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Rosengarten L. Administration of intravenous fluids and medicines in children and young people. Nurs Child Young People 2024; 36:34-42. [PMID: 37661751 DOI: 10.7748/ncyp.2023.e1481] [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] [Accepted: 04/25/2023] [Indexed: 09/05/2023]
Abstract
Managing intravenous (IV) access is a standard proficiency for UK nurses, enabling them to administer IV injections and IV infusions and to manage injection equipment and infusion pumps and devices. In this article the author describes various types of venous access devices that are commonly seen in practice and details the preparation, checking and administration of IV fluids and medicines, including some complications that may arise. The author also discusses the calculation of fluid requirements, types of IV fluids, displacement values and ongoing care of venous access devices.
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Affiliation(s)
- Leah Rosengarten
- health and life sciences, Northumbria University, Newcastle Upon Tyne, England
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2
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Kanaris C, Wahida R. Inotrope use in children with septic shock: a guide for general paediatricians. Arch Dis Child Educ Pract Ed 2024; 109:38-46. [PMID: 37532291 DOI: 10.1136/archdischild-2021-322339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/09/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Constantinos Kanaris
- Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Blizard Institute, Queen Mary University of London, London, UK
| | - Rula Wahida
- Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Özalp Gerçeker G, Yıldırım BG, Önal A, Ören H, Olgun HN, Bektaş M. The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study. Eur J Oncol Nurs 2023; 67:102430. [PMID: 37879193 DOI: 10.1016/j.ejon.2023.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications. METHOD This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed. RESULTS The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication. CONCLUSIONS The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population. CLINICALTRIALS GOV IDENTIFIER NCT05769452.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Büşra Güliz Yıldırım
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Ayşe Önal
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hatice Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
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4
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van Rens MF, Hugill K, Mahmah MA, Francia AL, van Loon FH. Effect of peripheral intravenous catheter type and material on therapy failure in a neonatal population. J Vasc Access 2023; 24:1284-1292. [PMID: 35196909 DOI: 10.1177/11297298221080071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In neonatal settings vascular access devices are essential for treatment. However, their use is not without risks. The design and materials of peripheral vascular access devices have been evaluated amongst adult populations, but contemporary studies in neonatal settings are scant. PURPOSE/OUTCOME MEASURES This research describes the prevalence of peripheral intravenous catheter failure related to three different catheter types with the intent to identify modifiable risks that might be used to evaluate device efficacy, innovate neonatal practice, and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. PARTICIPANTS Neonates who were admitted to the unit requiring intravenous treatment wherefore peripheral intravenous cannulation was indicated, were included in this study. RESULTS The use of different type of catheters resulted in significantly less therapy failures as phlebitis and increased dwell time, compared with the control groups. This remains significant after adjusting for age at insertion, gestational age, birth weight, and catheter type. CONCLUSIONS The study's findings are in accord with international literature concerning adult and pediatric patients concerning the superiority of PUR over PTFE catheters with respect to the risk of phlebitis and longer dwell times. However, the risk of failure of therapy did not differ between catheters. This finding is reassuring and supports practitioner judgment when selecting peripheral catheter devices.
