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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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Tsunozaki K, Suenaga H, Aoki M, Hamaguchi Y. Comparison of dwell time and complications between peripheral venous catheters and midline catheters in infants weighing ≥ 1500 g at birth. Pediatr Int 2023; 65:e15611. [PMID: 37658629 DOI: 10.1111/ped.15611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Newborns in the neonatal intensive care unit (NICU) often require infusion therapy immediately after admission. In such cases, the catheter must be selected according to the condition of the neonate. The aim of this study was to compare the performance of a peripheral venous catheter (PVC) in terms of dwell time, number of catheter replacements required, and complication rate with that of a midline catheter (MC) in neonates weighing ≥1500 g and requiring care in a NICU. METHODS The study had a retrospective observational design and included neonates with a birthweight of ≥1500 g who were admitted to a level III NICU between April 2019 and May 2021 and received infusion therapy via a PVC or MC. Patient, maternal, and infusion-related data were collected from the medical records. The outcomes were compared between the PVC and MC groups according to type of catheter used. RESULTS Univariate analyses of the infusion-related data demonstrated that neonates in the MC group (n = 52) had significantly longer dwell times, required fewer catheter replacements, and had a greater probability of completing therapy with less risk of extravasation than those in the PVC group (n = 54). CONCLUSION These findings confirm that the MC has advantages over the PVC, including a longer dwell time, fewer catheter replacements, and less risk of extravasation in newborns with a birthweight of ≥1500 g.
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Affiliation(s)
- Kinuyo Tsunozaki
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Hideyo Suenaga
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Mikihiro Aoki
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yo Hamaguchi
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Omura, Japan
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Jansen SJ, van der Hoeven A, van den Akker T, Veenhof M, von Asmuth EGJ, Veldkamp KE, Rijken M, van der Beek M, Bekker V, Lopriore E. A longitudinal analysis of nosocomial bloodstream infections among preterm neonates. Eur J Clin Microbiol Infect Dis 2022; 41:1327-1336. [PMID: 36178568 PMCID: PMC9556429 DOI: 10.1007/s10096-022-04502-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/19/2022] [Indexed: 12/01/2022]
Abstract
Nosocomial bloodstream infections (NBSIs), commonly due to central-line associated bloodstream infections (CLABSI), contribute substantially to neonatal morbidity and mortality. We aimed to identify longitudinal changes in incidence of NBSI, microbiological-spectrum, and antibiotic exposure in a large cohort of preterm neonates admitted to the neonatal intensive care unit. We retrospectively assessed differences in annual rates of NBSI (per 1000 patient-days), CLABSI (per 1000 central-line days), and antibiotic consumption (per 1000 patient-days) among preterm neonates (< 32 weeks’ gestation) hospitalized between January 2012 and December 2020. Multi-state Markov models were created to model states of progression of NBSI and infection risk given a central-line on days 0, 3, 7, and 10 of admission. Of 1547 preterm infants, 292 (19%) neonates acquired 310 NBSI episodes, 99 (32%) of which were attributed to a central-line. Over the years, a significant reduction in central-line use was observed (p < 0.001), although median dwell-time increased (p = 0.002). CLABSI incidence varied from 8.83 to 25.3 per 1000 central-line days, with no significant difference between years (p = 0.27). Coagulase-negative staphylococci accounted for 66% of infections. A significant decrease was found in antibiotic consumption (p < 0.001). Probability of NBSI decreased from 16% on day 3 to 6% on day 10. NBSI remains a common problem in preterm neonates. Overall antibiotic consumption decreased over time despite the absence of a significant reduction in infection rates. Further research aimed at reducing NBSI, in particular CLABSI, is warranted, particularly with regard to limiting central-line dwell-time and fine-tuning insertion and maintenance practices.
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Affiliation(s)
- Sophie J Jansen
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics & Gynecology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marieke Veenhof
- Department of Obstetrics & Gynecology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Erik G J von Asmuth
- Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Monique Rijken
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Martha van der Beek
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Riskin A, Iofe A, Zidan D, Shoris I, Toropine A, Zoabi-Safadi R, Bader D, Gover A. An Observational Study on the Use of Peripheral Intravenous Lines vs. Central Lines in a Neonatal Intensive Care Unit. CHILDREN 2022; 9:children9091413. [PMID: 36138722 PMCID: PMC9498162 DOI: 10.3390/children9091413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/21/2022]
Abstract
Background and Objectives: There is a debate regarding the preferred intravenous (IV) access for newborns. Our aim was to study practices regarding the choice of vascular access and outcomes. Methods: A seven-month prospective observational study on IV lines used in all newborns admitted to Bnai Zion Medical Center’s neonatal intensive care unit (NICU). Results: Of 120 infants followed, 94 required IV lines. Infants born at ≤32 weeks gestation, or with a head circumference ≤29 cm were more likely to require two or more IV lines or a central line for the administration of parenteral nutrition or medications for longer periods. However, central lines (umbilical or peripherally inserted central catheters (PICC)) were not associated with better nutritional status at discharge based on weight z-scores. Only one complication was noted—a central line-associated bloodstream infection in a PICC. Conclusions: Our data suggest preferring central IV access for preterm infants born at ≤32 weeks or with a head circumference ≤29 cm. We encourage other NICUs to study their own data and draw their practice guidelines for preferred IV access (central vs. peripheral) upon admission to the NICU.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
- Correspondence: ; Tel.: +972-48359063
| | - Adir Iofe
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Donia Zidan
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
| | - Arina Toropine
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Rasha Zoabi-Safadi
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - David Bader
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
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Gomes de Souza NM, Silveira Rocha R, Pinheiro Ferreira R, Bastos da Silveira Reis C, Souza Bandeira RS, Façanha Melo AP. Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study. J Clin Nurs 2021; 30:3439-3447. [PMID: 34545654 DOI: 10.1111/jocn.15799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. BACKGROUND Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60 minutes or more, duration longer than 30 days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. DESIGN Retrospective cohort, guided by the STROBE tool. METHODS We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p ≤ .05). RESULTS Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. CONCLUSION The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. RELEVANCE TO CLINICAL PRACTICE Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.
