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Xu HG, Campbell J, Takashima M, Larsen E, Coyer F, August D, Dean A, Pitt C, Griffin B, Marsh N, Rickard CM, Ullman A. Development and Preliminary Validation of a Central Venous Access Device-Associated Skin Impairment Classification Tool Using Modified Delphi and Clinimetric Methods. J Adv Nurs 2024. [PMID: 39258848 DOI: 10.1111/jan.16416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 07/31/2024] [Accepted: 08/11/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND An evidence and consensus-based instrument is needed to classify central venous access device-associated skin impairments. AIM The aim of this study was to design and evaluate the central venous access device-associated skin impairment classification tool. DESIGN A two-phase modified Delphi study. METHODS This two-phase study consisted of a literature review, followed by the development and validation of a classification instrument, by experts in the fields of central venous access devices and wound management (Phase 1). The instrument was tested (Phase 2) using 38 clinical photographs of a range of relevant skin impairments by the same expert panel. The expert panel consisted of registered nurses who were clinical researchers (n = 4) and clinical experts (n = 3) with an average of 24 years of nursing and research experience and 11 years of experience in wound management. Measures to assess preliminary content validity and inter-rater reliability were used. RESULTS The instrument consists of five overarching aetiological classifications, including contact dermatitis, mechanical injury, infection, pressure injury and complex clinical presentation, with 14 associated subcategory diagnoses (e.g., allergic dermatitis, skin tear and local infection), with definitions and signs and symptoms. High agreement was achieved for preliminary scale content validity and item content validity (I-CVI = 1). Inter-rater reliability of aetiologies was high. The overall inter-rater reliability of individual definitions and signs and symptoms had excellent agreement. CONCLUSION The development and preliminary validation of this classification tool provide a common language to guide the classification and assessment of central venous access device-associated skin impairment. IMPACT The comprehensive and validated classification tool will promote accurate identification of central venous access device-associated skin impairment by establishing a common language for healthcare providers. The availability of this tool can reduce clinical uncertainty, instances of misdiagnosis and the potential for mismanagement. Consequently, it will play a pivotal role in guiding clinical decision-making, ultimately enhancing the quality of treatment and improving patient outcomes. REPORTING METHOD The Guidance on Conducting and Reporting Delphi Studies (CREDES) was adhered to. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Hui Grace Xu
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia
| | - Mari Takashima
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Deanne August
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anna Dean
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Colleen Pitt
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Herston, Brisbane, Queensland, Australia
| | - Amanda Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Nathan, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Hastings A, Barton A. Rapid haemostasis to achieve dressing longevity: evaluation trial results using StatSeal catheter exit site protection. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S8-S14. [PMID: 39023031 DOI: 10.12968/bjon.2024.0164] [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: 07/20/2024]
Abstract
Peripherally inserted central catheters (PICCs) are vital in delivering intravenous therapy. Despite their advantages, PICCs can lead to complications such as catheter exit site bleeding, which can cause patient distress and increase infection risk. This study evaluated the efficacy of StatSeal, a topical haemostatic device, in managing PICC exit site bleeding. StatSeal uses a hydrophilic polymer and potassium ferrate to form a seal, reducing access site bleeding and minimising dressing changes. For this study, Patients were recruited at Frimley Health NHS Foundation Trust; the trial involved 177 patients with StatSeal, and shows that 99% did not require additional dressing changes within the standard 7-day period. The findings demonstrate StatSeal's effectiveness in improving patient outcomes by reducing exit site bleeding and associated complications, enhancing the efficiency of vascular access maintenance and potentially lowering associated healthcare costs. The trial emphasises the importance of innovative solutions such as StatSeal to advance PICC care and improve patient experience.
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Affiliation(s)
- Angela Hastings
- Clinical Nurse Specialist, Vascular access and IV therapy, Frimley Health NHS Foundation Trust, Frimley, angela
| | - Andrew Barton
- Nurse Consultant, IV Therapy and Vascular Access, Frimley Health NHS Foundation Trust, Frimley, and Chair, National Infusion and Vascular Access Society
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Zhang Y, Zhao R. Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in a patient with persistent left superior vena cava: A case report. J Vasc Access 2024:11297298231194859. [PMID: 38166452 DOI: 10.1177/11297298231194859] [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: 01/04/2024] Open
Abstract
Intracavitary electrocardiogram (IC-ECG) guidance is widely used for peripherally inserted central catheter (PICC) placement. The P wave variation has rarely been reported in persistent left superior vena cava (PLSVC). Here, we report a PLSVC case of P wave variation in PICC placement guided by IC-ECG. In this case, the P wave variation of the PLSVC was quite different from that of the right superior vena cava (RSVC). The tip of the catheter was located at the lower segment of the left superior vena cava according to postoperative radiography examination. PICC functioned normally, and no complications occurred.