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Affiliation(s)
- Matheus Fpt van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamad Adnan Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus Hj van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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5
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Xu HG, Keogh S, Ullman AJ, Marsh N, Tobiano G, Rickard CM, Clark J, Griffin B. Implementation frameworks, strategies and outcomes used in peripheral intravenous catheter studies: A systematic review. J Clin Nurs 2023; 32:6706-6722. [PMID: 36970881 DOI: 10.1111/jocn.16671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/28/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
AIMS The aim of this study was to critically evaluate implementation frameworks, strategies and/or outcomes used to optimise peripheral intravenous catheter (PIVC) care and/or promote guideline adherence. BACKGROUND Although a considerable volume of research has investigated the effectiveness of PIVC interventions and treatments to promote performance and prevent harm, how to best implement this evidence into dynamic clinical settings and populations is not well understood. Implementation science is central to translating evidence-based knowledge to the bedside; however, there is a gap in identifying the best implementation framework, strategies and/or outcomes to optimise PIVC care and/or guideline adherence. DESIGN A systematic review. METHOD The review was conducted using innovative automation tools. Five databases and clinical trial registries were searched on 14 October 2021. Qualitative and quantitative PIVC intervention studies reporting implementation strategies were included in the review. Data were extracted independently by experienced researchers in pairs. The Mixed Method Appraisal tool was used to assess the quality of individual studies. Narrative synthesis was used to present the findings. The systematic review was reported following the PRISMA checklist. RESULTS Of 2189 references identified, 27 studies were included in the review. Implementation frameworks were used in 30% (n = 8) of studies, with most used during the preparation (n = 7, 26%) and delivery phase (n = 7, 26%) and then evaluation phase (n = 4, 15%). Multifaceted strategies were commonly adopted (n = 24, 89%) to promote PIVC care or study interventions which were clinician (n = 25, 93%) and patient-targeted (n = 15, 56%). The most commonly reported implementation outcomes were fidelity (n = 13, 48%) and adoption (n = 6, 22%). Most studies were scored as low quality (n = 18, 67%). CONCLUSION We call for researchers and clinicians to work together and use implementation science frameworks to guide study design, implementation and evaluation in future PIVC studies, to improve evidence translation and thereby improve patient outcomes.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Good RJ, Diaz E, Thomas R, Wathen B, Carpenter TC. Ultrasound assessment of peripheral intravenous catheters by nurses in the pediatric intensive care unit. J Vasc Access 2023; 24:71-75. [PMID: 34121499 DOI: 10.1177/11297298211024805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA. DESIGN Prospective observational cohort study. SETTING PICU within a children's hospital. PATIENTS PICU patients with a PIV. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0-13.8) and median weight was 15.0 kg (IQR 9.6-59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28-0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p < 0.0001). In 106 PIVs with a UA that indicated the PIV was intravascular (i.e. negative UA), the median survival was 50.0 h (IQR 21.8-100.3). CONCLUSIONS Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.
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Affiliation(s)
- Ryan J Good
- Department of Pediatrics, Section of Critical Care, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Diaz
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Robin Thomas
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Beth Wathen
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Todd C Carpenter
- Department of Pediatrics, Section of Critical Care, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
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Karaoğlan N, Sarı HY, Devrim İ. Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S23. [PMID: 35439080 DOI: 10.12968/bjon.2022.31.8.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. METHOD The study was conducted in the largest children's hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. RESULTS The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P<0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P<0.001). CONCLUSION Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.
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Affiliation(s)
- Nalan Karaoğlan
- Nurse, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Hatice Yıldırım Sarı
- Professor, Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - İlker Devrim
- Professor, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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van Rens M, Hugill K, Francia AL, Abdelwahab AH, Garcia KL. Treatment of a neonatal peripheral intravenous infiltration/extravasation (PIVIE) injury with hyaluronidase: a case report. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S31-S36. [PMID: 35439074 DOI: 10.12968/bjon.2022.31.8.s31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents' wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population. CASE DESCRIPTION A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects. CONCLUSION This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology. HIGHLIGHTS In a neonatal population peripheral infusion therapy-related complication rates have been reported to be as high as 75% Peripheral IV infiltration and extravasation (PIVIE) is implicated in up to 65% of IV-related complications PIVIE injury has the potential to cause serious harm Prompt recognition and timely appropriate intervention can mitigate many of these risks Adhering to the 5Rs for vascular access optimizes infusion therapy and potentially reduces complications.