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Affiliation(s)
| | - Rebeca Silveira Rocha
- School Maternity Assis Chateubriand, Fortaleza, Brazil.,School Maternity Assis Chateubriand, Federal University of Ceará, Fortaleza, Brazil
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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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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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Neonatal and Pediatric Pressure Injuries Secondary to Limb Splinting for Intravascular Access: Case Series and Literature Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon.
Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016.
Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital.
Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases.
Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.
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Costa P, Dorea EP, Kimura AF, Yamamoto LY, Damiani LP. Incidence of Nonelective Removal of Single-Lumen Silicone and Dual-Lumen Polyurethane Percutaneously Inserted Central Catheters in Neonates. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.java.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Objective: To compare the incidence of nonelective removal of single-lumen silicone and dual-lumen polyurethane percutaneously inserted central catheters (PICCs).
Study Design: A prospective cohort study was conducted with neonates in whom 247 PICC lines had been successfully inserted. Patients were assigned to either the single-lumen silicone group or the dual-lumen polyurethane group and nonelective removal incidence was compared using a logistic regression model.
Results: Incidence of nonelective removal in dual-lumen polyurethane PICCs (n =91) was 48.3% versus 34% in single-lumen silicone PICCs (n =156). Thus, dual-lumen polyurethane catheters had a significantly increased chance of nonelective removal compared with single-lumen silicone PICCs (P =.004). The most usual complication in dual-lumen polyurethane PICCs was suspected catheter-related bloodstream infection; in single-lumen silicone PICCs it was external rupture.
Conclusions: Dual-lumen polyurethane PICCs are associated with higher rates of nonelective removal and complications such as suspected catheter-related bloodstream infection. Cautious nursing care is necessary to prevent complications.
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Affiliation(s)
- Priscila Costa
- Department of Maternal-Child and Psychiatric Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Eny Paiva Dorea
- Department of Maternal-Child Nursing, School of Nursing, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Amélia Fumiko Kimura
- Department of Maternal-Child and Psychiatric Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | - Lucas Petri Damiani
- Statistics and Mathematics Institute, University of São Paulo, São Paulo, Brazil
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Nandiolo-Anelone K, Allah K, Cissé L, Bankolé S, Oulaï M, Aké A. Les accidents d’extravasation perfusionnelle chez le nouveau-né : une expérience de 15 cas. ACTA ACUST UNITED AC 2014; 33:44-50. [DOI: 10.1016/j.main.2013.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/07/2013] [Accepted: 11/01/2013] [Indexed: 01/06/2023]
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Beall V, Hall B, Mulholland JT, Gephart SM. Neonatal Extravasation: An Overview and Algorithm for Evidence-based Treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hanrahan K. Hyaluronidase for treatment of intravenous extravasations: implementation of an evidence-based guideline in a pediatric population. J SPEC PEDIATR NURS 2013; 18:253-62. [PMID: 23822849 DOI: 10.1111/jspn.12035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 03/04/2013] [Accepted: 03/15/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe the implementation and evaluation of an evidence-based guideline, Hyaluronidase for Treatment of IV Extravasations, in a pediatric population. CONCLUSIONS Evidence of hyaluronidase efficacy suggests that timely administration will decrease the severity of tissue damage caused by extravasations, and result in cost savings. Implementation of this guideline increased user knowledge, incident reporting, and initiation of treatment, and decreased the average time to treatment administration. PRACTICE IMPLICATIONS Implementation strategies facilitate integration and sustained use of evidence-based treatments in clinical practice. Processes that promote evidence-based treatment are expected to improve outcomes and are therefore an important component of evaluation.
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Affiliation(s)
- Kirsten Hanrahan
- University of Iowa College of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA.
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Costa P, Bueno M, Alves AMA, Kimura AF. Incidence of Nonelective Removal of Percutaneously Inserted Central Catheters According to Tip Position in Neonates. J Obstet Gynecol Neonatal Nurs 2013; 42:348-56. [DOI: 10.1111/1552-6909.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Warren D. Implementation of a protocol for the prevention and management of extravasation injuries in the neonatal intensive care patient. INT J EVID-BASED HEA 2011; 9:165-71. [PMID: 21599845 DOI: 10.1111/j.1744-1609.2011.00213.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This project sought to determine nurses' understanding and management of infants with intravenous (IV) therapy. There were three specific aims: • To improve identification and management of extravasation injuries in neonates • To ensure management of extravasation injuries in neonates is classified according to IV extravasation staging guidelines • To develop a protocol that outlined actions required to manage extravasation injuries. METHODS This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute (JBI) Getting Research into Practice (GRIP) program. This method has been used to improve clinical practice by utilising an audit, feedback and re-audit sequence. The project was implemented in four stages over a 7-month period from 21 October 2009 to 30 May 2010. RESULTS Initially, there was poor compliance with all four criteria, ranging from zero to 63%. The GRIP phase of the project identified five barriers which were addressed throughout this project. These related to education of staff and the development of a protocol for the prevention and management of extravasation injuries in the neonatal population. Following implementation of best practice, the second audit showed a marked improvement in all four criteria, ranging from 70 to 100% compliance. CONCLUSIONS Overall, this project has led to improvements in clinical practice in line with current evidence. This has resulted in enhanced awareness of the risks associated with IV therapy and of measures to prevent an injury occurring within this clinical setting.
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Abstract
Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique.
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