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Huang W, Liu Z, Feng L, Zhu H. Peripheral intravenous therapy infiltration and extravasation (PIVIE) risks in 11 006 paediatric surgery inpatients in China: a retrospective observational study. J Int Med Res 2024; 52:3000605241283600. [PMID: 39382036 DOI: 10.1177/03000605241283600] [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: 10/10/2024] Open
Abstract
OBJECTIVE To determine the risk factors associated with peripheral intravenous therapy infiltration and extravasation (PIVIE) in paediatric surgery inpatients. METHODS This retrospective observational study was conducted at a tertiary general hospital in Sichuan, China. Logistic regression was employed to identify independent risk factors predictive of PIVIE. Kaplan-Meier survival analysis was undertaken to determine the relationship between the occurrence of PIVIE and the duration of that event (survival time). RESULTS This study included 11 006 paediatric surgery inpatients and 19 771 peripheral intravenous catheters (PIVCs). The incidence of PIVIE was 16.93% (3347 of 19 771). The following were significant predictors of PIVIE: sex (odds ratio [OR] 0.834; 95% confidence interval [CI] 0.772, 0.900); age (OR 0.945; 95% CI, 0.934, 0.956); disease classification (OR 0.962, 95% CI 0.950, 0.976); puncture site (OR 1.061; 95% CI 1.044, 1.078); and indwelling time (OR 1.257; 95% CI 1.215, 1.300). CONCLUSIONS Sex, age, type of disease, puncture site and indwelling time were risk factors for PIVIE. The puncture site should be effectively assessed and accurately selected. Informed judgements should be based on the child's sex, age and medical condition, so that the appropriate preventive measures to minimize the risk of PIVIE can be implemented.
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Affiliation(s)
- WenJiao Huang
- Department of Paediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Zheng Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Liwei Feng
- Department of Paediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Hong Zhu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
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2
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Lai JY, Wu MJ, Gautama MSN, Huang TW. Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2024; 151:131-139. [PMID: 39032564 DOI: 10.1016/j.jhin.2024.07.003] [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: 05/11/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
Midline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. We conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus and ProQuest, up to April 2024. The primary outcomes analysed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. Of 831 initially identified articles, five trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared with PICCs (relative risk = 1.95, 95% confidence interval = 1.23-3.08, P=0.005, I2= 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. PICCs are associated with fewer total complications and longer dwell times compared with MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional RCTs, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.
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Affiliation(s)
- J-Y Lai
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - M-J Wu
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - M S N Gautama
- Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali, Indonesia
| | - T-W Huang
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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3
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Gorski LA, Ong J, Van Gerpen R, Nickel B, Kokotis K, Hadaway L. Development of an Evidence-Based List of Non-Antineoplastic Vesicants: 2024 Update. JOURNAL OF INFUSION NURSING 2024; 47:290-323. [PMID: 39250767 DOI: 10.1097/nan.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Infiltration of a vesicant, called extravasation, can result in severe patient injuries. Recognition of vesicants and their relative risk of injury is essential to extravasation prevention, early recognition, and appropriate treatment. In this article, the Vesicant Task Force (VTF) updates the previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS list diverges from earlier vesicant lists, such as the 2017 VTF list, by adopting a risk stratification approach based upon documented patient outcomes, in contrast to the reliance on expert consensus or only surrogate risk indicators, such as pH and osmolarity. The methodology used to create the updated list is explained, and the criteria for high- and moderate-risk vesicants and cautionary vesicants are defined.
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Affiliation(s)
- Lisa A Gorski
- Author Affiliations: Ascension at Home, Brentwood, Tennessee (Gorski); Bryan Medical Center, Lincoln, Nebraska (Ong); Retired from Bryan Medical Center, Lincoln, Nebraska (Van Gerpen); Omaha, Nebraska (Nickel); Retired from BD Medical, Munster, Indiana (Kokotis); Lynn Hadaway Associates, Inc., Milner, Georgia (Hadaway)
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Thushara NL, Singh P, Priyadarshi M, Chaurasia S, Bhat NK, Basu S. Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial. Indian J Pediatr 2024; 91:794-800. [PMID: 37578610 DOI: 10.1007/s12098-023-04756-w] [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: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. METHODS The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC. Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. RESULTS Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. CONCLUSIONS Splint application did not affect functional PIVC duration and its related complications in neonates.
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Affiliation(s)
- Nadella Lakshmi Thushara
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Gürcan M, Karataş N, Kaya A, Turan SA, Güler E. The effect of a pushing technique with normal saline on peripheral intravenous catheter placement success in paediatric haematology and oncology: A randomized controlled trial. Eur J Oncol Nurs 2024; 71:102656. [PMID: 39002409 DOI: 10.1016/j.ejon.2024.102656] [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: 05/30/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE The aim of the present study is to determine the effect of the pushing technique with saline on the success of peripheral IV catheter placement in a paediatric haematology and oncology sample. METHODS The randomized controlled trial was conducted among 60 paediatric haematology and oncology patients aged between 0 and 17. The participants were randomly assigned to two peripheral intravenous catheter placement groups (intervention group, n:30, control group, n:30). Each patient was evaluated with the Difficult Intravenous Access (DIVA) score before being included in the study. Each patient was assessed using the Personal Information Form for Children and Catheter Registration Form. RESULTS The average age of the children was 86.4 months (SD = 60.0); 36.7% were female. The pushing technique with saline significantly increased the success of placing a peripheral IV catheter on the first attempt in the intervention group compared to the control group (F = 42.391, p = 0.000). The number of attempts during peripheral IV catheter placement significantly decreased in the intervention group compared with the control group (t = -5.676, p = 0.000). Complications were less in the intervention group compared with the control group (χ2 = 24.438, p = 0.000). The procedure time was significantly shorter in the intervention group compared with the control group (t = -4.026, p = 0.000). CONCLUSION The pushing technique with saline is an effective method to increase the first attempt success rate, decrease the number of attempts, reduce the procedure time, and reduce the complications during peripheral intravenous catheter placement procedures in paediatric haematology and oncology patients with difficult intravenous access. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05685290 & date of first recruitment: January 3, 2023) https://clinicaltrials.gov/ct2/show/NCT05685290.
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Affiliation(s)
- Meltem Gürcan
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Nimet Karataş
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Ayla Kaya
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Sevcan Atay Turan
- Paediatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Elif Güler
- Paediatric Hematology and Oncology Department, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey.
