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Aung SL, Sengupta A, Win NN, Rajkanna J, Oyibo SO. The Appropriate Use and Care of Peripheral Intravenous Cannulas: A Quality Improvement Project. Cureus 2025; 17:e76954. [PMID: 39758858 PMCID: PMC11700509 DOI: 10.7759/cureus.76954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 01/07/2025] Open
Abstract
Background Peripheral intravenous cannula (PIVC) insertion is a universal intervention for hospital inpatients. Previous studies have demonstrated that more than a third of inserted PIVCs remain unused in the emergency department and that there is inadequate documentation regarding the insertion and use of PIVCs. Additionally, the use of PIVC is associated with cannula-related complications. Using the PIVC care bundle attached to the guideline should help prevent cannula-related complications. As part of a quality improvement project, we aimed to perform an initial audit (1st cycle), implement interventions for improvements, and then perform a re-audit (2nd cycle) of our adherence with the use and completion of the care bundle for PIVC. Methodology An initial audit (1st cycle), followed by implementation of interventions, and then a re-audit (2nd cycle) of our adherence with the use and completion of the PIVC care bundle was performed. The standards/criteria used for both the 1st cycle and 2nd cycle of the project were obtained from our PIVC care bundle and comprised of documented evidence of the date of cannula insertion, site of cannula insertion, indication for cannula insertion, whether the cannula was inserted in a non-common site (e.g., lower limbs), cannula assessment at least every 24 hours, cannula-related complications, and whether the cannula care bundle was completed for the patient. A score of less than 75% was considered not adherent, 75-90% was partially adherent, 90-100% was adherent, and a score of 100% was considered fully adherent. The target adherence score for each standard/criterion was set a priori to 90-100%, and the results were compared between both cycles. An increase in the adherence score in the 2nd cycle over the 1st cycle was taken to indicate improvement, while a negative difference indicated challenges. Results There were 28 patients in the 1st cycle and 40 patients in the 2nd cycle of this project. The commonest initial indications for PIVC insertion were intravenous fluids and intravenous antibiotic administration. The hand and forearm were the commonly used sites of insertion, and none of the patients had a cannula-related complication. Compared to the 1st cycle, the results of the 2nd cycle demonstrated improvements in the adherence scores for all the standards/criteria, with the scores for documenting the site of insertion and using a commonly used/acceptable site indicating full adherence (100%). The score for documenting the indication for insertion indicated adherence (90-100%). The score for ensuring that the cannula was being assessed at least every 24 hours and the score for completing the care bundle both indicated partial adherence (75-90%). The score for documenting the date of cannula insertion indicated non-adherence (<75%). Conclusions This project has demonstrated improvement in adherence with the use and completion of the care bundle for PIVC insertion after implementing interventions for improvement. National guidance is required to produce a standard audit tool for general use. The importance of continued education, complete cannula care, and accurate documentation in enhancing adherence to consensus guidelines cannot be overemphasized.
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Affiliation(s)
- Shoon Lae Aung
- General Medicine, Peterborough City Hospital, Peterborough, GBR
| | - Aditya Sengupta
- General Medicine, Peterborough City Hospital, Peterborough, GBR
| | - Nwe Ni Win
- Internal Medicine, Peterborough City Hospital, Peterborough, GBR
| | - Jeyanthy Rajkanna
- Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR
| | - Samson O Oyibo
- Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR
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Doll MS, Aprile DCB, Gonçalves ALP, da Silva BSM, Kusahara DM, Lopes CT. Development and Content Validity of a Questionnaire on Peripheral Intravenous Catheter Maintenance and Knowledge of Nursing Professionals Regarding Best Practices. JOURNAL OF INFUSION NURSING 2025; 48:53-69. [PMID: 39760879 DOI: 10.1097/nan.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
Abstract
The aims of this study were to develop a questionnaire on peripheral intravenous catheter (PIVC) maintenance, evaluate its content validity, and assess factors influencing the level of knowledge of nursing professionals regarding best practices.The study was conducted in 3 stages: (1) development of a questionnaire on PIVC maintenance; (2) content validity assessment by experts with assessment of comprehensiveness, relevance, and clarity; and (3) application of the questionnaire to 1493 nursing professionals. Relationships between personal characteristics and knowledge levels were evaluated. The questionnaire score ranged from 0 to 26. The participants obtained a mean score of 13.7 (SD, 2.4). Factors associated with a higher knowledge level included higher educational level, training on PIVC maintenance upon admission, and employment in an institution with recurrent PIVC maintenance training. Gaps in knowledge included the recommended technique for active disinfection, how catheter stabilization should be performed, recommended technique for flushing and minimizing blood reflux into the catheter, appropriate frequency for assessing the insertion site of the catheter, and signs of catheter complications. A questionnaire for assessing knowledge of best practices in PIVC maintenance was developed and had adequate evidence of content validity. Aspects related to greater education were associated with a higher knowledge level. Knowledge gaps were identified.
