1
|
Bahl A, Gibson SM, Walton A. Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening. Ther Clin Risk Manag 2024; 20:559-566. [PMID: 39247171 PMCID: PMC11380876 DOI: 10.2147/tcrm.s479846] [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: 07/16/2024] [Accepted: 08/26/2024] [Indexed: 09/10/2024] Open
Abstract
Objective Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture. Methods This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow. Results Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P<0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P<0.001). Conclusion In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Alexis Walton
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| |
Collapse
|
2
|
Gorski LA, Ong J, Van Gerpen R, Nickel B, Kokotis K, Hadaway L. Development of an Evidence-Based List of Non-Antineoplastic Vesicants: 2024 Update. JOURNAL OF INFUSION NURSING 2024; 47:290-323. [PMID: 39250767 DOI: 10.1097/nan.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Infiltration of a vesicant, called extravasation, can result in severe patient injuries. Recognition of vesicants and their relative risk of injury is essential to extravasation prevention, early recognition, and appropriate treatment. In this article, the Vesicant Task Force (VTF) updates the previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS list diverges from earlier vesicant lists, such as the 2017 VTF list, by adopting a risk stratification approach based upon documented patient outcomes, in contrast to the reliance on expert consensus or only surrogate risk indicators, such as pH and osmolarity. The methodology used to create the updated list is explained, and the criteria for high- and moderate-risk vesicants and cautionary vesicants are defined.
Collapse
Affiliation(s)
- Lisa A Gorski
- Author Affiliations: Ascension at Home, Brentwood, Tennessee (Gorski); Bryan Medical Center, Lincoln, Nebraska (Ong); Retired from Bryan Medical Center, Lincoln, Nebraska (Van Gerpen); Omaha, Nebraska (Nickel); Retired from BD Medical, Munster, Indiana (Kokotis); Lynn Hadaway Associates, Inc., Milner, Georgia (Hadaway)
| | | | | | | | | | | |
Collapse
|
3
|
Nickel B. Vascular access device selection: Optimizing patient outcomes - Part 1. Nursing 2024; 54:25-37. [PMID: 39186158 DOI: 10.1097/nsg.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT A systematic evaluation of vascular access device (VAD) selection incorporates patient, device, and infusate characteristics to ensure optimal device placement. This article explores VAD selection from the perspective of vessel health and preservation and describes VAD selection options and indications, VAD-related complications, and strategies to reduce those complications.
Collapse
Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the 2024 Infusion Nurses Society Standards of Practice Committee chair
| |
Collapse
|
4
|
Hadaway L, Gorski LA. Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review. JOURNAL OF INFUSION NURSING 2024; 47:324-346. [PMID: 39250768 DOI: 10.1097/nan.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.
Collapse
Affiliation(s)
- Lynn Hadaway
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| | - Lisa A Gorski
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| |
Collapse
|
5
|
Mielke N, O'Sullivan C, Xing Y, Bahl A. The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study. Int J Equity Health 2024; 23:158. [PMID: 39134999 PMCID: PMC11318308 DOI: 10.1186/s12939-024-02213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/16/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Placement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes. METHODS This study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable. RESULTS Between January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001). CONCLUSIONS Black females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.
Collapse
Affiliation(s)
- Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Charlotte O'Sullivan
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, United States of America
| | - Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, 13 Mile Rd, Royal Oak, MI, 48073, United States of America.
| |
Collapse
|
6
|
Gibson SM, Sarlabous J, Adair L, Bahl A. Operation STICK Improves Vascular Access Outcomes in a Specialty Team: A Quasi-Experimental Study. J Nurs Care Qual 2024:00001786-990000000-00157. [PMID: 39151043 DOI: 10.1097/ncq.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Education and training may improve outcomes within an experienced vascular access team. PURPOSE The purpose of this study was to measure the impact of a standardized peripheral intravenous catheter insertion educational program (Operation STICK) on vascular access outcomes. METHODS A quasi-experimental study design was used. Adult inpatients with difficult intravenous access (DIVA) requiring ultrasound-guided insertion by a vascular access specialty team were eligible. Data were collected before and 7 months after the educational training program. RESULTS A total of 54 subjects were included (24 pre- and 30 post-implementation). Significant improvements were found for mean peripheral intravenous catheter dwell time (3.62 to 14.97 days, P < .001), completion of therapy (58.3% to 96.7%, P = .001), and first-stick success rate (79.2% to 100%, P = .013). Catheter-to-vein ratio significantly decreased (P = .007). CONCLUSIONS Standardized education/training in vascular access focusing on best practices yields favorable outcomes for DIVA patients within an established specialty team.
Collapse
Affiliation(s)
- Steven Matthew Gibson
- Author Affiliations: Vascular Access Specialty Nurse, Vascular Access Consulting, Henderson, Kentucky (Mr Gibson); Vascular Access Specialty Nurse, Baptist Hospital, Miami, Florida (Ms Sarlabous and Ms Adair); and Professor of Emergency Medicine, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan (Dr Bahl)
| | | | | | | |
Collapse
|
7
|
van Rens MFPT, van Boxtel AJH, Mermel LA. Comment on: Central-line-associated bloodstream infection (CLABSI) burden among Dutch neonatal intensive care units. J Hosp Infect 2024; 150:174-175. [PMID: 38823644 DOI: 10.1016/j.jhin.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | - A J H van Boxtel
- GloVANet/WoCoVA, PO Box 675, 3720 AR, Bilthoven, the Netherlands
| | - L A Mermel
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Hospital System, Providence, RI, USA
| |
Collapse
|
8
|
Carter H, Hanks S, Johnson R, Gale T. Educating for capability and preparing for practice: Integrating theory and skills. CLINICAL TEACHER 2024; 21:e13725. [PMID: 38233356 DOI: 10.1111/tct.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Capability is the ability to perform clinical skills in ever-changing real world contexts, adapting to challenges and integrating technical and non-technical skills and competencies, for example, cannulating an uncooperative patient at night. Going beyond teaching competency and ensuring capability is imperative, as recommended by the national outcomes for medical graduates. A course on intravenous cannulation was developed with e-learning modules and high-fidelity complex simulation scenarios, aiming to promote capability in practice. The course delivered an intravenous cannulation e-learning package between two practical simulations to 10 final-year medical students. The hybrid simulation design consisted of an actor with a bespoke cannulation part-task trainer strapped to their arm. Each simulation delivered a challenging scenario, requiring the integration of procedural and behavioural skills to succeed. Simulations were video recorded, and participants reviewed their performances before completing semi-structured interviews. Transcribed interviews were thematically analysed. Interview analysis demonstrated two overarching themes: 'Impact on Capability' and 'Preparedness for Practice'. There was consistent recognition of improved capability from the interviews. Simulation exercises were described as the most valuable tool for developing capability. The e-learning helped with structure, facilitating students' adaptation to scenarios. Participants felt that training in medical school was largely competency-based and did not tackle complex interactions. Following e-learning and simulations, students felt more prepared for clinical practice. The course structure has value for medical professionals in developing capability and preparing for clinical practice, helping to reach standards expected of graduates. Plans to assess capability across multiple undergraduate programmes through Entrustable Professional Activities are in progress.
Collapse
Affiliation(s)
- Harry Carter
- Peninsula Medical School, University of Plymouth, Plymouth, UK
- University Hospital of Wales, Cardiff, UK
| | - Sally Hanks
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Robert Johnson
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Peninsula Medical School, University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
9
|
Alomani H, Mostafa FA, Felemban B, Redwan H, Masaud K, Alshanqiti K, Neff C, Vidovic M. Practical Application for the Theory of Profound Knowledge in a Quality Improvement Project. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:140-143. [PMID: 39104798 PMCID: PMC11298044 DOI: 10.36401/jqsh-23-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Hakem Alomani
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Fadwa Abu Mostafa
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Basim Felemban
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Hani Redwan
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Khaled Masaud
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | | | - Claudine Neff
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Matea Vidovic
- King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| |
Collapse
|
10
|
Mimoz O, Debonne A, Glanard A, Keita Perse O, Lucet JC. Best practice in the use of peripheral venous catheters: A consensus from French experts. Infect Dis Now 2024; 54:104923. [PMID: 38759732 DOI: 10.1016/j.idnow.2024.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical devices in healthcare. While they are often perceived as innocuous because they are common, this perception does not match their risk factors. In France, 16% of intravenous device-associated bacteremia are due to PIVCs. This consensus document reports the French experience in PIVC management, issues arising from their complications, and a proposed path toward improved PIVC care. METHODS A panel of five French experts discussed this topic based on evidence and personal experience. A consensus process was applied to highlight the issues in need of increased awareness and to suggest possible improvements. PIVC topics were organized as General Statements, Indication, Preparation, Insertion, Maintenance, and Removal. An electronic survey was used to record agreement or disagreement; to expand the dataset, five additional French experts also answered the questions. RESULTS Out of 67 statements, 62 reached a consensus (the 80% agreement threshold was exceeded). Experts are increasingly aware that PIVCs are a significant source of complications, including local and bloodstream infections. Practices need to progress to improve patient outcomes, which will require better education for all personnel involved with the insertion and maintenance of PIVCs. CONCLUSIONS Current practice around PIVCs does not always comply with the recommendations issued. A new surveillance network targeting catheter-related healthcare-associated infections is now in place in France. Simplified, standardized, bundled solutions are needed to reduce avoidable harm from PIVCs. Healthcare practice has changed over time and new educational tools are needed to adapt to increased workload and time constraints.
