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Finazzi P, Rodriguez Perez C, Risso FM, Giannini AM. Training for ultrasound-guided implantation of central venous catheters eliminates venolysis in pediatric patients. J Vasc Access 2024:11297298241278775. [PMID: 39243115 DOI: 10.1177/11297298241278775] [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: 09/09/2024] Open
Abstract
BACKGROUND In the pediatric setting, the procurement of vascular access can be particularly difficult. Surgical venolysis was the first technique described but, in recent years, the literature has shown that ultrasound-guided implantation has fewer complications. The principal aim of this paper is to state how after a structured training to place ultrasound-guided central lines, venolysis was definitively abandoned in our hospital. We also analyzed the impact of training on the duration of procedures. Finally, the number of procedures performed per operator to maintain the quality standard achieved. METHOD In this observational retrospective study, we analyzed data from 2013 to 2020 of 1497 pediatric and neonatal central venous access placements in a single center during a training path. RESULTS Venolysis performed by the pediatric surgeons was used in 11% of total placements, the most in the smallest patients (76.1%, <1 year of age). With the implementation of training, this invasive technique became obsolete to the point where it was no longer practiced (24.6% of vascular placement in 2013 to 0% in 2020). In the placement performed by the pediatric anesthesiologists, time progressively decreased from 51.5 min in 2013 to 29.4 min in 2022. From the analysis of the number of procedures performed by pediatric anesthesiologists, the first consultant involved performed averaging 48 procedures per year, while the other consultants had an overall average of 16.7-25 placements per year. CONCLUSION Echo-guided vascular cannulation was found to be safe, reliable, and reproducible in pediatric patients and neonates and permits to deletion definitively venolysis. Well-structured training is essential and should be standardized in the future.
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Affiliation(s)
- Paolo Finazzi
- Pediatric Anesthesia and Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Alberto Michele Giannini
- Pediatric Anesthesia and Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
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Keeyapaj W, Cheung AT. Evaluation of the Efficacy of a Novel Dermatotomy Device for Central Venous Cannulation. J Cardiothorac Vasc Anesth 2024; 38:1951-1956. [PMID: 38908939 DOI: 10.1053/j.jvca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To test the effectiveness of a novel wire-guided scalpel (Guideblade) to create a precise dermatotomy incision for central venous catheter (CVC) insertion. DESIGN Prospective, nonrandomized interventional study. SETTING Stanford University, single-center teaching hospital. PARTICIPANTS Cardiac and vascular surgical patients (n = 100) with planned CVC insertion for operation. INTERVENTIONS A wire-guided scalpel was used during CVC insertion. RESULTS A total of 188 CVCs were performed successfully with a wire-guided scalpel without the need for additional equipment in 100 patients, and 94% of CVCs were accomplished with only a single dermatotomy attempt. "No bleeding" or "minimal bleeding" at the insertion site was observed in 90% of patients 30 minutes after insertion and 80.7% at the conclusion of surgery. CONCLUSION The wire-guided scalpel was effective in performing dermatotomy for CVC with a 100% success rate and a very high first-attempt rate. The wire-guided scalpel may decrease bleeding at the CVC insertion site.
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Affiliation(s)
- Worasak Keeyapaj
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305.
| | - Albert T Cheung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305
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Bavandipour A, Safaee M, Tarrahi MJ, Eizadi-Mood N. Central Venous Catheter Complications in the Poisoning Emergency Center: A 5-Year Cross-Sectional Study. Adv Biomed Res 2024; 13:58. [PMID: 39411691 PMCID: PMC11478964 DOI: 10.4103/abr.abr_218_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 10/19/2024] Open
Abstract
Background Central venous catheters (CVCs) are used widely in emergency centers, which may be associated with complications. There is a paucity of literature focusing on CVC complications, specifically in the poisoning emergency centers. In this study, we determined the frequency of CVC complications in patients with acute poisoning. Materials and Methods This was a cross-sectional study performed in the poisoning referral center. We reviewed the medical records of patients with acute poisoning who underwent CVC at the time of admission/during hospitalization in the poisoning intensive care unit or poisoning ward and were hospitalized between 2014 and 2019. Results During the study period, 33, l37 patients with acute poisoning had been admitted and CVC was placed for 400 patients (1.20% of total patients). Most of the CVCs had been placed via femoral (51%) (204 cases). The frequency of CVC complications was 13.75%. The CVC in the internal jugular (IJ) vein was associated with a higher complication (20.7%) (P value 0.02). Infection (9.2%) and pneumothorax (9.2%) were more observed with the IJ approach, while arterial puncture was more observed with subclavian (3.7%) (P value < 0.0001). Conclusions The frequency of CVC placement in acute poisoning patients was not noticeable. Although the femoral vein was the most commonly used approach in our institution, overall complications were more observed with the IJ vein approach.
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Affiliation(s)
- Amirmohammad Bavandipour
- Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masumeh Safaee
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nastaran Eizadi-Mood
- Department of Clinical Toxicology, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Qin KR, Ensor N, D'Amore M, Barnes R, Nataraja RM, Pacilli M. A pilot workshop for ultrasound-guided insertion of long peripheral catheters. J Vasc Access 2024; 25:1031-1032. [PMID: 36750764 DOI: 10.1177/11297298221125270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Kirby R Qin
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nicholas Ensor
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Matthew D'Amore
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Health, Clayton, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
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Nakazawa H, Tokumine J, Lefor AK, Yamamoto K, Karasawa H, Shimazu K, Yorozu T. Use of a photoacoustic needle improves needle tip recognition in a video recording of simulated ultrasound-guided vascular access: A pilot study. J Vasc Access 2024; 25:922-927. [PMID: 36519739 PMCID: PMC11075403 DOI: 10.1177/11297298221122137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND We developed a novel photoacoustic needle, which emits ultrasound produced by the photoacoustic effect. This study focused on the most common "pitfall" associated with placement during ultrasound-guided vascular access, which is misidentification of the needle tip. METHODS The study was conducted as a prospective cohort study using a questionnaire. The authors intentionally created two successful and one failed ultrasound-guided central venous catheterization videos using the photoacoustic needle on a simulator. Each of these three videos was then split into two movies for viewing, one with standard ultrasound images only and the second including the images from the photoacoustic needle, for a total of six movies. RESULTS Participants who were 18 anesthesiologists, 12 residents, and 10 medical students, watched each of the six movies and completed a survey whether the puncture was successful or not. In the results, there was a significant difference in the percentage of correct answers whether the movie depicted successful or failed puncture with and without the photoacoustic ultrasound (p = 0.0001). CONCLUSION The novel photoacoustic needle improved the ability to identify the needle tip on recorded videos. It may have efficacy to prevent serious mechanical complication during the ultrasound-guided vascular access in clinical practice.
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Affiliation(s)
- Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Katsuya Yamamoto
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Hiroyuki Karasawa
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Keisuke Shimazu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Zini T, Corso L, Mazzi C, Baraldi C, Nieddu E, Rinaldi L, Miselli F, Bedetti L, Spaggiari E, Rossi K, Berardi A, Lugli L. Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2024; 11:395. [PMID: 38671612 PMCID: PMC11048839 DOI: 10.3390/children11040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. METHODS We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. RESULTS The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26-40; median birth weight 1200 g, IQR 622-2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. CONCLUSIONS Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff.
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Affiliation(s)
- Tommaso Zini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Lucia Corso
- Post-Graduate School of Paediatrics, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cinzia Mazzi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Cecilia Baraldi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Elisa Nieddu
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Laura Rinaldi
- Anaesthesia and Intensive Care Medicine, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Francesca Miselli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Katia Rossi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.Z.); (C.M.); (C.B.); (E.N.); (F.M.); (L.B.); (E.S.); (K.R.); (L.L.)
