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Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [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: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
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Rickard CM, Larsen E, Walker RM, Mihala G, Byrnes J, Saiyed M, Cooke M, Finucane J, Carr PJ, Marsh N. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med 2023; 18:21-32. [PMID: 36372995 PMCID: PMC10099685 DOI: 10.1002/jhm.12995] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Emily Larsen
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Rachel M Walker
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Masnoon Saiyed
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro South Hospitals and Health Service, Queen Elizabeth II Hospital, Nathan, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Lulie M, Tadesse A, Tsegaye T, Yesuf T, Silamsaw M. Incidence of peripheral intravenous catheter phlebitis and its associated factors among patients admitted to University of Gondar hospital, Northwest Ethiopia: a prospective, observational study. Thromb J 2021; 19:48. [PMID: 34256784 PMCID: PMC8276507 DOI: 10.1186/s12959-021-00301-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlebitis, inflammation of tunica intima of venous wall, occurred in 13-56% of hospitalized patients. It is characterized by pain, erythema, swelling, palpable venous cord, and pussy discharge at catheter site. Cannula-related blood stream infection (CRBSI) is recognized complication of phlebitis. Adverse outcomes of phlebitis embrace patient discomfort, longer hospital stay and higher health care cost. This study aimed to determine the incidence and associated factors of peripheral vein phlebitis among hospitalized patients. METHODS A hospital-based prospective, observational study was conducted between April 1 and August 31, 2020 at University of Gondar hospital, Northwest Ethiopia. A consecutive sampling method was used to recruit 384 patients. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients' records. Presence and severity of phlebitis was identified by Jackson's Visual Infusion Phlebitis (VIP) Scoring System. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with occurrence of phlebitis. P-value < 0.05 was used to declare significant association. RESULT A total of 384 study subjects were included in the study. The mean age of study subjects was 46 years, with a range of 19 to 96 years. The incidence of phlebitis was 70% among study subjects. Mid-stage (grade 3) and advanced-stage (grade 4) phlebitis were noticed in 136/268 (51%) and 89/268 (33%) respectively. Odds of developing phlebitis were twofold higher in patients with catheter-in situ > 96 h (AOR = 2.261, 95% CI 1.087-4.702, P-value = 0.029) as compared to those with catheter dwell time < 72 h. Female patients were 70% (AOR = 0.293, 95% CI 0.031-0.626, P-value = 0.002) lower than male patients with risk of developing phlebitis. Patients who use infusates were 53% (AOR = 0.472, 95% CI 0.280-0.796, P-value = 0.005) less likely to develop phlebitis as compared to those who didn't use infusates. CONCLUSION The cannula must be reviewed on daily basis, and it should be removed if it stayed later than 96 h.
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Affiliation(s)
- Mulugeta Lulie
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Yesuf
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wang J, Li MM, Zhou LP, Xie RH, Pakhale S, Krewski D, Wen SW. Treatment for grade 4 peripheral intravenous infiltration with type 3 skin tears: A case report and literature review. Int Wound J 2021; 19:222-229. [PMID: 34129273 PMCID: PMC8684851 DOI: 10.1111/iwj.13624] [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: 02/28/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35‐year‐old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.
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Affiliation(s)
- Jie Wang
- Department of Nursing, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China
| | - Man-Man Li
- Digestive Medical Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China
| | - Le-Peng Zhou
- Department of Nursing, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China
| | - Ri-Hua Xie
- Department of Nursing, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China
| | - Smita Pakhale
- Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Risk Science International, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Obstetrics & Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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Elizabeth Gómez-Neva M, Alonso Rondon Sepulveda M, Buitrago-Lopez A. Lifespan of peripheral intravenous short catheters in hospitalized children: A prospective study. J Vasc Access 2021; 23:730-737. [PMID: 33845674 DOI: 10.1177/11297298211005299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the recommended lifespan of 223 peripheral intravenous accesses in pediatric services. METHOD In this cohort study, we monitored the time of intravenous catheter between insertion and removal in children aged up to 15 years old in a Hospital from Bogotá-Colombia. The routine catheter observations was registered in questionnaires during nursing shifts. Survival analyses were performed to analyze the lifespan of the catheter free of complications. RESULTS The median lifespan of peripheral intravenous catheters without complications was 129 h (IQR 73.6-393.4 h). This median time free from complications was much lower for children ⩽1 year 98.3 h (IQR 63-141 h), than for participants aged >1 year 207.4 h (IQR 100-393 h). Catheters of 24 G (gauge) caliber had a median complication free time of 128 h (IQR 69-207 h) and 22 G calibers 144 h (IQR 103-393 h). CONCLUSIONS In this study, 75% of peripheral indwell catheters remained free from complications for 74 h, the other extreme 25% of these patients could remain up to 393 h.