Collapse
Affiliation(s)
- Olivier Mimoz
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
| | - Anne Debonne
- Centre Hospitalier d'Argenteuil, Argenteuil, France.
| | | | | | - Jean-Christophe Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, F-75018 Paris, France; Université Paris Cité, Inserm, IAME, F-75018 Paris, France.
| |
Collapse
|
11
|
Yaqoob M, Masih S, Rasheed A, Shah Y, Uddin N, Siddiqui F, Rehan M, Khan RA, Ahmed F, Rehan M, Qasim R. Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S30-SIV. [PMID: 39023027 DOI: 10.12968/bjon.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. METHODS A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. RESULTS Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. CONCLUSION This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.
Collapse
Affiliation(s)
- Muhammad Yaqoob
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan; Program Director for Post-Graduate Nursing Programs, Dow Institute of Nursing & Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarfraz Masih
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Abdur Rasheed
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Yousaf Shah
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Nadeem Uddin
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Faraz Siddiqui
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Rehan
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Fahad Ahmed
- Indus College of Nursing and Midwifery, The Indus Hospital, Karachi, Pakistan
| | | | - Rubina Qasim
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
12
|
Fernandez-Fernandez I, Parra-García G, Blanco-Mavillard I, Carr P, Santos-Costa P, Rodríguez-Calero MÁ. Vascular access specialist teams versus standard practice for catheter insertion and prevention of failure: a systematic review. BMJ Open 2024; 14:e082631. [PMID: 38969373 PMCID: PMC11227807 DOI: 10.1136/bmjopen-2023-082631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE Billions of vascular access devices (VADs) are inserted annually for intravenous therapy worldwide. However, their use is not without challenges. Facilitating the process and enhancing results, hospital authorities have created vascular access specialist teams (VASTs) with advanced competencies in the evaluation, insertion, care and management of VADs. The objective is to compare the effectiveness of VASTs versus standard practice regarding cannulation success and vascular access maintenance in hospitalised adults. DESIGN Systematic review, using the Mixed Methods Appraisal Tool. DATA SOURCES We conducted a structured data search on Cochrane Library, MEDLINE, Web of Science, Scopus and EBSCOhost up to 31 May 2023. We did not impose a time limit regarding the date of publication. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised and non-randomised trials and observational studies. DATA EXTRACTION AND SYNTHESIS We included studies that described or evaluated the activity of VASTs compared with clinical practitioners. The outcomes analysed were the success of the cannulation and the incidence of associated adverse effects. RESULTS The search strategy produced 3053 papers published between 1984 and 2020, from which 12 were selected for analysis. VASTs are heterogeneously described among these studies, which mainly focus on insertions, frequently for patients with difficult intravenous access. Some patients presented with specific needs or requirement for specific insertion technique or catheter type. Compared with usual practice, these studies indicate that the involvement of a VAST is associated with a higher effectiveness in terms of first attempt insertions and insertion success rates, and a reduction in catheter-associated adverse events. However, meta-analyses confirming this trend are not currently possible. CONCLUSIONS It seems apparent that VASTS contribute to improving the health of patients during the administration of intravenous. VASTs seem to increase the effectiveness of VAD insertion and care and reduce complications. PROSPERO REGISTRATION NUMBER CRD42021231259.
Collapse
Affiliation(s)
| | | | - Ian Blanco-Mavillard
- Healthcare Implementation and Research Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma de Mallorca, Spain
- Care, Chronicity and Evidence in Health Research Group, Health research institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Higher School of Nursing of Coimbra, Coimbra, Portugal
- Portuguese Association for Vascular Access (APoAVa), Coimbra, Portugal
| | | |
Collapse
|
13
|
Hook M, Woda A, Bohr K, Ford C, Singh M. Using Implementation Science to Improve Short Peripheral Intravenous Catheter Outcomes. JOURNAL OF INFUSION NURSING 2024; 47:266-276. [PMID: 38968589 DOI: 10.1097/nan.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Short peripheral intravenous catheters (short PIVCs) are commonly used in acute care, guided by evidence-based policy with interventions to limit premature failure. Research on how nurses use evidence and change processes to optimize outcomes is needed. The study objective was to use a theory-based implementation science approach to evaluate and improve short PIVC insertion and care processes and reduce removals for adverse outcomes in acute care. This mixed-methods study was conducted with inpatient nursing units (n = 23) at a large urban quaternary medical center. Units identified and implemented one PIVC care intervention that could lower catheter removals for adverse outcomes over 3 months. Data from multiple sources were convergently analyzed to evaluate process and outcomes postintervention. Although overall frequency of PIVC removals for adverse outcomes was unchanged, several units improved their outcomes using implementation strategies. The determinant framework provides a plausible explanation for the study results. While adverse outcome rates remained below published rates, some units had limited success improving outcomes with traditional change strategies. Implementation strategies and readily accessible data can offer nursing units a new approach to effectively deploy, monitor, and maintain interventions to achieve improved outcomes.
Collapse
Affiliation(s)
- Mary Hook
- Author Affiliations: Advocate Health, Milwaukee, Wisconsin (Hook); Marquette University College of Nursing & Aurora St. Luke's Medical Center, Milwaukee, Wisconsin (Woda); Vivent Health, Kenosha, Wisconsin (Bohr); Aurora St. Luke Medical Center, Milwaukee, Wisconsin (Ford); Marquette University College of Nursing, Milwaukee, Wisconsin (Singh)
| | | | | | | | | |
Collapse
|
14
|
van Rens MFPT, Spencer TR, Hugill K, Francia ALV, van Loon FHJ, Bayoumi MAA. Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population. J Vasc Access 2024; 25:1229-1237. [PMID: 36794683 PMCID: PMC11308324 DOI: 10.1177/11297298231154629] [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: 09/09/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods. METHODS A retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar. A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG). In the historical cohort, the catheter was secured using a semi-permeable transparent membrane dressing while in the CG cohort, CG was applied at the insertion site on initial insertion and after any dressing change. This was the only variable intervention between both groups. RESULTS A total of 8330 peripheral catheters were inserted. All catheters were inserted and monitored by members of the NeoVAT team. 4457 (53.5%) were secured with just a semi-permeable transparent dressing and 3873 (46.5%) secured a semi-permeable transparent dressing with the addition of CG. The odds ratio for premature failure after securement with CG was 0.59 (0.54-0.65) when compared to the catheters secured with a semi-permeable transparent dressing, which was statistically significant (p < 0.001). The correlation between the occurrence of a complication and the use of CG for device securement was significant (p < 0.001). CONCLUSIONS The risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study's findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.