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Jorro-Barón F, Taffarel P. Balancing pediatric device utility and harm: navigating the challenges for safer healthcare. Pediatr Res 2024; 96:25-26. [PMID: 38443522 DOI: 10.1038/s41390-024-03126-2] [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: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
This article discusses the challenges in balancing the utility and harm associated with pediatric medical devices. Takashima et al. explored the prevalence and complications of invasive devices across three Australian pediatric tertiary hospitals and reported a high prevalence of complications, particularly with vascular access devices. We also highlight the need to pay attention to the use of these devices, particularly intravenous catheters, and the importance of a culture of patient safety in healthcare systems. We emphasize the need for a nuanced approach that carefully weighs the benefits against potential risks and encourages collaboration among stakeholders to establish robust regulatory frameworks and prioritize the safety and well-being of pediatric patients. Finally, we conclude by advocating the involvement of parents and families in gathering information about hospital safety incidents and fostering a culture of safety that supports reporting, flexibility, and learning. IMPACT: Reporting adverse events and their consequences is essential in the strategy to prevent them, allowing comparison with national or international standards, and identifying indicators to optimize and harbor the possibility of determining improvement measures that pursue a multifactorial approach and are cost-effective. Our comment advocates limiting the prevalence of medical invasive devices and their consequences by reviewing their epidemiology. Although advancements in medical technology have undoubtedly improved the diagnostic and therapeutic possibilities, the delicate balance between device utility and potential harm necessitates careful consideration.
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Affiliation(s)
- Facundo Jorro-Barón
- Institute for Clinical Effectiveness and Health Policy -IECS- Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
- Hospital Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Pedro Taffarel
- Hospital Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
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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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8
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Kamata M. Required volume for color flow injection test to confirm the intravascular placement of a peripheral venous catheter. J Vasc Access 2024:11297298241258625. [PMID: 38855976 DOI: 10.1177/11297298241258625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Confirmation of adequate peripheral intravenous catheter placement is essential before using venous catheters. The color flow injection test has been reported as a method with high sensitivity and specificity for this purpose. The technique involves administrating saline through the peripheral venous route to observe changes in the color flow pattern around the same vein at a more central location. However, the required volume of saline remains uncertain. This study aims to determine the appropriate dosage for conducting the test in pediatric patients and explore any potential correlations between dosage and patient characteristics. METHODS A prospective study was conducted in children under 6 years of age with American Society of Anesthesiologists Physical Status 1-2 presenting for general anesthesia. After an intravenous cannula was placed in the forearm under general anesthesia, normal saline was injected at a speed of approximately 1 mL/s while the axillary artery and vein were observed with color flow Doppler imaging. The volume of normal saline required to induce a change in the color flow pattern around the vessels was measured. Measurements were performed twice and averaged for comparison with patient characteristics and other factors. RESULTS The study cohort included 30 patients aged from 0.3 to 5.5 (2.6 ± 1.6) years. The change in color flow Doppler imaging was noted in all the patients, and the average volume was 1.40 ± 0.36 mL (95% confidence interval (CI), 1.27-1.54; p < 0.001), which was significantly correlated with age, with a correlation coefficient of 0.435 (95% CI, 0.09-0.69; p = 0.02). CONCLUSIONS The required volume for the color flow injection test is small; therefore, the test is easy to perform and minimally invasive in pediatric patients.
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Affiliation(s)
- Mineto Kamata
- Department of Anesthesiology, Saitama International Medical Center, Saitama, Japan
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Felipe MDAA, Peterlini MAS, Ullman A, Pedreira MDLG. Michigan appropriateness guide for intravenous catheters in pediatrics - miniMAGIC-Brasil: translation into Brazilian portuguese. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023159. [PMID: 38747843 PMCID: PMC11095236 DOI: 10.1590/1984-0462/2024/42/2023159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/25/2023] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. METHODS Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master's and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, "not equivalent"; 2, "inequivalent"; 3, "cannot assess"; 4, "quite equivalent"; 5, "totally equivalent". The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. RESULTS The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. CONCLUSIONS The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.
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Ullman AJ, Gibson V, Kleidon TM, Binnewies S, Ohira R, Marsh N, McBride C, Winterbourn K, Boyte F, Cunninghame J, Roberts N, Xu GH, Takashima M, Cooke M, Rickard CM, Byrnes J, Larsen E. An mHealth application for chronic vascular access: Consumer led co-creation. J Pediatr Nurs 2024; 76:68-75. [PMID: 38364591 DOI: 10.1016/j.pedn.2024.02.006] [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: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Children with chronic and complex health conditions frequently need intravenous devices. The current approach to intravenous device selection, insertion, and monitoring is inconsistent, and healthcare consumers are often negatively affected by siloed health information, and poor future planning. Despite child- and family-centred care being recognised as a pillar of paediatric nursing care, limited implementation for vascular access device planning and management is evident. DESIGN AND METHODS To address this, we conducted a multi-phased approach to co-create, then evaluate, a mobile health (mHealth) application: IV Passport. Co-creation involved a prioritisation survey, followed by a Passport advisory panel consensus meeting. Following confirmation of the required content and features of the Passport, the mHealth application was designed and content validation achieved via survey. RESULTS The prioritisation survey yielded recommendations for seven features (e.g., graphical presentations of current/past devices). Content for nine device types (e.g., totally implanted ports) was suggested, each with 10 related items (e.g., insertion site). Content items for device-associated complications, future vascular access plans, and educational resources were also suggested. Following design, the application was released through Apple and Android platforms; and adapted to a paper version. Content validation was established; 100% strongly agreed the application was easy to use; 80% agreed/strongly agreed that they would recommend the Passport to others. CONCLUSION IV Passport embodies effective child- and family-centred care through consumer co-creation to empower patients and families manage vascular access devices. PRACTICE IMPLICATIONS IV Passport remains active; and can be utilised across many healthcare settings and patient populations.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Craig McBride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | | | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Natasha Roberts
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Grace Hui Xu
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
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Charters B, Foster K, Lawton B, Lee L, Byrnes J, Mihala G, Cassidy C, Schults J, Kleidon TM, McCaffery R, Van K, Funk V, Ullman A. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:437-445. [PMID: 38558161 PMCID: PMC10985620 DOI: 10.1001/jamapediatrics.2024.0167] [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: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Importance Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes. Objective To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure. Design, Setting, and Participants A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024. Interventions Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient. Main Outcomes and Measures Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs. Results A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P ≤ .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups. Conclusions and Relevance In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
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Affiliation(s)
- Brooke Charters
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Kelly Foster
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Benjamin Lawton
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Leonard Lee
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Corey Cassidy
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
- North West Regional Hospital, Cooee, Tasmania, Australia
| | - Jessica Schults
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Herston Infectious Disease Institute, Brisbane, Queensland, Australia
| | - Tricia M. Kleidon
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Ruth McCaffery
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Kristy Van
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Vanessa Funk
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Central West Hospital and Health Service, Glasson House, Longreach, Queensland, Australia
| | - Amanda Ullman
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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12
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Ng SLA, Leow XRG, Ang WW, Lau Y. Effectiveness of near-infrared light devices for peripheral intravenous cannulation in children and adolescents: A meta-analysis of randomized controlled trials. J Pediatr Nurs 2024; 75:e81-e92. [PMID: 38195374 DOI: 10.1016/j.pedn.2023.12.034] [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: 03/23/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To examine the effectiveness of near-infrared light devices (NIR) on procedure time of successful cannulation, success rate at the first attempt, and pain scores among pediatric patients and explore potential covariates on the intervention effect. BACKGROUND Pediatric patients have encountered a high failure rate as compared with adult patients using traditional cannulation. NIR devices might help to access veins with an optimum viewing area and eliminate the number of attempts. However, methodological limitations and inconsistent results from previous reviews were found. METHODS A three-step comprehensive search was performed in nine databases. Meta-analysis, subgroup, and meta-regression analyses were conducted. Individual quality assessment and certainty of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessments, Development, and Evaluation criteria, respectively. RESULTS We included 18 randomized controlled trials (RCTs) with 5298 children and adolescents across nine countries. NIR light devices significantly reduce -29.43 s of procedure time and -0.47 attempts of peripheral intravenous cannulation compared with traditional methods. Subgroup analysis observed a significantly large effect size on procedure time using AccuVein with pre-procedure training at the clinics. However, NIR light devices do not significantly decrease the procedure time, first attempt success rate, and pain scores. Meta-regression identified sample size as a significant covariate that had an impact on the success rate at the first attempt. CONCLUSIONS The near-infrared light device can statistically significantly reduce the procedure time and the number of attempts. Given the low or very low certainty of the evidence, future well-designed RCTs are necessary.
