR 0.86, 95% CI 0.53 to 1.38; I² = 0%; 5 studies; 900 participants; low certainty evidence). We are uncertain whether use of integrated valve technology reduces all-cause mortality risk, as the certainty of evidence is very low (RR 0.85, 95% CI 0.44 to 1.64; I² = 0%; 2 studies; 473 participants). Integrated valve technology may make little or no difference to catheter failure risk when compared with PICCs with no valve (RR 0.80, 95% CI 0.62 to 1.03; I² = 0%; 4 studies; 720 participants; low certainty evidence). We are uncertain whether integrated-valve technology reduces PICC-related BSI risk (RR 0.51, 95% CI 0.19 to 1.32; I² = not applicable; 2 studies (no events in 1 study); 542 participants) or catheter breakage, as the certainty of evidence is very low (RR 1.05, 95% CI 0.22 to 5.06; I² = 20%; 4 studies; 799 participants). Anti-thrombogenic surface modification compared to no anti-thrombogenic surface modification for peripherally inserted central catheter design We are uncertain whether use of anti-thrombogenic surface modified catheters reduces risk of VTE (RR 0.67, 95% CI 0.13 to 3.54; I² = 15%; 2 studies; 257 participants) or PICC-associated BSI, as the certainty of evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces occlusion (RR 0.69, 95% CI 0.04 to 11.22; I² = 70%; 2 studies; 257 participants) or all-cause mortality risk, as the certainty of evidence is very low (RR 0.49, 95% CI 0.05 to 5.26; I² = not applicable; 1 study; 111 participants). Use of anti-thrombogenic surface modified catheters may make little or no difference to risk of catheter failure (RR 0.76, 95% CI 0.37 to 1.54; I² = 46%; 2 studies; 257 participants; low certainty evidence). No PICC-related BSIs were reported in one study (111 participants). As such, we are uncertain whether use of anti-thrombogenic surface modified catheters reduces PICC-related BSI risk (RR not estimable; I² = not applicable; very low certainty evidence). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces the risk of catheter breakage, as the certainty of evidence is very low (RR 0.15, 95% CI 0.01 to 2.79; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Antimicrobial impregnation compared to non-antimicrobial impregnation for peripherally inserted central catheter design We are uncertain whether use of antimicrobial-impregnated catheters reduces VTE risk (RR 0.54, 95% CI 0.05 to 5.88; I² = not applicable; 1 study; 167 participants) or PICC-associated BSI risk, as the certainty of evidence is very low (RR 2.17, 95% CI 0.20 to 23.53; I² = not applicable; 1 study; 167 participants). Antimicrobial-impregnated catheters probably make little or no difference to occlusion risk (RR 1.00, 95% CI 0.57 to 1.74; I² = 0%; 2 studies; 1025 participants; moderate certainty evidence) or all-cause mortality (RR 1.12, 95% CI 0.71 to 1.75; I² = 0%; 2 studies; 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter failure (RR 1.04, 95% CI 0.82 to 1.30; I² = not applicable; 1 study; 221 participants; low certainty evidence). Antimicrobial-impregnated catheters probably make little or no difference to PICC-related BSI risk (RR 1.05, 95% CI 0.71 to 1.55; I² = not applicable; 2 studies (no events in 1 study); 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter breakage (RR 0.86, 95% CI 0.19 to 3.83; I² = not applicable; 1 study; 804 participants; low certainty evidence).

AUTHORS' CONCLUSIONS

There is limited high-quality RCT evidence available to inform clinician decision-making for PICC materials and design. Limitations of the current evidence include small sample sizes, infrequent events, and risk of bias. There may be little to no difference in the risk of VTE, PICC-associated BSI, occlusion, or mortality across PICC materials and designs. Further rigorous RCTs are needed to reduce uncertainty.

Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study

OBJECTIVES

To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications.

METHODS

A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital.

RESULTS

Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37).

CONCLUSION

Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies.

IMPLICATIONS FOR PRACTICE

This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.

Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study

PURPOSE

This study aimed to assess peripheral intravenous catheter use, maintenance practices, and outcomes of paediatric patients in a developing country setting.

DESIGN AND METHODS

A point prevalence survey using validated checklist was conducted between March and April 2022 in ten hospitals in Indonesia. A total number of 478 participants were approached during the audit. Data were obtained from site observation and medical records.

RESULTS

Of the 386 patients surveyed, >90% (362) had one catheter in-situ. The catheters were mostly inserted by nurses (331, 86%), primarily in the dorsum of the hand (207, 54%) with the purpose of delivering intravenous infusions and medications (367, 95%). Simple transparent dressings (176, 46%) with splint and bandage (295, 76%) were predominantly used for securement methods. Insertion sites were not visible for 182 (47%) patients, and 151 (40%) of daily care practices were poorly documented. Complications were documented in the medical record for 166 (43%) catheters. Adjusted analysis indicated that patient diagnosis, ward, catheter size, location, dressings, infusate, and flushing administration were significantly associated with complications.

CONCLUSIONS

Findings indicate that issues related to paediatric intravenous catheter complications in Indonesia are comparable to developed country settings. Ongoing surveillance is important to evaluate the management practices to benchmark against guidelines, optimise patient safety, and improve outcomes.

PRACTICE IMPLICATIONS

Results demonstrate low and middle-income countries face similar challenges with catheter insertion and care. The study indicates the importance of applying vascular access needs assessments, providing training for inserters, identifying optimum dressing methods, and optimising documentation.

Vascular access device type for systemic anti-cancer therapies: a scoping review protocol

INTRODUCTION

Vascular access devices (VADs) are the most common invasive procedure performed in acute medicine and cancer patients undergo multiple invasive vascular access procedures. Our aim is to identify the type of evidence available regarding the best choice of VAD for cancer patients undergoing systemic anti-cancer therapy (SACT). In this article, the authors frame the scoping review protocol used, which will systematically report all published and unpublished literature around the use of VADs for the infusion of SACT in oncology.

INCLUSION CRITERIA

For studies to be included, they must focus on people or populations aged 18 years or older and report on vascular access in cancer patients. The concept is the variety of VAD use in cancer and reported insertion and post-insertion complications. The context surrounds the intravenous treatment of SACT whether in a cancer centre or non-cancer setting.

METHODS

The JBI scoping review methodology framework will guide the conduct of this scoping review. Electronic databases (CINAHL, Cochrane, Medline and Embase) will be searched. Grey literature sources and the reference lists of key studies will be reviewed to identify those appropriate for inclusion. No date limits will be used in the searches and studies will be limited to the English language. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion, and a third reviewer will arbitrate disagreements. All bibliographic data, study characteristics and indicators will be collected and charted using a data extraction tool.

A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure

BACKGROUND

Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear.

OBJECTIVES

To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure.

METHODS

In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry.

EXCLUSIONS

laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy.

PRIMARY OUTCOME

feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction).

SECONDARY OUTCOMES

PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost.

RESULTS

Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4-2.7) and 2.1 (95% CI 0.9-5.1) for Bundles 1 and 2, respectively.

CONCLUSIONS

A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123.

Awareness of Peripheral Intravenous Catheters Among Nurses, Physicians, and Students

OBJECTIVES

Peripheral intravenous catheters (PIVCs) are frequently used to meet patients' short-term health care needs. However, many PIVCs are not promptly removed at the completion of treatment, placing patients at risk of avoidable harm from serious complications including local and systemic infection. This study aims to report the proportion and accuracy of health care staff/students awareness of the presence of their patient's PIVC.

METHODS

We asked staff/students to recall the presence or absence of a PIVC in a patient under their care, as well as details of the date of insertion and PIVC location. We recorded concordance of responses with direct observations. To achieve this, face-to-face interviews were conducted with clinical staff/students at 2 adult hospitals.