Collapse
Affiliation(s)
| | | | - Kevin Hugill
- Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | - Airene LV Francia
- Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus HJ van Loon
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Mohammad AA Bayoumi
- Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
15
|
Bahl A, Johnson S, Hijazi M, Mielke N, Chen NW. Cost effectiveness of ultrasound-guided long peripheral catheters in difficult vascular access patients. J Vasc Access 2024; 25:1204-1211. [PMID: 36789955 DOI: 10.1177/11297298231154297] [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: 02/16/2023] Open
Abstract
OBJECTIVE Peripheral intravenous catheter (PIVC) placement is a routinely performed invasive procedure in hospital settings with an unacceptably high failure rate that can result in significant costs. This investigation aimed to determine the cost-effectiveness of using long peripheral catheters (LPC) versus standard short peripheral catheters (SPC) in the difficult vascular access (DVA) population. METHODS A secondary analysis was performed of a randomized control trial that compared a 20-gauge 4.78 cm SPC to a 20-gauge 6.35 cm SPC for the endpoint of survival. This study assessed cost-effectiveness of the comparative interventions. Costs associated with increased hospitalization length of stay due to PIVC failure, including labor, materials, equipment, and treatment delays were estimated by utilizing healthcare resource utilization data. Cost-effectiveness of the LPC was analyzed through the incremental cost-effectiveness ratio, the cost-effectiveness acceptability curve, and the incremental net benefit. A sensitivity analysis was conducted to evaluate the robustness of the results during the time interval of PIVC insertion. RESULTS Among the 257 patients, the average total cost for therapy was lower in the LPC group compared to the SPC group ($400 vs $521; mean difference -$121, 95% bootstrapped CI -$461 to $225). A marginally significant absolute difference of complication averted was found for LPC versus SPC (10.8%, p = 0.07). The estimated incremental cost-effectiveness ratio (ICER) for LPC as compared with SPC was -$1123 (95% bootstrapped CI -$8652 to $5964) per complication averted. In a willingness to pay (WTP) analysis, as WTP = $0, the incremental net benefit (INB) $121 was positive, indicating LPC was less costly. Analysis of PIVCs that survived ⩽48 h (n = 134) demonstrated a lower average total cost for therapy among the LPC group ($418 vs $531; mean difference -$113, 95% bootstrapped CI -$507 to $282). Forty-seven of 66 (71.2%) LPCs did not experience a complication, compared with 37 of 68 (54.4%) SPCs, resulting in a significant absolute difference of complication adverted of 16.8% (p = 0.04). In addition, with a positive slope, the INB $113 was positive as WTP = $0, indicating LPC was estimated to be cost-effective. CONCLUSIONS When using ultrasound guidance for vascular access, LPCs are potentially a cost-effective strategy for reducing PIVC complications in DVA patients compared to SPCs. Given this finding, ultrasound-guided LPCs should be routinely considered as first-line among the DVA population in order to improve their overall care and wellbeing.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Steven Johnson
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Mahmoud Hijazi
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nai-Wei Chen
- Research Institute, Beaumont Hospital, Royal Oak, MI, USA
| |
Collapse
|
16
|
Meto E, Cabout E, Rosay H, Espinasse F, Lot AS, Hajjam ME, Gnamien Clermont S, Launois R. Cost comparison of four venous catheters: Short peripheral catheter, Long peripheral line, Midline, and PICC for peripheral infusion. J Vasc Access 2024:11297298241258257. [PMID: 38855974 DOI: 10.1177/11297298241258257] [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: 06/11/2024] Open
Abstract
INTRODUCTION The use of midline catheters for patients requiring a peripheral IV infusion is sometimes limited by their cost. Although decision trees allow them to be positioned in relation to short peripheral cannulas (SPC), Midlines, and PICCs, their economic impact has not yet been evaluated. A study was conducted to estimate and compare the actual costs of using the three types of catheters for durations of 7, 14, and 21 days. METHODS A budget impact analysis compared midlines or mini-midlines/long peripheral cannulas (LPCs) with SPCs and PICCs for typical medical indications excluding indications requiring central line (infusion of irritant or vesicant drugs): treatment of peritonitis over 7 days, cystic fibrosis infection over 14 days, and meningitis over 21 days. A micro-costing study identified resources used during catheter care procedures (consumables, medical/nursing care, examinations, mechanical complications). The cost of remote systemic complications was estimated from the French national cost study. Literature review compared data based on published complication frequencies. RESULTS Midline is more economic than the SPC (saving of 39€ over 7 days and 174€ over 14 days), and than the PICC (saving of 102€ over 14 days and 95€ over 21 days). DISCUSSION Despite a much higher acquisition cost of the Midline than a SPC, the cost of using a Midline is lower. Although this approach cannot be the only argument for choosing a medical device, it can contribute to it in a tense economic context. The micro-costing has been performed in a center placing PICCline using fluoroscopy for catheter tip positioning. The implantation of a PICC with ECG technique does not require an interventional radiology facility and involves significantly lower logistical and personnel costs. This factor is a limitation in this study. However, even with the use of EGC, the cost difference is in favor of Midline.
Collapse
Affiliation(s)
- Elise Meto
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Elise Cabout
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Hervé Rosay
- Centre Léon Bérard, Centre de lutte contre le cancer, Lyon, France
| | | | | | | | | | - Robert Launois
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| |
Collapse
|
17
|
Drugeon B, Marjanovic N, Boisson M, Buetti N, Mimoz O, Guenezan J. Insertion site and risk of peripheral intravenous catheter colonization and/or local infection: a post hoc analysis of the CLEAN 3 study including more than 800 catheters. Antimicrob Resist Infect Control 2024; 13:57. [PMID: 38840171 PMCID: PMC11151591 DOI: 10.1186/s13756-024-01414-4] [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: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024] Open
Abstract
AIM Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications. METHODS We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models. RESULTS Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59]). CONCLUSION PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture.
Collapse
Affiliation(s)
- Bertrand Drugeon
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
| | - Nicolas Marjanovic
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM CIC1402, CHU de Poitiers, Poitiers, France
| | - Matthieu Boisson
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
- Service d'Anesthésie Et Réanimations Et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France
| | - Olivier Mimoz
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France.
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France.
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.
| | - Jérémy Guenezan
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
| |
Collapse
|
18
|
Doyle BJ, Kelsey LJ, Shelverton C, Abbate G, Ainola C, Sato N, Livingstone S, Bouquet M, Passmore MR, Wilson ES, Colombo S, Sato K, Liu K, Heinsar S, Wildi K, Carr PJ, Suen J, Fraser J, Li Bassi G, Keogh S. Design, development and preliminary assessment in a porcine model of a novel peripheral intravenous catheter aimed at reducing early failure rates. J Vasc Access 2024; 25:790-799. [PMID: 36281219 DOI: 10.1177/11297298221127760] [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: 02/18/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet despite best efforts by end-users, PIVCs experience unacceptably high early failure rates. We aimed to design a new PIVC that reduces the early failure rate of in-dwelling PIVCs and we conducted preliminary tests to assess its efficacy and safety in a porcine model of intravenous access. METHODS We used computer-aided design and simulation to create a PIVC with a ramped tip geometry, which directs the infused fluid away from the vein wall; we called the design the FloRamp™. We created FloRamp prototypes (test device) and tested them against a market-leading device (BD Insyte™; control device) in a highly-controlled setting with five insertion sites per device in four pigs. We measured resistance to infusion and visual infusion phlebitis (VIP) every 6 h and terminated the experiment at 48 h. Veins were harvested for histology and seven pathological markers were assessed. RESULTS Computer simulations showed that the optimum FloRamp tip reduced maximum endothelial shear stress by 60%, from 12.7 Pa to 5.1 Pa, compared to a typical PIVC tip and improved the infusion dynamics of saline in the blood stream. In the animal study, we found that 2/5 of the control devices were occluded after 24 h, whereas all test devices remained patent and functional. The FloRamp created less resistance to infusion (0.73 ± 0.81 vs 0.47 ± 0.50, p = 0.06) and lower VIP scores (0.60 ± 0.93 vs 0.31 ± 0.70, p = 0.09) than the control device, although neither findings were significantly different. Histopathology revealed that 5/7 of the assessed markers were lower in veins with the FloRamp. CONCLUSIONS Herein we report preliminary assessment of a novel PIVC design, which could be advantageous in clinical settings through decreased device occlusion and reduced early failure rates.
Collapse
Affiliation(s)
- Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, UK
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sebastiano Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Cardiovascular Research Institute Basel, University Hospital of Basel and University Basel, Switzerland
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
- Intensive Care Unit, The Wesley Hospital, Uniting Care Hospitals, Auchenflower, Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
- Intensive Care Unit, The Wesley Hospital, Uniting Care Hospitals, Auchenflower, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
19
|
Firooz M, Karkhah S, Hosseini SJ. The effect of transilluminator device on successful peripheral venous catheter placement in children: A systematic review and meta-analysis. J Vasc Access 2024; 25:703-712. [PMID: 36287005 DOI: 10.1177/11297298221132866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Peripheral venous catheter placement (PVCP) is difficult for children due to the small diameter of their veins in adipose tissue. The transilluminator device (TD) is proposed as the effective method for PVCP. Therefore, this meta-analysis aimed to assess the effect of TD on first attempt success rate (FASR), mean the number of attempts (MNA), and mean duration of successful PVC placement (MDSPP) in children. In a systematic review and meta-analysis, an extensive search of online databases including PubMed, Scopus, Science Direct, Web of sciences, Cochrane, Clinical trial.gov, ProQuest, and Google scholar search engine was conducted. Keywords were combined and searched from the earliest records up to December 2021. The current meta-analysis was performed using STATA V.14.0 software. Six studies (four RCTs and two non-RCTs design) were included in the present meta-analysis. Analysis showed using of TD significantly led to FASR to 34% in studies with RCTs design (RR = 1.34; CI = 1.18-1.53) although, non-RCT studies did not indicate it (RR: 0.95; CI = 0.50-1.79). Also, one RCT (WMD = -0.24; CI = -0.4 -0.08) and two non-RCTs 0.05 (WMD = -0.05; 95% CI = -0.46-0.37) reported the MNA. Two RCTs (WMD: -24.30; CI = -53.50-4.89) and one non-RCT (WMD: -295.20; CI = -359.34 to -231.06) found TD decreased MDSSP. RCTs and non-RCTs studies showed different results in terms of some outcomes. Based on the results of four RCTs studies, the use of TD significantly increased the FASR of PVCP. The results of two non-RCTs also showed TD insignificantly decreased the FASR of PVCP. More evidence (RCT design) is required for decision-making about the effectiveness of TD on successful PVCP.
