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Ray-Barruel G, Chopra V, Fulbrook P, Lovegrove J, Mihala G, Wishart M, Cooke M, Mitchell M, Rickard CM. The impact of a structured assessment and decision tool (I-DECIDED®) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study. Int J Nurs Stud 2023; 148:104604. [PMID: 37801935 DOI: 10.1016/j.ijnurstu.2023.104604] [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: 02/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. OBJECTIVE To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions. DESIGN Prospective, interrupted time-series study. SETTINGS Seven adult inpatient wards in three Australian hospitals. PARTICIPANTS 825 adults with 867 peripheral intravenous catheters. METHODS Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. RESULTS Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). CONCLUSIONS Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ANZCTR TRIAL REGISTRATION ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. TWEETABLE ABSTRACT #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Gabor Mihala
- Centre for Health Services Research, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Michael Wishart
- Infection Prevention and Control, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
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He C, Shi Y, Jia X, Wu X, Xing Q, Liang L, Ju M, Di X, Xia Y, Chen X, Shen J. Effect of indwelling depth of peripheral intravenous catheters on thrombophlebitis. Medicine (Baltimore) 2023; 102:e34427. [PMID: 37478230 PMCID: PMC10662823 DOI: 10.1097/md.0000000000034427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
To clarify the effect of catheter indwelling depth on the occurrence of thrombophlebitis, a total of 339 hospitalized patients were randomly enrolled and divided by the catheter indwelling depth into 2 groups. Then the effect of indwelling depth on thrombophlebitis was analyzed, and the independent influence factors on the occurrence of thrombophlebitis were clarified. There were 49 cases of thrombophlebitis, including 8 tumor-bearing patients and 41 patients with lung infection. Thirteen of the 135 patients with indwelling depth of 1 cm, and 36 of the 204 patients with indwelling depth of 1.9 cm suffered thrombophlebitis. The relationship between incidence rate of thrombophlebitis and clinicopathological parameters was analyzed. It was found the incidence of thrombophlebitis was significantly correlated with males (X2 = 5.77), lung infection (X2 = 7.79), and indwelling depth of 1.9 cm (X2 = 4.223). Multifactor analysis of variance showed the significant independent risk factors of thrombophlebitis were male [hazard ratio (HR) 3.12 (1.39-6.98)], and lung infection (HR 0.22 [0.06-0.69]), and the indwelling depth of 1.9 cm affected the occurrence of thrombophlebitis (HR 0.79 [0.42 -3.09]) but was not an independent risk factor. In our treatment center, while appropriate fixation was ensured, the catheter indwelling depth shall be as short as possible, so as to reduce the occurrence of thrombophlebitis. For patients with lung infection, nursing at the intubation site shall be strengthened, so as to decrease thrombophlebitis.
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Affiliation(s)
- Chenghong He
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yujing Shi
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xu Jia
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xihui Wu
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qian Xing
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Liang Liang
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mengyang Ju
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Xiaoke Di
- Department of Radiation Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yin Xia
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiaojiao Chen
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jun Shen
- Department of Oncology, Jurong People’s Hospital, Zhenjiang, Jiangsu, China
- Department of Oncology, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
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Nikhila T, Mohan PL, Mohammed Salim K, Aravind RS. Intravenous cannula induced phlebitis in a tertiary care referral hospital: A prospective observational study with implication from patient's feedback system. J Healthc Qual Res 2022; 37:357-365. [PMID: 35697599 DOI: 10.1016/j.jhqr.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medicines delivered directly to systemic circulation have saved many lives from life-threatening conditions, but also can impart undesirable effects. MATERIALS AND METHODS A prospective observational study was performed for 10 months in the tertiary care hospital to identify and evaluate cannula induced phlebitis in our study population. The data collection form retrieved demographic details, diseases and cannulation particulars of each patient. Moreover, a patient feedback questionnaire (Cronbach's alpha=0.70) retrieved their concerns toward cannulation. RESULTS Phlebitis was identified in 96 patients out of 146 subjects enrolled in the study; 52% had the first sign of phlebitis. Female patients were more prone, and the complication occurred irrespective of age (p>0.05). On the other hand, those on IV cefoperazone-sulbactam (n=13, 13.5%) followed by amoxicillin clavulanic acid (n=6, 6%) had significant cannulation complication (p<0.01). The cannula indwells time (p=0.001) and vein assessment (p=0.001) were statistically associated with incidence of phlebitis. Half of our samples had pain lasting about five minutes (χ2=9.2, p<0.05). Nevertheless, limited patients (n = 35, 36.5%) were prescribed topical Heparin Benzyl Nitrate, and none preferred to self-medicate nor opted for other home remedies. CONCLUSIONS The study depicted high prevalence of phlebitis factored in by poor vein assessment and increase in indwelling time. We recommend proper awareness with on-site skill improvement program for health professionals on administration techniques and monitoring principles in order to lower cannulation related complications.