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Affiliation(s)
- Marie Sylvie Doll
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
| | - Daniele Cristina Bosco Aprile
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
| | - Alexia Louisie Pontes Gonçalves
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
| | - Bianka Sousa Martins da Silva
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
| | - Denise Miyuki Kusahara
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
| | - Camila Takáo Lopes
- Author Affiliations: Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Doll); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Aprile); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (RN Gonçalves); Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Feira de Santana (UEFS), Bahia, Brazil (Prof da Silva); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Kusahara); Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil (Prof Lopes)
- Marie Sylvie Doll, MsC, earned her Master's degree from the Nursing Graduate Program at EPE-UNIFESP through the Scholarships Brazil Program-PAEC OAS-GCUB. This program is a collaboration between the Organization of American States, the Pan American Health Organization, and the Coimbra Group of Brazilian Universities, with support from the Division of Educational Themes of the Ministry of Foreign Affairs of Brazil. Daniele Cristina Bosco Aprile, MsC, BSN, PhD, is a PhD candidate, a professor (administrative education technician) on Nursing Fundamentals, and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-UNIFESP. Alexia Louisie Pontes Gonçalves, MsCc, BSN, is a Master's candidate and a member of the Research Group on the Nursing Process (GEPAPE) at EPE-Unifesp. She is specialized in Cardiovascular Health through a residency program at the Dante Pazzanese Institute of Cardiology. Currently, she works as an intensive care nurse at Hospital Sírio Libanês. Bianka Sousa Martins da Silva, PhD, BSN, is a postdoctoral researcher in the Pharmaceutical Sciences Graduate Program at UEFS. She is a member of the Safety, Technology, and Care Nucleus (SEGTEC/Unifesp) and a researcher at the Laboratory of Studies and Research in Innovation and Safety in Health Care (LaPIS/UEFS). She is a member of the Intravenous Therapy Nursing Network of Bahia (RETIVBA) and is affiliated with the Brazilian Association of Vascular Access (ABRAVA). Bianka also teaches an online course on Statistics for Clinical Research and Mixed Methods (EsPeCLiMM). Denise Miyuki Kusahara, PhD, BSN, is an adjunct professor in the Pediatric Nursing Department and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a leading researcher of the Research Group Safety, Technology, and Care (SEGTEC), focusing on patient safety, pediatric intensive care, and intravascular and drug therapy. Camila Takáo Lopes, PhD, BSN, FNI, is an adjunct professor at EPE-UNIFESP and serves as a Master's and Doctoral advisor in the Nursing Graduate Program at EPE-UNIFESP. She is a Research Productivity Fellow of the Brazilian National Council for Scientific and Technological Development and a member of the Nursing Process Research Group (GEPAPE)
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Casanova-Vivas S, García-Molina P, López-Guardiola P, Gil-Carbonell MJ, Hevilla-Cucarella EB, Solaz-Martínez V, Valdelvira-Gimeno B, Fernández-Martínez A, Visconti-Gijón JV, Ballestar-Tarín ML. The impact of enhancing vascular access care quality through monitoring and training: A multicentre observational study. J Vasc Access 2024:11297298241296163. [PMID: 39582190 DOI: 10.1177/11297298241296163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024] Open
Abstract