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Affiliation(s)
- Maria Elizabeth Gómez-Neva
- Faculty of Nursing, Department of Clinical Nursing, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Martin Alonso Rondon Sepulveda
- Faculty of Medicine, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Adriana Buitrago-Lopez
- Faculty of Medicine, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
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Marsh N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, Rickard CM. Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis. J Adv Nurs 2020; 76:3346-3362. [DOI: 10.1111/jan.14565] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Joan Webster
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Amanda J. Ullman
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Medicine Griffith University Brisbane Queensland Australia
- Centre for Applied Health Economics Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Division of Hospital Medicine Department of Medicine University of Michigan Ann Arbor Michigan USA
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
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Doesburg F, Oelen R, Renes MH, Bult W, Touw DJ, Nijsten MW. Towards more efficient use of intravenous lumens in multi-infusion settings: development and evaluation of a multiplex infusion scheduling algorithm. BMC Med Inform Decis Mak 2020; 20:206. [PMID: 32878609 PMCID: PMC7466776 DOI: 10.1186/s12911-020-01231-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-drug intravenous (IV) therapy is one of the most common medical procedures used in intensive care units (ICUs), operating rooms, oncology wards and many other hospital departments worldwide. As drugs or their solvents are frequently chemically incompatible, many solutions must be administered through separate lumens. When the number of available lumens is too low to facilitate the safe administration of these solutions, additional (peripheral) IV catheters are often required, causing physical discomfort and increasing the risk for catheter related complications. Our objective was to develop and evaluate an algorithm designed to reduce the number of intravenous lumens required in multi-infusion settings by multiplexing the administration of various parenteral drugs and solutions. METHODS A multiplex algorithm was developed that schedules the alternating IV administration of multiple incompatible IV solutions through a single lumen, taking compatibility-related, pharmacokinetic and pharmacodynamic constraints of the relevant drugs into account. The conventional scheduling procedure executed by ICU nurses was used for comparison. The number of lumens required by the conventional procedure (LCONV) and multiplex algorithm (LMX) were compared. RESULTS We used data from 175,993 ICU drug combinations, with 2251 unique combinations received by 2715 consecutive ICU patients. The mean ± SD number of simultaneous IV solutions was 2.8 ± 1.6. In 27% of all drug combinations, and 61% of the unique combinations the multiplex algorithm required fewer lumens (p < 0.001). With increasing LCONV, the reduction in number of lumens by the multiplex algorithm further increased (p < 0.001). In only 1% of cases multiplexing required > 3 lm, versus 12% using the conventional procedure. CONCLUSION The multiplex algorithm addresses a major issue that occurs in ICUs, operating rooms, oncology wards, and many other hospital departments where several incompatible drugs are infused through a restricted number of lumens. The multiplex algorithm allows for more efficient use of IV lumens compared to the conventional multi-infusion strategy.
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Affiliation(s)
- Frank Doesburg
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.
| | - Roy Oelen
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Maurits H Renes
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Wouter Bult
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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Heng SY, Yap RTJ, Tie J, McGrouther DA. Peripheral Vein Thrombophlebitis in the Upper Extremity: A Systematic Review of a Frequent and Important Problem. Am J Med 2020; 133:473-484.e3. [PMID: 31606488 DOI: 10.1016/j.amjmed.2019.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The acceptable incidence of thrombophlebitis following intravenous cannulation is 5%, as recommended by the Intravenous Nurses Society guidelines, but publications have reported startling figures of 20% to 80%. Given the frequency of intravenous lines, this presents a potential clinical problem. We aimed to determine the predisposing patient, catheter, and health care-related factors of peripheral vein thrombophlebitis in the upper extremity. METHODS In this systematic review, we used a comprehensive search strategy to identify risk factors of thrombophlebitis from inception to May 20, 2019. Studies reporting risk factors of peripheral vein thrombophlebitis of adult patients admitted to the hospital and receiving an intravenous cannulation were included. The Quality of Prognostic Studies tool was used in the assessment for risk of bias to determine the study quality. RESULTS Of the 6910 studies initially identified, 25 were eligible for inclusion. Qualitative syntheses revealed that patient-related factors that confer a higher risk included intercurrent illness, immunocompromised state, comorbidities such as diabetes mellitus, malignancy, previous thrombophlebitis, burns, and higher hemoglobin levels. Catheter-related risk factors included catheter size, duration, and site of insertion. Intravenous antibiotics and potassium chloride predisposed to thrombophlebitis. Cannulation by an intravenous therapy team and more nursing care were associated with a decreased risk. A P-value < .5 was considered to be statistically significant. CONCLUSION Recognition of the predisposing factors would allow for targeted strategies to aid in the prevention of this iatrogenic infection, which may include closer monitoring of patients who are identified to be vulnerable. Based on this systematic review, we developed an algorithm to guide clinical management. Further research is warranted to validate this algorithm.
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Affiliation(s)
- Shu Yun Heng
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Robert Tze-Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Joyce Tie
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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Kuş B, Büyükyılmaz F. Effectiveness of vialon biomaterial versus teflon catheters for peripheral intravenous placement: A randomized clinical trial. Jpn J Nurs Sci 2020; 17:e12328. [PMID: 32080973 DOI: 10.1111/jjns.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022]
Abstract
AIM This study was to determine the effects of the two types of catheter material (vialon biomaterial and teflon) on pain intensity, dwell time, and phlebitis score for peripheral intravenous catheter (PIVC) placement. METHODS Participants (N = 208) were randomly assigned to the vialon biomaterial group (n = 104), the teflon group (n = 104). After the PIVC placement, the intensity of pain and phlebitis score were evaluated. Catheter dwell mean time was determined. RESULTS The pain intensity scores were similar immediately after inserting the PIVC. No difference was observed between the pain scores in both groups (p ≥ .050). Catheter dwell mean time for the vialon biomaterial catheter group (4.72 ± 1.20 days) was significantly longer compared to the teflon catheter group (4.10 ± 0.92 days) (p ≤ .001). It was determined that the catheter was removed due to phlebitis development in 16.3% of the vialon biomaterial catheter group and 53.8% of the teflon catheter group. An advanced level of statistically significant difference was found between the two groups in terms of phlebitis development scores (p ≤ .001). CONCLUSIONS This study concluded that vialon biomaterial catheter (BD Insyte™ Autoguard™ BC winged) demonstrates longer dwell time of PIVC, lower phlebitis rate and phlebitis score than teflon catheter (BD Venflon™).