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Affiliation(s)
- T Nikhila
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Kerala University of Health Sciences, Kerala, India
| | - P L Mohan
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Kerala University of Health Sciences, Kerala, India
| | - K Mohammed Salim
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Kerala University of Health Sciences, Kerala, India.
| | - R S Aravind
- Department of Pharmacy, Zulekha Hospital, Dubai, United Arab Emirates
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Van Boxtel T, Pittiruti M, Arkema A, Ball P, Barone G, Bertoglio S, Biffi R, Dupont C, Fonzo-Christe C, Foster J, Jones M, Keck C, Ray-Barruel G, Sasse M, Scoppettuolo G, Van Den Hoogen A, Villa G, Hadaway L, Ryder M, Schears G, Stone J. WoCoVA consensus on the clinical use of in-line filtration during intravenous infusions: Current evidence and recommendations for future research. J Vasc Access 2021; 23:179-191. [PMID: 33506747 DOI: 10.1177/1129729821989165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The need for filtering intravenous infusions has long been recognized in the field of venous access, though hard scientific evidence about the actual indications for in-line filters has been scarce. In the last few years, several papers and a few clinical studies have raised again this issue, suggesting that the time has come for a proper definition of the type of filtration, of its potential benefit, and of its proper indications in clinical practice. The WoCoVA Foundation, whose goal is to increase the global awareness on the risk of intravenous access and on patients' safety, developed the project of a consensus on intravenous filtration. A panel of experts in different aspects of intravenous infusion was chosen to express the current state of knowledge about filtration and to indicate the direction of future research in this field. The present document reports the final conclusions of the panel.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jann Foster
- Western Sydney University, Sydney, Australia
| | - Matthew Jones
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access 2020; 23:57-66. [PMID: 33302797 DOI: 10.1177/1129729820978124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PVCs) are widely used vascular access devices for infusion therapy; however, they are associated with relatively high failure rates. This study aimed to identify the incidence, risk factors and medical costs of PVC-induced complications in adult hospitalised adult patients in China. METHODS An observational, prospective study on 1069 patients lasting 5 months was conducted at a tertiary teaching hospital. RESULTS Infiltration ranked first among PVC complications with an incidence of 17.8%, followed by occlusion (10.8%) and phlebitis (10.5%). Most complications in phlebitis (88.4%) and infiltration (93.7%) were Grade 1. Catheters left in for over 96 h did not show a higher incidence of complications. Patients from the surgical department were more susceptible to infiltration, phlebitis and occlusion. The 26 gauge (Ga) catheters decreased the risk of phlebitis and occlusion, whereas 24Ga catheters increased infiltration rates. Infusing irritant drugs increased phlebitis and infiltration rates. The presence of comorbidities and non-use of needleless connectors were associated with occlusion. Compared with forearm insertion, the risk of occlusion nearly doubled with the dorsum of the hand insertion and the risk of infiltration tripled with antecubital fossa insertion. Medical treatment costs for PVC complications ranged from 0.3 to 140.0 CNY. CONCLUSIONS Infiltration is the most common PVC-related adverse event. Clinically-indicated instead of routine replacement of catheters is safe. More efforts are warranted to improve nurses' adherence to recent guidelines in terms of insertion site selection and needleless connector utilisation to reduce medical costs associated with catheter replacement.
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Affiliation(s)
- Congcong Liu
- Ward III, Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lin Chen
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Dong Kong
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Fangfang Lyu
- Department of Cardiac Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Linlin Luan
- Ward II, Department of Anesthesia Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
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Manchegowda SN, Zbeidy R, Souki FG. Transient phlebitis: an unusual effect of intravenous diphenhydramine. BMJ Case Rep 2020; 13:13/7/e237273. [PMID: 32675136 DOI: 10.1136/bcr-2020-237273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Reine Zbeidy
- Anesthesiology, University of Miami School of Medicine, Miami, Florida, USA
| | - Fouad G Souki
- Anesthesiology, University of Miami School of Medicine, Miami, Florida, USA
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Harris V, Hughes M, Roberts R, Dolan G, Williams EM. The Development and Testing of a Chemotherapy-Induced Phlebitis Severity (CIPS) Scale for Patients Receiving Anthracycline Chemotherapy for Breast Cancer. J Clin Med 2020; 9:jcm9030701. [PMID: 32150833 PMCID: PMC7141200 DOI: 10.3390/jcm9030701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 11/16/2022] Open
Abstract
A chemotherapy induced phlebitis severity (CIPS) scale was developed in patients receiving anthracycline chemotherapy for breast cancer. A five-point severity scoring scale for chemotherapy-induced phlebitis was tested for inter-rater reliability. Ease of use was observed through timing assessments and a review of the completeness of documentation. A comparison of CIPS scale grade with participant reported severity scores was made. The final version was tested for inter-rater reliability, with 122 patient assessments. There was an 89.3% (109 of 122) agreement between the assessors (κ = 0.82, SE ± 0.042, 95% CI 0.74–0.90). Mean time to complete the scale was 1 min 36 s and documentation was fully completed for 98% of assessments. Patient reported severity closely matched the CIPS grade (κ = 0.54, SE ± 0.045, 95% CI 0.46–0.63). This new scale provides a list of symptoms associated with chemotherapy phlebitis, which can be scored quickly and accurately. It provides a reliable method for assessing chemotherapy-induced phlebitis, enabling a better understanding of its impact on patients’ quality of life, and to inform the appropriate choice of peripheral or central intravenous administration. Multicentre testing of the CIPS scale is recommended.
