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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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Kim J, Keum H, Albadawi H, Zhang Z, Graf EH, Cevik E, Oklu R. Multi-Functional Biomaterial for the Treatment and Prevention of Central Line-Associated Bloodstream Infections. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2405805. [PMID: 39148150 DOI: 10.1002/adma.202405805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/01/2024] [Indexed: 08/17/2024]
Abstract
Central venous catheters are among the most used medical devices in hospitals today. Despite advances in modern medicine, catheter infections remain prevalent, causing significant morbidity and mortality worldwide. Here, SteriGel is reported, which is a multifunctional hydrogel engineered to prevent and treat central line-associated bloodstream infections (CLABSI). The mechanical properties of SteriGel are optimized to ensure appropriate gelation kinetics, bio-adhesiveness, stretchability, and recoverability to promote durability upon application and to provide persistent protection against infection. In vitro assays demonstrated that SteriGel exhibits long-term antimicrobial efficacy and has bactericidal effects against highly resistant patient-derived pathogens known to be frequently associated with CLABSI. SteriGel outperformed Biopatch, which is a clinically used device for CLABSI, in ex vivo cadaver studies that simulate clinical scenarios. Furthermore, SteriGel has biocompatible, pro-healing, and anti-inflammatory properties in vitro and in a rat subcutaneous injection model, suggesting a potential synergistic effect in the prevention and treatment of CLABSI. SteriGel is a multifunctional adherent biomaterial with potent antimicrobial effects for sustained sterility while promoting healing of the catheter incision site to protect against infection.
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Affiliation(s)
- Jinjoo Kim
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Hyeongseop Keum
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Hassan Albadawi
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Zefu Zhang
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Erin H Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Enes Cevik
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Rahmi Oklu
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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Takashima M, Gibson V, Borello E, Galluzzo L, Gill FJ, Kinney S, Newall F, Ullman AJ. Pediatric invasive device utility and harm: a multi-site point prevalence survey. Pediatr Res 2024; 96:148-158. [PMID: 38200324 PMCID: PMC11257939 DOI: 10.1038/s41390-023-03014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND AIMS Invasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals. METHODS In 2022-2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics. RESULTS Of the 285 patients audited, 78.2% had an invasive device (n = 412 devices), with a median of 1 device-per-patient (interquartile range 1-2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices (n = 223; 54.1%), followed by gastrointestinal devices (n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices). CONCLUSIONS The study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings. IMPACT A high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient. The most common devices used in pediatric healthcare are vascular access devices (n = 223; 54.1%), however, 16% (n = 36) of these devices failed, and one-third had complications. The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.
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Affiliation(s)
- Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia.
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Eloise Borello
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lily Galluzzo
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
| | - Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Sharon Kinney
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Newall
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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Gavin NC, Northfield S, Mihala G, Somerville M, Kleidon T, Marsh N, Larsen E, Campbell J, Rickard CM, Ullman AJ. Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study. Semin Oncol Nurs 2024; 40:151618. [PMID: 38622044 DOI: 10.1016/j.soncn.2024.151618] [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: 10/08/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 04/17/2024]
Abstract
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.
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Affiliation(s)
- Nicole C Gavin
- Nurse Researcher, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston; Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Adjunct Associate Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Senior Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Senior Research Fellow, School of Medicine, University of Queensland, Herston; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Sarah Northfield
- Clinical Nurse Consultant, Specialist Palliative Care Service, Toowoomba Hospital, Queensland, Australia
| | - Gabor Mihala
- Biostatistician, School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Margarette Somerville
- Clinical Nurse Research, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia Kleidon
- Paediatrics and Neonatal Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Research Fellow, School of Nursing and Midwifery, Griffith University, Nathan; Nurse Practitioner, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- Acute/Critical Care Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Emily Larsen
- Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; School of Nursing and Midwifery, Griffith University, Nathan; Research Fellow, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jill Campbell
- Adjunct Senior Research Fellow, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire M Rickard
- Infection Prevention Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan; Professor, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus; and Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia
| | - Amanda J Ullman
- Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
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Li JY, Li J, Fan YY, Lin XL, Huang CL, Qin HY. Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method. J Vasc Access 2024; 25:759-766. [PMID: 35674111 DOI: 10.1177/11297298221075166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients. METHODS On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients. RESULTS Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall's harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients. CONCLUSION Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.