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Affiliation(s)
- Si Li Annalyn Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xin Rong Gladys Leow
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wen Wei Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Lau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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13
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Taşdelen Y, Topan A, Öztürk Şahin Ö. Paediatric nurses' experiences of success and failure in first-time peripheral intravenous catheter insertion: A qualitative study. J Pediatr Nurs 2024; 75:57-63. [PMID: 38101312 DOI: 10.1016/j.pedn.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE To explore in-depth the thoughts, anxiety factors, and experiences of paediatric nurses regarding the success and failure of first-time peripheral intravenous catheter insertion. DESIGN AND METHODS The study employed a qualitative research method using the phenomenology design. Face-to-face semi-structured in-depth interviews were conducted with nurses (N = 12) working in the paediatric service and neonatal intensive care unit of a teaching and research hospital. The transcripts were analysed using a phenomenological approach and an inductive process. RESULTS Four themes were identified: Peripheral Intravenous Catheter Insertion, Experience of Success on the First Attempt, Experience of Failure on the First Attempt, and Proposed Solutions. Nurses felt a sense of happiness when they successfully inserted a peripheral intravenous catheter on their first attempt in paediatric patients. Conversely, they experienced emotions such as sadness, worry, stress, and anxiety when they failed and had to make repeated attempts. CONCLUSION Unsuccessful peripheral intravenous catheter insertions cause distress and anxiety for nurses, patients, and parents alike. Therefore, nurses' experiences of peripheral intravenous catheter insertions in healthcare settings should not be ignored and require improvement. IMPLICATIONS FOR CLINICAL PRACTICE Unsuccessful peripheral intravenous catheter insertions affect children, parents, and nurses negatively, thus reducing the success rate of repeated peripheral intravenous catheter insertions. Therefore, it is advisable for nurses conducting paediatric peripheral intravenous catheterisations to undergo periodic training. A specialised intervention team should be established for cases of initial failure, and a mentoring system between seasoned and new nurses is recommended.
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Affiliation(s)
- Yeliz Taşdelen
- Karabük University, Faculty of Health Sciences, Department of Pediatric Nursing, Karabük, Türkiye.
| | - Aysel Topan
- Zonguldak Bülent Ecevit University, Faculty of Health Sciences, Department of Pediatric Nursing, Zonguldak, Türkiye.
| | - Özlem Öztürk Şahin
- Karabük University, Faculty of Health Sciences, Department of Pediatric Nursing, Karabük, Türkiye.
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14
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Zhang X, Xu S, Sun J, Yang Y, Piao M, Lee SY. Nomogram for Predicting the Risk of Complications in Hospitalized Children With Peripheral Intravenous Catheters. J Patient Saf 2024; 20:91-98. [PMID: 38126799 DOI: 10.1097/pts.0000000000001191] [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: 12/23/2023]
Abstract
OBJECTIVE The aim of the study is to identify the hospitalized children at risk of peripheral intravenous catheter (PIVC) complications by severity prediction. METHODS The study included the data of 301 hospitalized children with PIVC complications in 2 tertiary teaching hospitals. A researcher-designed tool was used to collect risk factors associated with PIVC complications. Predictors of PIVC complications at univariate analysis and multivariable logistic regression analysis by backward stepwise. A nomogram was constructed based on the results of the final multivariable model, making it possible to estimate the probability of developing complications. RESULTS A total of 182 participants (60.5%) had a moderate injury from PIVC complications. Multivariable logistic regression analysis indicated that the vascular condition, limb immobilization, needle adjustment in venipuncture, infusion length, infusion speed, and insertion site were independent predictors. The nomogram for assessing the severity of PIVC complications indicated good predictive accuracy (area under the curve = 0.79) and good discrimination (concordance index = 0.779). Decision curve analysis demonstrated that the nomogram was a good clinical value with a wide range of threshold probabilities (4%-100%). CONCLUSIONS The risk prediction model has good predictive performance, and the nomogram provides an easy-to-use visualization to identify the severity of PIVC complications and guide timely nursing care management.
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Affiliation(s)
- Xin Zhang
- From the Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Shuhui Xu
- Peking Union Medical College Hospital
| | - Jing Sun
- Peking Union Medical College Hospital
| | - Ying Yang
- Capital Institute of Pediatrics, Beijing, China
| | - Meihua Piao
- From the Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Shih-Yu Lee
- School of Nursing, Hungkuang University, Taichung, Taiwan, China
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15
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Özalp Gerçeker G, Yıldırım BG, Önal A, Ören H, Olgun HN, Bektaş M. The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study. Eur J Oncol Nurs 2023; 67:102430. [PMID: 37879193 DOI: 10.1016/j.ejon.2023.102430] [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: 07/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications. METHOD This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed. RESULTS The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication. CONCLUSIONS The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population. CLINICALTRIALS GOV IDENTIFIER NCT05769452.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Büşra Güliz Yıldırım
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Ayşe Önal
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hatice Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
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16
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Cruz JP, Baigulina B, Shalkenova Z, Tau G, Dossymbayeva E, Kostauletova A. Investigating the Kazakhstani Pediatric Nurses' intravenous catheter management knowledge and confidence: A cross-sectional study. Nurse Educ Pract 2023; 73:103816. [PMID: 37924652 DOI: 10.1016/j.nepr.2023.103816] [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: 08/18/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
AIM To assess Kazakh pediatric nurses' knowledge and confidence in peripheral intravenous catheter (PIVC) management and examine the personal and professional factors that influenced them. BACKGROUND Despite the significance of having high levels of PIVC insertion and care knowledge and confidence among pediatric nurses, the literature portrays inadequacies in the knowledge of these nurses in various parts of the globe. DESIGN This study is cross-sectional and observational, following the STrengthening the Reporting of OBservational studies in Epidemiology checklist in reporting. METHODS A convenience sample of 200 pediatric nurses working in the University Medical Center in Kazakhstan were surveyed from November to December 2022 using a paper-based questionnaire to assess the PIVC management knowledge and confidence. RESULTS The respondents had poor knowledge of patient assessment, PIVC insertion, maintenance, and removal. Participants reported high confidence in inserting and maintaining PIVCs among pediatric patients. Nurses' education, pediatric nursing experience, and training in PIVC management in the last 12 months were significant predictors of the nurses' knowledge. PIVC insertion and care knowledge directly influenced the nurses' confidence in these procedures. CONCLUSIONS Despite the high confidence of the nurses, their actual knowledge of these skills needed to be higher. Some personal and professional factors influence the knowledge and confidence of pediatric nurses.