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Affiliation(s)
- Matheus van Rens
- Nursing and Vascular Access, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Vascular Access and Neonatal Transport, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Krisha Lp Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Frunza IF, Boyar V, Fishbein J, Kurepa D. Correlation between visual inspection/physical exam and point-of-care ultrasound exam in the evaluation of neonatal peripheral intravenous catheter site. J Matern Fetal Neonatal Med 2021; 35:8552-8558. [PMID: 34632914 DOI: 10.1080/14767058.2021.1988564] [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: 10/20/2022]
Abstract
BACKGROUND A peripheral intravenous catheter (PIVC) is used to administer IV fluids and medications. The most common PIVC complication is peripheral intravenous extravasation and infiltration (PIVE/I). Early visual inspection and physical exam (VI/PE) of the insertion site performed by a registered nurse (RN) are essential to prevent or limit tissue damage caused by displaced PIV catheters. Skin ultrasound (US) of the PIVC site provides rapid, real-time, high-resolution images of the anatomic structures at the point of care (POC). OBJECTIVES To correlate the standard practice of clinical assessment (VI/PE) with POC-US exam to determine the location and function of PIVC suspicious for malfunctioning. DESIGN/METHODS PIVC sites suspicious of malfunctioning were assessed by RN and findings were recorded in the electronic medical record. POC-US exam of the PIVC site was performed immediately after VI/PE. Sonographic exam included B-mode assessment of the PIVC site subcutaneous tissue characteristics and PIVC location as assessed by the Doppler flow tracing during RN's normal saline flush. RN's decision to continue or discontinue the PIVC was based solely on her/his VI/PE. RESULTS Forty-four infants were studied. We found sufficient disagreement between the two methodologies (p = .0074), with discordance noted in 15 (34.1%) cases. In 29 (65.9%) cases there was concordance between VI/PE and POC-US, 18 to remove and 11 not to remove PIVC (Gwet AC1 correlation coefficient = 0.34). There was no significant correlation between VI/PE finding of tissue edema, the most common initial clinical evaluation sign, and POC-US finding of tissue edema or fluid pockets (p = .67, p = .21 respectively). RN's findings during the PIVC flush with normal saline (NS) were in perfect agreement with the findings of the Doppler signal on POC-US (Gwet's AC1 = 0.82) as well as with the final US-based decision to remove PIVC (p < .0001). CONCLUSION We found only a fair correlation between RN's VI/PE of the suspicious PIVC site and the POC-US exam of the same site. However, our data suggest that in the evaluation of questionable PIVC, POC-US could be used in conjunction with VI/PE. This combination may improve the accuracy of decisions to remove or maintain PIVCs, which will result in a decreased number of PIVC placement attempts and complications.
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Affiliation(s)
- Ioan-Florinel Frunza
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Vitaliya Boyar
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Joanna Fishbein
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
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Mishra U, Jani P, Maheshwari R, Shah D, D'Cruz D, Priyadarshi A, Galea C, Lowe K, Marceau J, Wright A. Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand. J Paediatr Child Health 2021; 57:1627-1633. [PMID: 34145664 DOI: 10.1111/jpc.15578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate skincare practices in the first 2 weeks of life in extremely premature infants across tertiary neonatal intensive care units (NICUs). METHODS A web-based secure survey invite was emailed to the medical directors of tertiary NICUs. The survey included questions on various aspects of skincare practices in the first 2 weeks of life in extremely premature infants (born before 28 weeks gestation). The person most familiar with local skincare practices was asked to complete the survey and only one response per unit was requested. We performed a descriptive analysis. RESULTS We received responses from 30 out of 32 NICUs (response rate 93%). Twenty-five NICUs (89%) reported offering resuscitation and intensive care to infants born at ≥23 weeks gestation. All NICUs reported occurrences of skin breakdown, including medical adhesive-related skin injury (30%), abrasion/friction-associated skin injury (46%), perineal skin breakdown (55%), pressure site injury (47%) and diaper dermatitis (60%). A high level of consensus (≥75%) was observed for certain practices, such as the use of polyethylene occlusive plastic wraps at birth and aqueous chlorhexidine solution for sterile procedures, but a low level of consensus (<25%) was observed for many other practices, including the skin risk assessment tool used. CONCLUSIONS Skin injuries in extremely premature infants are common and skincare practices vary considerably amongst NICUs. Clinical practice improvement projects and further clinical research will help improve consistency amongst NICUs. Further research is needed to assist the development of evidence-based guidelines and benchmarking for skincare practices in these vulnerable infants.