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Affiliation(s)
- Yuejiao Zhang
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ruiyi Zhao
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Zhang J, Ma G, Peng S, Hou J, Xu R, Luo L, Hu J, Yao N, Wang J, Huang X. Risk Factors and Predictive Models for Peripherally Inserted Central Catheter Unplanned Extubation in Patients With Cancer: Prospective, Machine Learning Study. J Med Internet Res 2023; 25:e49016. [PMID: 37971792 PMCID: PMC10690529 DOI: 10.2196/49016] [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: 05/15/2023] [Revised: 09/24/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in reducing the incidence of PICC-UE among patients with cancer. Precise prevention and treatment strategies are essential to improve patient outcomes and safety in clinical settings. OBJECTIVE This study aims to identify the independent risk factors associated with PICC-UE in patients with cancer and to construct a predictive model tailored to this group, offering a theoretical framework for anticipating and preventing PICC-UE in these patients. METHODS Prospective data were gathered from January to December 2022, encompassing patients with cancer with PICC at Xiangya Hospital, Central South University. Each patient underwent continuous monitoring until the catheter's removal. The patients were categorized into 2 groups: the UE group (n=3107) and the non-UE group (n=284). Independent risk factors were identified through univariate analysis, the least absolute shrinkage and selection operator (LASSO) algorithm, and multivariate analysis. Subsequently, the 3391 patients were classified into a train set and a test set in a 7:3 ratio. Utilizing the identified predictors, 3 predictive models were constructed using the logistic regression, support vector machine, and random forest algorithms. The ultimate model was selected based on the receiver operating characteristic (ROC) curve and TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) synthesis analysis. To further validate the model, we gathered prospective data from 600 patients with cancer at the Affiliated Hospital of Qinghai University and Hainan Provincial People's Hospital from June to December 2022. We assessed the model's performance using the area under the curve of the ROC to evaluate differentiation, the calibration curve for calibration capability, and decision curve analysis (DCA) to gauge the model's clinical applicability. RESULTS Independent risk factors for PICC-UE in patients with cancer were identified, including impaired physical mobility (odds ratio [OR] 2.775, 95% CI 1.951-3.946), diabetes (OR 1.754, 95% CI 1.134-2.712), surgical history (OR 1.734, 95% CI 1.313-2.290), elevated D-dimer concentration (OR 2.376, 95% CI 1.778-3.176), targeted therapy (OR 1.441, 95% CI 1.104-1.881), surgical treatment (OR 1.543, 95% CI 1.152-2.066), and more than 1 catheter puncture (OR 1.715, 95% CI 1.121-2.624). Protective factors were normal BMI (OR 0.449, 95% CI 0.342-0.590), polyurethane catheter material (OR 0.305, 95% CI 0.228-0.408), and valved catheter (OR 0.639, 95% CI 0.480-0.851). The TOPSIS synthesis analysis results showed that in the train set, the composite index (Ci) values were 0.00 for the logistic model, 0.82 for the support vector machine model, and 0.85 for the random forest model. In the test set, the Ci values were 0.00 for the logistic model, 1.00 for the support vector machine model, and 0.81 for the random forest model. The optimal model, constructed based on the support vector machine, was obtained and validated externally. The ROC curve, calibration curve, and DCA curve demonstrated that the model exhibited excellent accuracy, stability, generalizability, and clinical applicability. CONCLUSIONS In summary, this study identified 10 independent risk factors for PICC-UE in patients with cancer. The predictive model developed using the support vector machine algorithm demonstrated excellent clinical applicability and was validated externally, providing valuable support for the early prediction of PICC-UE in patients with cancer.