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Affiliation(s)
- Jonas Preposi Cruz
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Nur-Sultan 010000, Kazakhstan.
| | - Bakhytgul Baigulina
- Deputy Director of Nursing, University Medical Center Corporate Fund, Astana City 010000, Kazakhstan
| | - Zhanna Shalkenova
- Pediatric Admission Unit, University Medical Center Corporate Fund, Astana City 010000, Kazakhstan
| | - Galiya Tau
- Oncology Unit No. 2, University Medical Center Corporate Fund, Astana City 010000, Kazakhstan
| | - Elmira Dossymbayeva
- Pediatric Surgery Unit No. 1, University Medical Center Corporate Fund, Astana City 010000, Kazakhstan
| | - Anara Kostauletova
- Oncology Unit No. 3, University Medical Center Corporate Fund, Astana City 010000, Kazakhstan
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Indarwati F, Munday J, Keogh S. Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study. J Pediatr Nurs 2023; 73:106-112. [PMID: 37659338 DOI: 10.1016/j.pedn.2023.08.009] [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: 02/28/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE This study aimed to assess peripheral intravenous catheter use, maintenance practices, and outcomes of paediatric patients in a developing country setting. DESIGN AND METHODS A point prevalence survey using validated checklist was conducted between March and April 2022 in ten hospitals in Indonesia. A total number of 478 participants were approached during the audit. Data were obtained from site observation and medical records. RESULTS Of the 386 patients surveyed, >90% (362) had one catheter in-situ. The catheters were mostly inserted by nurses (331, 86%), primarily in the dorsum of the hand (207, 54%) with the purpose of delivering intravenous infusions and medications (367, 95%). Simple transparent dressings (176, 46%) with splint and bandage (295, 76%) were predominantly used for securement methods. Insertion sites were not visible for 182 (47%) patients, and 151 (40%) of daily care practices were poorly documented. Complications were documented in the medical record for 166 (43%) catheters. Adjusted analysis indicated that patient diagnosis, ward, catheter size, location, dressings, infusate, and flushing administration were significantly associated with complications. CONCLUSIONS Findings indicate that issues related to paediatric intravenous catheter complications in Indonesia are comparable to developed country settings. Ongoing surveillance is important to evaluate the management practices to benchmark against guidelines, optimise patient safety, and improve outcomes. PRACTICE IMPLICATIONS Results demonstrate low and middle-income countries face similar challenges with catheter insertion and care. The study indicates the importance of applying vascular access needs assessments, providing training for inserters, identifying optimum dressing methods, and optimising documentation.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
| | - Judy Munday
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Nursing Sciences, University of Agder, Grimstad, Norway.
| | - Samantha Keogh
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
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18
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Matthews R, Gavin NC, Marsh N, Marquart-Wilson L, Keogh S. Peripheral intravenous catheter material and design to reduce device failure: A systematic review and meta-analysis. Infect Dis Health 2023; 28:298-307. [PMID: 37419781 DOI: 10.1016/j.idh.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Patients require vascular access for medical treatments, diagnostic procedures and symptom management. Current failure rates of peripheral intravascular catheters (PIVCs) are unacceptably high (40-50%). This systematic review aimed to determine the effect of different PIVC materials and designs on the incidence of PIVC failure. METHODS A systematic search was conducted in November 2022 using CINAHL, PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Randomised controlled trials that compared PIVC novel PIVC material/design and standard material/design were included. The primary outcome was all causes of PIVC failure, any reason for device removal due to cessation of device function; and secondary outcomes included individual PIVC complications and infection (local or systemic), and dwell times. Quality appraisal was conducted using the Cochrane risk of bias tool. A meta-analysis was performed using random effects model. RESULTS Seven randomised controlled trials were eligible for inclusion. In meta-analysis, the impact of material and design on PIVC failure in the studies favoured the intervention arms (RR 0.71, 95% CI 0.57-0.89), however there was substantial heterogeneity (I2 = 81%, 95% CI 61-91%). Through subgroup analyses, a significant difference on PIVC failure favoured the closed system over the open system (RR 0.85, 95% CI 0.73 to 0.99; I2 = 23%, 95% CI 0-90%). CONCLUSION Catheter material and design can impact PIVC outcome. Conclusive recommendations are limited due to the small number of studies and inconsistent reporting of clinical outcomes. Further rigorous research of PIVC types is necessary to improve clinical practice and device selection pathways should reflect the resulting evidence.
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Affiliation(s)
- Robyn Matthews
- Cancer Nursing Professorial Precinct, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Nicole C Gavin
- Cancer Nursing Professorial Precinct, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Redcliffe Hospital, Brisbane, Queensland, Australia.
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Louise Marquart-Wilson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia; QIMR Berghofer, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia. https://twitter.com/S2Keogh
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19
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Kleidon TM, Gibson V, Cattanach P, Schults J, Royle RH, Ware RS, Marsh N, Pitt C, Dean A, Byrnes J, Rickard CM, Ullman AJ. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:1132-1140. [PMID: 37695594 PMCID: PMC10495929 DOI: 10.1001/jamapediatrics.2023.3526] [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: 03/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Importance Peripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs. Objective To compare device failure of MCs with PIVCs. Design, Setting, and Participants This was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer. Interventions Patients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, >5 years). One catheter was studied per patient. Main Outcomes and Measures The primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs. Results Of the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P <.001). MCs were associated with fewer insertion attempts (mean difference [MD], -0.3; 95% CI, -0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P <.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS -$151.67 [US -$101.13] per person; 95% credible interval, AUS -$171.45 to -$131.90 [US -$114.20 to -$87.95]). Conclusions and Relevance Findings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure. Trial Registration Australia New Zealand Clinical Trials Registry, ACTRN12620000724976.