AIM This study evaluates the impact of monitoring a primary quality indicator and the effect of training on improving the care and maintenance of vascular access devices. DESIGN A prospective, quasi-experimental, multicentre study with 10 periodical cross-sections from 2017 and 2020. PARTICIPANTS Adult patients hospitalised over 24 h, with or without vascular access device, excluding those in emergency, psychiatry, outpatients or minor surgery units. METHODS The study included 10 cross-sections between 2017 and 2020 in all participating hospitals, using the INCATIV® (Quality Indicators in Intravenous Therapy and Vascular Access) questionnaire. Training sessions for nursing staff were conducted between cross-sections, involving face-to-face sessions in open classrooms and clinical sessions in the units, based on the study Care bundle. RESULTS 53,991 vascular accesses were analysed, with an average INCATIV Index score of 8.95 (SD: 1.32), showing improvement from 8.09 in the first cross-section to 9.21 in the last. Significant variability was observed between hospitals, with secondary hospitals scoring lower on the INCATIV® Index. Training interventions 1 and 2 showed significant improvement across all hospital categories, whereas intervention 5 did not show significant effects. Compliance with main recommendations was studied, with a notable decrease in phlebitis rates from 4.45% in the first cross-section to 1.23% in the tenth. CONCLUSION The study developed a single indicator to assess and quantify vascular access care quality. It demonstrated that implementing a care bundle through serial training interventions and continuous assessment by nursing staff, supported by process indicators and data availability on the study platform, significantly reduces complications and enhances the quality and safety of vascular access care.
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Affiliation(s)
- Sonia Casanova-Vivas
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, Valencia, Spain
- Health Department, Valencian School of Health Studies, Valencia, Spain
| | - Pablo García-Molina
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, Valencia, Spain
- Associated Care Research Group, INCLIVA Foundation, Valencia, Spain
- Nursing Unit for Ulcers and Complex Wounds, University of Valencia Clinical Hospital, Valencia, Spain
| | | | | | | | | | | | | | | | - M Luisa Ballestar-Tarín
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, Valencia, Spain
- Nursing Department, Nursing Care and Education Research Group (GRIECE), GIUV2019-456, University of Valencia, Valencia, Spain
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Urbina A, Juvé-Udina ME, Adamuz J, González-Samartino M, Jiménez-Martínez E, Delgado-Hito P, Romero-García M. Association between peripheral venous catheter failure and care complexity factors in emergency department: a cross-sectional study. BMJ Open 2024; 14:e090101. [PMID: 39414293 PMCID: PMC11481137 DOI: 10.1136/bmjopen-2024-090101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/02/2024] [Indexed: 10/18/2024] Open
Abstract
OBJECTIVE The objective was to determine the prevalence of peripheral venous catheter (PVC) failure and its association with care complexity individual factors (CCIFs) in emergency department (ED) patients. DESIGN A cross-sectional, descriptive-correlational study was performed. METHODS All patients with a PVC inserted in the ED of a tertiary hospital were included. The period of study was from June 2021 to June 2022. The main outcomes were PVC failure (phlebitis, extravasation/infiltration, dysfunction/occlusion and dislodgement/involuntary withdrawal) and 26 CCIFs categorised into 5 domains (psycho-emotional, mental-cognitive, sociocultural, developmental and comorbidity/complications). Other secondary variables were also collected, such as level of triage or nursing care plan. All data were collected retrospectively from the electronic health records. A descriptive and inferential analysis was performed. RESULTS A total of 35 968 patients with one or more PVC inserted during their ED visit were included in the study. The prevalence of PVC failure was 0.9% (n=316). The statistically significant CCIFs associated with PVC failure were: incontinence, haemodynamic instability, transmissible infection, vascular fragility, anxiety and fear, impaired adaptation, consciousness disorders, lack of caregiver support and agitation. In addition, we identified that patients with a higher number of CCIFs were more frequently experienced PVC failure. CONCLUSION This study identified a prevalence of PVC failure in the ED of around 1%. The most prevalent complication was dysfunction, followed by extravasation and dislodgement. In addition, PVC failure was associated with comorbidity/complications, psycho-emotional and mental-cognitive CCIFs domains.