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Affiliation(s)
- Umesh Mishra
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Pranav Jani
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Dharmesh Shah
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Daphne D'Cruz
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Archana Priyadarshi
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Galea
- The University of Sydney, Sydney, New South Wales, Australia.,Grace Centre For Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The Cerebral Palsy Alliance, Sydney, New South Wales, Australia
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - James Marceau
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Audrey Wright
- Department of Neonatology, Westmead Hospital, Sydney, New South Wales, Australia
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11
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van Rens MFPT, Hugill K, Mahmah MA, Bayoumi M, Francia ALV, Garcia KLP, van Loon FHJ. Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study. BMJ Open 2021; 11:e047788. [PMID: 34497079 PMCID: PMC8438911 DOI: 10.1136/bmjopen-2020-047788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Infants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population. DESIGN This was a retrospective observational study. SETTING The study was performed on the neonatal intensive care unit of the Women's Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study. PARTICIPANTS This study included 12 978 neonates who required intravenous therapy. OUTCOME MEASUREMENTS The main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy. RESULTS A mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors. CONCLUSION Most infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad A Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Krisha L P Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - F H J van Loon
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
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12
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Reducing Peripheral Intravenous Catheter Extravasation in Neonates: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2021; 48:31-38. [PMID: 33427807 DOI: 10.1097/won.0000000000000728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to reduce total and severe peripheral intravenous extravasation (PIVE) incidence by 40% in our neonatal intensive care unit. SETTING/APPROACH This quality improvement initiative was performed at an academic, free-standing suburban children's hospital, in a level 4 neonatal intensive care unit from June 2017 to April 2018. Baseline extravasation data for a period of 6 months prior to the initiative were reviewed, along with a nursing knowledge questionnaire and random audits of catheter stabilization techniques. A Pareto chart and a key driver diagram were created to identify the most common causes of extravasations and lead to a series of process changes. We implemented 4 Plan-Do-Study-Act (PDSA) cycles: (1) dressing protocol for peripheral intravenous vascular (PIV) catheter securement that instituted standardized securement and safer equipment; (2) education on PIV assessment and maintenance, concentrating on hourly evaluation and documentation; (3) guidance algorithm for PIVE identification and treatment; and (4) escalation policy, limiting the number of placement attempts and increased use of a "superuser" team. OUTCOMES The overall prevalence of extravasations decreased by 54%, from 73 preintervention to 40 at postintervention. At baseline, 52% (38/73) extravasations were severe; however, those in the severe category decreased by 35% (14/40) postintervention. The overall rate of adherence to the PIV catheter management algorithm approached 95%; whereas adherence to the securement guideline fluctuated between 80% and 98%. IMPLICATION FOR PRACTICE The implementation of these new practice recommendations along with the education has resulted in a decreased rate and severity of extravasation. Frequent audits and reinforcements are integral to sustainment and to ensure accountability for the implemented procedures.
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Measuring the Validity and Reliability of the Vascular Access Complication Staging and Treatment Instrument in a Pediatric Population. JOURNAL OF INFUSION NURSING 2021; 44:225-243. [PMID: 34197352 DOI: 10.1097/nan.0000000000000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A multiphase study designed with Delphi and observational components was conducted to establish the preliminary validity and reliability of the 2018 Vascular Access Complication Staging and Treatment Instrument in pediatric and neonatal populations from a single, free-standing academic children's hospital. The instrument uses objective measurement criterion to determine the severity of swelling and tissue damage to inform treatment decisions. The results of the study provided preliminary empirical evidence to support a pediatric and neonatal intravenous complication staging instrument to assess degree of swelling and severity of tissue injury. The study also offered preliminary evidence that the instrument was perceived by the nurses who participated in the study to be efficient and easy to use.
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Improving Peripheral Intravenous Catheter Care for Children with Cancer Receiving Chemotherapy in Malawi. J Pediatr Nurs 2021; 56:13-17. [PMID: 33181367 DOI: 10.1016/j.pedn.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To change pediatric oncology nursing management of peripheral intravenous catheter (PIVC) insertion and care based on current best evidence. DESIGN AND METHODS Practice change strategies were developed, and nurses completed education on proper PIVC insertion, dressing placement, and ongoing PIVC assessment with emphasis on preventing chemotherapy extravasation. Nurses also completed a chemotherapy course as part of their orientation program. The plan for PIVC practice change was based on evidence from published research and established PIVC care guidelines. Pre-assessment data revealed numerous PIVC attempts and a high incidence of extravasation (42%) in children with cancer receiving treatment in Malawi. RESULTS Post-assessment data nine months later resulted in a reduced extravasation rate from 42% to 4% using point prevalence assessments. PIVC insertion attempts reduced following education and guideline implementation; 81% of children required more than 3 PIVC insertion attempts before the practice change. Only 1% of PIVC insertions required more than 3 attempts after education and practice change implementation. Nurses completed a 32-item written examination before the chemotherapy course; the mean score was 50/100. Upon completion of the chemotherapy course, nurses obtained a mean score of 97/100 on the written examination. CONCLUSIONS Using an organized approach to nursing practice change improved PIVC care in children with cancer. PRACTICE IMPLICATIONS This project provides evidence that nursing practice change strategies can be used in any setting including countries like Malawi with limited resources.
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Chan KM, Chau JPC, Choi KC, Fung GPG, Lui WW, Chan MSY, Lo SHS. Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design. BMC Pediatr 2020; 20:445. [PMID: 32967637 PMCID: PMC7510280 DOI: 10.1186/s12887-020-02346-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.