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Slosse C, Roche A, Hossu G, Fantin L, Amouyal N, Hani H, Bouaziz H, Ambroise-Grandjean G. Benefits of simulation for ultrasound-guided midline placement training: MC-in-Sim pilot study. J Vasc Access 2024:11297298241239155. [PMID: 38516868 DOI: 10.1177/11297298241239155] [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: 03/23/2024] Open
Abstract
INTRODUCTION Ultrasound-guided placement of Midlines catheters (MCs) is a standard procedure with many benefits for patients. Even if there are some guidelines worldwide, this invasive technique is still taught at the patient's bed and relies on mentoring in many care centers. The performance of this care by novice practitioners raises ethical and quality of care issues mainly because of its risk of complications. This study aimed to propose and assess a simulation-based learning method for the placement of MCs in novice practitioners. METHODS A single-center prospective observational study was conducted with anesthesia residents who had no prior experience of Midline placement. Two workshops were planned. The first one consisted of a theoretical training and a simulated practical phase. The second workshop included an assessment of theoretical memorization, a practical exercise and adherence to the training program. RESULTS The median score of the theoretical memorization was 14.6 (interquartile range [IQR]: 13.5-15.8). The MCs placement time was significantly higher (Med: 12.23 min; IQR: 12.21-12.80) for novice practitioners who did not successfully complete solo MCs placement in simulation versus novice practitioners who successfully completed solo MCs placement in simulation 6.66 min (IQR: 5.92-8.93) (p = 0.002). The number of attempts was significantly higher (p = 0.034) for the novice practitioners who did not successfully complete solo MCs placement in simulation with 67% having performed three punctures, against 0% for the novice practitioners who successfully completed solo MCs placement in simulation. All novice practitioners found this training model efficient for learning how to place MCs and considered it allows for reproducibility in care situations. CONCLUSION This ultrasound-guided MCs training on simulation is an agile and fast alternative to traditional bedside training for anesthesia novice practitioners.
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Affiliation(s)
- Côme Slosse
- Department of Anesthesiology and Intensive Care, University Hospital of Nancy, Nancy, Grand Est, France
- Inserm IADI U1254, University of Lorraine, Nancy, Grand Est, France
| | - Anaïs Roche
- Department of Anesthesiology and Intensive Care, University Hospital of Nancy, Nancy, Grand Est, France
| | - Gabriela Hossu
- Inserm IADI U1254, University of Lorraine, Nancy, Grand Est, France
- CIC-IT, University Hospital of Nancy, Nancy, Grand Est, France
| | - Luca Fantin
- Inserm IADI U1254, University of Lorraine, Nancy, Grand Est, France
| | - Noémie Amouyal
- Department of Anesthesiology and Intensive care, University Hospital of Strasbourg, Strasbourg, Grand Est, France
| | - Hind Hani
- Virtual Hospital of Lorraine, CUESim, University of Lorraine, Vandoeuvre les Nancy, Nancy, Grand Est, France
| | - Hervé Bouaziz
- Department of Anesthesiology and Intensive Care, University Hospital of Nancy, Nancy, Grand Est, France
| | - Gaëlle Ambroise-Grandjean
- Inserm IADI U1254, University of Lorraine, Nancy, Grand Est, France
- Obstetrics Department, University Hospital of Nancy, Nancy, Grand Est, France
- Midwifery Department, University of Lorraine, Nancy, Grand Est, France
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Tanabe H, Oosawa K, Miura M, Mizuno S, Yokota T, Ueda T, Zushi Y, Nagata M, Murayama R, Abe-Doi M, Sanada H. Effect of a thin-tipped short bevel needle for peripheral intravenous access on the compressive deformation and displacement of the vein: A preclinical study. J Vasc Access 2024; 25:265-273. [PMID: 35773962 DOI: 10.1177/11297298221075169] [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 Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model. METHODS The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion. RESULTS An ex vivo model was created with a vessel diameter of 2.7-3.7 mm and a depth of 2-5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs. CONCLUSION The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.
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Affiliation(s)
- Hidenori Tanabe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Kousuke Oosawa
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Manabu Miura
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Shinichi Mizuno
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Takayuki Yokota
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Takehiko Ueda
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Yasunobu Zushi
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Misako Nagata
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Brescia F, Pittiruti M, Spencer TR, Dawson RB. The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access 2024; 25:5-13. [PMID: 35633065 PMCID: PMC10845830 DOI: 10.1177/11297298221099838] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022] Open
Abstract
Insertion of Peripherally Inserted Central Catheters (PICCs) is potentially associated with the risk of immediate/early adverse events, some of them minimal (repeated punctures) and some relevant (accidental arterial puncture or nerve-related injury). Several strategies adopted during the insertion process may minimize the risk of such events, including late complication risks such as infection, venous thrombosis, or catheter dislodgment and/or malposition. This paper describes an update version of the SIP protocol (Safe Insertion of PICCs), an insertion bundle which includes eight effective strategies that aims to minimize immediate, early, or late insertion-associated complications. These strategies include: preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; appropriate skin antiseptic technique; choice of appropriate vein, adoption of the Zone Insertion Method™; clear identification of the median nerve and brachial artery; ultrasound-guided puncture; ultrasound-guided tip navigation; intra-procedural assessment of tip location; correct securement of the catheter, and appropriate protection of the exit site. This updated version of the SIP protocol includes several novelties based on the most recent evidence-based scientific literature on PICC insertion, such as the clinical relevance of the tunneling technique, the use of ultrasound for intra-procedural tip navigation and tip location, and the new technologies for the protection of the exit site (cyanoacrylate glue) and for the securement of the catheter (subcutaneous anchorage).
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario “A.Gemelli,” IRCCS, Rome, Italy
| | | | - Robert B Dawson
- Hospital Medicine and Vascular Access, Catholic Medical Center – Upper Connecticut Valley Hospital, Colebrook, NH, USA
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10
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Stone R, Walker RM, Marsh N, Ullman AJ. Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review. Australas Emerg Care 2023; 26:352-359. [PMID: 37423812 DOI: 10.1016/j.auec.2023.06.001] [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: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are. REVIEW METHODS A systematic integrative review was undertaken using Whittemore and Knafl's five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways. CONCLUSIONS This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients.
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Affiliation(s)
- Renee Stone
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Rachel M Walker
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Lundgreen Mason N, Thomas R, Skidmore C, Loveless B, Muir M, Limov A, Fritsch A, Yancey T, Zapata I, Nigh A. Comparing the Utility of Landmark-Palpation Guided to Ultrasound-Guided Teaching Methodologies for Subclavian Central Venous Access Using a Formalin-Embalmed Cadaver Model. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:1327-1337. [PMID: 38028367 PMCID: PMC10680480 DOI: 10.2147/amep.s439243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
Background Low-risk and realistic simulation strategies are needed to train clinical learners to perform hands-on invasive procedures. This follow-up study compares the utility of landmark-guided palpation-based to ultrasound-guided teaching techniques for subclavian central venous access using formalin-embalmed cadavers. Methods The subclavian veins of 3 cadavers were imaged with ultrasound to evaluate vein patency before palpation-based venous access was attempted. Twenty-three first-year medical students were trained to access the subclavian vein using palpation-based techniques. Training involved ten minutes of didactic orientation and ten minutes of hands-on practical instruction using cadavers. Participant confidence was measured using a 10-point Likert scale on pre- and post-training questionnaires. Objective skills testing for each participant included quantifying the number of skin punctures and recording the time elapsed from first skin puncture to fluid flashback into the syringe. Data was analyzed using a generalized linear model (GLM) approach. Results Participant confidence significantly increased following training in both ultrasound and palpation training groups across all questionnaire items (P<0.001). The ultrasound group had fewer skin punctures (P<0.001) and fewer failures (1) than the palpation group (6). Participants in the ultrasound group were more confident than those in the palpation group in their ability to locate the vein and select the optimal site for needle access (P<0.05). Conclusion Formalin-embalmed cadavers provide a safe, stress-free, and effective means by which to train students in subclavian vein access using both palpation and ultrasound-based techniques. Repeated practice accessing and aspirating fluid from a cadaveric subclavian vein significantly increases trainee confidence, an essential factor in physician performance that may lead to fewer complications. Introducing this type of low-risk and hands-on practice may be beneficial for trainees before they attempt subclavian vein access on live patients.