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Affiliation(s)
- Betül Kuş
- Health Science Faculty, Yozgat Bozok University, Yozgat, Turkey
| | - Funda Büyükyılmaz
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ying CX, Yusuf A, Keng SL. Perceptions of risk factors for phlebitis among Malaysian nurses. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S18-S23. [PMID: 31972104 DOI: 10.12968/bjon.2020.29.2.s18] [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: 06/10/2023]
Abstract
BACKGROUND Intravenous therapy is an integral part of professional nursing practice. Nurses have a responsibility to recognise risk factors for phlebitis. AIMS To investigate nurses' perceptions of risk factors for phlebitis in a tertiary teaching hospital in north-east Peninsular Malaysia. METHODS A cross-sectional study of 199 randomly selected nurses were surveyed for their perceptions of risk factors for phlebitis using a self-administered questionnaire. FINDINGS More than half of the nurses (56.8%) had a good perception levels of risk factors for phlebitis. There was a significant association between the clinical area and nurses' perceptions of risk factors for phlebitis (p=0.04). Nurses working in medical, orthopaedic, and surgical areas had slightly better perceptions than nurses working in multidisciplinary and oncology areas. CONCLUSION These findings suggest that nurses need to continually improve their knowledge about risk factors for phlebitis to ensure safer nursing practice.
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Affiliation(s)
| | - Azlina Yusuf
- Senior Lecturer, School of Health Sciences, Universiti Sains Malaysia, Malaysia
| | - Soon Lean Keng
- Associate Professor, Sunway University, Bandar Sunway, Malaysia
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Cobo Sánchez JL, Moya Mier S, González Menéndez F, Renedo González C, Lázaro Otero M, Pelayo Alonso R. Formación en una estrategia multimodal sobre el cuidado de los catéteres venosos periféricos: impacto en la preservación del árbol vascular de pacientes de una unidad de nefrología. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Un desarrollo adecuado de las fístulas arteriovenosas está relacionado con el estado del árbol vascular y el uso previo de dispositivos de acceso venoso periférico (CVP).
Objetivo: Evaluar el impacto de la formación en una estrategia multimodal para reducir las complicaciones relacionadas con el CVP en una unidad de hospitalización de nefrología.
Material y Método: Estudio cuasi-experimental pre-post intervención, en pacientes portadores de CVP en una unidad de hospitalización de nefrología. La intervención consistió en la formación en una estrategia multimodal para el manejo de CVP basada en 5 medidas basadas en evidencia. Para determinar el impacto se analizaron los registros electrónicos de los CVP insertados en los 3 meses previos a la actividad formativa (PRE) vs 3 meses posteriores (POST). Se realizó un análisis descriptivo e inferencial de las variables a estudio.
Resultados: CVP estudiados: PRE n=96, POST n=120. Número medio de CVP/paciente: PRE 2,07 vs POST 1,75 (p=0,02). Calibre: PRE 18G 1%, 20G 18%, 22G 80%, 24G 1%; POST 20G 20%, 22G 80% (p=NS). Duración media: PRE 192h, <7 días 26% vs POST 171h, <7 días 30% (p=NS). Causas de retirada: Alta / no precisa PRE 41% vs POST 38% (p=NS), Flebitis PRE 27% vs POST 13% (p=NS).
Conclusiones: la formación en una estrategia multimodal ha conseguido reducir: número de CVP por paciente, número de flebitis, uso de CVP de mayor calibre y tiempo que permanecen insertados. Una estrategia multimodal sobre el manejo de los CVP puede ayudar a preservar el árbol vascular en pacientes nefrológicos.
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Lv L, Zhang J. The incidence and risk of infusion phlebitis with peripheral intravenous catheters: A meta-analysis. J Vasc Access 2019; 21:342-349. [PMID: 31547791 DOI: 10.1177/1129729819877323] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Phlebitis is a common complication associated with the use of peripheral intravenous catheters. The aim of this study was to estimate the incidence of phlebitis with peripheral intravenous catheter use and to identify risk factors for phlebitis development. Method: Literature survey was conducted in electronic databases (CINAHL, Embase, Google Scholar, Ovid, and PubMed), and studies were included if they used peripheral intravenous catheter for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain overall and subgroup phlebitis incidence rates and odds ratio between males and females in phlebitis incidence. Results: Thirty-five studies were included (20,697 catheters used for 15,791 patients; age 57.1 years (95% confidence interval: 55.0, 59.2); 53.9% males (95% confidence interval: 42.3, 65.5)). Incidence of phlebitis was 30.7 per 100 catheters (95% confidence interval: 27.2, 34.2). Incidence of severe phlebitis was 3.6% (95% confidence interval: 2.7%, 4.6%). Incidence of phlebitis was higher in non-intervened (30% (95% confidence interval: 27%, 33%)) than in intervened (21% (95% confidence interval: 15%, 27%)) groups, and with Teflon (33% (95% confidence interval: 25%, 41%)) than Vialon (27% (95% confidence interval: 21%, 32%)) cannula use. Odds of developing phlebitis was significantly higher in females (odds ratio = 1.42 (95% confidence interval: 1.05, 1.93); p = 0.02). Longer dwelling time, antibiotics infusion, female gender, forearm insertion, infectious disease, and Teflon catheter are important risk factors for phlebitis development identified by the included studies. Conclusion: Incidence of phlebitis with the use of peripheral intravenous catheters during infusion is 31%. Severe phlebitis develops in 4% of all patients. Risk of phlebitis development can be reduced by adapting appropriate interventions.