Collapse
Affiliation(s)
- Mahbobeh Firooz
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | |
Collapse
|
20
|
Marsh N, Larsen EN, Ullman AJ. Authors' response to "Comment on Marsh et al. (2023) 'Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis'". Int J Nurs Stud 2024; 153:104727. [PMID: 38458125 DOI: 10.1016/j.ijnurstu.2024.104727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Affiliation(s)
- N Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia.
| | - E N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - A J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| |
Collapse
|
21
|
Xu HG, Corley A, Ware RS, Nghiem S, Stirling S, Wang C, Marsh N. Using a LOng peripheral intraVEnous catheter with retractable guidewire to optimize first-insertion success for patients with Difficult IntraVenous Access in the emergency department (LOVE-DIVA): a study protocol for a randomized controlled trial. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S28-S34. [PMID: 38578937 DOI: 10.12968/bjon.2024.33.7.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION First-insertion success rates for peripheral vascular access devices (PVADs) in patients with difficult venous access (DIVA) are low, which negatively affects staff workload, patient experience, and organizational cost. There is mixed evidence regarding the impact of a peripheral vascular access device with retractable coiled tip guidewire (GW; AccuCath™, BD) on the first-insertion success rate. The aim of this study is to investigate whether the use of long GW-PVADs, compared with standard PVADs, reduces the risk of first-time insertion failure, in patients admitted to emergency departments (EDs). METHODS AND ANALYSIS A parallel-group, two-arm, randomized controlled trial will be carried out in two Australian EDs to compare long GW-PVADs (5.8 cm length) against standard care PVADs (short or long). Patients ≥18 years of age meeting DIVA criteria will be eligible for the trial. The sample size is 203 participants for each arm. Web-based central randomization will be used to ensure allocation concealment. Neither clinicians nor patients can be blinded to treatment allocation. Primary outcome is the first-insertion success rate. Secondary outcomes include the number of insertion attempts, time to insert PVAD, all-cause failure, dwell-time, patient-reported pain, serious adverse events, complications, subsequent vascular access devices required, patient satisfaction, staff satisfaction, and healthcare costs. Differences between the two groups will be analyzed using Cox proportional hazards regression. Cost-effectiveness analysis will also be conducted. Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION The study is approved by Metro South Ethics Committee (HREC/2022/QMS/82264) and Griffith University (2022/077). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION ACTRN12622000299707.
Collapse
Affiliation(s)
- Hui Grace Xu
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Amanda Corley
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Son Nghiem
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Scott Stirling
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Carrie Wang
- Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| |
Collapse
|
22
|
Barton A. Extravasation and infiltration: under-recognised complications of intravenous therapy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S18-S26. [PMID: 38578942 DOI: 10.12968/bjon.2024.33.7.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Occasionally, the administration of intravenous (IV) therapies can go wrong. Infiltration or extravasation is a complication when a drug or IV therapy leaks into the tissues surrounding the vascular access device. Extravasation can cause serious and often life-changing injuries. Extravasation is often associated with systemic anti-cancer therapy but non-chemotherapy drugs have been reported as having a greater risk of serious complications. This study outlines the first UK Infusion unit evaluation of the ivWatch infusion monitoring device which was undertaken from August 2023 to January 2024. Out of 2254 infusions monitored with ivWatch, the device prevented 122 cases of infiltration and extravasation from causing any harm to the patient, corresponding to a 5.4% 'check IV' notification rate.
Collapse
Affiliation(s)
- Andrew Barton
- Nurse Consultant IV Therapy and Vascular Access, IVAS Lead Nurse, FHFT Product Selection Group Chair, National Infusion and Vascular Access Society (NIVAS) Chair, WoCoVA Global Committee Member
| |
Collapse
|
23
|
Godfrey J, Gallipoli L. Introducing an ultrasound-guided longer length peripheral IV catheter for patients with difficult venous access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S4-S8. [PMID: 38700139 DOI: 10.12968/bjon.2024.33.7.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
AIM Insertion of a peripheral intravenous catheter (PIVC) is one of the most common procedures carried out in hospitals worldwide, but failure rates are unacceptably high. This local quality improvement project aimed to assess improvements in first-stick success rate, dwell time and overall catheter success rate when implementing a longer-length peripheral intravenous catheter (LPIVC) under ultrasound guidance for patients with difficult venous access (DVA). METHODS Data were collected from 386 DVA patients requiring a PIVC at one hospital. Number of catheter insertion attempts, catheter dwell time and reason for catheter removal were recorded for each patient. To implement the new DVA catheterisation pathway, registered nurses undertook a training programme comprising workshops and ultrasound-guided cannulation technique practice on phantoms. Costs and waste weights associated with LPIVC insertion, compared with midline insertion, were calculated. RESULTS First-stick success rate was 95.0% using the LPIVC under ultrasound guidance. Dwell time ranged from 1 to 80 days, with a large proportion of those dwelling <1 day being placed in day-case patients. Treatment success rate with the LPIVCs was 83.6%. Equipment costs for an LPIVC insertion were £89.22 lower than for a midline insertion, and the weight of waste generated per procedure was 1 kg lower for LPIVCs. CONCLUSIONS First-stick success rate of LPIVCs, aided by improved purchase in the vein and visualisation with ultrasound guidance, was very high, superior to rates reported in other studies. The procedure provides a better patient experience as successful first attempts avoid unnecessary further insertion attempts. Other benefits are increased nursing time efficiency, a reduction in clinical waste and the lower cost of the equipment required.
Collapse
Affiliation(s)
- Julie Godfrey
- Lead Vascular Access Consultant Nurse, Mid and South Essex NHS Foundation Trust
| | - Luigi Gallipoli
- PICC and Vascular Access Clinical Nurse Specialist, Mid and South Essex NHS Foundation Trust
| |
Collapse
|
24
|
Faltoni M, Catho G, Pianca E, Minka-Obama B, Zanella MC, Chraiti MN, Fortchantre L, Harbarth S, Buetti N. Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study. Clin Microbiol Infect 2024; 30:548-551. [PMID: 38142893 DOI: 10.1016/j.cmi.2023.12.018] [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: 09/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI. METHODS Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors. RESULTS A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results. DISCUSSION Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI.
Collapse
Affiliation(s)
- Matteo Faltoni
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Eva Pianca
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka-Obama
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Nöelle Chraiti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Loïc Fortchantre
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolὸ Buetti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; IAME U 1137, INSERM, Université Paris-Cité, Paris, France.
| |
Collapse
|
25
|
Kaphan K, Auypornsakul S, Somno J, Wongwattananan W, Jamsittikul K, Baicha W, Somsri S, Sawatrak T. The Prevalence and Associated Factors of Peripheral Intravenous Complications in a Thai Hospital. JOURNAL OF INFUSION NURSING 2024; 47:120-131. [PMID: 38422405 PMCID: PMC10916754 DOI: 10.1097/nan.0000000000000538] [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: 03/02/2024]
Abstract
Complications of peripheral intravenous catheters (PIVCs) remain a major contributor to health care costs and are a patient safety problem. The objective of this cross-sectional descriptive study was to examine the prevalence of complications and factors associated with complications from peripheral intravenous fluid administration. The study was conducted at a tertiary care hospital in Thailand. The instruments were developed from the literature review. Data were analyzed using SPSS statistics, version 22. The study examined 441 patients with a total of 497 PIVC sites. Phlebitis (level 1 and 2 only) occurred at 2.41% of all sites; infiltration (level 1 and 2 only) occurred at 1.01% of all sites, and extravasation (mild and moderate only) occurred at 0.60% of all sites. Factors associated with the occurrence of infiltration complications included receiving intravenous (IV) crystalloids (P = .03) and receiving IV analgesic drugs (P = .001). Age was statistically significantly related to extravasation complications (P = .001). Nurses should be aware of possible complications from peripheral intravenous fluid administration, especially in older patients and those receiving IV crystalloids or analgesic drugs.