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Affiliation(s)
- Andrea Urbina
- Nursing Knowledge Management and Information Systems Department, Nursing Research Group (IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
- Nursing Faculty, University of Barcelona, Barcelona, Spain
| | - Maria-Eulàlia Juvé-Udina
- Catalan Institute of Health, Barcelona, Catalunya, Spain
- Nursing Research Group (IDIBELL), Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Jordi Adamuz
- Nursing Knowledge Management and Information Systems Department, Nursing Research Group (IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
- Nursing Faculty, University of Barcelona, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing Knowledge Management and Information Systems Department, Nursing Research Group (IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
- Nursing Faculty, University of Barcelona, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Nursing Faculty, University of Barcelona, Barcelona, Spain
- Infectious Disease Department. Nursing Research Group (IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Pilar Delgado-Hito
- Nursing Faculty, University of Barcelona, Barcelona, Spain
- Nursing Research Group (IDIBELL), Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Marta Romero-García
- Nursing Faculty, University of Barcelona, Barcelona, Spain
- Nursing Research Group (IDIBELL), Bellvitge Institute for Biomedical Research, Barcelona, Spain
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Nickel B. Optimizing peripheral I.V. access outcomes - Part 2. Nursing 2024; 54:19-29. [PMID: 39302746 DOI: 10.1097/nsg.0000000000000069] [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: 09/22/2024]
Abstract
ABSTRACT Peripheral I.V. access failure is a source of patient discomfort and dissatisfaction with a significant financial impact on healthcare. This article reviews the benefits and the risks of peripheral I.V. catheter (PIVC) utilization, infusate characteristics and their impact on peripheral vasculature, PIVC site assessment and management, and PIVC research priorities. Part 1 of this series was published in Nursing's September 2024 issue.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the chair of the 2024 Infusion Nurses Society Standards of Practice Committee
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Nickel B. Vascular access device selection: Optimizing patient outcomes - Part 1. Nursing 2024; 54:25-37. [PMID: 39186158 DOI: 10.1097/nsg.0000000000000050] [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: 08/27/2024]
Abstract
ABSTRACT A systematic evaluation of vascular access device (VAD) selection incorporates patient, device, and infusate characteristics to ensure optimal device placement. This article explores VAD selection from the perspective of vessel health and preservation and describes VAD selection options and indications, VAD-related complications, and strategies to reduce those complications.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the 2024 Infusion Nurses Society Standards of Practice Committee chair
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Høvik LH, Gjeilo KH, Ray-Barruel G, Lydersen S, Børseth AW, Gustad LT. Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study. J Clin Nurs 2024; 33:2593-2608. [PMID: 38716868 DOI: 10.1111/jocn.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/03/2024] [Accepted: 04/10/2024] [Indexed: 06/14/2024]
Abstract
AIM To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. DESIGN Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. METHOD Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. RESULTS The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. CONCLUSION This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. IMPACT The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. REPORTING METHOD The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). PATIENT OR PUBLIC CONTRIBUTION A patient representative has been involved in planning this study.