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Affiliation(s)
- Kam Ming Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong.,The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Genevieve Po Gee Fung
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong
| | - Wai Wa Lui
- Pharmacy Department, United Christian Hospital, Kowloon, Hong Kong
| | - Meme Suk Ying Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Rosengarten L, Camara C. A guide to central venous access devices in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S6-S14. [PMID: 37243306 DOI: 10.12968/bjon.2020.29.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central venous access devices (CVADs) are commonly used in the care of children both in the short term and long term. Health professionals providing care for children who have CVADs in place are required to have a clear understanding of the benefits and risks associated with their use. This article introduces the different types of CVADs commonly used in paediatrics and provides step-by-step guidance on the use and care of these devices.
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Affiliation(s)
- Leah Rosengarten
- Lecturer, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| | - Claire Camara
- Graduate Tutor, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
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17
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Girard P, Plancq MC, Tourneux P, Deroussen F, Gouron R, Klein C. Extravasation of calcium solution in the child: Value of negative-pressure wound therapy. Arch Pediatr 2019; 26:407-410. [PMID: 31630900 DOI: 10.1016/j.arcped.2019.09.011] [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: 07/05/2019] [Revised: 08/18/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Abstract
The extravasation of a calcium solution into soft tissue constitutes a medical emergency, and a lack of adequate management can lead to significant functional and cosmetic sequelae. Here, we report on the management of and long-term outcome in two children who experienced calcium infusion leakage. We also describe the emergency procedures used in cases of extravasation and discuss the role of negative pressure wound therapy as an appropriate adjunct to conventional techniques for dealing with serious extravasation-related injuries.
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Affiliation(s)
- P Girard
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - M-C Plancq
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Pôle femme-couple-enfant, médecine néonatale et réanimation pédiatrique, groupe hospitalier Sud, 80054 Amiens cedex 1, France
| | - F Deroussen
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - R Gouron
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - C Klein
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France.
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18
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Kleidon TM, Cattanach P, Mihala G, Ullman AJ. Implementation of a paediatric peripheral intravenous catheter care bundle: A quality improvement initiative. J Paediatr Child Health 2019; 55:1214-1223. [PMID: 30702181 DOI: 10.1111/jpc.14384] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/07/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Abstract
AIM To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles. METHODS A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured. RESULTS Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved. CONCLUSION This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high.
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Affiliation(s)
- Tricia M Kleidon
- Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,Paediatric Critical Care Research Group, Children's Health Queensland, Brisbane, Queensland, Australia
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19
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Büyükyılmaz F, Şahiner NC, Cağlar S, Eren H. Effectiveness of an Intravenous Protection Device in Pediatric Patients on Catheter Dwell Time and Phlebitis Score. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:236-241. [PMID: 31562930 DOI: 10.1016/j.anr.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients. METHODS This randomized controlled trial comprised 60 pediatric patients (aged 2-24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal. RESULTS The mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05). CONCLUSION The I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.
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Affiliation(s)
- Funda Büyükyılmaz
- Fundamentals of Nursing Department, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Nejla C Şahiner
- Pediatric Nursing Department, Faculty of Health Science, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Seda Cağlar
- Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Handan Eren
- Fundamentals of Nursing Department, Faculty of Health Science, Karamanoğlu Mehmetbey University, Karaman, Turkey
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20
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Pezeshkpour P, Armstrong NC, Mahant S, Muthusami P, Amaral JG, Parra DA, Temple MJ, Connolly BL. Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment. Pediatr Radiol 2019; 49:1354-1361. [PMID: 31302737 DOI: 10.1007/s00247-019-04470-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication. OBJECTIVE To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access. MATERIALS AND METHODS We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath. RESULTS Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0). CONCLUSION Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.