Collapse
Affiliation(s)
- Kraiwan Kaphan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Siriporn Auypornsakul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Jenjira Somno
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Watsaporn Wongwattananan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Kamonthip Jamsittikul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Wilaiporn Baicha
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Saowanuch Somsri
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Thanyanan Sawatrak
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| |
Collapse
|
26
|
Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters. Expert Rev Med Devices 2024; 21:207-216. [PMID: 38445649 DOI: 10.1080/17434440.2024.2324885] [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: 10/24/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. AREAS COVERED This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. EXPERT OPINION Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.
Collapse
Affiliation(s)
- Nancy Moureau
- Nursing Research, PICC Excellence,Inc. Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
Collapse
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Gala S, Alsbrooks K, Bahl A, Wimmer M. The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective. J Res Nurs 2024; 29:6-18. [PMID: 38495321 PMCID: PMC10939017 DOI: 10.1177/17449871231213025] [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: 03/19/2024] Open
Abstract
Background Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. Aims This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Methods Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. Results The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. Conclusion This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.
Collapse
Affiliation(s)
- Smeet Gala
- Associate Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Kim Alsbrooks
- Senior Director Medical Affairs, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Amit Bahl
- Emergency Medicine Physician, Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Megan Wimmer
- Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| |
Collapse
|
29
|
Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [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: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | | |
Collapse
|
30
|
Bahl A, Clement V, DiLoreto E, Mielke N, Carr A, Panza G, Gibson SM. Evaluating the impact of external forces on peripheral intravenous catheter movement using ultrasound: A randomized pilot study. J Vasc Access 2024:11297298231222052. [PMID: 38183179 DOI: 10.1177/11297298231222052] [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: 01/07/2024] Open
Abstract
BACKGROUND A major contributor to peripheral intravenous catheter (PIVC) failure may be related to PIVC movement within the vein which is associated with vein wall damage. The magnitude of PIVC movement against the vein wall has not previously been quantified. This study aimed to examine PIVC movement within the vein when minor forces were applied to the PIVC. METHODS This was a prospective, pilot trial including healthy volunteers in an outpatient research laboratory. The primary objective was to examine the in movement (millimeters) of the PIVC using ultrasound with external pull forces (4, 5, and 6 lbs; 1.8, 2.3, and 2.7 kg, respectively) applied to the PIVC in random order. RESULTS Participants (N = 11) were aged 40.36 ± 16.10 years with 54.55% being Male. Mean ± SD PIVC movement for 4, 5, and 6 lbs of force was 4.65 ± 1.88, 3.88 ± 2.28, and 5.25 ± 2.06 mm, respectively. There was substantial PIVC movement when a force was applied to the PIVC, but no statistically significant difference between 4, 5, and 6 lb forces (p > 0.05). CONCLUSION When external pull forces were applied to the PIVC, substantial PIVC movement within the vein occurred in a healthy population. Strategies that reduce PIVC movement and/or remove or limit external pull forces from the PIVC are needed. Future studies on hospitalized patients are warranted to quantify vein wall injury and PIVC failure due to PIVC movement from various pull forces.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | | | - Emily DiLoreto
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | | | - Gregory Panza
- Department of Research, Hartford Healthcare, Hartford, CT, USA
| | | |
Collapse
|
31
|
Mousavi H, Ghanbari A, Karkhah S, Alizadeh J, Kazemnejad Leyli E, Jafaraghaee F. The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study. J Vasc Access 2024; 25:132-139. [PMID: 35634967 DOI: 10.1177/11297298221101804] [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: 02/06/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheter (PIVC) placement is the most common invasive clinical procedure, often performed by nurses in hospitals worldwide. This study aimed to assess the effect of clinical guideline education on the knowledge and practice of nurses for PIVC placement based on short message service (SMS). METHODS In a quasi-experimental study with parallel groups, 66 nurses working in two general university hospitals in Iran were enrolled. Data was collected from 2017 to 2018. PIVC placement was assessed before, immediately, and 4 weeks after educational intervention based on SMS (twice a day for 10 days). RESULTS Nurses' knowledge score immediately after intervention versus before intervention was higher in the intervention group than in the control group (4.48 vs -0.70; p < 0.001). Nurses' knowledge score in 4 weeks after intervention versus immediately after intervention was lower in the intervention group than in the control group (0.03 vs 0.42; p = 0.014). Nurses' knowledge scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (4.52 vs -0.27; p < 0.001). Nurses' practice score immediately after intervention versus before intervention was higher in the intervention group than in the control group (0.57 vs -0.18; p = 0.174). Nurses' practice score 4 weeks after intervention vs immediately after intervention was higher in the intervention group than in the control group (-0.10 vs -0.38; p = 0.046). Nurses' practice scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (0.47 vs -0.56; p = 0.001). CONCLUSION Educational intervention by SMS had a significant effect on increasing the knowledge and practice of nurses toward clinical guidelines for PIVC placement. Therefore, it is suggested that educational intervention by SMS be conducted to improve nurses' knowledge as an effective educational method.
Collapse
Affiliation(s)
- Hengameh Mousavi
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari
- Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Quchan School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Alizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad Leyli
- Department of Bio-Statistics, Social Determinants of Health Research Center, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Jafaraghaee
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
32
|
Bahl A, Mielke N, Johnson S. Reliability and compliance of peripheral intravenous catheter documentation: A prospective observational study. J Vasc Access 2024; 25:89-93. [PMID: 35578560 DOI: 10.1177/11297298221097555] [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
OBJECTIVE Proper documentation of the functionality and complications of peripheral intravenous catheters (PIVC) is the standard of care. This data can improve communication among team members about access concerns and highlight opportunities to improve PIVC care. Our objective is to determine if nursing personnel are compliant with institutional standards for documentation and documentation is reliable. METHODS This prospective observational analysis was conducted at a tertiary care academic center with 120,000 ED visits and 1100 hospital beds. Adults over 18 with a PIVC placed in the ED via palpation technique who were being admitted to regular medical/surgical wards were eligible. The primary outcome was compliance with PIVC documentation per institutional standards. Secondary outcomes included compliance subcategorized as insertion, daily assessment, and removal and reliability of assessments. RESULTS During July and August 2020, 77 patients were enrolled with a total of 1201 observations of PIVC compliance. PIVC documentation compliance was 86.0% (1033/1201). Compliance on insertion and removal was 93.3% (431/462) and 80.5% (186/231), respectively, with removal assessment being the least compliant at 49.4%. Daily catheter assessments were compliant 81.9% (416/508) of the time. PIVC documentation reliability was based on 693 total observations with 87.9% (609/693) reliability overall, and a reliability of 91.6% (423/462) and 74.9% (173/231) for insertion and removal, respectively. PIVC orientation had the highest reliability (98.7%) while post-removal assessment had the lowest reliability (45.5%). CONCLUSIONS We observed moderate documentation compliance and reliability for PIVC assessments for catheters placed in the ED. Documentation of removal-related variables was the most deficient aspect of the assessments. Given the high rate of PIVC failure and its vast array of consequences, improvement of PIVC documentation of removal reasons is essential to better identify type and incidence of complications and help develop targeted solutions. Further larger studies are needed to survey PIVC documentation practices.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Steven Johnson
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| |
Collapse
|
33
|
Wilson GM, Winsett RP, Modi B, Jia R, Patton T, Silberberg D. Comparative intervention assessing a catheter stabilization device on peripheral intravenous line loss. J Vasc Access 2024; 25:82-88. [PMID: 35578556 DOI: 10.1177/11297298221098331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Short peripheral intravenous catheters are the most common invasive procedure used to deliver medications, blood products, and fluids to patients, and failure has the potential to impact the quality of care. METHODS This study compared IVs stabilized with current transparent film dressing to those using an engineered stabilization device. The first phase of the study evaluated documentation; data from patient records were found less than optimal but most complete for securement and removal, the two fields most critical to the study. The second phase measured IV dwell time, restart rates, and time between IV loss and restarts. RESULTS Although there were no statistically significant differences in restarts, the IV dwell time was longer when the engineered device was in place, helping to extend the life of the IV and prevent interruption of care. In the absence of data on the cost of infections and other complications, the use of an engineered device increased the cost of IV starts. CONCLUSIONS Adding an engineered stabilization device increases the cost of peripheral IV starts, but contributes to reducing IV restarts and preventing IV complications due to destabilized IVs. Although there were no statistically significant differences in restarts, the IV dwell time was longer when the device was in place, helping to extend the life of the IV and prevent interruption of care. Complete and accurate documentation and improved quality depended upon the ability to abstract unit-level data, which is vital for capturing the appropriate healthcare indicators. Clinical nurses must be involved in the decision-making regarding health records and operability at the unit level.