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Affiliation(s)
- Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiyuan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jianmei Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ran Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lingxia Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaji Hu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Nian Yao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaan Wang
- Vascular Access Department, Hainan Provincial People's Hospital, Hainan, China
| | - Xin Huang
- Department of Nursing, Affiliated Hospital of Qinghai University, Qinghai, China
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Yeh TC, Chen CM, Cheng CH, Sheu CC, Tsai MJ, Chang WA. A modified method for measuring the length of peripherally inserted central catheters to reduce the risk of malposition during catheter insertion. SAGE Open Med 2023; 11:20503121231204488. [PMID: 37829287 PMCID: PMC10566264 DOI: 10.1177/20503121231204488] [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: 06/06/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Background Malposition may occur during peripherally inserted central catheter insertion. Accurately measuring the length of a peripherally inserted central catheter is crucial to preventing malposition, including "long peripherally inserted central catheter placement," in which the tip of a peripherally inserted central catheter is deeper than the target position. The traditional method of measuring peripherally inserted central catheter length involves measuring from the insertion site to the parasternal notch and down to the third or fourth intercostal space, which may result in overestimation because of the thickness of the pectoralis major and anterior chest wall. To avoid this overestimation, the authors developed and tested a modified method for reducing long peripherally inserted central catheter placement. Methods This study employed a retrospective design. Chest X-rays were used to examine the peripherally inserted central catheter tip positions in 48 patients in the medical intensive care unit who had undergone peripherally inserted central catheter insertion. The traditional and modified measurement methods were used to measure the peripherally inserted central catheter length in 17 and 31 patients, respectively. Fisher's exact test was used to examine between-group differences in the incidence of different types of peripherally inserted central catheter malposition. Results The peripherally inserted central catheter tip position was near the target position in five patients (29.41%) in the traditional measurement group and 17 patients (54.84%) in the modified measurement group (p = 0.132), whereas long peripherally inserted central catheter placement occurred in six patients (35.29%) in the traditional measurement group and one patient (3.23%) in the modified measurement group (p = 0.006). However, the incidence of other types of peripherally inserted central catheter malposition did not differ significantly between the groups. Conclusions The results of this study that the proposed modified measurement method may be able to reduce the incidence of long peripherally inserted central catheter placement among medical intensive care unit patients. The method must be further evaluated in prospective studies and studies with larger sample sizes in the future.
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Affiliation(s)
- Tung-Chi Yeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chih-Hung Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Wei-An Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Huang Q, Chen L, Aiqun J, Shi F, Feng D. Effectiveness of the Hospital-Community-Family Nursing Model in Breast Cancer Patients Discharged with PICC Lines. J Community Health Nurs 2023; 40:255-265. [PMID: 37128144 DOI: 10.1080/07370016.2023.2205405] [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: 05/03/2023]
Abstract
PURPOSE To investigate the effectiveness of the hospital-community-family nursing model in breast cancer patients discharged with PICC lines. To investigate the effectiveness of the hospital-community-family nursing model in breast cancer patients discharged with PICC lines. DESIGN A randomized controlled study. METHOD A total of 160 breast cancer patients who had been discharged from the hospital with PICC lines were enrolled in the study and divided into observation and control groups, each consisting of 80 patients. The control group received conventional nursing care and education, while the observation group received care under the "hospital-community-family" tertiary linkage nursing model. FINDINGS The results of this study suggest that the adoption of the hospital-community-family tertiary linkage nursing model can improve compliance and quality of life in breast cancer patients with PICC lines. Additionally, the model can also reduce the likelihood of complications for patients. CONCLUSION This study highlights the importance of promoting the application of the hospital-community-family triple linkage nursing model in breast cancer patients with PICC lines to improve the therapeutic effect. CLINICAL EVIDENCE The hospital-community-family triple linkage nursing model is an effective strategy to improve the effectiveness of home nursing.
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Affiliation(s)
- Qin Huang
- BSN. Department of Nephrology, Rugao Hospital Affiliated to Nantong University, Nantong, China
| | - Lixia Chen
- Department of Radiology, Rugao Hospital Affiliated to Nantong University, Nantong, China
| | - Jia Aiqun
- Department of Chemotherapy, Rugao Hospital Affiliated to Nantong University, Nantong, China
| | - Falan Shi
- Department of General Surgery, Rugao Hospital Affiliated to Nantong University, Nantong, China
| | - Dan Feng
- Department of Hematology, Rugao Hospital Affiliated to Nantong University, Nantong, China
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Kumar Upadhyay A, Prakash B, Shekhar S, Kumar A, Prakash A. Embolization of a Fractured Peripherally Inserted Central Catheter to Pulmonary Arteries: A Sporadic Life-Threatening Phenomenon. Cureus 2023; 15:e43044. [PMID: 37680431 PMCID: PMC10480559 DOI: 10.7759/cureus.43044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/09/2023] Open
Abstract
The peripherally inserted central catheter (PICC) is a non-tunneled central venous catheter placed in the upper limb venous system, mainly in the basilic vein, and the tip terminates in the superior vena cava (SVC). A PICC is a preferred modality of central venous access in oncology, as it is associated with minimal discomfort and can be kept in situ for up to one year. Despite multiple advantages, it is also associated with complications. Fracture and migration are rare but potentially serious complications that can lead to arrhythmias, cardiac perforation, cardiac tamponade, pulmonary embolism, and sepsis. The migrated PICC fragment can be retrieved using percutaneous techniques, which have a high success rate of excess, with minimum complications. In our patient of adenocarcinoma gastroesophageal junction, the fractured and migrated PICC to pulmonary arteries was retrieved using the balloon catheter method. With more and more cancer patients using PICCs for chemotherapy administration, healthcare workers must be aware of the standard and sporadic complications of PICCs. Care of the PICC is crucial, and any lapse may lead to fracture and embolization, which is a potentially life-threatening complication. This case highlights the importance of healthcare persons being aware of the possibility of catheter embolization and methods to prevent and mitigate this phenomenon.