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Affiliation(s)
| | - Rebecca Thomas
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Chad Skidmore
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Bosten Loveless
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Maxton Muir
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Abigail Limov
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Alexa Fritsch
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Taylor Yancey
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
| | - Isain Zapata
- Rocky Vista University College of Osteopathic Medicine – Colorado, Parker, CO, 80134, USA
| | - Andrew Nigh
- Rocky Vista University College of Osteopathic Medicine – Southern Utah, Ivins, UT, 84738, USA
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12
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Tanwani J, Nabecker S, Hiansen JQ, Mashari A, Siddiqui N, Arzola C, Goffi A, Peacock S. Use of a Novel Three-Dimensional Model to Teach Ultrasound-guided Subclavian Vein Cannulation. ATS Sch 2023; 4:344-353. [PMID: 37795109 PMCID: PMC10547090 DOI: 10.34197/ats-scholar.2022-0104in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/18/2023] [Indexed: 10/06/2023] Open
Abstract
Background Central venous cannulation is an essential skill in perioperative and critical care medicine. Ultrasound guidance is the standard of care for femoral and internal jugular vein access, with the subclavian vein being perceived to be less amenable to ultrasound-guided (UG) insertion, resulting in a lack of procedural competency and low cannulation rate. There is a paucity of resources and a lack of experience among staff physicians to effectively instruct trainees. Simulation-based medical education has the potential to help maintain high-stakes, infrequently performed skills and counteract possible unrecognized skill decline. We aimed to create a novel, low-cost, high-fidelity three-dimensional (3D) model for UG subclavian vein (UG-SCV) access with an accompanying curriculum to improve this important skill. Methods A curriculum was created consisting of preparatory material reviewing UG-SCV access, followed by an in-person didactic lecture focusing on ultrasound use and management of complications and a deliberate practice session scanning volunteers and practicing UG vascular puncture on a 3D model. A qualitative usability test design was used to assess the validity of the curriculum in trainees with advanced vascular access skills (anesthesiologists). Participants were second-year anesthesia residents, anesthesia fellows, and staff physicians. Focus groups conducted after each session explored the face validity of the model and curriculum. By applying a usability design, the curriculum was optimized and finalized. Results Between September 2020 and February 2021, 28 participants tested the curriculum. The focus groups ensured that the curriculum achieved its objective, with iterative changes made after each session in a quality improvement framework Plan-Do-Study-Act approach. After the third cycle, minimal changes were suggested, and the curriculum and 3D model were finalized. An additional group of participants was used to ensure that no new input would help improve the curriculum further. Conclusions A focused curriculum for enhancing skills in UG-SCV cannulation using a novel 3D model was successfully implemented and validated through a usability test design. This curriculum is better targeted for practitioners experienced in central venous access to master a subclavian approach and maintain their skill level.
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Affiliation(s)
- Jaya Tanwani
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Joshua Qua Hiansen
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Azad Mashari
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Cristian Arzola
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Alberto Goffi
- Keenan Research Centre and Li Ka Shing
Knowledge Institute, Department of Critical Care Medicine, St. Michael’s
Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical
Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Peacock
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
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13
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Walsh E, Fitzsimons M. Preventing mechanical complications associated with central venous catheter placement. BJA Educ 2023; 23:229-237. [PMID: 37223695 PMCID: PMC10201402 DOI: 10.1016/j.bjae.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- E.C. Walsh
- Massachusetts General Hospital, Boston, MA, USA
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14
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Zawadka M, La Via L, Wong A, Olusanya O, Muscarà L, Continella C, Andruszkiewicz P, Sanfilippo F. Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. Crit Care Med 2023; 51:642-652. [PMID: 36861982 DOI: 10.1097/ccm.0000000000005819] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients. DATA SOURCES PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time. DATA EXTRACTION Independent extraction by two authors according to prespecified criteria. DATA SYNTHESIS After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I2 = 0%; low certainty), and access time (MD = -10.14 s; [95% CI -17.34 to -2.94]; p = 0.006; I2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.
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Affiliation(s)
- Mateusz Zawadka
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Olusegun Olusanya
- Department of Perioperative Medicine, St Bartholomew's Hospital, London, United Kingdom
| | - Liliana Muscarà
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Carlotta Continella
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Pawel Andruszkiewicz
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
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15
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Sekiguchi S, Moriyama K, Tokumine J, Lefor AK, Nakazawa H, Tomita Y, Yorozu T. Near-infrared venous imaging may be more useful than ultrasound guidance for novices to obtain difficult peripheral venous access: A crossover simulation study. Medicine (Baltimore) 2023; 102:e33320. [PMID: 36961182 PMCID: PMC10036034 DOI: 10.1097/md.0000000000033320] [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: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Difficult peripheral venous access, especially in obese people, is challenging for novices. We conducted a randomized cross-over study to examine whether near-infrared venous imaging or ultrasound guidance is more useful for novice operators to obtain difficult peripheral venous access. METHODS Medical students were recruited as participants. After receiving basic training using commercial simulators, participants were randomly assigned to obtain simulated venous access using a difficult venous access simulator with near-infrared venous imaging or ultrasound guidance in a randomized cross-over design. A difficult venous access simulator was newly developed with deep and narrow vessels to simulate an obese patient. The primary outcome measure of the study was the first-time success rate (%), and the secondary outcome measures included procedure time (seconds) and the number of 3 consecutive successful attempts, to represent proficiency with the procedure. Pearson chi-square test, the Wilcoxon signed-rank test, and generalized estimating equations were used for statistical analysis. RESULTS Forty-one medical students with no experience performing peripheral venous access were enrolled in this study. The rate of successful first attempts did not differ between the 2 groups (70% for near-infrared; 65% for ultrasound guidance; P = .64). The duration of the procedure for the first attempt was significantly shorter using near-infrared imaging (median: 14; interquartile range: 12-19) compared to ultrasound guidance (median 46; interquartile range: 26-52; P = .007). The number of attempts until 3 consecutive successes was not significantly different comparing the 2 approaches (near-infrared: 3 (3, 7.25), ultrasound guidance: 3 (3, 6.25), P = .63). CONCLUSION There was no difference in success rate of first-time attempts or acquiring proficiency for the 2 methods. However, duration of the first attempt was significantly shorter with near-infrared imaging than with ultrasound guidance. Near-infrared imaging may require less training than ultrasound guidance. Near-infrared venous imaging may be useful for novices to obtain difficult peripheral venous access in obese patients.
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Affiliation(s)
- Shinichiro Sekiguchi
- Department of Medical Education, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yasuhiko Tomita
- Department of Medical Education, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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16
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Brescia F, Pittiruti M, Ostroff M, Spencer TR, Dawson RB. The SIC protocol: A seven-step strategy to minimize complications potentially related to the insertion of centrally inserted central catheters. J Vasc Access 2023; 24:185-190. [PMID: 34320856 DOI: 10.1177/11297298211036002] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | | | | | - Robert B Dawson
- Catholic Medical Center - Upper Connecticut Valley Hospital, Colebrook, NH, USA
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17
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Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz Miluy G, Lamperti M, Goossens GA, Simcock L, Dupont C, Inwood S, Bertoglio S, Nicholson J, Pinelli F, Pepe G. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access 2023; 24:165-182. [PMID: 34088239 DOI: 10.1177/11297298211023274] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.
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Affiliation(s)
| | | | | | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals, Leuven, Belgium and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Dupont
- Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, France
| | | | | | - Jackie Nicholson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- Catholic University Hospital 'A. Gemelli', Rome, Italy
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18
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Sugiki D, Matsushima H, Asao T, Tokumine J, Lefor AK, Kamisasanuki T, Suzuki M, Gomei S. A web-based self-learning system for ultrasound-guided vascular access. Medicine (Baltimore) 2022; 101:e31292. [PMID: 36316890 PMCID: PMC9622633 DOI: 10.1097/md.0000000000031292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ultrasound-guided vascular access is practiced widely. Optimal educational methods have not yet been established. We hypothesized that a step-by-step web-based learning system is effective for self-learning. In this study, we examined the potential of this system as a self-learning tool. This was an observational study at a single institution. Participants included residents, who were self-educated through the web-based system. Skill proficiency was measured after self-learning. The primary outcome was the extent to which self-learning enabled residents to acquire proficiency in the basic skills of ultrasound-guided vascular access: needle visualization, hand-eye coordination, and avoiding posterior wall penetration. A secondary outcome was the time required to achieve proficiency. Thirty-nine residents were enrolled in this study. Eleven residents (28%) passed the first skill assessment test. There was no significant difference in the number of days that the web-based system was accessed, the total number of screen views, or the total learning time between participants who passed and those who failed the first test. Skill assessment scores between those who passed and those who failed the first test were different, especially the score for hand-eye coordination, and the number of posterior wall penetrations. Self-learning with a web-based system enabled 28% of residents to pass the first skill assessment test. The remaining 72% failed the first skill assessment test but continued to learn using the web-based system and eventually passed the test. Hence, the web-based system needed formative testing to function as a self-learning system. Simulation education for vascular access is expected to increase in educational content and methods. Self-learning through a web-based learning system is a leading candidate for this growth.