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Affiliation(s)
- Lise Husby Høvik
- Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anita Wang Børseth
- Regional Centre for Infection Prevention and Control, Central Norway Regional Health Authority, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Hook M, Woda A, Bohr K, Ford C, Singh M. Using Implementation Science to Improve Short Peripheral Intravenous Catheter Outcomes. JOURNAL OF INFUSION NURSING 2024; 47:266-276. [PMID: 38968589 DOI: 10.1097/nan.0000000000000556] [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: 07/07/2024]
Abstract
Short peripheral intravenous catheters (short PIVCs) are commonly used in acute care, guided by evidence-based policy with interventions to limit premature failure. Research on how nurses use evidence and change processes to optimize outcomes is needed. The study objective was to use a theory-based implementation science approach to evaluate and improve short PIVC insertion and care processes and reduce removals for adverse outcomes in acute care. This mixed-methods study was conducted with inpatient nursing units (n = 23) at a large urban quaternary medical center. Units identified and implemented one PIVC care intervention that could lower catheter removals for adverse outcomes over 3 months. Data from multiple sources were convergently analyzed to evaluate process and outcomes postintervention. Although overall frequency of PIVC removals for adverse outcomes was unchanged, several units improved their outcomes using implementation strategies. The determinant framework provides a plausible explanation for the study results. While adverse outcome rates remained below published rates, some units had limited success improving outcomes with traditional change strategies. Implementation strategies and readily accessible data can offer nursing units a new approach to effectively deploy, monitor, and maintain interventions to achieve improved outcomes.
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Affiliation(s)
- Mary Hook
- Author Affiliations: Advocate Health, Milwaukee, Wisconsin (Hook); Marquette University College of Nursing & Aurora St. Luke's Medical Center, Milwaukee, Wisconsin (Woda); Vivent Health, Kenosha, Wisconsin (Bohr); Aurora St. Luke Medical Center, Milwaukee, Wisconsin (Ford); Marquette University College of Nursing, Milwaukee, Wisconsin (Singh)
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Dobrescu A, Constantin AM, Pinte L, Chapman A, Ratajczak P, Klerings I, Emprechtinger R, Allegranzi B, Zingg W, Grayson ML, Toledo J, Gartlehner G, Nussbaumer-Streit B. Effectiveness and Safety of Measures to Prevent Infections and Other Complications Associated With Peripheral Intravenous Catheters: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:1640-1655. [PMID: 38593192 DOI: 10.1093/cid/ciae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. METHODS We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980-16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. RESULTS 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33-.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49-1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non-chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. CONCLUSIONS Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. CLINICAL TRIALS REGISTRATION The protocol was registered in the Open Science Framework (https://osf.io/exdb4).
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Affiliation(s)
- Andreea Dobrescu
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Larisa Pinte
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Andrea Chapman
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Robert Emprechtinger
- Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - M Lindsay Grayson
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Infectious Diseases Department, Austin Health, Melbourne, Australia
| | - Joao Toledo
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- High Impact Epidemics, WHO Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
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Leff PJ, Dinner BA, Chuang KY, Leff DB. Characteristics that increase the risk for pain on propofol injection. BMC Anesthesiol 2024; 24:190. [PMID: 38807072 PMCID: PMC11131289 DOI: 10.1186/s12871-024-02573-y] [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: 12/25/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Propofol for anesthesia has become increasingly popular for endoscopic procedures. However, pain on propofol injection (POPI) remains an issue with administration. The primary endpoint of this study was to identify patient characteristics and factors, such as IV site and gauge, that could predict the occurrence of POPI. METHODS This was a prospective chart review study of 291 patients undergoing endoscopic procedures. The patient's demographics, intravenous (IV) site, and gauge were extrapolated. POPI was scored 0-3: 0 for no pain, 1 for minimal discomfort or awareness of sensation, 2 for discomfort but manageable/tolerable, and 3 for severe discomfort with writhing. RESULTS 291 patient charts were reviewed. One patient was excluded for a lower extremity IV site. 225 (77.6%) had no pain, 48 (16.6%) grade 1 pain, 16 (5.5%) grade 2 pain, and 1 (0.3%) grade 3 pain. 137, 13, and 140 patients respectively had antecubital (AC), forearm, and hand IVs. Zero patients with an AC IV experienced a score greater than 1. Compared to AC, forearm IVs with pain of 2-3 had a univariate odds ratio (OR) of 11.3 (0.66,1.92; p-value < 0.001), and hand IVs had a univariate OR of 18.8 (2.46,143.3; p-value < 0.001) with a multivariable OR 15.2 (1.93,118.9; p-value 0.004). Patients with anxiety/depression and pain had a univariate OR 2.31 (1.09, 7.27; p-value 0.031) with a multivariable OR 2.85 (1.06, 7.74; p-value 0.039). SSRI/SNRI use had a univariate OR 1.56 (0.57,4.28; p-value 0.38). Alcohol use had a univariate OR 1.24 (0.39,3.91; p-value 0.71). Narcotic use had a Univariate OR 6.18 (1.49,25.6; p-value 0.012). Diabetic patients had a univariate OR of 1.42 (0.45,4.48; p-value 0.55). Chronic pain had a univariate OR of 3.11 (1.04,9.28; p-value 0.042). Females had a univariate OR 0.98 (0.37,2.63; p-value 0.95). CONCLUSION This study identified potential characteristics for having POPI. The incidence of POPI was statistically significant in patients with hand and forearm IVs compared to AC IV sites, larger IV gauges, history of depression/anxiety, history of chronic narcotic use, fibromyalgia, and chronic pain syndromes. This shows the potential of premedicating with analgesics or using AC sites on these select patients to help reduce the risk of POPI.