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Affiliation(s)
| | | | - Shashank Shekhar
- Medical Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, IND
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He X, Wu S, Zhang F, Ge W, Wu D, Chen M, Li K, Ren X. Assessing pripherally inserted central catheter tip location in multiple postures: A case report. Asia Pac J Oncol Nurs 2023; 10:100238. [PMID: 37273821 PMCID: PMC10238864 DOI: 10.1016/j.apjon.2023.100238] [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: 03/04/2023] [Accepted: 04/14/2023] [Indexed: 06/06/2023] Open
Abstract
This report presents a case involving a 21-year-old male patient with acute promyelocytic leukemia, where the peripherally inserted central catheter (PICC) tip location was diagnosed differently using ultrasound and computed tomography. The PICC was inserted into the left upper arm via the basilic vein. Echocardiography performed in the left lateral recumbent position suggested the PICC tip to be in the right atrium, deepest at the level of the tricuspid annulus. However, trans-catheter contrast-enhanced echocardiography, performed with a different posture involving left shoulder abduction and slight external rotation, revealed the tip to be at the cavo-atrial junction. Additionally, chest computed tomography, conducted in the supine position with raised arms, indicated the tip to be located at the upper one-third of the superior vena cava. These contradictory diagnoses can be attributed to the use of different body postures during the assessments. Considering the clinical efficacy and safety, it is crucial to fully consider the influence of multiple postures on PICC tip location during placement and determination. We recommend incorporating at least two opposite extreme daily postures to assess the nearest and farthest positions of the tip, ensuring effective and safe PICC placement and reducing the risk of complications.
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Affiliation(s)
- Xining He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shengzheng Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Fan Zhang
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Wenhao Ge
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Dudu Wu
- Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Mei Chen
- Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Keyan Li
- Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Xiuyun Ren
- Department of Ultrasound, Hainan Hospital of PLA General Hospital, Sanya, China
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Luo H, Jin C, Li X, Jiang Y, Zhou J. Quantified versus willful handgrip exercises for the prevention of PICC-related thrombosis: A meta-analysis and systematic review. Medicine (Baltimore) 2023; 102:e32706. [PMID: 36897677 PMCID: PMC9997825 DOI: 10.1097/md.0000000000032706] [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: 09/21/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Thrombosis is a common yet serious complication in patients with peripherally inserted central venous catheter (PICC), the prevention of thrombosis is very important to the prognosis of PICC patients. We aimed to evaluate the effects of quantified versus willful grip exercises for the prevention of PICC-related thrombosis, to provide evidence to the clinical nursing care of PICC patients. METHODS Two authors searched PubMed et al databases for randomized controlled trials (RCTs) comparing the effects of quantified versus willful grip exercises in PICC patients up to August 31, 2022. Quality assessment and data extraction were independently performed by 2 researchers, and meta-analysis was performed using RevMan 5.3 software. RESULTS 15 RCTs involving 1741 PICC patients were finally included in this meta-analysis. Synthesized outcomes indicated that compared with willful grip exercises, quantified grip exercises reduced the incidence of PICC-related thrombosis (odds ratio = 0.19, 95% confidence interval [CI]: 0.12-0.31) and infection (odds ratio = 0.30, 95% CI: 0.15-0.60) in PICC patients, increased the maximum venous velocity (mean difference = 3.02, 95% CI: 1.87-4.17) and mean blood flow (mean difference = 3.10, 95%CI: 1.57-4.62) in PICC patients (all P < .05). There were no publication biases amongst the synthesized outcomes (all P > .05). CONCLUSION Quantified grip exercises can effectively reduce the occurrence of PICC-related thrombosis and infection, improve the venous hemodynamics. Limited by study population and regions, large-sample, and high-quality RCTs are still needed in the future to further evaluate the effects and safety of quantified grip exercises in PICC patients.