RESULTS

Overall, 90% (n = 216) of staff responses (94% of nurses, 100% of nursing students, 76% of medical staff) correctly identified the presence/absence of a PIVC. Clinicians correctly identified the PIVC location 55% (n = 71) of the time.

CONCLUSIONS

Health care services must recognize the implications of this lack of awareness and implement and evaluate tailored quality improvement efforts to address this.

Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools

Objectives

This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter (PIVC) insertion and care practices.

Methods

The six-step forward and backward translation method was used to translate the adapted questionnaires. The English version questionnaires included the point prevalence audit checklist, the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire, plus a Patient/parent Experience Survey. Data collection was conducted in Indonesia between October 2019 and February 2020. In total, there were six translators (two for each instrument), nine-panel vascular access experts (three for each instrument), and 30 participants (ten for each instrument) of the target population involved in the translation and validation of the three instruments. Three-panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index and kappa index were calculated. Ten-panel members of the target population evaluated each questionnaire regarding feasibility, clarity, logical sequence, and formatting. Qualitative comments from the panel were also reviewed.

Results

The translation process indicated relatively low discrepancies between translators except for semantic equivalence. There were nine, eight, and one semantic discrepancies found in the forward translation of the point prevalence audit checklist, nurse survey, and patient/parent experience survey. The semantic discrepancies were less prevalent in the backward translation, with only one, three, and two items reported during the process. The item validity index for all of the three instruments showed relatively high agreement between experts (I-CVI > 0.78, S-CVI/Ave >0.90, S-CVI/UA > 0.70, and kappa index >0.74). The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically. However, some re-formatting of the nurse survey and patient/parent experience survey were needed to avoid ambiguity and confusion for the participants.

Conclusions

The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context. They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.

Peripheral intravenous catheter securement: An integrative review of contemporary literature around medical adhesive tapes and supplementary securement products

AIM

To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure.

DESIGN

Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement.

DATA SOURCES

The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000-21 September 2020.

REVIEW METHODS

Studies enrolling hospitalised participants >16 years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists.

RESULTS

Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence.

CONCLUSION

Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications; multiproduct dressing and securement bundles were prevalent; and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence.

Nurses' Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study

A significant number of adult oncology patients require at least one peripheral intravenous catheter to fulfill their therapeutic plan. Recent evidence indicates that catheter failure rates are high in this cohort, impacting care outcomes and patient experience during cancer treatment. This reality represents a challenge to nurses worldwide since in most international settings they are responsible for delivering quality care during the insertion and maintenance of such devices. This study aims to explore current nursing practices regarding the insertion, maintenance, and surveillance of peripheral intravenous catheters in oncology patients. A two-phase mix-method study was conducted with the nursing team from the surgical ward of a large oncology hospital in Portugal. In phase one (observational prospective study), nurses' practices during catheter insertion and maintenance were observed by the research team and recorded using standardized instruments and validated scales. In phase two, three online focus groups were conducted with the nursing team to present the results observed in phase one and explore their perceptions of current practices. All ethical principles were assured throughout the study. Significant divergent practices were observed and identified by the nurses, especially concerning patient involvement, nurses' adherence to the aseptic, non-touch technique, catheter stabilization and dressing, and catheter flushing and locking. Such practices may partially explain the high complication rate found (26%) and substantiate the need for future intervention in this field.

Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital

AIMS AND OBJECTIVES

To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually).

BACKGROUND

Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy.

DESIGN

Observational point prevalence study.

METHODS

Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used.

RESULTS

There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases.

CONCLUSIONS

Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC.

RELEVANCE TO CLINICAL PRACTICE

Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.

L, Mihala G, Harris PNA, Rickard CM. SECUREment bundles to prevent peripheral intravenous catheter failure—the SECURE-PIVC trial: study protocol for a pilot randomized controlled trial

Introduction

Peripheral intravenous catheters (PIVCs) are widely used, but failure is unacceptably common with up to 69% failing before treatment is complete. PIVC securement reduces failure, but the optimal way to achieve this is unclear. Tapes and supplementary securement products are widely used, however rigorous testing of these to reduce PIVC failure remains unexplored.