Collapse
Affiliation(s)
- Gabriela M Wilson
- Multi-Interprofessional Center for Health Informatics, The University of Texas at Arlington, Arlington, TX, USA
| | | | - Bhumika Modi
- Former Health Informatics student, University of Southern Indiana, Evansville, IN, USA
| | - Ru Jia
- Former Health Informatics student, University of Southern Indiana, Evansville, IN, USA
| | - Terilea Patton
- Former Health Informatics student, University of Southern Indiana, Evansville, IN, USA
| | - Debra Silberberg
- Former Health Informatics student, University of Southern Indiana, Evansville, IN, USA
| |
Collapse
|
34
|
Heath J, Finn E, Dancel R, Stephens JR. Pilot study of peripheral internal jugular venous catheters on a hospitalist-run medicine procedure service. J Hosp Med 2024; 19:31-34. [PMID: 37751415 DOI: 10.1002/jhm.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
Providers caring for hospitalized patients with difficult intravenous access (DIVA) frequently use central venous catheters (CVCs). One potential alternative is a peripheral internal jugular (PIJ) catheter, which is less traumatic to place and has fewer lumens than a CVC. We describe the results of 2 years' experience from a pilot project of a medicine procedure service placing PIJ catheters in hospitalized patients with DIVA. We successfully placed 34/35 (97%) PIJ catheters in 32 patients with zero complications. Median duration of use was 2.5 days (range 0-53 days, IQR 1-5). Catheter failure rate within 7 days was 32.4%, though it varied across catheter types: 9.5% in 8-10 cm midline catheters versus 69.2% (p < .001) in 6 cm angiocatheter wire introducers or shorter peripheral intravenous catheters. Our results suggest that PIJ catheters may be an option to reduce the mechanical and infectious risks associated with CVCs in some hospitalized patients with DIVA.
Collapse
Affiliation(s)
- Jonathon Heath
- Department of Medicine, Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin Finn
- Department of Medicine, Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ria Dancel
- Department of Medicine, Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Medicine, Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
35
|
Mielke N, Xing Y, Gibson SM, DiLoreto E, Bahl A. Bridging the Gap in Traditional PIVC Placement: An Evaluation of Operation STICK Vascular Access Outcomes. Ther Clin Risk Manag 2023; 19:937-948. [PMID: 38023627 PMCID: PMC10676087 DOI: 10.2147/tcrm.s435628] [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: 09/07/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Education and training is core to improving peripheral intravenous access outcomes. This study aimed to show that a vascular access training program (Operation STICK) in the emergency department (ED) improves the outcomes of traditionally placed peripheral intravenous catheters (PIVC). Methods This was a pre-post quasi-experimental study of traditionally placed PIVCs at a large ED in southeastern Michigan, United States. A control group (non-OSTICK) was compared to an experimental group (OSTICK) using a 3:1 propensity score matched analysis. Groups were comprised of ED patients with traditional PIVC placements in two separate six-month periods: non-OSTICK PIVCs from April to September 2021 and OSTICK PIVCs (placed by an OSTICK graduate) from October 2022 to March 2023. The primary outcome was PIVC functionality. The secondary outcome was adherence to best practices. Results A total of 6512 PIVCs were included in the study; 4884 (75.0%) were in the non-OSTICK group, while 1628 (25.0%) were in the OSTICK group. 68.1% of OSTICK PIVCs and 59.7% of non-OSTICK PIVCs were placed by ED technicians (p < 0.001). 91.3% of OSTICK PIVCs were placed on the first attempt, and 98.5% were placed within two attempts. A subgroup analysis of admitted patients (2540 PIVCs; 553 (21.8%) OSTICK-trained and 1987 (78.2%) non-OSTICK-trained) revealed 87.6% of OSTICK PIVCs and 80.3% of non-OSTICK PIVCs were 20 gauge (p < 0.001). The median proportion of dwell time to hospital length of stay was 94% for OSTICK PIVCs, compared to 88% for non-OSTICK PIVCs (p < 0.001). Conclusion This study underscores the value of education and training in enhancing vascular access outcomes. Implementing Operation STICK, a comprehensive vascular access training program, at a large ED has led to high first-stick success, adherence to best practice recommendations for site and device selection, and improved PIVC functionality for traditionally placed catheters.
Collapse
Affiliation(s)
- Nicholas Mielke
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, USA
| | | | - Emily DiLoreto
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| |
Collapse
|
36
|
Vadgaonkar A, Kothale N, Patil P, Kothari AH, Shetty YC. Factors determining success and the cost of materials used in securing intravenous access in an emergency setting: A prospective observational study. Int Emerg Nurs 2023; 71:101338. [PMID: 37716174 DOI: 10.1016/j.ienj.2023.101338] [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: 12/02/2022] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Multiple failed attempts at securing intravenous catheter access cause increased patient dissatisfaction and higher costs. We aimed to identify the factors leading to multiple failed attempts and estimate the cost of resources wasted. METHODS Participants were recruited from the emergency department for a prospective, observational study. Healthcare workers inserting peripheral intravenous catheters were observed. Patient characteristics and the number of attempts needed were recorded. RESULTS Three hundred thirty-four patients were enrolled, and an average of 1.74 ± 1.026 (Range: 1 - 5) access attempts were needed per patient. Only 56.28% of the insertions were successful on the first attempt. On multivariate linear regression with attempts as the outcome variable, age (β = 0.01, 95%CI 0.004 - 0.014, p = 0.0006), catheter calibre (β 20G = -0.25, 95%CI -0.45 - -0.07, p = 0.008), visibility (β = 0.23, 95%CI 0.02 - 0.44, p = 0.026) and palpability (β = 0.44, 95%CI 0.21 - 0.66, p = 0.0001) of the vein were statistically significant predictors. The average total cost of materials required was $6.4 USD per patient, of which $1.76 USD was spent towards unsuccessfully inserted catheters that were consequently thrown away. CONCLUSIONS Our study shows that securing IV access often requires multiple attempts, with nearly 30% of the total cost amounting towards materials wasted. The risk of multiple attempts is highest for older patients with invisible and non-palpable veins.
Collapse
Affiliation(s)
- Aditya Vadgaonkar
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India.