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Affiliation(s)
- Hongliang Luo
- Department of cardiothoracic surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Jin
- Department of urology surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohong Li
- Department of urology surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yinzhu Jiang
- Department of urology surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Zhou
- Department of neonatal surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Oza-Gajera BP, Davis JA, Farrington C, Lerma EV, Moossavi S, Sheta MA, Dwyer A, Almehmi A. PICC line management among patients with chronic kidney disease. J Vasc Access 2023; 24:329-337. [PMID: 34218708 DOI: 10.1177/11297298211025897] [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: 11/17/2022] Open
Abstract
More than 1 million peripherally inserted central catheters (PICC) are placed annually in the US and are used to provide convenient vascular access for a variety of reasons including long term antibiotic treatment, chemotherapy, parenteral nutrition, and blood draws. Although they are relatively easy to place and inexpensive, PICC line use is associated with many complications such as phlebitis/thrombophlebitis, venous thrombosis, catheter-related infection, wound infection, and central vein stenosis. These complications are far more deleterious for patients with chronic kidney disease (CKD) whose lives depend on a functioning hemodialysis access once they reach end stage kidney disease (ESKD). Despite recent guidelines to avoid PICC lines in CKD and ESKD patients, clinical use remains high. There is an ongoing urgency to educate and inform health care providers and the CKD patients themselves in preserving their venous real estate. In this article, we review AV access and PICC line background, complications associated with PICC lines in the CKD population, and recommendations for alternatives to placing a PICC line in this vulnerable patient population.
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Affiliation(s)
| | - James A Davis
- Washington University North County Dialysis, St. Louis, MO, USA
| | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine, Chicago, CA, USA
| | | | | | - Amy Dwyer
- University of Louisville, Louisville, KY, USA
| | - Ammar Almehmi
- University of Alabama at Birmingham, Birmingham, AL, USA
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Li S, Lu H. Functions of Heparin Sodium Injection in the Prevention of Peripherally Inserted Central Catheter-Related Venous Thrombosis in NSCLC Patients during Postoperative Chemotherapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1239058. [PMID: 36299679 PMCID: PMC9592220 DOI: 10.1155/2022/1239058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
Objective This study intended to analyze hazardous factors of venous thrombosis by comparing the effect of different doses of heparin sodium injection on the incidence rate of peripherally inserted central catheter (PICC)-related venous thrombosis in non-small cell lung carcinoma (NSCLC) patients during postoperative chemotherapy. Methods 425 NSCLC patients who received PICC catheterization in Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital from July 2019 to July 2021 were collected. Based on their different pathological types, patients were given two different chemotherapy regimens: pemetrexed+cisplatin or paclitaxel+cisplatin. Patients were grouped according to the different doses of heparin sodium injection adopted. Control group (n = 140). Catheters were sealed with 10 mL saline only. Group I (n = 142). In addition to routine maintenance with normal saline, 2 mL of 10 IU/mL heparin sodium injection was sealed in the catheters under positive pressure every time after catheterization. Group II (n = 143). In addition to routine maintenance with normal saline, 5 mL of 10 IU/mL heparin sodium injection was sealed in the same manner as Group I. The baseline characteristics of the three groups of patients were compared by statistical means. Doppler ultrasonography was applied to check the venous thrombosis. The hazardous factors of venous thrombosis were analyzed through correlation analysis and binary logistic regression method. Results The incidence rates of thrombosis in the control group, Group I, and Group II were 20.00%, 7.04%, and 2.09%, respectively, with statistically significant differences (P < 0.01). Additionally, through the collinear correlation analysis of baseline characteristics, a significant correlation between the dosage of heparin sodium injection and the incidence of thrombosis was observed (P < 0.05), but there were no significant differences between other baseline data and the incidence of thrombosis (P > 0.05). Binary logistic regression analysis revealed that postoperative use of heparin sodium injection (Group I: OR = 0.312; P = 0.003; Group II: OR = 0.082, P < 0.001) was a protective factor for preventing thrombosis. In addition, the thromboprophylaxis effect of Group II was better than that of Group I. No serious adverse reactions were found in safety analysis. Conclusion Heparin sodium could significantly lower the incidence rate of PICC-related venous thrombosis in NSCLC patients during postoperative chemotherapy. Heparin sodium injection is safe enough to be promoted among PICC patients with a high risk of venous thrombosis.