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Affiliation(s)
- Ji-Yue Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yu-Ying Fan
- Nasopharyngeal Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xi-Ling Lin
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chun-Li Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Ying Qin
- Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [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: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Imbriaco G, Spencer TR, Bardin-Spencer A. 10 best practice tips with radial arterial catheterization. J Vasc Access 2024; 25:363-368. [PMID: 35655446 DOI: 10.1177/11297298221101243] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Radial arterial catheters (RAC) are used extensively across critical care settings (Anesthesia, Intensive Care, Emergency Medicine) for continuous hemodynamic monitoring, allowing for immediate adjustments in vasopressor therapies and blood collection. Radial catheter failures are an ongoing significant issue for critical care clinicians with reported incidences at almost 25%. Common complications include loss of function, lack of blood return, poor quality waveforms and dislodgement, posing potential patient risks, and sudden loss of intra-arterial monitoring frequently requires prompt replacement. Contemporary research and technological improvements have highlighted several concepts to enhance the approach of RAC insertion and management while reducing immediate and late complications. The authors have prioritized the following 10 "best practice" aspects that may improve overall device function and reliability.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est (Prehospital Emergency Medical Dispatch Centre), Helicopter Emergency Medical Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Department of Medical and Surgical Sciences, School of Medicine and Surgery, University of Bologna, Bologna, Italy
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Takashima M, Hyun A, Gibson V, Borello E, Ullman A. Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38263365 DOI: 10.1111/jan.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
AIM This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. DESIGN This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. DATA SOURCES MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. REVIEW METHODS Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. RESULTS This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. CONCLUSIONS This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. IMPACT Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. REPORTING METHOD MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria Gibson
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Eloise Borello
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Ullman
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Brisbane, Queensland, Australia
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Paterson RS, Larsen EN, Cooke M, Rickard CM, Walker RM, Marsh N. Integrated versus non-integrated peripheral intravenous catheters: a cross-sectional survey of nurse experiences. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S6-S16. [PMID: 36715520 DOI: 10.12968/bjon.2023.32.2.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Integrated peripheral intravenous catheters (PIVCs) demonstrate clinical efficacy, however, device complexity and design differences may be a potential barrier to implementation. AIMS To assess nurse acceptability of integrated PIVC systems. METHODS A cross-sectional survey was nested within a multicentre randomised controlled trial. One hundred nurses caring for patients with integrated and non-integrated PIVCs completed a 17-item survey about key differences between devices (eg function and appearance, perceived patient comfort and skin injuries). FINDINGS Most nurses reported the integrated PIVC wings prevented device movement (80%), achieved patient comfort in areas of flexion (78%), and no patients developed skin injuries (100%). Nurses rated the ease of accessing and overall confidence using the integrated PIVC as significantly higher than the non-integrated design (P<0.001). CONCLUSION The integrated PIVC received positive feedback from nurses and had few barriers to implementation.
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Affiliation(s)
- Rebecca S Paterson
- Senior Research Assistant, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Emily N Larsen
- Research Fellow, Vascular Access, Griffith University and Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marie Cooke
- Professor Emeritus, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- Professor, Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Rachel M Walker
- Associate Professor, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole Marsh
- Professor and Nursing and Midwifery Director (Research), Griffith University and Royal Brisbane and Women's Hospital, Brisbane, Australia
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10
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Prado NCDC, Menezes HFD, Sousa PAF, Lopes DCL, Santos FRD, Santos RSDC, Almino RHSC, Silva RARD. Terms of specialized nursing language in the care of the newborn with central venous catheter. Rev Bras Enferm 2022; 75:e20210572. [PMID: 35920494 DOI: 10.1590/0034-7167-2021-0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To construct and validate a specialized nursing terminology for the care of newborns with peripherally inserted central venous catheters (PICC), based on the Betty Neuman Systems Model. METHODS Methodological study, carried out in a public maternity hospital, operationalized by the steps: extraction of terms from medical records of neonates using PICC; normalization; cross-mapping with the 2019/2020 version of ICNP®; organization in the Seven Axes; and content validation with nurses using content validity index and kappa coefficient. RESULTS 1,718 terms were extracted, and 372 relevant terms were normalized, with 265 constants and 107 non-constants. A total of 335 terms were validated, 246 of which were constant and 89 were not constant, which reached an agreement index and kappa ≥ 0.80. CONCLUSION Relevant terms were identified, which aid newborns using central venous catheters; thus, a terminological subset will be contributed to information in nursing practice.