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Affiliation(s)
- Luyu Lv
- Venous Blood Collection Room, Changchun Children’s Hospital, Changchun, China
| | - Jiaqian Zhang
- Department of Cardiology, Sino-Japanese Friendship Hospital, Jilin University, Changchun, China
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A Model of Phlebitis Associated with Peripheral Intravenous Catheters in Orthopedic Inpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183412. [PMID: 31540024 PMCID: PMC6765841 DOI: 10.3390/ijerph16183412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/24/2022]
Abstract
Phlebitis leads to increased discomfort for patients, longer hospital stays, and higher healthcare costs. This study aimed to identify predictive factors of peripheral phlebitis related to intravenous injection among orthopedic inpatients, develop a prediction model, and evaluate the goodness-of-fit of the prediction model. This study included 270 orthopedic patients who were hospitalized in the orthopedic ward of a general hospital. A peripheral intravenous injection-related questionnaire based on previous studies and the modified Infusion Nurses Society scale were used to collect data. Phlebitis risk factors were identified, and a prediction model was developed using the Bayesian regression model. Vein quality, contrast medium use, hygiene duration, and period of nursing clinical experience were significant based on their 95% confidence intervals. The prediction model exhibited good discrimination. The prediction model developed in this study can be used for screening high-risk patients for peripheral intravenous catheter-related phlebitis and for providing basic data for developing interventions for the prevention and management of peripheral intravenous catheter-related phlebitis.
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Kuroda N, Fujimoto A, Okanishi T, Sato K, Itamura S, Baba S, Nishimura M, Ichikawa N, Enoki H. Low Body Mass Index and Low Intelligence Quotient Are Infection Risk Factors in Vagus Nerve Stimulation. World Neurosurg 2019; 130:e839-e845. [PMID: 31295613 DOI: 10.1016/j.wneu.2019.06.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Risk factors for infection after vagus nerve stimulation (VNS) device implantation represent an important issue but remain unclear. We hypothesized that specific risk factors for infection would be associated with VNS device implantation. This study reviewed patients with epilepsy who underwent VNS device implantation and undertook a statistical analysis of risk factors for surgical site infection (SSI). METHODS We reviewed all medical records for patients who underwent VNS therapy in our facility between August 2011 and May 2018. Age, sex, height, body weight, body mass index (BMI), intelligence quotient (IQ), surgical incision opening time, blood loss, epilepsy classification, activities of daily living, and generator replacement were statistically compared between cases with and without SSI. RESULTS We performed 208 VNS device implantation surgeries at our facility during the study period. Among these, 150 patients underwent initial implantation, 56 patients underwent first generator replacement, and 2 patients underwent second replacement. Six patients (2.7%) with initial implantation and 3 patients (5.4%) with first replacement showed SSI. Low BMI was a risk factor for infection at initial implantation (P < 0.0012) using a BMI within 1.78 kg/m2 of the cutoff for being underweight (100% sensitivity, 25% specificity). Low IQ (P = 0.0015) was also a risk factor for SSI. CONCLUSIONS This study identified low BMI and low IQ at initial implantation as risk factors for infection.
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Affiliation(s)
- Naoto Kuroda
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shinji Itamura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Doesburg F, Smit JM, Paans W, Onrust M, Nijsten MW, Dieperink W. Use of infrared thermography in the detection of superficial phlebitis in adult intensive care unit patients: A prospective single-center observational study. PLoS One 2019; 14:e0213754. [PMID: 30865728 PMCID: PMC6415825 DOI: 10.1371/journal.pone.0213754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022] Open
Abstract
Common methods to detect phlebitis may not be sufficient for patients in the intensive care unit (ICU). The goal of this study was to investigate the feasibility of infrared (IR) thermography to objectively detect phlebitis in adult ICU patients. We included a total of 128 adult ICU-patients in a pilot and subsequent validation study. Median [interquartile range] age was 62 [54–71] years and 88 (69%) patients were male. Severity of phlebitis was scored using the visual infusion phlebitis (VIP)-score, ranging from 0 (no phlebitis) to 5 (thrombophlebitis). The temperature difference (ΔT) between the insertion site and a proximal reference point was measured with IR thermography. In 78 (34%) catheters early phlebitis and onset of moderate phlebitis was observed (VIP-score of 1–3). In both the pilot and the validation study groups ΔT was significantly higher when the VIP-score was ≥1 compared to a VIP-score of 0 (p<0.01 and p<0.001, respectively). Multivariate analysis identified ΔT (p<0.001) and peripheral venous catheter (PVC) dwell time (p = 0.001) as significantly associated with phlebitis. IR thermography may be a promising technique to identify phlebitis in the ICU. An increased ΔT as determined with thermography may be a risk factor for phlebitis.
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Affiliation(s)
- Frank Doesburg
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
| | - Joya M Smit
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Wolter Paans
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Marisa Onrust
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
| | - Maarten W Nijsten
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
| | - Willem Dieperink
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
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Simonetti V, Comparcini D, Miniscalco D, Tirabassi R, Di Giovanni P, Cicolini G. Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study. NURSE EDUCATION TODAY 2019; 73:77-82. [PMID: 30544076 DOI: 10.1016/j.nedt.2018.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/22/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement. OBJECTIVE To determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence. DESIGN Cross-sectional. SETTINGS The study was carried out (March-September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna). PARTICIPANTS A convenience sample of NSs (n = 1056) was involved. METHODS We collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample. RESULTS Most participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%). In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores. "Infusionset removal after 24 h when lipids or blood products are administered" (75.4%). CONCLUSIONS NSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.
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Affiliation(s)
| | - Dania Comparcini
- UNIVPM University, Italy; ASUR Marche, AV5 Ascoli Piceno Hospital, Italy; AO Ospedali Riuniti di Ancona Hospital, Italy.
| | | | | | | | - Giancarlo Cicolini
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy; ASL 02 Abruzzo, Chieti, Italy.
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Simin D, Milutinović D, Turkulov V, Brkić S. Incidence, severity and risk factors of peripheral intravenous cannula‐induced complications: An observational prospective study. J Clin Nurs 2019; 28:1585-1599. [DOI: 10.1111/jocn.14760] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Dragana Simin
- Department of Nursing, Faculty of Medicine University of Novi Sad Novi Sad Serbia
| | - Dragana Milutinović
- Department of Nursing, Faculty of Medicine University of Novi Sad Novi Sad Serbia
| | - Vesna Turkulov
- Department of Infectious Disease, Faculty of Medicine University of Novi Sad Novi Sad Serbia
| | - Snežana Brkić
- Department of Infectious Disease, Faculty of Medicine University of Novi Sad Novi Sad Serbia
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Abstract
Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.