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Affiliation(s)
- Shanquan Li
- Venous Catheterization Nursing Clinic, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, Guangdong Province, China 518100
| | - Hong Lu
- Nursing Department, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, Guangdong Province, China 518100
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12
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Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2791464. [PMID: 36158127 PMCID: PMC9499753 DOI: 10.1155/2022/2791464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
Background. Peripherally inserted central catheter (PICC), as one of the important intravenous routes for the rescue and treatment of critically ill patients, has been widely used in the fluid resuscitation of critically ill patients in intensive care. In particular, PICC can be widely used in the treatment of cancer patients. With the wide application of peripheral central venous catheterization, the clinical findings of bloodstream infection complications caused by PICC have gradually attracted the attention of doctors and patients. Aims. To investigate the effect of specialized placement and PICC placement care on patients with lung cancer who underwent PICC puncture. Patients were selected and divided into a comparison group and an observation group of 40 patients each according to the randomized residual grouping method. In the comparison group, routine PICC placement and catheter maintenance were performed, while the observation group was provided with specialized placement and PICC placement care. The differences in immune and tumor marker levels and nursing compliance between the two groups were observed and compared before and after nursing care. Results. There was no significant difference in the comparison of tumor marker levels between the two groups of patients before care, while the levels of CYFRA21-1, CA125, and VGEF in the observation group were significantly lower than those in the comparison group after care, and this difference was statistically significant (
). There was no statistically significant difference in the comparison of immune levels between the two groups before care (
), while the comparison of CD4+, CD3+, and CD4+/CD8+ after care was significantly different and higher in the observation group than in the comparison group, and the comparison was statistically significant (
). The compliance rate of 93.8% in the observation group was significantly higher than that of 77.9% in the comparison group, and this difference was statistically significant for comparison (
). Conclusion. PICC placement care is more effective in patients with lung cancer and performing PICC puncture, significantly improves patients’ immune and tumor marker levels, improves patients’ negative emotions, reduces disease uncertainty, and improves nursing compliance.
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Li FX, Li YP, Zhang HY, Tian MJ, Gao HH, Zhang GJ, Su P. Guidewire-Assisted Reduction Technology Combined with Postural Reduction Improves the Success Rate of Internal Vein Catheterisation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7171578. [PMID: 35620382 PMCID: PMC9130005 DOI: 10.1155/2022/7171578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the value of guidewire-assisted reduction technology (which increases the stiffness of a catheter through the use of a guidewire, thereby protecting the puncture point and distal vein from breakage) combined with postural reduction for malpositioned catheters in the internal jugular vein during peripherally inserted central venous catheter catheterisation. Methods From January 2015 to August 2020, we used ultrasound to perform guided puncture and monitoring. We identified the tip of the catheter as malpositioned in the internal jugular vein in 99 patients during the catheterisation process. These patients were divided randomly into a control group and an experimental group. In the control group, 43 cases received guidewire-assisted reduction technology, while in the experimental group, 56 patients received guidewire-assisted reduction technology combined with an upright posture. This study compared the efficacy of these two methods. Results The results showed that 30 catheters were reduced successfully in the control group, with a success rate of 69.8%. In the experimental group, 53 cases were successfully reduced, with a success rate of 94.6%. The catheter reduction success rate in the experimental group was significantly higher than in the control group; this was a statistically significant difference (P=0.001). Conclusion Guidewire-assisted reduction technology combined with postural reduction can improve the success rate of the reduction of malpositioned catheters in the internal jugular vein.
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Affiliation(s)
- Feng-Xian Li
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Yan-Ping Li
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Hong-Yang Zhang
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Mei-Jing Tian
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Huan-Huan Gao
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Gui-Juan Zhang
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Peng Su
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
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Liu M, Zheng C, Guan X, Ke Z, Zou P, Yang Y. Development of central venous access device-associated skin impairment assessment instrument. Nurs Open 2022; 9:2095-2107. [PMID: 35502576 PMCID: PMC9190675 DOI: 10.1002/nop2.1220] [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: 06/30/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/12/2022] Open
Abstract
AIM To develop an assessment tool to assess the severity and healing of skin impairment with the central venous access device. DESIGN Delphi technique. METHODS The instrument domain list was developed through a systematic literature review and semi-structured interviews. Experts from China evaluated the relevance and significance of these items in assessing the degree of skin impairment surrounding central venous access device sites through two Delphi rounds. The APA Style JARS checklist for this article was used. RESULTS For the systematic literature review, 28 articles were included to develop the wound assessment instrument. From the articles and interview contents, 15 criteria were selected based on reporting frequency. After further screening via in-depth discussion, the central venous access devices associated with the skin impairment assessment tool were refined to include 14 major domains. Through a two-phase Delphi process, 71 items in 12 domains were ultimately retained.