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Affiliation(s)
- Tricia M. Kleidon
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Victoria Gibson
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ruth H. Royle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Colleen Pitt
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Anna Dean
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Claire M. Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amanda J. Ullman
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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20
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van Rens MF, Hugill K, Mahmah MA, Francia AL, van Loon FH. Effect of peripheral intravenous catheter type and material on therapy failure in a neonatal population. J Vasc Access 2023; 24:1284-1292. [PMID: 35196909 DOI: 10.1177/11297298221080071] [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: 11/16/2022] Open
Abstract
BACKGROUND In neonatal settings vascular access devices are essential for treatment. However, their use is not without risks. The design and materials of peripheral vascular access devices have been evaluated amongst adult populations, but contemporary studies in neonatal settings are scant. PURPOSE/OUTCOME MEASURES This research describes the prevalence of peripheral intravenous catheter failure related to three different catheter types with the intent to identify modifiable risks that might be used to evaluate device efficacy, innovate neonatal practice, and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. PARTICIPANTS Neonates who were admitted to the unit requiring intravenous treatment wherefore peripheral intravenous cannulation was indicated, were included in this study. RESULTS The use of different type of catheters resulted in significantly less therapy failures as phlebitis and increased dwell time, compared with the control groups. This remains significant after adjusting for age at insertion, gestational age, birth weight, and catheter type. CONCLUSIONS The study's findings are in accord with international literature concerning adult and pediatric patients concerning the superiority of PUR over PTFE catheters with respect to the risk of phlebitis and longer dwell times. However, the risk of failure of therapy did not differ between catheters. This finding is reassuring and supports practitioner judgment when selecting peripheral catheter devices.
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Affiliation(s)
- Matheus Fpt van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamad Adnan Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus Hj van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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21
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Federica B, Nizar Yahya B, Hevan Al-Atroushy A, Wahida Ibraheem A, Bayar Saleem H, Bijeen Fareq J, Sholker Khalid M, Shaima Shimo J, Nora Suleeman S, Saad Zebari M, Stefano M. It is possible to create a vascular access team in a middle resource country? Experience of Hevi Paediatric Teaching Hospital at DUHOK - IRAQ. J Vasc Access 2023; 24:994-999. [PMID: 34903090 DOI: 10.1177/11297298211055402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Vascular access devices are critically important for the treatment of neonates and paediatric patients. Vascular cannulation is a key clinical skill for healthcare professionals working in the neonatal and paediatric wards. The creation of specialised Teams dedicated to the positioning of Vascular Venous Accesses is increasingly used and of fundamental importance for good patients care. The aim of the study is to evaluate the effectiveness of a training intervention for the staff of the Intensive Care Units for the insertion of the short/long peripheral catheter and to create a NuVa Team (Nurse-led Vascular Access Team). METHODS At the Hevi Paediatric Teaching Hospital, a course and an on-the-job training programme were carried out for two doctors and six nurses on the insertion of the in long peripheral catheters newborns and paediatric patients admitted at the hospital. The data collected were analysed from April 2017 to December 2020. A pre and post-procedure study was designed to determine whether establishing the Nurses Vascular Accesses Team (NuVa) is associated with higher success rates and a reduced risk of catheter-related complications. RESULTS A total of 271 Leader-cath™ catheters were placed during the study period. The mean age at catheters insertion was 2.9 years, the mean residence time was 11.7 days. Most catheters were inserted by five nurses (n = 216 (80%)); the remainder was entered by two paediatricians (n = 55 (20%)), p = 0.001. General reasons for removal were home discharge (n = 103 (38%)), deceases (n = 81 (30%)), accidental causes (n = 43 (16%)), leg/arm oedema (n = 21 (8%)), mechanical problems (n = 10 (3.5%)), physician's indication (n = 9 (3%)) and skin infection (n = 4 (1.5%)), p = 0.001. CONCLUSIONS The standardisation of the procedure for inserting the catheters placement and the creation of a NuVa Team has been of fundamental importance in gaining awareness of the procedure and allows healthcare professionals to insert the catheter without complications.
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Affiliation(s)
- Buzzi Federica
- E.U.project MADAD, Italian Association for Solidarity among Peoples, Duhok, Kurdistan Region, Iraq
- Hematology and Bone Marrow Transplantation Unit and Paediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Adel Hevan Al-Atroushy
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | | | - Haji Bayar Saleem
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Jalal Bijeen Fareq
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Mohammad Sholker Khalid
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Jaafar Shaima Shimo
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Suleeman Nora Suleeman
- Emergency Department, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | | | - Maiandi Stefano
- Health Professions Directorate, Research and Development, ASST di Lodi, Lodi, Italy
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22
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Sharp R, Muncaster M, Baring CL, Manos J, Kleidon TM, Ullman AJ. The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study. J Clin Nurs 2023; 32:6690-6705. [PMID: 37204006 DOI: 10.1111/jocn.16759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
AIMS AND OBJECTIVES Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice. BACKGROUND Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice. DESIGN Qualitative description. METHODS A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi-structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis. RESULTS There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress-before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre-determined theme, (4) Recommendations for good clinical practice is also described. CONCLUSIONS Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Michele Muncaster
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Catherine L Baring
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Jacinta Manos
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Tricia M Kleidon
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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23
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Kleidon TM, Schults J, Rickard C, Ullman AJ. Ultrasound-guided PIVC insertion: a randomised controlled trial protocol. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S28. [PMID: 37495404 DOI: 10.12968/bjon.2023.32.14.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is an alternative to traditional anatomical landmark-based insertion. However, data on its performance in paediatric patients of varying levels of difficult intravenous access are limited. The researchers hypothesise that ultrasound-guided PIVC insertion will increase first-attempt success compared with landmark technique. This randomised, parallel-group, single-centre, superiority trial commenced recruiting in July 2021, including hospitalised children (aged 0 (>37 weeks gestation) to 18 years) requiring a PIVC. It will recruit 180 children, stratified by degree of perceived difficulty, and centrally randomised into two groups (ratio 1:1). The primary outcome is first-attempt PIVC insertion success. Secondary outcomes include total number of PIVC insertion attempts, PIVC insertion failure, post-insertion complications, dwell time, patient/parent satisfaction, and healthcare costs. The current study will inform the superiority of ultrasound-guided PIVC insertion in comparison with landmark technique. Adoption by healthcare facilities might improve patient outcomes and decrease healthcare costs.
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Affiliation(s)
- Tricia M Kleidon
- Nurse Practitioner, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Jessica Schults
- Senior Research Fellow, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Professor of Paediatric Nursing, Children's Health, Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
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24
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Indarwati F. Site selection and incidence of peripheral intravenous catheter complications. Evid Based Nurs 2023; 26:106. [PMID: 36396429 DOI: 10.1136/ebnurs-2022-103558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Ferika Indarwati
- School of Nursing, Faculty of Health, Centre for Health Care Trnsformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
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25
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Faris GO, Abdulkareem AG, Ismael NH, Qader DJ. Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq. BMC Nurs 2023; 22:188. [PMID: 37277836 DOI: 10.1186/s12912-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Obedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure's success. OBJECTIVES To determine the peripheral cannulation technique evaluation among nurses working in the emergency departments. METHODS This descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses' general characteristics and an observational checklist to assess the nurses' pre, during and post practices regarding peripheral cannulation technique. RESULTS According to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique. CONCLUSIONS Nurses were not practised peripheral cannulation technique appropriately; however, half of the nurses' had an average level of practice, although their practices were not followed the standard protocols.