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A Randomized Controlled Study to Evaluate the Effectiveness of 2 Treatment Methods in Reducing Incidence of Short Peripheral Catheter-Related Phlebitis. JOURNAL OF INFUSION NURSING 2018; 41:131-137. [PMID: 29489709 DOI: 10.1097/nan.0000000000000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Short peripheral catheter (SPC)-related phlebitis can lead to bloodstream infections and affect patients' quality of life. A randomized trial was carried out to evaluate the effectiveness of 2 treatment methods in reducing the incidence of SPC-related phlebitis. The 2 treatment methods differed in terms of the cleansing solution used before insertion and dressing material used after removal. The results demonstrated that the type of cleansing solution and postremoval dressing material did not make a difference in the incidence of phlebitis. Strict adherence to aseptic techniques and prompt removal of the SPC remained the cornerstone in the prevention of phlebitis.
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20
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Alcaraz-Martínez J, Aranaz-Andrés JM, Cantero-Sandoval A, Piñera-Salmerón P, Mas-Luzón J, Serrano-Martínez JA, González Garro E. [Use of complementary tests in emergencies and their relation with patient safety incidents]. J Healthc Qual Res 2018. [PMID: 29534933 DOI: 10.1016/j.cali.2018.01.003] [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: 10/17/2022]
Abstract
OBJECTIVE To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.
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Affiliation(s)
- J Alcaraz-Martínez
- Unidad de Calidad y Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España.
| | - J M Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica enRed en Epidemiología y Salud Pública (CIBERESP), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - A Cantero-Sandoval
- Servicio de Urgencias, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - J Mas-Luzón
- Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España
| | - J A Serrano-Martínez
- Servicio de Urgencias, Hospital Universitario J.M. Morales Meseguer, Murcia, España
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Xu L, Hu Y, Huang X, Fu J, Zhang J. Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults: A nonblinded, cluster-randomized trial in China. Int J Nurs Pract 2017; 23. [PMID: 28990241 DOI: 10.1111/ijn.12595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Lichun Xu
- School of Nursing; Fudan University; Shanghai China
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Yan Hu
- School of Nursing; Fudan University; Shanghai China
| | - Xiaojin Huang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jianguo Fu
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jinhui Zhang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
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Enes SMS, Opitz SP, Faro ARMDCD, Pedreira MDLG. Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon. Rev Esc Enferm USP 2017; 50:263-71. [PMID: 27384206 DOI: 10.1590/s0080-623420160000200012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. OBJETIVO Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:207-215. [DOI: 10.1007/s00103-016-2488-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan YHG, Tai WLS, Sim C, Ng HLI. Optimising peripheral venous catheter usage in the general inpatient ward: a prospective observational study. J Clin Nurs 2016; 26:133-139. [DOI: 10.1111/jocn.13451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Crystal Sim
- Nursing Service; Tan Tock Seng Hospital; Singapore City Singapore
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25
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Abstract
Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.
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26
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Johann DA, Danski MTR, Vayego SA, Barbosa DA, Lind J. Risk factors for complications in peripheral intravenous catheters in adults: secondary analysis of a randomized controlled trial. Rev Lat Am Enfermagem 2016; 24:e2833. [PMID: 27901218 PMCID: PMC5172614 DOI: 10.1590/1518-8345.1457.2833] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: analyze the risk factors linked to complications in peripheral intravenous catheters. METHOD: secondary data analysis of a randomized controlled trial with 169 medical and surgical patients placed in two groups, one with integrated safety catheter (n=90) and other using simple needle catheter (n=79), with three months follow-up time. RESULTS: the risk factors that raised the odds of developing complications were: hospitalization between 10-19 days (p=0.0483) and 20-29 days (p=0,0098), antimicrobial use (p=0.0288) and use of fluid solutions (p=0.0362). The 20 Gauge lowered the risks of complications (p=0.0153). Multiple analysis showed reduction of risk for the 20 Gauge (p=0.0350); heightened risk for solutions and fluids (p=0.0351) and use of corticosteroids (p=0.0214). CONCLUSION: risk factors linked to complications in peripheral intravenous catheters were: hospitalization periods between 10-29 days, antimicrobial infusion, solutions and fluids and corticosteroids. Regarding complications, 20 Gauge is a protecting factor compared with 22. Brazilian Clinical Trials Registry: RBR-46ZQR8. OBJETIVO: analisar os fatores de risco relacionados à ocorrência de complicações no cateterismo venoso periférico. MÉTODO: análise secundária de dados de um ensaio clínico randomizado, no qual 169 pacientes clínicos e cirúrgicos foram alocados no grupo em uso de cateter de segurança completo (n = 90) e no grupo que utilizou cateter sobre agulha simples (n = 79), tempo de seguimento de três meses. RESULTADOS: os fatores de risco que aumentaram as chances de desenvolvimento de complicações foram: períodos de internação compreendidos entre 10 a 19 dias (p = 0,0483) e 20 a 29 dias (p = 0,0098), uso de antimicrobianos (p = 0,0288) e soluções e planos de soro (p = 0,0362). O calibre 20 Gauge diminuiu os riscos de ocorrência de complicações (p=0,0153). A análise múltipla apontou redução do risco para o calibre 20 (p = 0,0350); aumento do risco para a infusão de soluções e planos de soro (p = 0,0351) e administração de corticosteróides (p = 0,0214). CONCLUSÃO: os fatores de risco relacionados à ocorrência de complicações no cateterismo venoso periférico foram tempo de internação entre 10 e 