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Affiliation(s)
- Phillip J Leff
- Department of Internal Medicine, Creighton University Phoenix, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
| | - Brett A Dinner
- Department of Internal Medicine, Creighton University Phoenix, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Keng-Yu Chuang
- Department of Gastroenterology, Creighton University Phoenix, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - David B Leff
- Central Arizona Medical Associates, 3638 E Southern Ave, Ste C108, Mesa, AZ, USA
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11
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Casanova-Vivas S, Ballestar-Tarín ML, García-Molina P, Lorente-Pomar AB, Palau Gomar A, Hevilla Cucarella EB, Blasco JM, Gomis-Baldoví S. An Explanatory Model of Vascular Access Care Quality: Results of a Cross-Sectional Observational Study. NURSING REPORTS 2024; 14:1049-1057. [PMID: 38804412 PMCID: PMC11130970 DOI: 10.3390/nursrep14020079] [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: 02/01/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
The management of nursing care regarding patients' vascular access is a priority. This study determines the contribution of the variables involved in the quality of care and maintenance of vascular access (VA) devices in admitted patients in the Valencian Community. METHODS Using the STROBE statement, an observational, cross-sectional study was conducted on 1576 VA devices. Data were collected using the INCATIV Questionnaire. We performed a multivariate analysis of the questionnaire variables. RESULTS In total, 50% had a good or very good assessment of the VA condition. This was positively correlated with anatomical location, dressing type, dressing date record, use of needle-free connectors (NFCs), date of last dressing change, presence of phlebitis, visibility of the insertion site and characteristics of the dressing's condition (p < 0.001). The model indicated that the presence of phlebitis was the clearest predictor of a poor VA care assessment (OR = 20.579), followed by no visibility of the insertion site (OR = 14.209). Results also indicated that uncovered VA lumens or no NFCs used were related to a negative quality assessment. CONCLUSION By managing and controlling these variables, the likelihood of providing optimal care is ensured. This enables the establishment of a standardised care approach for all nursing professionals and the building of a new quality indicator.
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Affiliation(s)
- Sonia Casanova-Vivas
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (S.C.-V.)
- Servicio de Prevención de Riesgos Laborales, Conselleria de Sanidad, 46010 Valencia, Spain
| | - María Luisa Ballestar-Tarín
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (S.C.-V.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
| | - Pablo García-Molina
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (S.C.-V.)
| | | | - Ana Palau Gomar
- Hospital Francesc de Borja de Gandia, Conselleria de Sanidad, 46702 Valencia, Spain;
| | - Enrique Bdo. Hevilla Cucarella
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanidad Universal y Salud Pública, 46010 Valencia, Spain;
| | - José-María Blasco
- Group of Physiotherapy in the Ageing Processes: Socio and Healthcare Strategies, Departamento de Fisioterapia, Universitat de València, 46010 Valencia, Spain;
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12
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Pérez-Granda MJ, Irigoyen-von-Sierakowski Á, Toledo N, Rodríguez E, Cruz ML, Hernanz G, Serra JA, Kestler M, Muñoz P, Guembe M. Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients. Eur J Clin Microbiol Infect Dis 2024; 43:703-712. [PMID: 38326546 DOI: 10.1007/s10096-024-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. METHODS We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. RESULTS A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). CONCLUSIONS We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.