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Affiliation(s)
- Daisuke Sugiki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hisao Matsushima
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takayuki Asao
- Gunma University Center for Mathematics and Data Science, Gunma, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
- *Correspondence: Joho Tokumine, Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, Japan (e-mail: )
| | | | - Toshirou Kamisasanuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mitsuhiro Suzuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Sayaka Gomei
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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19
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Mastrandrea G, Giuliani R, Graps EA. International good practices on central venous catheters' placement and daily management in adults and on educational interventions addressed to healthcare professionals or awake/outpatients. Results of a scoping review compared with the existent Italian good practices. Front Med (Lausanne) 2022; 9:943164. [PMID: 36275789 PMCID: PMC9584299 DOI: 10.3389/fmed.2022.943164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/08/2022] [Indexed: 11/14/2022] Open
Abstract
This scoping review aims to check the existing international literature related to the placement and management of central venous catheters (CVCs) in adults and compare them with the Good Practices published by the Italian Society of anesthesiology intensive care (hereafter “SIAARTI Good Practices”) and the protocols written by the Italian Expert group on long-term central venous accesses (hereafter “GAVeCeLT Protocols”) and verify the existence of experiences focused on the daily assessment of the implantation site and on educational interventions on awake patients or caregivers to enhance their empowerment. A systematic search approach has been applied. Our composite research question has been primarily defined by the PICO: only patients over 18 years of age with CVC for any clinical reason except for kidney replacement therapy; placement and management of CVCs with procedures recommended by the recent international guidelines/bundles and specific educational interventions are the interventions to be compared with standard CVC placement and management without any educational interventions. In total, two different types of outcomes have been taken into consideration: catheter-related complications rate (A) and patient/caregiver involvement (B). Eligible articles have been limited to Systematic Review OR Meta-analysis OR Guidelines in Human field, focusing on adults, English language only, from January 2015 to December 2020. Searched Medical Subject Headings (MeSHs) Terms were “venous” AND “catheters,” and the correspondence with the designed PICO framework was then checked directly by the authors. A comprehensive search was conducted by two reviewers on 15 February 2021 in four databases, and 32 full-text articles were finally included and qualitatively assessed. The included articles appear to be in line with the indications provided by the available Italian Good Practices and explain the complexity of this procedure. The need to promote the use of bundles and checklists related to CVC placement and dressing procedures comes to light. These organizational technologies can be implemented following the creation of teams dedicated to venous access that are subjected to continuous training. As regards the impact of educational initiatives, implementing paths of health education and proper hospital discharge preparation for both healthcare workers and families increases safety for the patient with CVC.
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Affiliation(s)
- Giovanni Mastrandrea
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy,Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II – BARI, Bari, Italy,*Correspondence: Giovanni Mastrandrea
| | - Rachele Giuliani
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy
| | - Elisabetta A. Graps
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy
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20
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Adrian M, Borgquist O, Kröger T, Linné E, Bentzer P, Spångfors M, Åkeson J, Holmström A, Linnér R, Kander T. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth 2022; 129:843-850. [DOI: 10.1016/j.bja.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 11/02/2022] Open
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21
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Mongodi S, Bonomi F, Vaschetto R, Robba C, Salve G, Volta CA, Bignami E, Vetrugno L, Corradi F, Maggiore SM, Pelosi P, Mojoli F. Point-of-care ultrasound training for residents in anaesthesia and critical care: results of a national survey comparing residents and training program directors' perspectives. BMC MEDICAL EDUCATION 2022; 22:647. [PMID: 36031630 PMCID: PMC9420188 DOI: 10.1186/s12909-022-03708-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/19/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has become an essential tool for anaesthesia and critical care physicians and dedicated training is mandatory. This survey describes the current state of Italian residency training programs through the comparison of residents' and directors' perspective. METHODS Observational prospective cross-sectional study: 12-question national e-survey sent to Italian directors of anaesthesia and critical care residency programs (N = 40) and residents (N = 3000). Questions focused on POCUS teaching (vascular access, transthoracic echocardiography, focused assessment for trauma, transcranial Doppler, regional anaesthesia, lung and diaphragm ultrasound), organization (dedicated hours, teaching tools, mentors), perceived adequacy/importance of the training and limiting factors. RESULTS Five hundred seventy-one residents and 22 directors completed the survey. Bedside teaching (59.4-93.2%) and classroom lessons (29.7-54.4%) were the most frequent teaching tools. Directors reported higher participation in research projects (p < 0.05 for all techniques but focused assessment for trauma) and simulation (p < 0.05 for all techniques but transthoracic echocardiography). Use of online teaching was limited (< 10%); however, 87.4% of residents used additional web-based tools. Consultants were the most frequent mentors, with different perspectives between residents (72.0%) and directors (95.5%; p = 0.013). Residents reported self-training more frequently (48.5 vs. 9.1%; p < 0.001). Evaluation was mainly performed at the bedside; a certification was not available in most cases (< 10%). Most residents perceived POCUS techniques as extremely important. Residents underestimated the relevance given by directors to ultrasound skills in their evaluation and the minimal number of exams required to achieve basic competency. Overall, the training was considered adequate for vascular access only (62.2%). Directors mainly agreed on the need of ultrasound teaching improvement in all fields. Main limitations were the absence of a standardized curriculum for residents and limited mentors' time/expertise for directors. CONCLUSION POCUS education is present in Italian anaesthesia and critical care residency programs, although with potential for improvement. Significant discrepancies between residents' and directors' perspectives were identified.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
- Rianimazione I, Fondazione IRCCS Policlinico S. Matteo, DEA piano -1, Viale Golgi 19, 27100, Pavia, Italy.
| | - Francesca Bonomi
- Anesthesia and Intensive Care, ASST-Pavia - Civil Hospital of Vigevano, Pavia, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Anesthesia and Intensive Care, Ospedale Maggiore della Carità, Novara, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Giulia Salve
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Elena Bignami
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Francesco Corradi
- Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Salvatore Maurizio Maggiore
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy
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22
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Ultrasound-guided vascular access in the neonatal intensive care unit: a nationwide survey. Eur J Pediatr 2022; 181:2441-2451. [PMID: 35296915 DOI: 10.1007/s00431-022-04400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Ultrasound-guided vascular access (USG-VA) is recommended by international practice guidelines but information regarding its use in the neonatal intensive care unit (NICU) is lacking. Our objective was to assess neonatologist's perceptions and current implementation of USG-VA in Spain. This was a nationwide online survey. The survey was composed of 37 questions divided in 4 domains: (1) neonatologist's background, (2) NICU characteristics, (3) personal perspectives about USG-VA, and (4) clinical experience in USG-VA. One-hundred and eighty survey responses from 59 NICUs (62% of Spanish NICUs) were analyzed. Most neonatologists (81%) perceive that competence in USG-VA is indispensable or very useful in clinical practice. However, 64 (35.5%) have never used USG-VA in real patients. Among neonatologists with some experience in USG-VA most perform less than 5 procedures per year (59% in venous access and 80% in arterial access) and a 38% and 60% have never used USG for venous and arterial access, respectively, in very low birth weight infants (VLBWI). More than a half of neonatologists (55.5%) use US to check catheter tip location but a 46.6% always perform a radiography for confirmation. Spanish neonatologists report that resident/fellow training in USG-VA is absent (52.2%) or unstructured (32%) in their units. The lack of adequate training is identified by a 60% of neonatologists as the most important barrier for implementation of USG-VA and 87% would recommend that future neonatologists receive formal training. CONCLUSION Spanish neonatologists perceive that USG-VA is important in clinical practice but currently, these techniques are largely underused. Our results indicate that specific training in USG-VA should be implemented in the NICU. WHAT IS KNOWN • Ultrasound-guided vascular access is recommended as the preferred method for central venous access and arterial line placement in children and adults. • The degree of current implementation of ultrasound for vascular access in the NICU and the perceptions of neonatologist about its use are largely unknown. WHAT IS NEW • Most neonatologists consider that competence in ultrasound-guided vascular access is an indispensable aid for clinical practice. • However, most neonatologists are not adequately trained in ultrasound-guided vascular access and the technique is largely underused.