Methods and analysis

In adult medical-surgical wards at a tertiary hospital, this pilot randomized controlled trial tests standard care (bordered polyurethane dressing plus nonsterile tape over the extension tubing) against two securement interventions (intervention one: standard care plus two sterile tape strips over the PIVC hub; intervention two: intervention one plus a tubular bandage). Patients >18 years of age requiring a PIVC for >24 hours are eligible. Patients with laboratory-confirmed positive blood cultures within 24 hours of screening, known allergy to study products, current or high-risk of skin tear, or non-English speaking without interpreter are excluded. Sample size is 35 per trial arm, and central randomization is computer-generated with allocation concealed until entry. Patients and clinical staff cannot be blinded to treatment allocation. However, infection outcomes are assessed by a blinded investigator. Primary outcome is study feasibility. Secondary outcomes (PIVC failure, dwell time, skin adverse events, PIVC colonization, and cost) are compared between groups. Feasibility outcomes are reported descriptively.

Ethics and trial commencement

Ethical approvals were received from Royal Brisbane and Women's Hospital (HREC/18/QRBW/44571) and Griffith University (2018/1000). Trial commencement was May 2019. Trial registration: ACTRN12619000026123.

Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study

PURPOSE

To identify modifiable and non-modifiable risk factors for peripheral intravenous catheter (PIV) failure among patients requiring intravenous treatment for oncology and haematology conditions.

METHODS

A single-centre prospective cohort study was conducted between October 2017 and February 2019. Adult in-patients requiring a PIV for therapy were prospectively recruited from two cancer units at a tertiary hospital in Queensland, Australia. The primary outcome was a composite of complications leading to PIV failure (local and bloodstream infection; occlusion; infiltration/extravasation; leakage; dislodgement; and/or phlebitis). Secondary outcomes were (i) PIV dwell time; (ii) insertion and (iii) failure of a CVAD; (iv) adverse events; (v) length of hospital stay. Outcomes were investigated using Bayesian multivariable linear regression modelling and survival analysis.

RESULTS

Of 200 participants, 396 PIVs were included. PIV failure incidence was 34.9%; the most common failure type was occlusion/infiltration (n = 74, 18.7%), then dislodgement (n = 33, 8.3%), and phlebitis (n = 30, 7.6%). While several patient and treatment risk factors were significant in univariable modelling, in the final multivariable model, only the use of non-sterile tape (external to the primary dressing) was significantly associated with decreased PIV dislodgement (hazard ratio 0.06, 95% confidence interval 0.01, 0.48; p = 0.008).

CONCLUSION

PIV failure rates among patients receiving cancer treatment are high, the sequelae of which may include delayed treatment and infection. Larger studies on risk factors and interventions to prevent PIV failure in this population are needed; however, the use of secondary securements (such as non-sterile tape) to provide further securement to the primary PIV dressing is particularly important.

TRIAL REGISTRATION

Study methods were registered prospectively with the Australian New Zealand Clinical Trials Registry on the 27^th March 2017 (ACTRN12617000438358); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true.

Skin Complications Associated With Pediatric Central Venous Access Devices: Prevalence, Incidence, and Risk