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Affiliation(s)
- Min Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chonghao Zheng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiangyun Guan
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ziwei Ke
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, Canada
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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15
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Wang X, Wang L, Sheng Y, Zhu C, Jiang N, Bai C, Xia M, Shao Z, Gu Z, Huang X, Zhao R, Liu Z. Automatic and accurate segmentation of peripherally inserted central catheter (PICC) from chest X-rays using multi-stage attention-guided learning. Neurocomputing 2022. [DOI: 10.1016/j.neucom.2022.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Analysis of Nursing Effect and Impact of Narrative Nursing Model on Anxiety of Tumor Patients with PICC under Chemotherapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3698845. [PMID: 34671405 PMCID: PMC8523226 DOI: 10.1155/2021/3698845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 01/29/2023]
Abstract
Objective To explore the nursing effect of the narrative nursing model on tumor patients with PICC under chemotherapy and the impact on patients' anxiety. Methods 200 tumor patients with PICC under chemotherapy treated in our hospital from March 2019 to March 2021 were randomly selected and divided into the control group (routine nursing) and the experimental group (narrative nursing) by the draw method, with 100 cases each. All patients were investigated with the General Anxiety Disorder-7 (GAD-7) scale, and their anxiety scores were over 5 points. The GAD-7 anxiety scores, satisfaction scores, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, quality of life (QLI) scores, and Mental Status Scale in Non-Psychiatric Settings (MSSNS) scores before intubation (T0), 1 d after intubation (T1), 3 d after intubation (T2), and after extubation (T3) of patients in both groups were compared. The adverse reaction rate (ARR) during placement was assessed in both groups, and the effectiveness of patient care was evaluated after extubation. Results Compared with the control group, the experimental group obtained significantly higher satisfaction scores and QLI scores at T0, T1, T2, and T3 and lower GAD-7 anxiety scores, SAS scores, SDS scores, and MSSNS scores at T0, T1, T2, and T3, which were statistically significant (P < 0.05). The experimental group had a significantly higher efficiency of care than the control group and a significantly lower ARR during treatment (P < 0.05). Conclusion The narrative nursing model can remarkably improve the nursing effect, alleviate the anxiety, and provide a more quality nursing for tumor patients with PICC under chemotherapy.
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"With a PICC line, you never miss": The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103438. [PMID: 34593288 DOI: 10.1016/j.drugpo.2021.103438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND People who use drugs (PWUD), and especially those who inject drugs, are at increased risk of acquiring bloodborne infections (e.g., HIV and HCV), experiencing drug-related harms (e.g., abscesses and overdose), and being hospitalized and requiring inpatient parenteral antibiotic therapy delivered through a peripherally inserted central catheter (PICC). The use of PICC lines with PWUD is understood to be a source of tension in hospital settings but has not been well researched. Drawing on theoretical and analytic insights from "new materialism," we consider the assemblage of sociomaterial elements that inform the use of PICCs. METHODS This paper draws on n = 50 interviews conducted across two related qualitative research projects within a program of research about the impact of substance use on hospital admissions from the perspective of healthcare providers (HCPs) and people living with HIV/HCV who use drugs. This paper focuses on data about PICC lines collected in both studies. RESULTS The decision to provide, maintain, or remove a PICC is based on a complex assemblage of factors (e.g., infections, bodies, drugs, memories, relations, spaces, temporalities, and contingencies) beyond whether parenteral intravenous antibiotic therapy is clinically indicated. HCPs expressed concerns about the risk posed by past, current, and future drug use, and contact with non-clinical spaces (e.g., patient's homes and the surrounding community), with some opting for second-line treatments and removing PICCs. The majority of PWUD described being subjected to threats of discharge and increased monitoring despite being too ill to use their PICC lines during past hospital admissions. A subset of PWUD reported using their PICC lines to inject drugs as a harm reduction strategy, and a subset of HCPs reported providing harm reduction-centred care. CONCLUSION Our analysis has implications for theorizing the role of PICC lines in the care of PWUD and identifies practical guidance for engaging them in productive and non-judgemental discussions about the risks of injecting into a PICC line, how to do it safely, and about medically supported alternatives.
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Salgueiro-Oliveira A, Bernardes RA, Adriano D, Serambeque B, Santos-Costa P, Sousa LB, Gama F, Barroca R, Braga LM, Graveto J, Parreira P. Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7618. [PMID: 34300069 PMCID: PMC8303562 DOI: 10.3390/ijerph18147618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses' perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: 'nursing practices' and 'patients'. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice.