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Affiliation(s)
- María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Álvaro Irigoyen-von-Sierakowski
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Neera Toledo
- Intermal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Rodríguez
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Cruz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giovanna Hernanz
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Serra
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Centre On Frailty and Healthy Ageing, CIBERFES, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Martha Kestler
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Antequera IG, Saba A, Furlan MDS. Phlebitis in Medical-Surgical Units: A Case-Control Study in a Brazilian Hospital. JOURNAL OF INFUSION NURSING 2024; 47:132-141. [PMID: 38422406 DOI: 10.1097/nan.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The most commonly used vascular access is the peripheral intravenous catheter (PIVC). However, it can trigger complications and the occurrence of adverse events, such as phlebitis. This study evaluated the variables that are associated with the occurrence of phlebitis in medical and surgical inpatient units. This is an observational, retrospective, case-control study in medical and surgical hospitalization units of a private general hospital in the city of São Paulo. Participants were an average age of 66.3 years, and 71% were hospitalized in medical units. The risk variables associated with phlebitis were medical hospitalization (odds ratio [OR] = 4.36; P = .002), presence of comorbidity (OR = 10.73; P < .001), and having 5 or more PIVCs (OR = 53.79; P = .001). Regarding intravenous therapy, the use of contrast was a risk variable (OR = 2.23; P = .072). On the other hand, patient education regarding PIVCs was a protective measure against the development of phlebitis. The nursing team plays an essential role in the care of patients with PIVCs, inpatient guidance, planning, and device choice, taking into account the risk factors for phlebitis to maintain the preservation of vascular health and reduce adverse events.
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Affiliation(s)
- Isabela Granado Antequera
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
| | - Amanda Saba
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
| | - Maryana da Silva Furlan
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
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Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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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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Natale F, Raucci G, Molinari R, Alfieri R, D’Arienzo D, Pezzullo E, Loffredo FS, Golino P, Cimmino G. Catch the Cath or Not? A Hamletic Dilemma after 10 Years. J Cardiovasc Echogr 2023; 33:189-191. [PMID: 38486691 PMCID: PMC10936701 DOI: 10.4103/jcecho.jcecho_68_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 03/17/2024] Open
Abstract
In the last few years, a tremendous advancement has been made in the therapeutical management of several diseases with an increasing need for parental drug administration. To avoid repeated venous insertions and the patient's anxiety related to these procedures, it is now common practice to insert a catheter to leave it in place for a longer time. However, these procedures may generate some complications, such as failure of insertion, embolization, and infection. Different noninvasive techniques have been proposed and used for the retrieval of lost or misplaced foreign objects. Here, we presented a case of the lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years ago, incidentally detected during an echocardiographic examination. Here, we presented a case of a lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years before.
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Affiliation(s)
- Francesco Natale
- Department of Cardiology, Vanvitelli Cardiology Unit, Monaldi Hospital, Piazza Miraglia, Naples, Italy
| | - Giuseppe Raucci
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Riccardo Molinari
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Roberta Alfieri
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Diego D’Arienzo
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Enrica Pezzullo
- Department of Cardiology, Vanvitelli Cardiology Unit, Monaldi Hospital, Piazza Miraglia, Naples, Italy
| | - Francesco S Loffredo
- Department of Cardiology, Vanvitelli Cardiology Unit, Monaldi Hospital, Piazza Miraglia, Naples, Italy
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, Vanvitelli Cardiology Unit, Monaldi Hospital, Piazza Miraglia, Naples, Italy
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
- Department of Internal Medicine, Gerontology and Neurology, Cardiology Unit, Azienda Ospedaliera Universitaria “Luigi Vanvitelli”, Piazza Miraglia, Naples, Italy
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