Central venous access devices (CVADs) are vital to enable treatment for children with cancer and other complex health conditions. However, complications effecting the CVAD wound are commonly reported. This study aimed to identify the incidence and prevalence of CVAD-associated skin complications current management, and characteristics associated with complication development, in pediatrics. A prospective observational study performed across medical, oncology, and hematology departments at a tertiary pediatric hospital in Australia, between April and July 2017. Children admitted with CVADs were assessed twice weekly for CVAD-associated skin complications and associated signs and symptoms. The data were analyzed using descriptive statistics (i.e., proportions, frequency) and time-to-event multivariable regression (i.e., hazard ratios [HRs]). Two hundred and seventy-one CVADs were reviewed over 43,787 catheter days, with over one eighth of participants (14%; n = 37) having a CVAD-associated skin complication during their admission (0.95 per 1,000 catheter days, 95% confidence interval [CI; 0.61, 1.17]), most commonly contact dermatitis (11%; n = 29; 0.72 per 1,000 catheter days 95% CI [0.50, 1.04]). Within biweekly checks the median point prevalence of complications varied between 0.4% and 11% and clinical management was wide-ranging. A primary diagnosis of oncology (HR 2.89, 95% CI [1.10, 7.62]) or medical/surgical (HR 2.55, 95% CI [1.04, 6.22]) conditions; plain, nonbordered polyurethane dressings (HR 4.92, 95% CI [2.00, 12.13]); and poor dressing integrity (HR 2.64, 95% CI [1.18, 5.92]) were significantly associated with contact dermatitis. In conclusion, substantial numbers of pediatric patients experience CVAD-associated skin complications, and innovations are necessary to identify, prevent, and treat these health care-associated injuries.

Peripherally inserted central catheters in critically ill patients - complications and its prevention: A review

Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients' improvement, reduce health care cost, and lessen the incidence of various PICC-related complications. Therefore, this study aimed to outline current literature on PICC procedures, potential complications, and measures for prevention. Understanding evidence-based guidelines regarding insertion technique, early detection of complications, and care bundle of PICC is significant in complication prevention. Implementation of education, training, and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications. Thus, the strict care of indwelling PICC lines, the targeted and reasonable PICC-associated complication prevention, and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.

Teaching module for improving oncology nurses' knowledge and self-confidence about central line catheters caring, complications, and application: A pretest-posttest quasi-experimental design

The aim of the present study was to assess the effectiveness of implementing an educational module based on the Centers for Disease Control and Prevention guidelines on the nurses' knowledge and self-confidence regarding central line catheters (CVCs) caring, complications, and application. A pretest-posttest quasi-experimental design was used. A sample of 100 oncology nurses from oncology units participated in two groups, experimental group (N = 50) and control group (N = 50). The participants completed knowledge test and self-confidence scale before and after the educational program. The results showed that there was a significant difference between the experimental and control groups regarding knowledge related to CVC guidelines and management after the interventional sessions (t = -7.85, P = .001). The mean and standard deviation for experimental group were 15.95 (5.45) and 7.35 (2.73) for the control group. Furthermore, the results showed significant difference (t = -22.20, P = .001) between the experimental group (M = 61.50, SD = 14.20) and the control group (M = 35.50, SD = 7.20) regarding self-confidence in managing CVCs. It is concluded that using educational program strengthens nurses' skills, improves safety, and increases opportunity to learn, and thus, it will increase the self-confidence.

Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study

INTRODUCTION

Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice.

METHODS AND ANALYSIS

The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion.

ETHICS AND DISSEMINATION

Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published.

TRIAL REGISTRATION NUMBER

ANZCTR: 12617000067370; Pre-results.

Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial

Background

Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure.

Methods

This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged ≥ 16 years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU + SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL + Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA + SPU). All groups except TA + SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected.

Results

PICC failure incidence was: PAL + CHG + Tape (1/5; 20%; 17.4/1000 days), SPU + SSD + CHG (control) (4/39; 10%; 9.0/1000 days), TA + SPU (3/35; 9%; 9.6/1000 days), and CSD + CHG (3/42; 7%; 9.4/1000 days). Recruitment to PAL + CHG + Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD + CHG, TA + SPU (TA applied only at PICC insertion time), and control treatments were acceptable to patients and health professionals.

Conclusion

A large RCT of CSD + CHG and TA + SPU (but not PAL + CHG + Tape) versus standard care is feasible.

Trial registration

Australian and New Zealand Clinical Trials Registry, ACTRN12616000027415. Registered on 15 January 2016.

Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care

AIM

To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions.

METHODS

A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools.