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23
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Annetta MG, Bertoglio S, Biffi R, Brescia F, Giarretta I, Greca AL, Panocchia N, Passaro G, Perna F, Pinelli F, Pittiruti M, Prisco D, Sanna T, Scoppettuolo G. Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement. J Vasc Access 2022; 23:660-671. [PMID: 35533088 DOI: 10.1177/11297298211072407] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Insertion of venous access devices (VAD) is usually considered a procedure with low risk of bleeding. Nonetheless, insertion of some devices is invasive enough to be associated with bleeding, especially in patients with previous coagulopathy or in treatment with antithrombotic drugs for cardiovascular disease. The current practices of platelet/plasma transfusion in coagulopathic patients and of temporary suspension of the antithrombotic treatment before VAD insertion are based on local policies and are often inadequately supported by evidence, since many of the clinical studies on this topic are not recent and are not of high quality. Furthermore, the protocols of antithrombotic treatment have changed during the last decade, after the introduction of new oral anticoagulant drugs. Though some guidelines address some of these issues in relation with specific procedures (port insertion, etc.), no evidence-based document covering all the aspects of this clinical problem is currently available. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to develop a consensus on the management of antithrombotic treatment and bleeding disorders in patients requiring VADs. After a systematic review of the available evidence, the panel of the consensus (which included vascular access specialists, surgeons, intensivists, anesthetists, cardiologists, vascular medicine experts, nephrologists, infective disease specialists, and thrombotic disease specialists) has structured the final recommendations as detailed answers to three sets of questions: (1) which is an appropriate classification of VAD-related procedures based on the specific bleeding risk? (2) Which is the appropriate management of the patient with bleeding disorders candidate to VAD insertion/removal? (3) Which is the appropriate management of the patient on antithrombotic treatment candidate to VAD insertion/removal? Only statements reaching a complete agreement were included in the final recommendations, and all recommendations were offered in a clear and synthetic list, so to be easily translated into clinical practice.
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Affiliation(s)
| | | | - Roberto Biffi
- Surgical Unit, Istituto Europeo di Oncologia, Milano, Italy
| | - Fabrizio Brescia
- Anesthesia and Intensive Care, Centro di Riferimento Oncologico, Aviano, Italy
| | - Igor Giarretta
- Internal Medicine, University Hospital "A.Gemelli," Rome, Italy
| | - Antonio La Greca
- Vascular Access Team, University Hospital "A.Gemelli," Rome, Italy
| | - Nicola Panocchia
- Nephrology and Dialysis Unit, University Hospital "A.Gemelli," Rome, Italy
| | | | | | - Fulvio Pinelli
- Anesthesia and Intensive Care, Careggi University Hospital, Firenze, Italy
| | - Mauro Pittiruti
- Vascular Access Team, University Hospital "A.Gemelli," Rome, Italy
| | - Domenico Prisco
- Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Tommaso Sanna
- Cardiology, University Hospital 'A.Gemelli', Rome, Italy
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24
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Rabelo-Silva ER, Lourenço SA, Maestri RN, Candido da Luz C, Carlos Pupin V, Bauer Cechinel R, Bordini Ferro E, Aurélio Lumertz Saffi M, do Campo Silva TC, Martins de Andrade L, Sales Gomes LF, Alves da Gama L, Marques de Araújo M, Santo FRFDE, López Pedraza L, Hirakata VN, Santana Soares V, Sousa Montenegro W, Rocha Costa de Freitas G, Souza de Jesus T, Chopra V. Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters. BMJ Qual Saf 2022; 31:652-661. [PMID: 35086961 PMCID: PMC9411873 DOI: 10.1136/bmjqs-2021-013869] [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: 06/22/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023]
Abstract
Background Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. Methods We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. Results Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). Conclusions Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed.
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Affiliation(s)
| | | | | | | | | | | | - Eduarda Bordini Ferro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Aurélio Lumertz Saffi
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | - Leticia López Pedraza
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vânia Naomi Hirakata
- Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Vineet Chopra
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
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25
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Tamblyn R, Brieva JL, Cain M, Martinez FE. The Effects of Introducing a Mobile Application-Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study. JMIR Hum Factors 2022; 9:e35199. [PMID: 35051900 PMCID: PMC8938840 DOI: 10.2196/35199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients’ electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6% (38/1059) to 20.5% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% (29/38) and 83.2% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3% (13/85) to 62.8% (54/86; P<.001). Adherence to one’s logbook was similar in both groups with 60% (6/10) of first-time users in the before group and 79.5% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted.
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Affiliation(s)
- Robert Tamblyn
- John Hunter Hospital, Lookout Rd, New Lambton Heights NSW 2305, Newcastle, AU
| | - Jorge L Brieva
- John Hunter Hospital, Lookout Rd, New Lambton Heights NSW 2305, Newcastle, AU
| | - Madeleine Cain
- John Hunter Hospital, Lookout Rd, New Lambton Heights NSW 2305, Newcastle, AU
| | - F Eduardo Martinez
- John Hunter Hospital, Lookout Rd, New Lambton Heights NSW 2305, Newcastle, AU
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26
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Crocoli A, Martucci C, Persano G, De Pasquale MD, Serra A, Accinni A, Aloi IP, Bertocchini A, Frediani S, Madafferi S, Pardi V, Inserra A. Vascular Access in Pediatric Oncology and Hematology: State of the Art. CHILDREN 2022; 9:children9010070. [PMID: 35053694 PMCID: PMC8774620 DOI: 10.3390/children9010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/15/2021] [Accepted: 12/30/2021] [Indexed: 12/27/2022]
Abstract
Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.
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Affiliation(s)
- Alessandro Crocoli
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Cristina Martucci
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
- Correspondence: ; Tel.: +39-0668592155
| | - Giorgio Persano
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Maria Debora De Pasquale
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Annalisa Serra
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Antonella Accinni
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Ivan Pietro Aloi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Arianna Bertocchini
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Simone Frediani
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Silvia Madafferi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Valerio Pardi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
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27
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O’Dwyer M, Fleming CA, Ahern S, Barrett S, Raftery NB, Ní Dhonnchú T, Doddakula K. OUP accepted manuscript. BJS Open 2022; 6:6526458. [PMID: 35143631 PMCID: PMC8830760 DOI: 10.1093/bjsopen/zrab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Coronary artery anastomosis training and assessment are vital for patient safety and for conferring a prognostic benefit. A systematic review and meta-analysis were performed to analyse the impact of simulation on coronary anastomosis proficiency in terms of time taken and skill score. Methods This review was conducted in accordance with PRISMA guidelines, searching PubMed, Embase and Cochrane databases on 10 October 2020, using the terms ‘Coronary anastomosis simulation’ or ‘vascular anastomosis simulation’ and ‘anastomosis simulation’. Studies included had objective measurement of scores of before and after simulation. Meta-analysis was performed using RevMan, version 5.4 (Cochrane Library). Results From a pool of 1687 articles, 12 articles evaluating the use of simulation in teaching coronary anastomosis were identified, with objective scores at baseline and after simulation. The 12 papers included 274 subjects. Data on 223 subjects could be extracted for analysis in performing coronary anastomosis in a simulated environment. Eight trials evaluated improvement in time and 12 trials evaluated performance using an objective evaluation score. In comparison with no formal simulation training, simulation was associated with improved skill in a five-point scale (standardized mean difference 1.68 (95 per cent c.i. 1.23 to 2.13; P < 0.001)) and time (mean difference 205.9 s (95 per cent c.i. 133.62 to 278.18; P < 0.001)) in trials included in the meta-analysis. Furthermore, novice cardiothoracic surgeons benefited more from simulation as regards time improvement compared with senior cardiothoracic surgeons (293 versus 120 s improvement; P = 0.003). Fidelity of simulator did not have a significant effect on rates of improvement. Conclusion Simulation-based training in coronary anastomosis is associated with improved time efficiency and overall performance in comparison with no intervention. Further studies are necessary to determine the optimum timing of trainees progressing from simulation training to live operating.