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Affiliation(s)
- Paymun Pezeshkpour
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Nicholas C Armstrong
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Limerick, Limerick, Ireland
| | - Sanjay Mahant
- Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Prakash Muthusami
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, ON, Canada
| | - Joao G Amaral
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, ON, Canada
| | - Dimitri A Parra
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, ON, Canada
| | - Michael J Temple
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, ON, Canada
| | - Bairbre L Connolly
- Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, ON, Canada
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21
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Sangam SL. Quality improvement measures for early detection of severe intravenous infiltration in infants. BMJ Open Qual 2019; 8:e000407. [PMID: 31297453 PMCID: PMC6590970 DOI: 10.1136/bmjoq-2018-000407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/23/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
Intravenous infiltration is one of the most commonly seen morbidity in infants admitted to the neonatal intensive care unit (NICU). The risk of intravenous infiltration in preterm infants is probably due to prolonged peripheral intravenous access requirement for nutritional support and usage of other intravenous medications to support their growth. Infants are more likely to develop intravenous infiltrations due to the increased fragility of their blood vessels, deficient subcutaneous tissue and inability to express pain. As a result, the intravenous infiltrates in infants can rapidly progress to severe stage 3 and stage 4 infiltrates with necrosis if timely intervention is not provided. Also, factors obscuring to identify stage 1 and stage 2 infiltrates, may lead their progression to severe infiltration. Root cause analysis was performed following two severe intravenous infiltrates that required plastic surgery intervention in our level III NICU. Quality improvement measures were implemented. We developed a unique intravenous securing method, conducted educational programmes for NICU staff, increased intravenous site surveillance and ascertained to maintain the intravenous pump pressures in the reference range. The hospital NICU intravenous care policy was updated with quality improvement measures. Data were collected preintervention and postintervention. The incidence of intravenous infiltration in preterm infants varies widely in different places. This may be due to under-reporting of these relatively rare adverse events, but may also be due to the fact that the preterm infants represent a small portion of the patient population. The present study has shown that severe infiltration was associated with an increase in intravenous days. Following the quality improvement measures, there were no reported cases of severe intravenous infiltration. In conclusion, the awareness of the problem with evidence-based quality improvement measures may help in early detection of intravenous infiltrates and decrease the severe intravenous infiltration in infants.
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Affiliation(s)
- Subhasri Lakshmi Sangam
- Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Robert Wood Johnson University Medical Center, New Brunswick, New Jersey, USA
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22
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Desarno J, Sandate I, Green K, Chavez P. When in Doubt, Pull the Catheter Out: Implementation of an Evidence-Based Protocol in the Prevention and Management of Peripheral Intravenous Infiltration/Extravasation in Neonates. Neonatal Netw 2019; 37:372-377. [PMID: 30567887 DOI: 10.1891/0730-0832.37.6.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The vast majority of infants in the NICU receive peripheral intravenous (PIV) therapy for administration of fluids, nutrition, medications, and blood products. The potential complications of infiltration and extravasation are common in this population. Consequences of inf.ltration and extravasation may be prevented or mitigated by early detection and prompt treatment. In addition, innovative therapies for wound care are constantly evolving. In order to improve outcomes, a practice guideline for intravenous (IV) infiltration prevention, management, and treatment is presented based on literature review and consultation with wound care experts. The guideline includes preventive measures, standardized IV assessment, staging, an algorithm outlining injury, and wound care recommendations.
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23
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Turkish Validation of the Infiltration Scale in Infants. J Pediatr Nurs 2019; 44:e13-e19. [PMID: 30360938 DOI: 10.1016/j.pedn.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To test the validity and reliability of an infiltration scale in infants that was adapted for the pediatric population. DESIGN AND METHODS The present study is an observational prospective study. The study was conducted in a NICU of a training and research hospital in Istanbul. Data were obtained from131 infants who were <4 kg. Language validity of the scale was tested by expert linguists. The comments of fourteen experts were taken for content validity. For reliability testing, three observers independently evaluated the scale. RESULTS Infiltration developed in 28.72% of infants who were examined and grade 2 infiltration was detected at rate of 58%. The content validity index of the scale was 0.93. The Cronbach's alpha was calculated as 0.96 in the agreement of the three observer nurses' evaluations. A highly significant association was detected between the coherence of Cohen's kappa values and Intra-Class Correlation coefficient (ICC) (p < 0.01). CONCLUSIONS The infiltration scale is a valid and reliable scale in infants. The validity and reliability of the scale has been verified and may be used in the identification of infiltration in infant gestational age between 24 and 39 weeks and weighing <4 kg. PRACTICE IMPLICATIONS The infiltration scale for infants is a valid and reliable tool for monitoring catheter sites in the prevention of complications such as infiltration due to PIV therapy practices in neonatal intensive care units.