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Affiliation(s)
- Anabela Salgueiro-Oliveira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Rafael A. Bernardes
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - David Adriano
- Coimbra Hospital and Universitary Centre—General Hospital, 3041-801 Coimbra, Portugal;
| | - Beatriz Serambeque
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics Institute of Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3000-548 Coimbra, Portugal
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Liliana B. Sousa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Fernando Gama
- Coimbra Hospital and Universitary Centre, 3004-561 Coimbra, Portugal;
| | - Rita Barroca
- Hospital dos Lusíadas, 1500-458 Lisbon, Portugal;
| | - Luciene M. Braga
- Nursing Department, Federal University of Viçosa, Viçosa 36570-900, Brazil;
| | - João Graveto
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Pedro Parreira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
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19
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Kelly L, Dreher D, Kim G, Hughes T, Sabouri AS. Placement of a Peripherally Inserted Central Catheter in a Prone Patient With COVID-19: Feasibility and Case Report. JOURNAL OF INFUSION NURSING 2021; 44:199-202. [PMID: 34197349 PMCID: PMC8257419 DOI: 10.1097/nan.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The emergence of the coronavirus disease 2019 (COVID-19) virus has increased in patients with acute respiratory distress syndrome (ARDS). The use of prone positioning during COVID-19-associated ARDS has led to improved oxygenation and decreased mortality. Extended hours of proning may delay or prevent traditional approaches to central vascular access, such as jugular, subclavian, or femoral cannulation. A peripherally inserted central catheter (PICC) is a viable option for prone patients. This article presents a PICC placement in a 56-year-old man with COVID-19 ARDS who required 20- to 24-hour prone positioning during his care in the intensive care unit. Insertion of a PICC while the patient is prone expedites lifesaving medications and infusions without waiting for the patient to be stable enough to be turned to the supine position.
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Affiliation(s)
- Linda Kelly
- Corresponding Author: Linda Kelly, DNP, CNP, NCMP, Massachusetts General Hospital, 55 Fruit St, MGH Bigelow 1034, Boston, MA 02114 ()
| | - Denise Dreher
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - Georgia Kim
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - Timothy Hughes
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - A. Sassan Sabouri
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
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20
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Gupta N, Gandhi D, Sharma S, Goyal P, Choudhary G, Li S. Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting. Quant Imaging Med Surg 2021; 11:1619-1627. [PMID: 33816196 DOI: 10.21037/qims-20-694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vascular access procedures are crucial for the management of various critically ill pediatric and adult patients. Venous access is commonly performed in the form routine as well as tunneled peripherally inserted central catheters (PICC). These venous accesses are commonly used in emergency, surgical as well as ICU settings, for various infusions, total parenteral nutrition, long term intravenous antibiotics, frequent blood draws, etc. PICC insertion is guided using ultrasound and fluoroscopic guidance, which decreases the risk of complications that are otherwise seen with central venous accesses like triple lumen catheters, etc. PICC insertion and care is very simple and can be performed by specially trained PICC nurses and that helps in decreasing the overall cost of healthcare. This review article is written with educational intent for the readers to discuss indications, contraindications, procedure techniques, imaging, care of routine as well as tunneled PICC.
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Affiliation(s)
- Nishant Gupta
- Department of Radiology, Bassett Healthcare, Cooperstown, NY, USA
| | - Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Salil Sharma
- Department of Radiology, Bassett Healthcare, Cooperstown, NY, USA
| | - Pradeep Goyal
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gagandeep Choudhary
- Department of Radiology; Division of Molecular Imaging & Therapeutics and Neuroradiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shuo Li
- Department of Radiology, KU School of Medicine-Wichita, University in Wichita, Wichita, KS, USA
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21
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Li J, Huang XF, Luo JL, Zhang JY, Liang XL, Huang CL, Qin HY. Effect of video-assisted education on informed consent and patient education for peripherally inserted central catheters: a randomized controlled trial. J Int Med Res 2020; 48:300060520947915. [PMID: 32910712 PMCID: PMC7488911 DOI: 10.1177/0300060520947915] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the effects of a video-assisted education intervention on informed consent and patient education for peripherally inserted central catheters (PICCs). METHODS We conducted a randomized controlled trial comparing the effects on informed consent of video-assisted patient education and traditional face-to-face discussion in a catheter outpatient ward of a cancer centre in Guangzhou, China, in 2018. Participants were 140 patients randomly allocated (1:1 ratio) to two groups: video-assisted or traditional intervention. General information, patient retention of PICC-related information, working time spent by nurses on the procedure, and patient and nurse satisfaction with the procedure were assessed. RESULTS The time used for informed consent was significantly shorter in the experimental group (1.02 ± 0.24 minutes) than in the control group (6.87 ± 1.10 minutes). The time used for PICC-related education was significantly shorter in the experimental group (1.03 ± 0.28 minutes) than in the control group (5.11 ± 0.57 minutes). Nurses' degree of satisfaction with the procedure was significantly higher in the experimental group (4.10 ± 0.57) than in the control group (2.60 ± 0.70). CONCLUSION The use of video-assisted informed consent and patient education in this cancer centre decreased nurses' working time and improved nurses' satisfaction.Clinical trial registration number: ChiCTR1800015664.
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Affiliation(s)
- Jia Li
- Department of Catheter Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xue-Fang Huang
- Department of Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jie-Lin Luo
- Department of Catheter Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jiang-Yun Zhang
- Department of Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xiao-Lin Liang
- Department of Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chun-Li Huang
- Department of Outpatient Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Ying Qin
- Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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