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Affiliation(s)
- Marliza O’Dwyer
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
- Correspondence to: Marliza O'Dwyer, Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland (e-mail: )
| | | | - Shane Ahern
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Sean Barrett
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Nicola B. Raftery
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tara Ní Dhonnchú
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Kishore Doddakula
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
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28
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Okano H, Mayumi T, Kataoka Y, Banno M, Tsujimoto Y, Shiroshita A, Taito S, Tokumine J. Outcomes of Simulation-Based Education for Vascular Access: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17188. [PMID: 17243645 PMCID: PMC8365863 DOI: 10.7759/cureus.17188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/12/2022] Open
Abstract
Simulation training is key to developing skills for vascular access. However, the efficacy of simulation-based education remains unclear. We conducted a well-designed and updated systematic review to investigate the efficacy of these programs. Randomized controlled trials (RCTs) were researched using the following databases from inception until July 26, 2020: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Education Resources Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP). RCTs included patients undergoing insertion of central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and radial arterial catheters. We compared the group that received simulation training with the group that received traditional training. We also assessed the success rate, adverse events, and first-attempt success using a random-effects meta-analysis. The protocol was registered at Protocols.io (dx.doi.org/10.17504/protocols.io.biu6keze). Seven RCTs (n=866) were evaluated. The meta-analysis showed that simulation-based education increased the overall success rate compared with traditional education (risk ratio: 1.08, 95% CI: 1.03 to 1.13; six RCTs; 840 participants; I2=0%; moderate certainty of evidence). However, it was unclear whether or not simulation-based education had an effect on reducing adverse events when compared with traditional education (risk ratio: 1.00, 95% CI: 0.63 to 1.58; five studies; 750 participants; I2=37%; very low certainty of evidence) or on raising first-attempt success rates (risk ratio: 1.34, 95% CI: 0.93 to 1.94; three studies; 244 participants; I2=59%; very low certainty of evidence). Simulation-based education may help develop skills for successful vascular access. However, it is unclear whether simulation-based education actually reduces the incidence of adverse events. Fine control of the needle tip is probably necessary to prevent adverse events. Simulation-based education might be required in the future for outcome-based task training.
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Affiliation(s)
- Hiromu Okano
- Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, JPN
| | - Takuya Mayumi
- Department of Cardiovascular Medicine, Kanazawa University, Kanazawa, JPN
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, JPN
| | - Masahiro Banno
- Department of Systematic Reviewers, Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
- Department of Psychiatry, Seichiryo Hospital, Nagoya, JPN
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JPN
| | - Akihiro Shiroshita
- Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, JPN
| | - Shunsuke Taito
- Division of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, JPN
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Abstract
Central venous cannulation is a frequent need for urgent or scheduled hemodialysis. Many studies confirmed the pivotal role of ultrasound in this procedure. Vascular access guidelines strongly recommend ultrasound guidance. Its usefulness has been demonstrated not only in reducing complications of venipuncture but more recently for the evaluation of central venous catheter (CVC) placement and real-time check for possible complications. The use of ultrasound requires a precise technique for the correct handling of the probe and the needle movement. Different approaches as the out-of-plane, in-plane, and oblique methods are available, enabling the most appropriate for the individual case. Although the learning curve for CVC ultrasound placement is usually fast, formal training and certification for beginners are strongly recommended.
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Affiliation(s)
- Giacomo Forneris
- CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Valle D'Aosta Valley, G. Bosco Hospital and University of Turin, Torino, Italy
| | - Antonio Marciello
- Division of Nephrology and Dialysis, ASL TO3 di Collegno e Pinerolo, PO Edoardo Agnelli, Pinerolo, Italy
| | - Daniele Savio
- Interventional Radiology Unit, Radiology Department, G. Bosco Hospital, Turin, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," Università di Milano, Milano, Italy
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30
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Schmiederer IS, Kearse LE, Lin DT, Anderson TN, Lau JN, Korndorffer JR. Isolating steps instead of learners: Use of deliberate practice and validity evidence in coronavirus disease (COVID)-era procedural assessment. Surgery 2021; 170:1652-1658. [PMID: 34272045 PMCID: PMC8276111 DOI: 10.1016/j.surg.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
Background In surgical training, assessment tools based on strong validity evidence allow for standardized evaluation despite changing external circumstances. At a large academic institution, surgical interns undergo a multimodal curriculum for central line placement that uses a 31-item binary assessment at the start of each academic year. This study evaluated this practice within increased in-person learning restrictions. We hypothesized that external constraints would not affect resident performance nor assessment due to a robust curriculum and assessment checklist. Methods From 2018 to 2020, 81 residents completed central line training and assessment. In 2020, this curriculum was modified to conform to in-person restrictions and social distancing guidelines. Resident score reports were analyzed using multivariate analyses to compare performance, objective scoring parameters, and subjective assessments among “precoronavirus disease” years (2018 and 2019) and 2020. Results There were no significant differences in average scores or objective pass rates over 3 years. Significant differences between 2020 and precoronavirus disease years occurred in subjective pass rates and in first-time success for 4 checklist items: patient positioning, draping, sterile ultrasound probe cover placement, and needle positioning before venipuncture. Conclusion Modifications to procedural training within current restrictions did not adversely affect residents’ overall performance. However, our data suggest that in 2020, expert trainers may not have ensured learner acquisition of automated procedural steps. Additionally, although 2020 raters could have been influenced by logistical barriers leading to more lenient grading, the assessment tool ensured training and assessment integrity.
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Affiliation(s)
| | | | - Dana T Lin
- Department of Surgery, Stanford University Medical Center, CA
| | | | - James N Lau
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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van Loon FH, Timmerman R, den Brok GP, Korsten EH, Dierick-van Daele AT, Bouwman AR. The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial. J Vasc Access 2021; 23:295-303. [PMID: 33530828 DOI: 10.1177/1129729821990217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Peripheral intravenous cannulation is the preferred method to obtain vascular access, but not always successful on the first attempt. Evidence on the impact of the intravenous catheter itself on the success rate is lacking. Faster visualization of blood flashback into the catheter, as a result of a notched needle, is thought to increase first attempt success rate. The current study aimed to assess if inserting a notched peripheral intravenous catheter will increase first attempt cannulation success up to 90%, when compared to inserting a catheter without a notched needle. DESIGN In this block-randomized trial, adult patients in the intervention group got a notched peripheral intravenous catheter inserted, patients in the control group received a traditional non-notched catheter. The primary objective was the first attempt success rate of peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines and hospital policy. RESULTS About 328 patients were included in the intervention group and 330 patients in the control group. First attempt success was 85% and 79% for the intervention and control group respectively. First attempt success was remarkably higher in the intervention group regarding patients with a high risk for failed cannulation (29%), when compared to the control group (10%). CONCLUSION This study was unable to reach a first attempt success of 90%, although first attempt cannulation success was higher in patients who got a notched needle inserted when compared to those who got a non-notched needle inserted, unless a patients individual risk profile for a difficult intravenous access.
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Affiliation(s)
- Fredericus Hj van Loon
- Department of Technical and Anesthesia Nursing Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ricky Timmerman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Ph den Brok
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik Hm Korsten
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
| | - Angelique Tm Dierick-van Daele
- Department of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur Ra Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
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Soundappan SSV, Lam L, Cass DT, Karpelowsky J. Open Versus Ultrasound Guided Tunneled Central Venous Access in children: A Randomized Controlled Study. J Surg Res 2020; 260:284-292. [PMID: 33360753 DOI: 10.1016/j.jss.2020.11.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this study was to compare open insertion to ultrasound guided percutaneous insertion of central access catheters performed in a tertiary pediatric hospital in terms of its safety and complication rates. METHODS This was an ethics approved prospective randomized trial of children under 16 y of age. Procedure was performed by surgeons with varying experience with percutaneous and open insertion. Primary outcome studied was complications-immediate and late. Secondary outcomes were time taken to complete procedure, conversion rates, duration of line use. RESULTS A total of 108 patients were analyzed. Sixty-four were male. Right internal jugular vein was accessed in 97. Eighty-one lines were double lumen, 23 implantable access devices, and the rest were single lumen catheters. More than one needle puncture was needed in 22% of the cases but there were no conversions in the ultrasound group. Twelve patients needed more than one insertion to achieve optimal position of the tip. Eleven patients had immediate and late complications. Percutaneous lines lasted 45 d longer though this was not statistically significant. Operating time was 20.6% shorter with percutaneous access. Post-removal measurement of vein size by ultrasound demonstrated significant decrease in size in the open group. CONCLUSIONS Ultrasound guided percutaneous insertion was safe. The study also demonstrated a decrease in operating times, preservation of vein size, and no increase in complication rates in the US group when performed by operators of varying expertise.