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Fonzo-Christe C, Parron A, Combescure C, Rimensberger PC, Pfister RE, Bonnabry P. Younger age and in situ duration of peripheral intravenous catheters were risk factors for extravasation in a retrospective paediatric study. Acta Paediatr 2018; 107:1240-1246. [PMID: 29461646 DOI: 10.1111/apa.14280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/11/2017] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Abstract
AIM Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed. RESULTS We analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ duration of PIVCs were associated risk factors (p < 0.001). CONCLUSION Extravasation was frequent and neonates were particularly at risk. Younger age and longer in situ PIVC duration were independent risk factors for extravasation.
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Affiliation(s)
- C Fonzo-Christe
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - A Parron
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
| | - C Combescure
- Clinical Research Centre and Division of Clinical Epidemiology; Geneva University Hospitals; Geneva Switzerland
| | - PC Rimensberger
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - RE Pfister
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - P Bonnabry
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
- School of Pharmaceutical Sciences; University of Geneva/University of Lausanne; Geneva Switzerland
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25
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Özalp Gerçeker G, Kahraman A, Yardimci F, Bilsin E, Binay Ş, Çevik Özdemir HN, Karakul A, Zengin D, Ardahan Sevgili S, Gümüş M, Başbakkal Z, Akpınar S. Infiltration and extravasation in pediatric patients: A prevalence study in a children’s hospital. J Vasc Access 2018; 19:266-271. [DOI: 10.1177/1129729817747532] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study is to determine the prevalence of infiltration and extravasation among children staying in a children’s hospital and the interventions carried out when infiltration or extravasation occurred. Methods: A prospective and descriptive research design was used in the study, conducted between September 2015 and February 2016, and determined the prevalence of infiltration and extravasation and their characteristics. The study sample consisted of 297 peripheral catheters in 173 pediatric patients. Results: Of 297 peripheral catheters, 50.8% were located on the right and 30.6% were inserted in the dorsal metacarpal vein. Infiltration and extravasation occurred in 2.9% and 2.3% of the patients, respectively. The prevalence of infiltration and extravasation was 5.5 and 4.4 per 1000 patient-days, respectively. The applied interventions after infiltration or extravasation included covering with a gauze dressing or alcohol-soaked cotton, cold application, irrigation with physiological saline, and elevation. Conclusion: The infiltration and extravasation prevalence were found to be high, but the interventions to address them were inadequate. Training and implementation strategies should be planned for pediatric nurses to prevent infiltration and extravasation.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir, Turkey
| | - Ayşe Kahraman
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Figen Yardimci
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Elif Bilsin
- Department of Nursing, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey
| | - Şeyda Binay
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | | | - Atiye Karakul
- Department of Pediatric Nursing, Faculty of Health Sciences, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Dilek Zengin
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Seda Ardahan Sevgili
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Merve Gümüş
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Zümrüt Başbakkal
- Department of Pediatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
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Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access. J Neurosci Nurs 2017; 49:191-195. [DOI: 10.1097/jnn.0000000000000286] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang Y, Kong M, Ge Y. Extravasation management in the pediatric oncology ward of Children's Hospital of Fudan University: a best practice implementation project. ACTA ACUST UNITED AC 2016; 14:258-265. [PMID: 28009678 DOI: 10.11124/jbisrir-2016-003221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Extravasation in a pediatric patient can cause a serious adverse event, but many nurses have insufficient experience to deal with it during intravenous administration. Our division implemented a best practice project, which included extravasation kit instruction preparation, staff education and an update of institutional policy and procedures. The project focused on auditing the extent to which the protocol was implemented and promoting its implementation. OBJECTIVES The objective of the project was to establish an evidence-based policy and procedure for extravasation management, improve knowledge regarding best practice of extravasation management among staff and formalize the documentation template for extravasation events. METHODS The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used to examine compliance with criteria based on the best available evidence before and after the implementation of strategies to promote the use of the evidence-based practice protocol. RESULTS Four criteria showed a noticeable improvement in compliance: increased use of extravasation kit (0-100%), updated policies and procedure (0-94%), staff education (19-94%) and documented outcomes (13-88%). CONCLUSIONS The project successfully established effective strategies for establishing an extravasation kit instruction sheet, updating policies and procedures, continuous staff education and nursing documentation to ensure best practice and improve patient outcomes.