RESULTS

Across the six sites, 1027 patients were screened with CVADs prevalent in 26.1% (n = 268), and 261 CVADs in 248 patients available for audit. Variations in management were evident with dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs (n = 35), and non-sterile dressings used to reinforce 26.4% of CVADs (n = 69). Almost half of CVADs (49.4%; n = 132) had no documentation regarding site assessment in the previous 4 h, and 13.4% had no planned use in the next 24 h (35 CVAD). CVAD-associated complications within the previous 7 days were evident in 9.5% of CVADs (n = 27), most commonly catheter blockage (5.7% CVAD, n = 15), and bloodstream infection (1.9% CVAD, n = 5). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; P = 0.04), and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; P = 0.04), had significantly higher proportions of CVAD-associated complications in the previous 7 days. Variation between the sites' guidelines was evident across many practices.

CONCLUSIONS

CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity.

Infection risks associated with peripheral vascular catheters

BACKGROUND

Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey.

METHOD

A narrative review of studies describing the infection risks associated with PVCs.

RESULTS

It is estimated that 30-80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment.

DISCUSSION

This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies.

Effectiveness of a training program in compliance with recommendations for venous lines care

Background

The impact of training programs on the care and maintenance of venous lines (VL) has been assessed mainly in patients admitted to the intensive care unit (ICU). Data on the impact of such programs in a whole general hospital are scarce. The objective of this study was to assess compliance with VL care after an extensive training program aimed at nurses caring for adult ICU and non-ICU patients.

Methods

We performed 2 point prevalence studies in a general hospital. A specialized nurse visited all hospitalized adult patients, performed a bedside inspection, and reviewed the nursing records for patients with a VL before and after a 1-year training program. The program included an interactive on-line teaching component and distribution of pocket leaflets and posters with recommendations on VL care.

Results

Data recorded for the first and second prevalence studies were as follows: number of patients visited, 753 vs. 682; total number of patients with ≥ 1 VL implanted on the visit day, 653 (86.7 %) vs 585 (85.8 %); catheters considered unnecessary on the study day, 183 (22.9 %) vs 48 (7.1 %) (p < 0.001); number of catheters with local clinical evidence of infection on the study day, 18 (2.2 %) vs 12 (1.8 %) (p = 0.52); registration of insertion day (42.3 % vs 50.1 %; p = 0.003); and registration of day of dressing change (41.2 % vs 49.1 %; p = 0.003). Maintenance parameters improved more in non-ICU than in ICU patients.

Conclusion

A multidisciplinary teaching program to improve VL care and compliance with recommendations is effective. Point prevalence studies are easy to carry out and effective at demonstrating increases in compliance, mainly in non-ICU patients.

Evaluation of a Pilot Educational Program on Safe and Effective Insertion and Management of Peripheral Intravenous Catheters

Peripheral intravenous catheter (PIVC) insertion and subsequent care have been highlighted as areas for improvement in the management of intravascular devices; however, only the fundamentals of PIVC care are routinely taught to registered nurses in Australia. In 2013, a vascular access-focused elective postgraduate course, Peripheral Intravenous Access and Care (8035NRS) was commenced for students enrolled in any of the Griffith University master's degree programs. It was developed with the intent to translate research knowledge into practice by providing access to the latest research findings and current best practices in peripheral intravenous access. Topics covered preinsertion, insertion, and postinsertion care and were developed for the online environment, which is known to be conducive to individual student learning styles. Learning activities included viewing short videos delivered by local and international clinical researchers. This course is the first known university-provided, postgraduate academic course on this subject in Australia, and possibly 1 of the few available internationally. The course succeeded in its aim of increasing knowledge and skills about safe, evidence-based PIVC insertion and care to registered nurses. Its development and implementation at the postgraduate level may be regarded as a strategy to provide a greater understanding regarding scope and relevance for nursing practice and for informed decision making on optimum integration at the undergraduate level. This ultimately will increase positive patient outcomes and the patient experience of vascular access.