29 dias, infusão de antimicrobianos, soluções e planos de soro e corticosteróides. Ressalta-se o calibre 20 como fator protetor ao desenvolvimento de complicações, quando comparado ao 22. Registro Brasileiro de Ensaios Clínicos: RBR-46ZQR8. OBJETIVO: analizar los factores de riesgo relacionados a la ocurrencia de complicaciones en el cateterismo venoso periférico. MÉTODO: análisis secundario de datos de un ensayo clínico aleatorizado, en el cual 169 pacientes clínicos y quirúrgicos fueron asignados al grupo que usaba catéter de seguridad completo (n = 90) y al grupo que utilizó catéter plástico sobre aguja (tipo Abbocath) (n = 79); tiempo de seguimiento de tres meses. RESULTADOS: los factores de riesgo que aumentaron las probabilidades de desarrollar complicaciones fueron: períodos de internación comprendidos entre 10 y 19 días (p = 0,0483) y entre 20 y 29 días (p = 0,0098); uso de antimicrobianos (p = 0,0288); y uso soluciones y administración de suero (p = 0,0362). El calibre 20G de la aguja disminuyó los riesgos de ocurrencia de complicaciones (p = 0,0153). El análisis múltiple apuntó: reducción del riesgo para el calibre 20G (p = 0,0350); aumento del riesgo para la infusión de soluciones, administración de suero (p = 0,0351) y administración de corticosteroides (p = 0,0214). CONCLUSIÓN: los factores de riesgo relacionados a la ocurrencia de complicaciones en el cateterismo venoso periférico fueron el tiempo de internación entre 10 y 29 días, la infusión de antimicrobianos, soluciones, administración de suero y corticosteroides. Se destaca el calibre 20G como factor protector para el desarrollo de complicaciones, cuando comparado al calibre 22G. Registro Brasileño de Ensayos Clínicos: RBR-46ZQR8.
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Affiliation(s)
| | | | - Stela Adami Vayego
- PhD, Adjunct Professor, Departamento de Estatística, Universidade
Federal do Paraná, Curitiba, PR, Brazil
| | - Dulce Aparecida Barbosa
- PhD, Associate Professor, Escola Paulista de Enfermagem, Universidade
Federal de São Paulo, São Paulo, SP, Brazil
| | - Jolline Lind
- Master's student, Programa de Pós-Graduação em Enfermagem, Universidade
Federal do Paraná, Curitiba, PR, Brazil
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Zhu A, Wang T, Wen S. Peripheral intravenous cathetersin situfor more than 96 h in adults: What factors affect removal? Int J Nurs Pract 2016; 22:529-537. [PMID: 27723177 DOI: 10.1111/ijn.12492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/09/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Aiqun Zhu
- Department of Emergency; The Second Xiangya Hospital of Central South University; Changsha Hunan China
| | - Ting Wang
- Department of Emergency; The Second Xiangya Hospital of Central South University; Changsha Hunan China
| | - Shali Wen
- Organ Transplantation Ward; The Second Xiangya Hospital of Central South University; Changsha Hunan China
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Haruki Y, Hagiya H, Sakuma A, Haruki M, Oka Y, Sugiyama T, Kawakami Y, Kondo S. [Investigation of Intravenous Azithromycin Treatment Safety When Reducing Solvent for Intensive Care Unit Patients]. YAKUGAKU ZASSHI 2016; 135:987-90. [PMID: 26234357 DOI: 10.1248/yakushi.15-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intravenous azithromycin (AZM) was approved for use in December 2011 in Japan. In general, intravenous AZM injections are diluted to 1 mg/mL, with a total infusion volume of 500 mL to avoid phlebitis. Patients in intensive care units (ICUs) require small infusion volumes. We retrospectively evaluated the total AZM infusion volume in 65 ICU patients receiving AZM treatment from December 2011 to August 2014. Thirteen patients (20.0%) received a reduced volume [100 mL (5 mg/mL) or 250 mL (2 mg/mL)] using an infusion pump over 2 h. No peripheral phlebitis was observed in any patient. Based on this result, it is assumed that AZM can be safely administered to ICU patients even though the volume of solvent is reduced. AZM is widely recommended for the treatment of community-acquired respiratory infections and is used in patients with severe infections. Further investigation is required in additional patients to understand the effects of AZM volume reduction in greater detail.
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Affiliation(s)
- Yuto Haruki
- Department of Pharmacy, Tsuyama Chuo Hospital
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodriguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tan PC, Mackeen A, Khong SY, Omar SZ, Azmi MAN. Peripheral Intravenous Catheterisation in Obstetric Patients in the Hand or Forearm Vein: A Randomised Trial. Sci Rep 2016; 6:23223. [PMID: 26987593 PMCID: PMC4796788 DOI: 10.1038/srep23223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/26/2016] [Indexed: 11/09/2022] Open
Abstract
A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.
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Affiliation(s)
- Peng Chiong Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Anjana Mackeen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Su Yen Khong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - M. A. Noor Azmi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
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Danski MTR, Johann DA, Vayego SA, Oliveira GRLD, Lind J. Complicações relacionadas ao uso do cateter venoso periférico: ensaio clínico randomizado. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar as complicações decorrentes do uso e tipo de cateter venoso periférico em adultos. Métodos Ensaio clínico randomizado; realizado em um hospital de ensino, no período de 2012 a 2015; incluiu-se 169 adultos internados em unidades clínicas e cirúrgicas que necessitaram de punção venosa periférica e com permanência prevista de mais de 96 horas. A randomização aleatória sistematizada alocou 90 participantes no Grupo Experimental (cateter de segurança completo) e 79 no Grupo Controle (cateter curto flexível). Resultados A taxa geral de complicações foi 55,62%, houve 18,34% de flebite, infiltração 11,83%, obstrução 11,24% e tração 9,47%. Não houve diferença significativa entre os grupos para a ocorrência de complicações, flebite, obstrução e tração. Conclusão A taxa de complicações no cateterismo venoso periférico foi alta, mas quando comparados, sem diferença estatística significativa, o cateter de segurança completo teve taxas menores de complicações após o quarto dia de sobrevida.