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Affiliation(s)
- Yingwen Wang
- Hematology Oncology Division, Children's Hospital of Fudan University, Shanghai, China
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Peripheral intravenous cannulation: complication rates in the neonatal population: a multicenter observational study. J Vasc Access 2016; 17:360-5. [PMID: 27312758 DOI: 10.5301/jva.5000558] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Neonates admitted to a neonatal intensive care unit (NICU) rely highly on intravenous (IV) therapy, for which the peripheral intravenous cannula (PIVC) is the preferred device to allow such therapies to proceed. Placement of a PIVC is a painful procedure and repeated attempts for successful insertion should therefore be limited. We aimed to quantify the incidence, complications, and factors associated with these complications. METHODS We conducted a prospective observational study to examine PIVC-related complications in level III NICUs of two university medical centers (UMC) in The Netherlands. We performed descriptive analyses and binary logistic regression analysis to identify factors associated with PIVC complications. RESULTS A total of 518 catheters were inserted in 235 infants. The first-time success rate was 45%. The predominant reason for non-elective removal due to complications was infiltration (N = 193; 67%). No significant association was found between discipline of the inserter, vein visualization device and location of the PIVC and whether or not a catheter needed to be removed due to a complication. CONCLUSIONS In this study the majority of PIVCs were removed after the occurrence of a complication. The most common complication was infiltration. Strategies to identify and prevent infiltration in an NICU population are required. Future interventional studies should attempt to improve first-time insertion success and reduce PIVC failure from infiltration in the neonate. Based on the results of the present study, neonatologists and physician assistants are the preferential PIVC inserters. Advanced training of all members of vascular access specialist teams and ongoing monitoring of PIVC-related complications are recommended.
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Driscoll Md C, Langer M, Burke S, El Metwally Md D. Improving Detection of IV Infiltrates in Neonates. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:u204253.w3874. [PMID: 26734388 PMCID: PMC4693037 DOI: 10.1136/bmjquality.u204253.w3874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022]
Abstract
Neonates and infants in the neonatal intensive care unit suffer significant morbidity when intravenous (IV) catheters infiltrate. The underreporting of adverse events through hospital voluntary reporting systems, such as ours, can complicate the monitoring of low incidence events, like IV infiltrates. Based on severe cases of IV infiltrates observed in our neonatal intensive care unit, we attempted to improve the detection of all infiltrates and reduce the incidence of Stage 4 infiltrates. We developed, and initiated the use of, an evidence-based guideline for the improved surveillance, prevention, and management of IV infiltrates, with corresponding educational interventions for faculty and staff. We instituted the use of a checklist for compliance with guidelines, and as a mechanism of surveillance. The baseline incidence rate of IV infiltrates, determined by the voluntary reporting system, was 5 per 1000 line days. Following initiation of the guidelines and checklist, the IV infiltrate rate increased to 9 per 1000 line days. In most months, the detection of IV infiltrates was improved by use of the checklist. During the post-intervention period the rate of Stage 4 infiltrates, as measured by usage of nitroglycerin ointment, was significantly reduced. In conclusion, the detection of IV infiltrates was improved following our quality improvement interventions. Further, use of an evidence-based guideline for managing infiltrates may reduce the most severe infiltrate injuries.
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Affiliation(s)
| | | | - Susan Burke
- University of Maryland Medical Center, U.S.A
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Laudenbach N, Braun CA, Klaverkamp L, Hedman-Dennis S. Peripheral i.v. stabilization and the rate of complications in children: an exploratory study. J Pediatr Nurs 2014; 29:348-53. [PMID: 24613130 DOI: 10.1016/j.pedn.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Abstract
Peripheral intravascular catheter insertion is the most common invasive procedure performed on the hospitalized child with a significant potential for complications. This study compared complication rates between a standard aseptic taping technique and a commercially-available adhesive anchoring device in 80 hospitalized children ages 2-17 years. Eighteen (18) participants (22.5%) experienced a complication with occlusion being the most common (n=8) followed by infiltration (n=4), leaking (n=3), and dislodgement (n=2). There were no differences in complication rates or types between the two groups. This study provides evidence that a stabilization device may not be necessary in short-duration PIVs in children.
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Affiliation(s)
| | - Carie A Braun
- Department of Nursing, College of St. Benedict/St. John's University, St. Joseph, MN.
| | | | - Sigrid Hedman-Dennis
- Department of Nursing, College of St. Benedict/St. John's University, St. Joseph, MN
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Evaluating the quality of interventions: improving pediatric nursing practice through research. J Pediatr Nurs 2012; 27:767-9. [PMID: 23041563 DOI: 10.1016/j.pedn.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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