| | - Nikit Kothale
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Prakash Patil
- Dept of Pharmacology and Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Abhi H Kothari
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Yashashri C Shetty
- Dept of Pharmacology and Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
| |
Collapse
|
37
|
Marsh N, Larsen E, O'Brien C, Peach H, Keogh S, Davies K, Mihala G, Hewer B, Booker C, McCarthy AL, Flynn J, Rickard CM. Controlling peripheral intravenous catheter failure by needleless connector design: A pilot randomised controlled trial. J Clin Nurs 2023; 32:7909-7919. [PMID: 37587796 DOI: 10.1111/jocn.16852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
AIM To test the feasibility of a study protocol that compared the efficacy of neutral- and negative-pressure needleless connectors (NCs). DESIGN A single-centre, parallel-group, pilot randomised control trial. METHODS Our study compared neutral-(intervention) and negative-pressure (control) NCs among adult patients in an Australian hospital. The primary feasibility outcome was measured against predetermined criteria (e.g. eligibility, attrition). The primary efficacy outcome was all-cause peripheral intravenous catheter failure, analysed as time-to-event data. RESULTS In total, 201 (100 control; 101 intervention) participants were enrolled between March 2020 and September 2020. All feasibility criteria were met except eligibility, which was lower (78%) than the 90% criterion. All-cause peripheral intravenous catheter failure was significantly higher in the intervention group (39%) compared to control (19%). CONCLUSION With minor modifications to participant screening for eligibility, this randomised control trial is feasible for a large multicentre randomised control trial. The neutral NC was associated with an increased risk of peripheral intravenous catheter failure. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There are several NC designs available, often identified by their mechanism of pressure (positive, negative and neutral). However, NCs can contribute to peripheral intravenous catheter failure. This is the first randomised controlled trial to compare neutral and negative NC designs. Negative pressure NCs had lower PIVC failure compared to neutral NCs, however the results might not be generalisable to other brands or treatment settings. Further high-quality research is needed to explore NC design. REPORTING METHOD Study methods and results reported in adherence to the CONSORT Statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Hannah Peach
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Samantha Keogh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Karen Davies
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Catriona Booker
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Mater Research Institute, Brisbane, Queensland, Australia
| | - Julie Flynn
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| |
Collapse
|
38
|
Campos C, Lopez M, Irwin-Nieto V, Richards R, Deen MR, Lalata A. Foundation for implementing a comprehensive vascular access excellence initiative organization-wide to improve vascular access device insertion and standardize care: best practice for an acute care hospital. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S26-S37. [PMID: 37883312 DOI: 10.12968/bjon.2023.32.19.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
INTRODUCTION In 2016, a 263-bed public district hospital in California trialed a peripheral intravenous catheter (PIVC) inserted using ultrasound, with the potential to increase first attempt success in difficult intravenous access (DIVA) patients. This led to the implementation of a hospital-wide initiative to improve nursing vascular access skills and expedite vascular access device (VAD) placement. METHODS To trial a PIVC and ultrasound-guided (USG) insertion, a training program was developed and led to a doctoral Capstone project piloting an evidence-based nurse-driven protocol for the identification of DIVA patients. A Vascular Access Committee was established to achieve vascular access excellence throughout the hospital by increasing the number of nurses with advanced skills in VAD placement and by developing a central venous access device (CVAD) insertion and maintenance bundle to decrease the incidence of central line-associated bloodstream infections (CLABSI). With ongoing support of nursing leadership and achievement of ANCC Magnet Recognition® in 2021, the hospital developed a comprehensive initiative to provide patients with a consistent level of nursing expertise for VAD placement across all shifts. RESULTS Requests for USGPIVCs increased throughout the hospital, DIVA patients themselves requested ultrasound guidance be used for PIVC insertions, and there were fewer requests for Emergency Department (ED) physicians to insert CVADs. From the related Doctor of Nursing Practice (DNP) Capstone project, there were higher first-attempt cannulation successes, longer PIVC dwell times, and a reduction in devices and supplies utilized. The CVAD bundles resulted in the number of central line-associated bloodstream infections decreasing from four in 2019 to one in 2020. Since the initiative's inception, a total of 92 nurses completed the USGPIVC insertion training, and patient access to advanced-skilled clinicians is now available around the clock. DISCUSSION This manuscript discusses the initiative implemented to standardize patient care through a collaborative multidisciplinary approach and has potential generalizability to other acute care hospitals to reduce associated healthcare costs and to prevent poor patient outcomes by expediting the arrival of a vascular access nurse for DIVA patients. CONCLUSION The vascular access excellence initiative implemented provided an effective strategy to enhance the skills and confidence of nurses in VAD placement and improved efficiency in processes to expedite the arrival of an advanced skilled nurse to place VADs on DIVA. Targeted educational initiatives improved patient outcomes by reducing catheter-related bloodstream infections.
Collapse
Affiliation(s)
- Cheryl Campos
- Salinas Valley Health Medical Center, Monterey, California, USA
| | - Megan Lopez
- Salinas Valley Health Medical Center, Monterey, California, USA
| | | | - Randy Richards
- Salinas Valley Health Medical Center, Monterey, California, USA
| | - Melissa R Deen
- Salinas Valley Health Medical Center, Monterey, California, USA
| | - Agnes Lalata
- Salinas Valley Health Medical Center, Monterey, California, USA
| |
Collapse
|
39
|
Abstract
This article provides clinical guidance on performing cannulation on an adult. The site, equipment selection and aseptic non-touch technique will be discussed. The clinical procedural technique of cannulation will be explained and the article will also provide an awareness of the dangers and complications of this invasive technique for both the patient and the health professional.
Collapse
Affiliation(s)
- Claire Ford
- Assistant Professor, Adult Nursing, Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne
| |
Collapse
|
40
|
Swanson S, Luu V, Smith R, Gross A, Tudor J, MacKenzie D, Taroc AM, Gow KW, Nelson LY, Seibel EJ. A temperature-sensitive, high-adhesion medical tape: a comparative, single-blind clinical trial. J Wound Care 2023; 32:665-675. [PMID: 37830828 PMCID: PMC10798267 DOI: 10.12968/jowc.2023.32.10.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Medical adhesives are used to secure wound care dressings and other critical devices to the skin. While high peel-strength adhesives provide more secure skin attachment, they are difficult to remove from the skin and are correlated with medical adhesive-related skin injuries (MARSI), including skin tears, and an increased risk of infection. Lower-adhesion medical tapes may be applied to avoid MARSI, leading to dressing or device dislodgement and further medical complications. METHOD This paper reports on the clinical testing of a new, high-adhesion medical tape, ThermoTape (University of Washington, US), designed for low skin trauma upon release. ThermoTape was benchmarked with Tegaderm (3M, US) and Kind Removal Tape (KRT) (3M, US). All three tapes were applied to both the left and right forearm of healthy volunteers and were removed 24 hours later-the right arm without applying heat and the left arm by applying a heat pack for 30 seconds before removal. Tape wear, self-reported pain (0-10 scale) and skin redness 15 minutes after removal were recorded. RESULTS This was a 53-subject comparative, single-blind clinical trial. There were clinically and statistically significant results supporting reduced pain during removal of ThermoTape with warming, with an average 58% decrease in pain, paired with a statistically significant 45% reduction in skin redness (p<0.01 for both values). In contrast, there were statistically insignificant differences in pain and redness for removal of Tegaderm and KRT with warming. ThermoTape after warming, in comparison with Tegaderm without warming, produced a reduced pain score of >1 on the 0-10 Wong-Baker/Face pain scale, which was statistically significant (p<0.01). CONCLUSION These results provide compelling evidence that warming ThermoTape prior to removal can reduce pain and injury when compared with standard medical tapes. This could allow for stronger attachment of wound care dressings and critical medical devices while reducing cases of MARSI.
Collapse
Affiliation(s)
- Shawn Swanson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Vivian Luu
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Ryan Smith
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Allayna Gross
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Joelle Tudor
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Devin MacKenzie
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
- Washington Clean Energy Testbeds, University of Washington, Seattle, WA, US
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, US
| | | | - Kenneth W Gow
- Seattle Children’s Hospital, Seattle, WA, US
- Department of Surgery, University of Washington, Seattle, WA, US
| | - Leonard Y Nelson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Eric J Seibel
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| |
Collapse
|
41
|
Hugill K, van Rens MFPT, Alderman A, Kaczmarek L, Lund C, Paradis A. Safe and effective removal of cyanoacrylate vascular access catheter securement adhesive in neonates. Front Pediatr 2023; 11:1237648. [PMID: 37691778 PMCID: PMC10492643 DOI: 10.3389/fped.2023.1237648] [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: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Neonatal vascular access continues to pose challenges. Recent times have seen considerable innovations in practice and the design and manufacture of materials used to provide infusion-based therapies with the intent of reducing the incidence and severity of vascular access-related complications. However, despite these efforts, vascular access-related complication rates remain high in this patient group and research evidence remains incomplete. In neonates, a medical-grade formulation of cyanoacrylate adhesive is widely used to secure percutaneously inserted central venous catheters and is beginning to establish a role in supporting the effective securement of other devices, such as umbilical and peripheral intravenous catheters. This Perspective article considers issues specific to the removal of cyanoacrylate used to secure vascular access devices from neonatal skin before its bonding releases due to natural skin exfoliation processes. The aim of this information is to ensure the safe and effective removal of octyl-cyanoacrylate adhesive-secured vascular access catheters from neonatal skin and stimulate professional discussion.
Collapse
Affiliation(s)
- Kevin Hugill
- Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Angela Alderman
- NICU, Carilion Children’s Hospital, Roanoke, VA, United State
| | | | - Carolyn Lund
- NICU, UCSF Benioff Children's Hospital, Oakland, CA, United State
- School of Nursing, University of California, San Francisco, CA, United State
| | - Amy Paradis
- NICU, CNS Doctors Medical Center, Modesto, CA, United State
| |
Collapse
|
42
|
Borgonovo F, Quici M, Gidaro A, Giustivi D, Cattaneo D, Gervasoni C, Calloni M, Martini E, La Cava L, Antinori S, Cogliati C, Gori A, Foschi A. Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review. Antibiotics (Basel) 2023; 12:1338. [PMID: 37627758 PMCID: PMC10451375 DOI: 10.3390/antibiotics12081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.