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Affiliation(s)
- Gona Othman Faris
- Department of Maternal Neonate Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
| | - Awayi Ghazy Abdulkareem
- Department of Pediatric Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq.
| | - Niyan Hakim Ismael
- Department of Adult Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
| | - Delan Jamal Qader
- Department of Adult Nursing, College of Nursing, University of Sulaimani, Sulaimaniyah, Iraq
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26
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Baye ND, Teshome AA, Ayenew AA, Amare TJ, Mulu AT, Abebe EC, Tiruneh GA, Ayele TM, Muche ZT, Teklemariam AB, Melese BD, Agidew MM, Seid MA. Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study. BMC Nurs 2023; 22:11. [PMID: 36631864 PMCID: PMC9832806 DOI: 10.1186/s12912-022-01164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Peripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia. METHODS AND SETTING An institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed. RESULTS The incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63-6.27), admission unit (AHR = 1.88, 95%CI: 1.07-4.02), sickness (AHR = 0.24, 95% CI: 1.31-4.66), medication type (AHR = 2.04, 95%CI: 1.13-3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02-0.99), clinical experience (AHR = 0.52, CI:0.26-0.84), and flushing (AHR = 0.71, 95%CI: 0.34-0.98) were potential predictors of PIVC complication. CONCLUSION Knowing the predictor factors helps clinicians to provide effective care and to detect complications early.
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Affiliation(s)
- Nega Dagnew Baye
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atalo Agimas Ayenew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadeg Jemere Amare
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anmut Tilahun Mulu
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Ayalew Tiruneh
- grid.510430.3Department of Clinical Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklie Mengie Ayele
- grid.510430.3Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zelalem Tilahun Muche
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Awgichew Behaile Teklemariam
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melese
- grid.510430.3Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Mekonnen Agidew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Öntürk ZK, İsabetli S, Bahadır M, Doğru E. The effect of "pediatric peripheral intravenous access (PPIVA) pathway" on the success of vascular access in children. J Pediatr Nurs 2022; 69:e32-e38. [PMID: 36494235 DOI: 10.1016/j.pedn.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Determine the affects of the developed "Pediatric Peripheral Intravenous Access (PPIVA) Pathway" on the success of the vascular access in children. DESIGN AND METHODS A quantitative approach was used using a quasi-experimental single-group post-test design involved pediatric patients. The patients who were first attempted for peripheral vascular access were subjected to the procedure in accordance with the "PPIVA Pathway". The data was collected via a form on which we recorded down the patients' characteristics alongside their procedural data, as well as the Difficult Intravenous Access (DIVA) Score. For statistical analysis, the R vers. 2.15.3 program was utilized. RESULTS The patients who applied to the pediatric observation clinic had a mean age of 8.14 ± 5.01 years. The DIVA total mean score of the patients was 1.73 ± 1.79. 89.1% (n = 163) of pediatric peripheral intravenous procedures were successfully completed on the first access. The logistic regression analysis model was found to be statistically significant to identify the factors that affect pediatric peripheral intravenous success on the first attempt (χ2 = 24.701; p < 0.001). A one-point increase in the DIVA score was found to reduce the likelihood of success on the first attempt by 56.1% [OR (95% CI) = 0.439 (0.280, 0.686), p < 0.001]. CONCLUSIONS Using an algorithm to perform a peripheral intravenous intervention in children increases the likelihood of success on the first attempt. PRACTICE IMPLICATIONS Using PPIVA Pathway shall improve the provision of atraumatic care for children, as the success rate of pediatric peripheral intravenous access on the first attempt is high.
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Affiliation(s)
- Zehra Kan Öntürk
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Department of Nursing, Acıbadem Mehmet Ali Aydınlar Üniversitesi Kerem Aydınlar Kampüsü, Kayışdağı Cad. No:32 Ataşehir, İstanbul, Turkey.
| | - Serpil İsabetli
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Merve Bahadır
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Ebru Doğru
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
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28
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Burek AG, Liljestrom T, Dundon M, Shaughnessy EE, Suelzer E, Ullman A. Long peripheral catheters in children: A scoping review. J Hosp Med 2022; 17:1000-1009. [PMID: 36165458 DOI: 10.1002/jhm.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Long peripheral catheters (LPCs) are emerging vascular access devices used for short-medium term vascular access needs. Literature in adults suggests LPCs have longer dwell-times than peripheral intravenous catheters (PIVs) and lower rates of serious complications than peripherally inserted central catheters (PICCs). The role of LPCs in children is less established. The objective of this scoping review is to describe and synthesize the existing literature on the effectiveness and safety of LPCs in children. METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were done in MEDLINE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Scopus, CINAHL (Ebsco), and Google Scholar most recently on February 22, 2022. Studies were included if published in English on or after 2000 and included patients <18 years of age. RESULTS Twenty-one studies were included. The body of literature is variable in quality, measurements, and reported outcomes. Median dwell-time ranged from 5 to 14 days. The rate of completion of therapy ranged from 20% to 86%. Dislodgement, occlusion, and infiltration were the most common complications reported (0%-31%). Venous thromboembolism rates ranged from 0% to 13%. The rate of catheter-related bloodstream infection was 0% in 9 of 10 studies. Less than 50% of studies reported comparative outcomes. CONCLUSION LPCs show promising outcomes in select populations, with longer dwell-time than PIVs and possibly lower rates of serious complications than PICCs. However, more research is needed to clarify the optimal use of LPCs in pediatrics.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tracey Liljestrom
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Melanie Dundon
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin E Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama, USA
| | - Elizabeth Suelzer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amanda Ullman
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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29
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Berlanga-Macías C, Díez-Fernández A, Martínez-Hortelano JA, Sequí-Domínguez I, Saz-Lara A, Pozuelo-Carrascosa D, Martínez-Vizcaíno V. Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review. BMC Nurs 2022; 21:307. [DOI: 10.1186/s12912-022-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction.
Methods
An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low.
Results
Twelve systematic reviews with a range of 75–1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported.
Conclusions
The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical.
Trial registration
PROSPERO: CRD42021290824.