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Affiliation(s)
- Valerie Harris
- Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK; (M.H.); (R.R.)
- Correspondence: ; Tel.: +44-02920-615888
| | - Meinir Hughes
- Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK; (M.H.); (R.R.)
| | - Rosie Roberts
- Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK; (M.H.); (R.R.)
| | - Gina Dolan
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK; (G.D.); (E.M.W.)
| | - E. Mark Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK; (G.D.); (E.M.W.)
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Ray-Barruel G, Cooke M, Chopra V, Mitchell M, Rickard CM. The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation. BMJ Open 2020; 10:e035239. [PMID: 31969371 PMCID: PMC7044901 DOI: 10.1136/bmjopen-2019-035239] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making. DESIGN AND SETTING I-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases. METHODS Initial face validity was confirmed with a vascular access working group. Next, content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, the USA and Canada. Finally, inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 peripheral intravenous catheter (PIVC) assessments. Assessments were timed to ensure feasibility, and the second rater was blinded to the first's findings. Content validity index (CVI), mean item-level CVI (I-CVI), internal consistency, mean proportion of agreement, observed and expected inter-rater agreements, and prevalence-adjusted bias-adjusted kappas (PABAK) were calculated. Ethics approvals were obtained from university and hospital ethics committees. RESULTS The I-DECIDED tool demonstrated strong content validity among international vascular access experts (n=7; mean I-CVI=0.91; mean proportion of agreement=0.91) and clinicians (n=11; mean I-CVI=0.93; mean proportion of agreement=0.94), and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%, with PABAK for each principle ranging from 0.5882 ('patient education') to 1.0000 ('document the decision'). Time to complete assessments averaged 2 min, and nurse-reported acceptability was high. CONCLUSION This is the first comprehensive, evidence-based, valid and reliable PIVC assessment and decision tool. We recommend studies to evaluate the outcome of implementing this tool in clinical practice. TRIAL REGISTRATION NUMBER 12617000067370.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Nursing Research, Queen Elizabeth II Jubilee Hospital, Princess Alexandra Hospital, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Division of Hospital Medicine, Patient Safety Enhancement Program, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
| | - Marion Mitchell
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Nursing Research & Development, and Critical Care Research Group, Royal Brisbane & Women's Hospital, Princess Alexandra Hospital, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Tork-Torabi M, Namnabati M, Allameh Z, Talakoub S. Vancomycin Infusion Methods on Phlebitis Prevention in Children. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:432-436. [PMID: 31772917 PMCID: PMC6875886 DOI: 10.4103/ijnmr.ijnmr_149_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 06/19/2019] [Accepted: 08/07/2019] [Indexed: 11/15/2022]
Abstract
Background: Hospitalized children require antibiotic therapy. The most common side effect of intravenous injections is Phlebitis. Due to high usage of Vancomycin in children and subsequent phlebitis in their intravenous lines, the current study aimed at comparing the effects of two intervention and routine vancomycin infusion methods in preventing phlebitis in hospitalized children. Materials and Methods: The current study is a quasi-experimental study investigating 74 individuals between ages of 1 month and 6 years undergoing treatment using vancomycin. First, 37 children, hospitalized in internal medicine ward of Isfahan Paediatrics' Hospital, Iran with vancomycin infusion orders, were placed in control group, and another 37 children were placed in the intervention group through matching with control group. The intervention group used phlebitis prevention guidelines, created by the authors, while control group used routine infusion method of the hospital. Data were analyzed by SPSS software, and statistical significance was set at 5%. Results: The occurrence of phlebitis was 45.90% in intervention and 89.10% in control group. Results showed that the frequency of phlebitis in intervention group was significantly lower than control group (χ2= 15.79, df = 1, p < 0.001) and the average time of phlebitis onset in control group was also significantly lower than that of the intervention group (t72= 2.99, p = 0.004). Conclusions: According to the results, intervention vancomycin infusion method is more effective in reducing phlebitis as a result of intravenous catheter, compared to the routine vancomycin infusion method.