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Affiliation(s)
- Soundappan S V Soundappan
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia.
| | | | - Daniel T Cass
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Jonathan Karpelowsky
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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Comment on: “ECO-SEOM-SEEO safety recommendations guideline for cancer patients receiving intravenous therapy”, looking to the future. Clin Transl Oncol 2020; 22:2136-2138. [DOI: 10.1007/s12094-020-02441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brown W, Santhosh L, Brady AK, Denson JL, Niroula A, Pugh ME, Self WH, Joffe AM, O'Neal Maynord P, Carlos WG. A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit. Crit Care 2020; 24:621. [PMID: 33092615 PMCID: PMC7583182 DOI: 10.1186/s13054-020-03317-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
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Affiliation(s)
- Wade Brown
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
| | - Lekshmi Santhosh
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna K Brady
- Division of Pulmonary and Critical Care Medicine, Oregon Health Science University, Portland, OR, USA
| | - Joshua L Denson
- Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abesh Niroula
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Meredith E Pugh
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - P O'Neal Maynord
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, TN, USA
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Reducing central vein catheterization complications with a focused educational program: a retrospective cohort study. Sci Rep 2020; 10:17530. [PMID: 33067489 PMCID: PMC7568571 DOI: 10.1038/s41598-020-74395-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/24/2020] [Indexed: 01/29/2023] Open
Abstract
Central venous catheters (CVCs) are frequently used, but the rate of complications is high. This study evaluates the effects of a short training program for CVC insertion in a university-based teaching hospital. A sample of adults with CVCs inserted outside the intensive care unit was selected from two academic years: 2015, year without structured training, and 2016, year with structured training. Clinical and laboratory information, as well as the procedure’s characteristics and complications (mechanical and infectious) were collected. The incidence of complications before and after the training was compared. A total of 1502 punctures were evaluated. Comparing the pre- and post-training period, there was an increase in the choice for jugular veins and the use of ultrasound. A numerical reduction in the rate of complications was identified (RR 0.732; 95% CI 0.48–1.12; P = 0.166). This difference was driven by a statistically significant lower rate of catheter-related infections (RR 0.78; 95% CI 0.64–0.95; P = 0.047). In the multivariate analysis, aspects regarding technique (ultrasound use, multiple punctures) and year of training were associated with outcomes. Structured training reduces the rate of complications related to CVC insertion, especially regarding infections.
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Brescia F, Pittiruti M, Ostroff M, Biasucci DG. Rapid Femoral Vein Assessment (RaFeVA): A systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters. J Vasc Access 2020; 22:863-872. [PMID: 33063616 DOI: 10.1177/1129729820965063] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In this paper we describe a new protocol—named RaFeVA (Rapid Femoral Vein Assessment)—for the systematic US assessment of the veins in the inguinal area and at mid-thigh, designed to evaluate patency and caliber of the common and superficial femoral veins and choose the best venipuncture site before insertion of a FICC.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Rome, Italy
| | - Matthew Ostroff
- APN/Vascular Coordinator Saint Joseph’s University Medical Center, Paterson, NJ, USA
| | - Daniele G Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Rome, Italy
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Ortiz Miluy G, Nataren Cigarroa E, Cubero Pérez MA. Comment on: "ECO-SEOM-SEEO safety recommendations guideline for cancer patients receiving intravenous therapy", looking to the future. Clin Transl Oncol 2020:10.1007/s12094-020-02489-2. [PMID: 32951107 DOI: 10.1007/s12094-020-02489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Ortiz Miluy
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - E Nataren Cigarroa
- Hospital Universitario Dr. Jesús Gilberto Gómez Maza, Tuxtla Gutiérrez, Mexico
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Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses' Attitudes and Knowledge of Peripherally Inserted Central Catheter Maintenance in Primary Hospitals in China: A Cross-Sectional Survey. Risk Manag Healthc Policy 2020; 13:903-913. [PMID: 32801965 PMCID: PMC7395679 DOI: 10.2147/rmhp.s250741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
Background and Aim The promotion of peripherally inserted central catheter (PICC) maintenance in primary hospitals can benefit discharged patients with PICCs living in remote areas a lot. Yet, no primary hospitals had introduced PICC maintenance technology in Hunan province, China. The present study aimed to evaluate nurses’ attitudes and knowledge of PICC maintenance in primary hospitals in Hunan province, China. Materials and Methods From November 2018 to January 2019, a total of 560 nurses from 28 community hospitals and 28 township hospitals in 14 cities across Hunan were recruited in the present study. All nurses were registered nurses engaged in clinical work related to intravenous infusion, and their attitudes and knowledge of PICC maintenance were measured by a self-designed questionnaire that was based on literature review and expert consultation. Results The response rate was 93.6% (560 of 598). Almost all participants could realize the importance and necessity of PICC maintenance. More than 90% of the participants expressed interest in PICC maintenance and showed strong demands for relevant training. However, the nurses’ correct response rate of most knowledge items was at a low level (7.14–57.68%), with only three items exhibiting the correct response rate of 90% or higher. The factors influencing the nurses’ PICC maintenance knowledge included their nursing experience, professional title, work setting, and department. Conclusion Although nurses in primary hospitals had a positive attitude toward PICC maintenance, their knowledge level was unsatisfactory, which might be a barrier to the promotion of PICC maintenance technology in primary hospitals in Hunan province, China. Multiple parties should get involved and take measures to improve the nurses’ PICC maintenance knowledge, including the government, nursing associations, large-scale hospitals, and primary hospitals themselves. Besides, new training models and dynamic assessment methods should be explored to improve training effectiveness in the future.
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Affiliation(s)
- Binbin Xu
- Teaching and Research Office of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Xiangya Nursing School, Central South University, Changsha, Hunan, People's Republic of China
| | - Jinghui Zhang
- Teaching and Research Office of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jianmei Hou
- Xiangya Nursing School, Central South University, Changsha, Hunan, People's Republic of China
| | - Mengdan Ma
- Xiangya Nursing School, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhihong Gong
- Xiangya Nursing School, Central South University, Changsha, Hunan, People's Republic of China
| | - Siyuan Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, People's Republic of China
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Bell JA, Spencer TR. Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes. J Vasc Access 2020; 22:81-89. [DOI: 10.1177/1129729820924554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.
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Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses' knowledge of peripherally inserted central catheter maintenance and its influencing factors in Hunan province, China: a cross-sectional survey. BMJ Open 2020; 10:e033804. [PMID: 32444430 PMCID: PMC7247379 DOI: 10.1136/bmjopen-2019-033804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The present study aimed to assess the level of knowledge on peripherally inserted central catheter (PICC) maintenance among nurses in China and to analyse the related factors influencing this variable. DESIGN A cross-sectional survey. SETTING Ninety-one hospitals at three different levels in Hunan Province, China: county hospitals, municipal hospitals and provincial hospitals. PARTICIPANTS A total of 4110 registered nurses engaged in clinical work related to intravenous infusion. PRIMARY AND SECONDARY OUTCOME MEASURES Nurses' knowledge of PICC maintenance was measured by the score of an anonymous, self-reported questionnaire. RESULTS The mean score of PICC maintenance among 4110 nurses was 72.86±14.86. 83.5% of the participants exhibited a score of 60 or above, and 34.1% of them exhibited a good grade with a score of 80 or above. The difference in the correct rate among different dimensions was statistically significant (H=17.721, p<0.01). The generalised linear model indicated that the factors influencing the nurses' PICC maintenance knowledge included gender, age, professional title, work setting and previous history of PICC maintenance training. CONCLUSIONS In conclusion, the knowledge of PICC maintenance was at a medium level among nurses in Hunan province, China. Multiple steps should be taken to improve the nurses' PICC maintenance knowledge, including disseminating PICC maintenance knowledge in multiple ways, such as courses, lectures, seminars and new media. Particular attention should be given to populations who responded poorly in this survey, and targeted education for nurses should be distributed based on their performance on specific dimensions, such as the replacement of dressing and needle-free connectors. In addition, the quality of the nurses' practical performance could be measured in the future.
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Affiliation(s)
- Binbin Xu
- Department of Respiratory Medicine, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jinghui Zhang
- Department of Respiratory Medicine, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jianmei Hou
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Mengdan Ma
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Zhihong Gong
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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Abstract
More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.