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Dufficy M, Takashima M, Cunninghame J, Griffin BR, McBride CA, August D, Ullman AJ. Extravasation injury management for neonates and children: A systematic review and aggregated case series. J Hosp Med 2022; 17:832-842. [PMID: 36039964 PMCID: PMC9804918 DOI: 10.1002/jhm.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pediatric extravasation injuries are significant healthcare-associated injuries, with sometimes significant sequelae. Evidence-based guidance on management is necessary to prevent permanent injury. PURPOSE A systematic review of the literature, including aggregated case series, investigating extravasation injury management of hospitalized pediatric patients. DATA SOURCES PubMed, Cummulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica database (EMBASE) were searched on December 13, 2021. STUDY SELECTION Primary research investigating extravasation injury management of hospitalized pediatric patients (to 18 years), published from 2010 onwards and in English, independently screened by two authors, with arbitration from a third author. DATA EXTRACTION Data regarding the study, patient (age, primary diagnosis), extravasation (site, presentation, outcome), and treatment (first aid, wound management) were extracted by two authors, with arbitration from a third author. DATA SYNTHESIS From an initial 1769 articles, 27 studies were included with extractable case data reported in 18 studies, resulting in 33 cases. No clinical trials were identified, instead, studies were primarily case studies (52%) of neonates (67%), with varied extravasation symptoms. Studies had good selection and ascertainment, but few met the causality and reporting requirements for quality assessments. Signs and symptoms varied, with scarring (45%) and necrosis (30%) commonly described. Diverse treatments were categorized into first aid, medical, surgical, and dressings. CONCLUSIONS Despite infiltration and extravasation injuries being common within pediatric healthcare, management interventions are under-researched, with low-quality studies and no consensus on treatments or outcomes.
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Affiliation(s)
- Mitchell Dufficy
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Mari Takashima
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Bronwyn R. Griffin
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
| | - Craig A. McBride
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Deanne August
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
- Grantley Stable Neonatal UnitRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Amanda J. Ullman
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
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Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022:S2588-994X(22)00067-7. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
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van Rens M, Hugill K, Francia AL, Abdelwahab AH, Garcia KL. Treatment of a neonatal peripheral intravenous infiltration/extravasation (PIVIE) injury with hyaluronidase: a case report. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S31-S36. [PMID: 35439074 DOI: 10.12968/bjon.2022.31.8.s31] [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: 06/14/2023]
Abstract
INTRODUCTION Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents' wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population. CASE DESCRIPTION A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects. CONCLUSION This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology. HIGHLIGHTS In a neonatal population peripheral infusion therapy-related complication rates have been reported to be as high as 75% Peripheral IV infiltration and extravasation (PIVIE) is implicated in up to 65% of IV-related complications PIVIE injury has the potential to cause serious harm Prompt recognition and timely appropriate intervention can mitigate many of these risks Adhering to the 5Rs for vascular access optimizes infusion therapy and potentially reduces complications.
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Affiliation(s)
- Matheus van Rens
- Nursing and Vascular Access, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Vascular Access and Neonatal Transport, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Krisha Lp Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Indarwati F, Munday J, Keogh S. Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools. Int J Nurs Sci 2022; 9:179-186. [PMID: 35509701 PMCID: PMC9052259 DOI: 10.1016/j.ijnss.2022.03.005] [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: 09/15/2021] [Revised: 01/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter (PIVC) insertion and care practices. Methods The six-step forward and backward translation method was used to translate the adapted questionnaires. The English version questionnaires included the point prevalence audit checklist, the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire, plus a Patient/parent Experience Survey. Data collection was conducted in Indonesia between October 2019 and February 2020. In total, there were six translators (two for each instrument), nine-panel vascular access experts (three for each instrument), and 30 participants (ten for each instrument) of the target population involved in the translation and validation of the three instruments. Three-panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index and kappa index were calculated. Ten-panel members of the target population evaluated each questionnaire regarding feasibility, clarity, logical sequence, and formatting. Qualitative comments from the panel were also reviewed. Results The translation process indicated relatively low discrepancies between translators except for semantic equivalence. There were nine, eight, and one semantic discrepancies found in the forward translation of the point prevalence audit checklist, nurse survey, and patient/parent experience survey. The semantic discrepancies were less prevalent in the backward translation, with only one, three, and two items reported during the process. The item validity index for all of the three instruments showed relatively high agreement between experts (I-CVI > 0.78, S-CVI/Ave >0.90, S-CVI/UA > 0.70, and kappa index >0.74). The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically. However, some re-formatting of the nurse survey and patient/parent experience survey were needed to avoid ambiguity and confusion for the participants. Conclusions The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context. They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.
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Affiliation(s)
- Ferika Indarwati
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Judy Munday
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
- Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia
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Indarwati F, Munday J, Keogh S. Nurse knowledge and confidence on peripheral intravenous catheter insertion and maintenance in pediatric patients: A multicentre cross-sectional study. J Pediatr Nurs 2022; 62:10-16. [PMID: 34798582 DOI: 10.1016/j.pedn.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients. DESIGN AND METHODS An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score. RESULTS A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p < 0.05). CONCLUSION Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance. PRACTICE IMPLICATIONS The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
| | - Judy Munday
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia.
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Santos LMD, Figueredo IB, Silva CSGE, Catapano UO, Silva BSM, Avelar AFM. Risk factors for infiltration in children and adolescents with peripheral intravenous catheters. Rev Bras Enferm 2022; 75:e20210176. [DOI: 10.1590/0034-7167-2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: to estimate the incidence of infiltration and the factors associated with its occurrence in children and adolescents in the operative period and with peripheral intravenous catheters. Methods: a longitudinal and prospective study with children and adolescents using peripheral intravenous catheters, conducted at the surgical clinic unit of a pediatric hospital in Feira de Santana, State of Bahia, from April 2015 to December 2016. The study used Pearson’s chi-square and Fisher’s exact test for the analysis. It also applied multiple analyses using Poisson regression with robust variance. Results: the incidence of infiltration was 31.2% and was associated with female sex (RR=0.53; CI=[0.30-0.96]), non-eutrophic children (RR=2.27; CI=[1.25-4.20]), who used non-irritating and non-vesicant drugs (RR=1.72; CI=[1.03-2.87]), vesicant drugs (RR=1.84; CI=[1.05-3.22]) and irritating/vesicant electrolytes (RR=2.35; CI=[1.38-3.97]). Conclusions: the study suggests the development of strategies that will help in the prevention of this adverse event through the knowledge of the associated factors.