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Affiliation(s)
- Maryam Tork-Torabi
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboubeh Namnabati
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Allameh
- Department of Pediatric, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedigheh Talakoub
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Wei T, Li XY, Yue ZP, Chen YY, Wang YR, Yuan Z, Lin Q, Tan Y, Peng SY, Li XF. Catheter dwell time and risk of catheter failure in adult patients with peripheral venous catheters. J Clin Nurs 2019; 28:4488-4495. [PMID: 31410906 DOI: 10.1111/jocn.15035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/04/2019] [Accepted: 08/04/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. BACKGROUND Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. DESIGN Prospective, observational study. We have complied with the STROBE checklist of items. METHODS This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. RESULTS A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. CONCLUSIONS The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. RELEVANCE TO CLINICAL PRACTICE The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.
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Affiliation(s)
- Tao Wei
- Nursing Department, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xu-Ying Li
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Zhi-Ping Yue
- Nursing Department, Nin Xiang Traditional Chinese Medical Hospital, Ningxiang, China
| | - Yong-Yi Chen
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Yi-Ren Wang
- Department of Epidemiology and Statistics, School of Public Health, Central south University, Changsha, China
| | - Zhong Yuan
- Vascular Access Center, Hunan cancer hospital, Changsha, China
| | - Qin Lin
- Vascular Access Center, Hunan cancer hospital, Changsha, China
| | - Yan Tan
- Nursing Department, Hunan cancer hospital, Changsha, China
| | - Si-Yi Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xing-Feng Li
- Nursing Department, Hunan cancer hospital, Changsha, China
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11
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Høvik LH, Gjeilo KH, Lydersen S, Rickard CM, Røtvold B, Damås JK, Solligård E, Gustad LT. Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res 2019; 19:636. [PMID: 31488150 PMCID: PMC6729030 DOI: 10.1186/s12913-019-4497-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.
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Affiliation(s)
- Lise Husby Høvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway. .,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Department of Cardiothoracic Surgery, Department of Cardiology and National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Claire M Rickard
- Alliance for Vascular Access teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Benedikte Røtvold
- Department of Anesthesia, Levanger Hospital, Clinic of Surgery, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jan Kristian Damås
- Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medicine, Levanger Hospital, Clinic of Medicine and rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
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12
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To Replace or Not to Replace? Replacing Short Peripheral Catheters Based on Clinical Indication. JOURNAL OF INFUSION NURSING 2019; 42:143-148. [PMID: 30985563 DOI: 10.1097/nan.0000000000000322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Short peripheral catheters (SPCs) are the most frequently used medical devices in hospital settings. Many hospital policies state that SPCs be replaced at 96 hours, which can be unnecessary and costly. A pre-post quality improvement initiative was implemented following complications surrounding removal of timed SPC catheters compared with those removed by clinical indication, using the Visual Infusion Phlebitis (VIP) scale. Data collected included patient demographics, SPC characteristics, nursing time, and product use. SPCs replaced based on clinical indication remained intact longer and had fewer complications than those in the group with routinely replaced SPCs. Decreasing SPC replacements by use of clinical indication resulted in cost savings of $7263.60/unit/month.
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13
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Ray-Barruel G, Cooke M, Mitchell M, Chopra V, Rickard CM. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study. BMJ Open 2018; 8:e021290. [PMID: 29866733 PMCID: PMC5988165 DOI: 10.1136/bmjopen-2017-021290] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice. METHODS AND ANALYSIS The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published. TRIAL REGISTRATION NUMBER ANZCTR: 12617000067370; Pre-results.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Division of Hospital Medicine, Patient Safety Enhancement Program, Michigan Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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14
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Ray-Barruel G, Rickard CM. Helping nurses help PIVCs: decision aids for daily assessment and maintenance. ACTA ACUST UNITED AC 2018; 27:S12-S18. [DOI: 10.12968/bjon.2018.27.8.s12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gillian Ray-Barruel
- Research Fellow, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- Professor of Nursing, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Professor of Nursing, School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Professor of Nursing, Division of Nursing, Midwifery and Social Work, University of Manchester, UK
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15
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Peripheral intravenous catheter assessment: beyond phlebitis. LANCET HAEMATOLOGY 2017; 4:e402-e403. [DOI: 10.1016/s2352-3026(17)30145-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
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