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European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol 2020; 37:344-376. [DOI: 10.1097/eja.0000000000001180] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Cabalatungan SN, Thode HC, Singer AJ. Emergency medicine physicians infrequently perform pediatric critical procedures: a national perspective. Clin Exp Emerg Med 2020; 7:52-60. [PMID: 32252134 PMCID: PMC7141987 DOI: 10.15441/ceem.19.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/12/2019] [Indexed: 01/15/2023] Open
Abstract
Objective To our knowledge, this is the first comprehensive study using a nationally representative database to estimate the frequency of critical procedures (endotracheal tube intubation [ETI], cardiopulmonary resuscitation [CPR], and central line insertion [CLI]) in children and adults. Methods The study was based on the secondary analysis of the 2010-2014 National Hospital Ambulatory Medical Care Survey. We included adult and pediatric patients undergoing critical procedures in the emergency department. We extracted demographic and clinical information, including the performance of critical procedures. For frequent procedures (≥1 per year), we estimated the annual number of critical procedures per emergency physician (EP) by dividing the total number of annual critical procedures by the total number of EPs (estimated at 40,000). For infrequent procedures, we calculated the average interval between procedures. We summarized the data with descriptive statistics and 95% confidence intervals (CIs). Results There were an estimated 668 million total emergency department visits (24% pediatric). On average, a single EP performed 8.6 (95% CI, 5.5 to 11.7) CLIs, 3.7 (95% CI, 2.4 to 5.0) CPRs, and 6.3 (95% CI, 5.3 to 7.4) ETIs per year in adults. In comparison, a single EP performed one pediatric CLI, CPR, and ETI every 3.2 (95% CI, 1.9 to 9.8), 5.2 (95% CI, 2.8 to 33.5), and 2.8 (95% CI, 1.6 to 8.9) years, respectively. Conclusion Our nationwide findings confirm those of previous smaller studies that critical procedures are significantly fewer in children than adults. We suggest that methods to retain skills in pediatric critical procedures should be developed for general EPs to ensure that they deliver the highest level of care across the entire age spectrum.
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Affiliation(s)
- Shadd N Cabalatungan
- Department of Emergency Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
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De Boo DW, Marshall E, Erskine B, Koukounaras J, Kavnoudias H, Thomson KR. Evaluation of a radiographer-led peripherally inserted central catheter insertion service. J Med Imaging Radiat Oncol 2020; 64:471-476. [PMID: 32037725 DOI: 10.1111/1754-9485.12998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate a radiographer-led peripherally inserted central catheter (PICC) insertion service within an interventional radiology suite using ultrasound and fluoroscopic guidance. METHODS Data from 366 consecutive PICC insertions by five trained angiography-specialized radiographers were prospectively collected over a 12-month period. For each PICC insertion, patient demographics, including past medical history of cystic fibrosis (CF), number of punctures, vein used, final tip position, contrast administration and screening time were recorded. Institutional review board approval was obtained. RESULTS The overall PICC insertion success rate was 100%. Fifty-five (15%) had a known medical history of CF. Three hundred and thirty-one (90%) PICC insertions required a single puncture and 32 (9%) required two punctures. The remaining three insertions required three punctures. The basilic vein was most commonly used (69%) followed by the brachial vein (29%), and the cephalic vein was used only in 2%. Administration of contrast medium was necessary during 27 (7%) PICC insertions. Mean screening time was 10.7 s. CONCLUSION Our specifically trained, radiographer-led PICC insertion service proved to be successful. Both straightforward and complex insertions, for example in CF patients could be adequately and efficiently performed.
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Affiliation(s)
- Diederick W De Boo
- Department of Radiology, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Elissa Marshall
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Brendan Erskine
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Kenneth R Thomson
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
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Alfonso Hernández G, Pinilla Roa AE. Evaluación de competencias sobre el cateterismo venoso central. Propuesta para la formación de médicos residentes. Rev Salud Publica (Bogota) 2020. [DOI: 10.15446/rsap.v22n1.75764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Realizar una propuesta de evaluación formativa para el desarrollo de competencias profesionales sobre el cateterismo venoso central hecho por médicos residentes en una institución universitaria.Materiales y Métodos Estudio de caso con enfoque alternativo apoyado en la teoría fundamentada. Mediante 17 entrevistas a docentes, especialistas, residentes y personal administrativo, se identificaron el contexto y las tensiones sobre términos educativos y actores del proceso. Se trianguló y categorizó la información para elaborar esta propuesta.Resultados La propuesta debe incluir una planificación de actividades por niveles y evaluación continua. La simulación, observación, demostraciones en vivo y supervisión permanente son prerrequisitos que garantizan la seguridad del paciente. Se debe formar a los estudiantes de posgrado en ultrasonido. El docente deberá ser experto en el procedimiento y tener formación pedagógica. La evaluación formativa debe incluir diagnóstico inicial, autoevaluación, recertificación e instrumentos como listas de chequeo, rúbricas y recursos web para registro de actividades.Conclusión El proceso educativo de enseñanza/aprendizaje/evaluación del cateterismo venoso central es complejo. Por tanto, la propuesta debe implementarse desde el currículo, buscando la idoneidad profesional, la seguridad del paciente y la participación conjunta de instituciones de salud y educación.
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Spencer TR, Bardin-Spencer A. Ultrasound Guidance for Vascular Access Procedures by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians. ACTA ACUST UNITED AC 2019. [DOI: 10.2309/j.java.2019.004.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Practical guide for safe central venous catheterization and management 2017. J Anesth 2019; 34:167-186. [PMID: 31786676 PMCID: PMC7223734 DOI: 10.1007/s00540-019-02702-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Abstract
Central venous catheterization is a basic skill applicable in various medical fields. However, because it may occasionally cause lethal complications, we developed this practical guide that will help a novice operator successfully perform central venous catheterization using ultrasound guidance. The focus of this practical guide is patient safety. It details the fundamental knowledge and techniques that are indispensable for performing ultrasound-guided internal jugular vein catheterization (other choices of indwelling catheters, subclavian, axillary, and femoral venous catheter, or peripherally inserted central venous catheter are also described in alternatives).
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Lindgren S, Gustafson P, Hammarskjöld F. Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009-2017. Acta Anaesthesiol Scand 2019; 63:1378-1383. [PMID: 31313279 DOI: 10.1111/aas.13430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/20/2019] [Accepted: 06/07/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Insertion and use of central venous access devices (CVADs) can be associated with serious adverse events. The incidence is generally low but considering the vast use of CVADs the consequences can, from a patient safety and health economics perspective, be severe. No exact knowledge exists of number of catheters or complications in Sweden, as there is currently no comprehensive registry. The aim was to analyse injuries reported to the Swedish National Patient Insurance Company (Löf) within 7 days after insertion or removal of a CVAD. METHODS A retrospective analysis of all injuries filed in the period 2009-2017 was performed, evaluating patient data, type of catheter, insertion technique and type of injury. If the injury was deemed avoidable by Löf, degree of disability and mortality was registered. RESULTS A total of 87 claims of injuries were found of which 36 (41%) were assessed as avoidable. The most common injuries were: bleeding (18%), early infection (17%), pneumothorax (17%) and early thrombosis (15%). No patients died of their injuries, but 17 of 36 suffered permanent disability of varying degrees. Ultrasound-guided insertion was used in 19% of the cases. CONCLUSION In Sweden, few injuries related to CVAD use are reported to Löf. About 40% of filed claims were categorized as having an avoidable injury and therefore eligible for compensation. About half of the compensated patients suffered a permanent disability. The results indicate underreporting of CVC-related injuries in Sweden during the studied time-period.
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Affiliation(s)
- Sophie Lindgren
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy, Gothenburg University Gothenburg Sweden
| | - Pelle Gustafson
- The Swedish National Patient Insurance Company (Löf) Stockholm Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive care Ryhov County Hospital Jönköping Sweden
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Oliver LA, Oliver JA, Ohanyan S, Park W, Benelyahoo A, Vadivelu N. Ultrasound for peripheral and arterial access. Best Pract Res Clin Anaesthesiol 2019; 33:523-537. [PMID: 31791568 DOI: 10.1016/j.bpa.2019.10.002] [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] [Received: 07/15/2019] [Accepted: 10/17/2019] [Indexed: 12/27/2022]
Abstract
Peripheral venous access is perhaps the most commonly performed procedure in hospitals, urgent care, or surgical centers across the country. The ability to obtain peripheral intravenous (IV) access, and in a timely manner, is arguably one of the most important skill sets to be mastered by health care professionals. While skill and experience play a role in successful and timely vascular access, numerous patient factors such as obesity, diabetes, IV drug use, and chronic kidney disease may pose unique challenges to even the most skilled health care professional. In patients with difficult access, there are often multiple attempts, which can be both time consuming for the provider and painful for the patients. Direct visualization of blood vessels using ultrasonography has an advantage over the standard landmark technique and can improve the success rate of peripheral IV or arterial line placement in this patient population. Given the success of ultrasound guidance with access placement, it is imperative that all health care profesionals become proficient with this technique. The aim of this review article is to provide concise and practical information on the basics of ultrasound and its application to obtain peripheral venous and arterial access.
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Affiliation(s)
- Lori-Ann Oliver
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Jodi-Ann Oliver
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Sargis Ohanyan
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - William Park
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Aharon Benelyahoo
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Nalini Vadivelu
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States.
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