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Danski MTR, Oliveira GLRD, Johann DA, Pedrolo E, Vayego SA. Incidência de complicações locais no cateterismo venoso periférico e fatores de risco associados. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Estimar a incidência de complicações locais associadas ao cateterismo periférico e identificar os fatores de risco associados ao desenvolvimento da complicação mais frequente. Métodos Coorte prospectiva realizada com 92 adultos submetidos a cateterismo venoso periférico, internados em unidades clínicas e cirúrgicas. Mediante observação diária do cateter, determinou-se o tempo de permanência e as complicações locais advindas do uso do Cateter de Segurança Completo, após capacitação das equipes de enfermagem. Utilizou-se os testes Exato de Fisher, G de Williams, Qui-quadrado, U de Mann-Whitney e Risco Relativo. Resultados Observou-se 56,52% de complicações locais. O tempo de permanência superior a 72 horas aumenta o risco para desenvolvimento de flebite em 2,34 (RR; p=0,0483; IC [0,91; 6,07]). Conclusão A incidência de complicações locais foi elevada, havendo predominância de flebite; o tempo de permanência superior a 72 horas foi detectado como fator de risco para sua ocorrência.
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Milutinović D, Simin D, Zec D. Risk factor for phlebitis: a questionnaire study of nurses' perception. Rev Lat Am Enfermagem 2015; 23:677-84. [PMID: 26444170 PMCID: PMC4623731 DOI: 10.1590/0104-1169.0192.2603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 04/01/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES to assess nurses' perceptions of risk factors for the development of phlebitis, with a special focus on the perception of phlebitic potentials of some infusion medications and solutions. METHOD a cross-sectional questionnaire study, which included a sample of 102 nurses. RESULTS Nurses recognized some factors that may reduce the incidence of phlebitis; however, more than half of the nurses were unaware that the material and diameter of the cannula can affect the incidence rate of phlebitis. Furthermore,underlying disease and high pH of medications or solutions were identified as potential risk factors, whereas low pH and low osmolality were not. Nurses identified Vancomycin and Benzylpenicillin antibiotics with the strongest phlebitic potential. Among other medications and intravenous fluids, Aminophylline, Amiodaronehydrochloride and Potassium chloride 7.4% were identified as potentially causing phlebitis. CONCLUSION predisposing factors for phlebitis relating to patients and administered therapy were identified by nurses, while some cannula related risk factors, in particular its physicochemical properties and the time for cannula replacement, were not fully perceived.
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Affiliation(s)
- Dragana Milutinović
- PhD, Associate Professor, Department of Nursing, Faculty of Medicine,
University of Novi Sad, Serbia
| | - Dragana Simin
- Assistant Professor, Department of Nursing, Faculty of Medicine,
University of Novi Sad, Serbia
| | - Davor Zec
- Master's student, Faculty of Medicine, University of Josip Juraj
Strossmayer, Croatia. RN, Medical Critical Care Unit, Department for Internal Disease,
Clinical Hospital Centre of Osijek, Croatia
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Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics. Antimicrob Agents Chemother 2015; 59:4901-6. [PMID: 26055373 DOI: 10.1128/aac.00612-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/30/2015] [Indexed: 11/20/2022] Open
Abstract
French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of drug incompatibility under multidrug infusion conditions.
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Chiu PC, Lee YH, Hsu HT, Feng YT, Lu IC, Chiu SL, Cheng KI. Establish a perioperative check forum for peripheral intravenous access to prevent the occurrence of phlebitis. Kaohsiung J Med Sci 2015; 31:215-21. [PMID: 25835279 DOI: 10.1016/j.kjms.2015.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 10/28/2014] [Accepted: 01/16/2014] [Indexed: 10/23/2022] Open
Abstract
The prevalence of intravenous (IV) catheter-related infections is 0.5 per 1000 device days, and these infections cause tenderness, erythema, swelling and phlebitis. Catheter-related bloodstream infections (CRBSI) may independently increase hospital costs and length of stay; the aim of the study was to set up a standard operating procedure (SOP) for the maintenance of peripheral vein catheter patency and the prevention of IV catheter-related complications. This is a retrospective study, enrolling patients who received anesthesia between April 2010 and January 2011. The study included 1 month of pretest phase, and 3 months each of "notification" phase, "observation" phase and "end" phase, respectively. The cannulations were set up by surgical ward nurses following the SOP on establishing peripheral intravenous catheter in our hospital. The cannulation sites were then examined before surgery and postoperatively by registered nurse anesthetists using the Baxter Scale. We also tried to set up a feedback circuit to let ward nurses know about the IV patency rate. As a result, 14,682 patients were enrolled in the study. The incidence of IV therapy-related adverse events was 0.78% in the notification phase, 0.43% in the observation phase, and 0.13% in the end phase. Overall IV therapy-related events declined significantly (p < 0.01), and the presence of phlebitis was associated with age (p < 0.05). An SOP established to assess IV patency through a checklist can reduce phlebitis and improve quality. The checklist increases ward nurses' and nurse anesthetists' awareness of IV patency, and the feedback circuit substantially reduces IV event rate.