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Kleidon TM, Schults J, Rickard CM, Ullman AJ. Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic Review and Meta-Analysis. J Hosp Med 2021; 16:742-750. [PMID: 34797998 DOI: 10.12788/jhm.3718] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Insertion and function of pediatric peripheral intravenous catheters (PIVCs) present challenges. We systematically reviewed techniques and technologies to improve PIVC outcomes (first-time insertion success, overall insertion success, time to insertion, dwell time, failure, and complications). DATA SOURCES Cochrane Central Register of Controlled Trials (CONTROL), Cumulative Index to Nursing and Allied Health (CINAHL), US National Library of Medicine, and Embase. STUDY SELECTION English-language pediatric trials published post 2010 reporting PIVC outcomes. DATA EXTRACTION Following Cochrane standards, two authors screened, extracted, and critiqued study quality (Grading of Recommendations Assessment, Development and Evaluation approach) data, random effects analysis, results expressed as risk ratios (RR), mean differences (MD) and 95% CIs. RESULTS Twenty-one studies (3237 children; 3098 PIVCs) were included. First-time insertion success significantly increased with ultrasound guidance (compared with landmark insertion; RR, 1.60; 95% CI, 1.02-2.50). Use of ultrasound guidance (compared with landmark insertion) did not improve overall PIVC insertion success (RR, 1.10; 95% CI, 0.94-1.28). There was no evidence of an effect of near-infrared (compared with landmark) on first-time insertion success (RR, 1.21; 95% CI, 0.91-1.59) or number of attempts (MD, -0.65; 95% CI, -1.59 to 0.29); however, it significantly reduced PIVC insertion time (MD, -132.47; 95% CI, -166.68 to -98.26) and increased first-time insertion success in subgroup analysis of patients with difficult intravenous access (RR, 2.72; 95% CI, 1.02-7.24). LIMITATIONS Few studies per intervention, small sample sizes, and inconsistent outcome measures precluded definitive conclusions. CONCLUSIONS Ultrasound and near-infrared appear to improve pediatric PIVC insertion. High-quality studies examining the full extent of techniques and technologies are needed. Registration: CRD42020175314.
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Affiliation(s)
- Tricia M Kleidon
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Jessica Schults
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Claire M Rickard
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Amanda J Ullman
- Queensland Children's Hospital, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- The University of Queensland, Queensland, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
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Igelström E, Campbell M, Craig P, Katikireddi SV. Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review. J Clin Epidemiol 2021; 140:22-32. [PMID: 34437948 PMCID: PMC8809341 DOI: 10.1016/j.jclinepi.2021.08.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aimed to review how 'Risk of Bias In Non-randomized Studies-of Interventions' (ROBINS-I), a Cochrane risk of bias assessment tool, has been used in recent systematic reviews. STUDY DESIGN AND SETTING Database and citation searches were conducted in March 2020 to identify recently published reviews using ROBINS-I. Reported ROBINS-I assessments and data on how ROBINS-I was used were extracted from each review. Methodological quality of reviews was assessed using AMSTAR 2 ('A MeaSurement Tool to Assess systematic Reviews'). RESULTS Of 181 hits, 124 reviews were included. Risk of bias was serious/critical in 54% of assessments on average, most commonly due to confounding. Quality of reviews was mostly low, and modifications and incorrect use of ROBINS-I were common, with 20% reviews modifying the rating scale, 20% understating overall risk of bias, and 19% including critical-risk of bias studies in evidence synthesis. Poorly conducted reviews were more likely to report low/moderate risk of bias (predicted probability 57% [95% CI: 47-67] in critically low-quality reviews, 31% [19-46] in high/moderate-quality reviews). CONCLUSION Low-quality reviews frequently apply ROBINS-I incorrectly, and may thus inappropriately include or give too much weight to uncertain evidence. Readers should be aware that such problems can lead to incorrect conclusions in reviews.
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Affiliation(s)
- Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR.
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
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Huang LS, Huang Y, Hu J. Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses' knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study. BMC Nurs 2021; 20:236. [PMID: 34814906 PMCID: PMC8609804 DOI: 10.1186/s12912-021-00758-1] [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: 05/17/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses' knowledge, attitude, and practice (KAP) concerning PIVC fixation. METHODS An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses' KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. RESULTS The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses' knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). CONCLUSION PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses' KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients.
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Affiliation(s)
- Li-Sha Huang
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yan Huang
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Deceases of Woman and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Juan Hu
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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Peripheral Venous Catheter-related Bloodstream Infections in Hospitalized Children: The Role of Gram-negative Bacteria. Pediatr Infect Dis J 2021; 40:e395-e399. [PMID: 34232922 DOI: 10.1097/inf.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral venous catheter (PVC) is the most used vascular access device in medicine, allowing administration of intravenous fluids and medications. Known complications associated with PVC include extravasation, phlebitis and rarely bloodstream infection (BSI). Data regarding PVC-related BSI in children are lacking. Our aim was to evaluate the epidemiology, clinical and microbiologic characteristics of pediatric inpatients with PVC-related BSI. METHODS A retrospective study was conducted in a pediatric tertiary care center. Children with BSI, admitted to general pediatric departments during 2010-2019, were identified and their medical records examined. Patients with BSI and phlebitis were further characterized and included in the analysis. We excluded patients with central venous catheters, other identified source of infection and with BSI upon admission. Data collected included patients' demographics and clinical and microbiologic characteristics. RESULTS Twenty-seven children with PVC-related BSI were identified and included in the study, consisting of 0.2% of the total BSI cases. Patient's median age was 24 (range, 1.5-213) months, 14/27 (52%) were female and 6 (22%) were previously healthy while 21 (78%) had prior medical conditions. Sixteen (59.3%) patients had Gram-negative BSI and 6 (22.2%) Gram-positive bacteria. Polymicrobial infection occurred in 4 (14.8%) patients and Candida albicans in 1 (3.7%) patient. The most common isolated bacteria were Klebsiella spp and Staphylococcus aureus. Longer dwell-time was a predictor of Gram-negative bacteria. CONCLUSIONS PVC-related BSI due to Gram-negative bacteria was more common than to Gram-positive bacteria. Clinicians should consider an initial broad-spectrum antibiotic coverage for PVC-related BSI in hospitalized pediatric patients.
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Garcia MG, Dutton H, Samuel K, Marusich J. Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics. J Pediatr Nurs 2021; 61:59-66. [PMID: 33770665 DOI: 10.1016/j.pedn.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Pediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids. DESIGN AND METHODS A pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding. RESULTS Structured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%. CONCLUSIONS Structured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients. PRACTICE IMPLICATIONS Sustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.
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Affiliation(s)
| | - Hayden Dutton
- Children's Health Children's Medical Center, TX, USA
| | - Kiele Samuel
- Children's Health Children's Medical Center, TX, USA
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Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
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42
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van Rens MFPT, Hugill K, Mahmah MA, Bayoumi M, Francia ALV, Garcia KLP, van Loon FHJ. Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study. BMJ Open 2021; 11:e047788. [PMID: 34497079 PMCID: PMC8438911 DOI: 10.1136/bmjopen-2020-047788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Infants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population. DESIGN This was a retrospective observational study. SETTING The study was performed on the neonatal intensive care unit of the Women's Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study. PARTICIPANTS This study included 12 978 neonates who required intravenous therapy. OUTCOME MEASUREMENTS The main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy. RESULTS A mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors. CONCLUSION Most infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad A Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Krisha L P Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - F H J van Loon
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
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43
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Tayal A, Lodha R. Improving the Detection of Phlebitis in Hospitalized Children. Indian J Pediatr 2021; 88:328-329. [PMID: 33609231 DOI: 10.1007/s12098-021-03703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Anshula Tayal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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44
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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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