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Pearse I, Corley A, Larsen EN, Rickard CM, Ware RS, Campbell J, Coyer F, Alexandrou E, O'Brien C, Marsh N. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial. Trials 2022; 23:390. [PMID: 35549750 PMCID: PMC9097412 DOI: 10.1186/s13063-022-06322-9] [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: 11/18/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. METHODS This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) 'standard' (in accordance with local hospital policy) CVAD dressings (control) or (2) 'standard' dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is 'dressing failure' defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). DISCUSSION This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021.
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Affiliation(s)
- India Pearse
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia. .,Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Australia. .,School of Nursing and Midwifery, Griffith University, Brisbane, Australia. .,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Herston, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jill Campbell
- National Health and Medical Research Council Centre for Research Excellence, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Fiona Coyer
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia.,Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- AVATAR Group, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery and Centre for Applied Nursing Research, Western Sydney University, Penrith, Australia.,Department of Intensive Care, Liverpool Hospital, Liverpool, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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12
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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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13
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Corley A, Marsh N, Ullman AJ, Rickard CM. Peripheral intravenous catheter securement: An integrative review of contemporary literature around medical adhesive tapes and supplementary securement products. J Clin Nurs 2022; 32:1841-1857. [PMID: 35118759 DOI: 10.1111/jocn.16237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
| | - Amanda J Ullman
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
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Prado NCDC, Menezes HFD, Sousa PAF, Lopes DCL, Santos FRD, Santos RSDC, Almino RHSC, Silva RARD. Termos da linguagem especializada de enfermagem no cuidado ao recém-nascido com cateter venoso central. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0572pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Construir e validar uma terminologia especializada de enfermagem para o cuidado a recém-nascidos com cateter venoso central de inserção periférica (PICC), com base no Modelo de Sistemas de Betty Neuman. Métodos: Estudo metodológico, realizado em uma maternidade pública, operacionalizado pelas etapas: extração dos termos de prontuários de neonatos em uso de PICC; normalização; mapeamento cruzado com a versão 2019/2020 da CIPE®; organização nos Sete Eixos; e validação de conteúdo com enfermeiros usando-se índice de validade de conteúdo e coeficiente kappa. Resultados: Extraíram-se 1.718 termos, sendo normalizados 372 termos pertinentes, estando 265 constantes e 107 não constantes. Foram validados 335 termos, sendo 246 constantes e 89 não constantes, os quais atingiram um índice de concordância e kappa ≥ 0,80. Conclusão: Identificaramse termos relevantes, que oportunizam a assistência aos recém-nascidos em uso de cateter venoso central; assim se contribuirá com um subconjunto terminológico para a informação na prática de enfermagem.
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Outcomes following port-a-catheter placement in the Medicare population. Surg Open Sci 2020; 3:39-43. [PMID: 33937739 PMCID: PMC8077681 DOI: 10.1016/j.sopen.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to evaluate the long-term complication profile associated with port-a-catheter placement. Methods Patients undergoing port-a-catheter placement from 2007 to 2012 with 5-year follow up were identified. Descriptive statistics, χ2 tests, and multivariate regression models were analyzed. Results Any complication occurring within 5 years postoperatively was common (59.04%, n = 53,353). Arrhythmogenic (32.66%, n = 30,625) and thrombovascular (36.80%, n = 34,499) complications were more common than infection (17.86%, n = 16,745) and mechanical (10.31%, n = 9,670) complications. Multivariate analysis demonstrated that history of atrial fibrillation is a risk factor for developing any complication (odds ratio 7.99, 95% confidence interval 7.29-8.77). Conclusion Patients with history of atrial fibrillation have increased odds of developing infectious, thrombovascular, mechanical, and arrhythmogenic complications with port-a-catheter placement. This study is the first to show that postprocedure arrhythmias occur at significant rates within the 5-year follow-up period. We caution that development of new arrhythmia should be monitored throughout a prolonged follow-up period. We hope our analysis encourages multidisciplinary coordination of patients with ports so that implants are promptly removed when they are no longer needed to avoid these complications.
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Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study. Support Care Cancer 2020; 29:1487-1496. [PMID: 32710173 DOI: 10.1007/s00520-020-05643-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
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 27th March 2017 (ACTRN12617000438358); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true.
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Kleidon TM, Rickard CM, Gibson V, Mihala G, Schults JA, Xu H(G, Bauer MJ, Marsh N, Larsen EN, Cattanach P, Ullman AJ. Smile - Secure my intravenous line effectively: A pilot randomised controlled trial of peripheral intravenous catheter securement in paediatrics. J Tissue Viability 2020; 29:82-90. [DOI: 10.1016/j.jtv.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 01/07/2023]
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