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Affiliation(s)
- Po-Chun Chiu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ya-Hui Lee
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Te Hsu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Tung Feng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shun-Li Chiu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Drouet M, Chai F, Barthélémy C, Lebuffe G, Debaene B, Décaudin B, Odou P. Influence of vancomycin infusion methods on endothelial cell toxicity. Antimicrob Agents Chemother 2015; 59:930-4. [PMID: 25421476 PMCID: PMC4335869 DOI: 10.1128/aac.03694-14] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/19/2014] [Indexed: 01/09/2023] Open
Abstract
Peripheral intravenous therapy is frequently used in routine hospital practice and, due to various factors, its most common side effect is phlebitis. The infusion of vancomycin is particularly associated with phlebitis despite its widespread use. French guidelines recommend central intravenous infusion for high concentrations of vancomycin, but peripheral intravenous therapy is often preferred in intensive care units. Methods of vancomycin infusion are either intermittent infusion or continuous infusion. A comparison of these methods under in vitro conditions simulating clinical use could result in better infusion efficacy. Human umbilical vein endothelial cells (HUVECs) were therefore challenged with clinical doses of vancomycin over a 24- to 72-h period using these infusion methods. Cell death was measured with the alamarBlue test. Concentration-dependent and time-dependent vancomycin toxicity on HUVECs was noted with a 50% lethal dose at 5 mg/ml after 24 h, reaching 2.5 mg/ml after 72 h of infusion, simulating long-term infusion. This toxicity does not seem to be induced by acidic pH. In comparing infusion methods, we observed that continuous infusion induced greater cell toxicity than intermittent infusion at doses higher than 1 g/day. The increasing use of vancomycin means that new guidelines are required to avoid phlebitis. If peripheral intravenous therapy is used to reduce infusion time, along with intermittent infusion, vein irritation and localized phlebitis may be reduced. Further studies have to be carried out to explore the causes of vancomycin endothelial toxicity.
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Affiliation(s)
- Maryline Drouet
- University Lille Nord de France, Lille, France Department of Biopharmacy, Galenic and Hospital Pharmacy, UDSL, EA GRIIOT 4481, Lille 2 University, Lille, France Department of Pharmacy, Lille University Hospital, Lille, France
| | - Feng Chai
- University Lille Nord de France, Lille, France INSERM U1008, Controlled Drug Delivery Systems and Biomaterials, Lille 2 University, Lille, France
| | - Christine Barthélémy
- University Lille Nord de France, Lille, France Department of Biopharmacy, Galenic and Hospital Pharmacy, UDSL, EA GRIIOT 4481, Lille 2 University, Lille, France
| | - Gilles Lebuffe
- Department of Anesthesia and Intensive Care, Lille University Hospital, Lille, France
| | - Bertrand Debaene
- Department of Anesthesia and Intensive Care, Poitiers University Hospital, INSERM U1070, Poitiers, France
| | - Bertrand Décaudin
- University Lille Nord de France, Lille, France Department of Biopharmacy, Galenic and Hospital Pharmacy, UDSL, EA GRIIOT 4481, Lille 2 University, Lille, France Department of Pharmacy, Lille University Hospital, Lille, France
| | - Pascal Odou
- University Lille Nord de France, Lille, France Department of Biopharmacy, Galenic and Hospital Pharmacy, UDSL, EA GRIIOT 4481, Lille 2 University, Lille, France Department of Pharmacy, Lille University Hospital, Lille, France
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Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini D, Capasso L, Di Baldassarre A, Eltaji Elfarouki G. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi‐centre prospective study. J Adv Nurs 2014; 70:2539-49. [DOI: 10.1111/jan.12403] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
- ASL 02 Abruzzo Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Valentina Simonetti
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Dania Comparcini
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
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Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Fernández MM, Gallemi G, García I, Aguilar MC, Rodríguez-Baño J, Martinez JA. Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: a quasiexperimental cohort study. Am J Infect Control 2013; 41:520-6. [PMID: 23084473 DOI: 10.1016/j.ajic.2012.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Data concerning the effectiveness of strategies implemented to reduce short peripheral vein catheter (PVC)-related adverse events are scarce. METHODS A quasiexperimental study (2004-2011) was conducted to evaluate an intervention to reduce peripheral vein phlebitis (PVP) and PVC-related bloodstream infections (BSIs). Bundle intervention consisted of health care worker education and training, withdrawal of unnecessary catheters, exchange catheter policy, withdrawal of catheters at early stages of PVP, use of scales as a measuring tool, and repeated period-prevalence surveillance of PVC adverse events on wards. A Poisson exponentially weighted moving average control chart was used to assess time series analysis. RESULTS One thousand six hundred thirty-one patients with 2,325 short catheters inserted were prospectively followed. PVP decreased by 48% (12.1% [95% confidence interval (CI): 10.7-13.2] during the intervention period versus 23.3% [95% CI: 16.4-30.1] in preintervention period; P < .05), and no reduction of PVP measured as 1,000 catheter-days was noted (48.6 [95% CI: 46.1-51.2] vs 37.9 [95% CI: 24.5-51.4], P > .05). A significant incidence reduction in PVC-related BSIs and health care-acquired Staphylococcus aureus BSIs was also achieved. CONCLUSION A comprehensive multifaceted hospital approach was successful in reducing PVC-related adverse effects. Poisson exponentially weighted moving average control chart fits well as time series using Poisson data when very few events are present.
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Affiliation(s)
- Gabriel Mestre
- Nosocomial Infection Control Unit, Delfos Medical Center, Barcelona, Spain.
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[Adverse events associated with vascular catheters in Emergency]. Med Clin (Barc) 2013; 140:334-5. [PMID: 23122611 DOI: 10.1016/j.medcli.2012.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/19/2012] [Indexed: 11/20/2022]
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Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District, Westmead, NSW 2145, Australia.
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Retirada sistemática de los catéteres venosos periféricos: ¿salva vidas o incrementa costes? Med Clin (Barc) 2012; 139:203-5. [DOI: 10.1016/j.medcli.2012.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/23/2022]
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