Collapse
Affiliation(s)
- Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Massimiliano Quici
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Antonio Gidaro
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Davide Giustivi
- Emergency Department and Vascular Access Team ASST Lodi, 26900 Lodi, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Calloni
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Elena Martini
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Leyla La Cava
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Chiara Cogliati
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| |
Collapse
|
43
|
Bahl A, Mielke N, Xing Y. Risk of midline catheter-related thrombosis due to catheter diameter: An observational cohort study. Thromb Res 2023; 228:172-180. [PMID: 37331120 DOI: 10.1016/j.thromres.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Deep vein thrombosis is a common and serious complication associated with midline catheters (MC). The aim of this investigation was to determine if catheter diameter is related to development of thrombosis. METHODS This was an observational cohort study conducted at a tertiary care academic center in Southeastern Michigan. Hospitalized adults that required a MC were eligible participants. Primary outcome was symptomatic MC associated upper extremity deep vein thrombosis (DVT) comparing three catheter diameters. Secondary outcomes included complications based on size and DVT comparing catheter to vein ratio. RESULTS Between January 1, 2017, and December 31, 2021, 3088 MCs met inclusion criteria; the distribution of 3 French (Fr), 4 Fr, and 5 Fr MCs was 35.1 %, 57.0 %, and 7.9 %, respectively. The majority of the population was female (61.2 %) and the average age was 64.2 years old. DVT occurred in 4.4 %, 3.9 %, and 11.9 % of 3 Fr, 4 Fr, and 5 Fr MCs, respectively (p < 0.001). In multivariable regression analysis, there was no difference in the odds of developing DVT for the 4 Fr MC compared to the 3 Fr (aOR 0.88; 95 % CI 0.59-1.31; p = 0.5243), however, there was significantly higher odds for the 5 Fr (aOR 2.72; 95 % CI 1.62-4.51; p = 0.001). Additionally, for every additional day the MC was in place, the odds of DVT increased by 3 % (aOR 1.03; 95 % CI 1.01-1.05; p = 0.0039). When comparing accuracy of the size model versus catheter to vein ratio model for predicting DVT, receiver operating characteristic curve analysis demonstrated the area under the curve for size was 73.70 % (95 % CI 68.04 %-79.36 %) compared to 73.01 % (95 % CI: 66.88 %-79.10 %) for catheter-to-vein ratio. CONCLUSIONS Smaller diameter catheters should be preferentially chosen to mitigate the risk of thrombosis when therapy via midline catheters is required. Choosing a catheter based on reduced size or 1:3 catheter to vein ratio threshold has similar accuracy in predicting DVT.
Collapse
Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States of America.
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, United States of America
| |
Collapse
|
44
|
de Souza LC, Campos JF, de Oliveira HC, de Azevedo Vianna C, de Bakker GB, Machado DM, Brandão MAG, da Silva RC. Effect of rapid cycle deliberate practice in peripheral intravenous catheters insertion training: A simulation experimental study. Nurse Educ Pract 2023; 71:103734. [PMID: 37544240 DOI: 10.1016/j.nepr.2023.103734] [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: 10/11/2022] [Revised: 03/06/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
AIM to compare the effect of rapid cycle deliberate practice simulation training with skill-training simulation on peripheral intravenous catheter insertion for Licensed Practical Nurses. BACKGROUND The use of peripheral intravenous catheters is associated with high rates of complications, although it is widely used in clinical practice. Training strategies to ensure good performance can minimize the risks inherent to this procedure. DESIGN A randomized simulation experimental pre-post interventional study. METHODS Sixty participants were allocated to intervention (n = 30) or control (n = 30) groups. Participants allocated to the intervention group were trained through the Rapid cycle deliberate practice simulation strategy, while participants in the control group were trained through the skill-training simulation strategy. A pre-test was applied before any intervention and a post-test after intervention. The primary outcome was the performance in the peripheral intravenous catheter insertion skill. The comparison of correct performance in the tests was analyzed intergroup and intragroup. The effect size of the interventions was also analyzed. The t-Student and Mann-Whitney tests compared the difference between the groups. The training effect was calculated by Cohen's dm and Glass's Δ measures. RESULTS Performance between the pre-post-test increased from 59.4% to 96% (p < 0.001) in the intervention group and from 57.8% to 93.5% in the control group (p < 0001). There was no statistical difference between the groups after intervention (p = 0225). Cohen's dm measurement was 2.95 and 3.59 in the control and intervention groups, respectively. CONCLUSIONS The rapid cycle deliberate practice simulation strategy resulted in Licensed Practical Nurses' performance improvements in peripheral intravenous catheter insertion, evidenced by the increase of correct performance actions in the post-test compared to the pre-test. However, with no statistical difference compared to the skill-training simulation strategy.
Collapse
Affiliation(s)
- Lucimar Casimiro de Souza
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil.; Hospital Samaritano Botafogo, Rua Assunção, 275, Botafogo, Zipcode: 22251-030 Rio de Janeiro, Brazil
| | - Juliana Faria Campos
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil..
| | - Hudson Carmo de Oliveira
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil
| | - Carla de Azevedo Vianna
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil.; Pró-Cardíaco Hospital, Rua General Polidoro 192, Botafogo, Zipcode: 22280-003, Rio de Janeiro, Brazil
| | - Gabriela Barcellos de Bakker
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil.; Americas Medical City Hospital, Rua Jorge Cury 550, Barra da Tijuca, Zipcode: 22775-00, Rio de Janeiro, Brazil
| | - Debora Mazioli Machado
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil.; Pró-Cardíaco Hospital, Rua General Polidoro 192, Botafogo, Zipcode: 22280-003, Rio de Janeiro, Brazil
| | - Marcos Antônio Gomes Brandão
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil
| | - Rafael Celestino da Silva
- Anna Nery School of Nursing, Federal University of Rio de Janeiro, Rua Afonso Cavalcanti, 275/ Cidade Nova, Zipcode: 20211-110, Rio de Janeiro, Brazil
| |
Collapse
|
45
|
Smith E, Irimia V. Evaluation of extended-length cannula inserted using ultrasound guidance in patients with difficult IV access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S14-S20. [PMID: 37495414 DOI: 10.12968/bjon.2023.32.14.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways.
Collapse
Affiliation(s)
- Emily Smith
- Vascular Access Lead Nurse, Aintree Hospital, Liverpool Hospitals NHS Foundation Trust
| | - Valentin Irimia
- Clinical Interventions Nurse Specialist, Clatterbridge Cancer Centre Liverpool, was an IV Access Clinical Nurse Specialist at Aintree Hospital at the time of the evaluation
| |
Collapse
|
46
|
Kim JW, Jarzembak J, Kim K. Bimanual Intravenous Needle Insertion Simulation Using Nonhomogeneous Haptic Device Integrated into Mixed Reality. SENSORS (BASEL, SWITZERLAND) 2023; 23:6697. [PMID: 37571480 PMCID: PMC10422502 DOI: 10.3390/s23156697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
In this study, we developed a new haptic-mixed reality intravenous (HMR-IV) needle insertion simulation system, providing a bimanual haptic interface integrated into a mixed reality system with programmable variabilities considering real clinical environments. The system was designed for nursing students or healthcare professionals to practice IV needle insertion into a virtual arm with unlimited attempts under various changing insertion conditions (e.g., skin: color, texture, stiffness, friction; vein: size, shape, location depth, stiffness, friction). To achieve accurate hand-eye coordination under dynamic mixed reality scenarios, two different haptic devices (Dexmo and Geomagic Touch) and a standalone mixed reality system (HoloLens 2) were integrated and synchronized through multistep calibration for different coordinate systems (real world, virtual world, mixed reality world, haptic interface world, HoloLens camera). In addition, force-profile-based haptic rendering proposed in this study was able to successfully mimic the real tactile feeling of IV needle insertion. Further, a global hand-tracking method, combining two depth sensors (HoloLens and Leap Motion), was developed to accurately track a haptic glove and simulate grasping a virtual hand with force feedback. We conducted an evaluation study with 20 participants (9 experts and 11 novices) to measure the usability of the HMR-IV simulation system with user performance under various insertion conditions. The quantitative results from our own metric and qualitative results from the NASA Task Load Index demonstrate the usability of our system.
Collapse
Affiliation(s)
- Jin Woo Kim
- Computer Science, Kent State University, 800 E Summit St, Kent, OH 44240, USA;
| | - Jeremy Jarzembak
- College of Nursing, Kent State University, 800 E Summit St, Kent, OH 44240, USA;
| | - Kwangtaek Kim
- Computer Science, Kent State University, 800 E Summit St, Kent, OH 44240, USA;
| |
Collapse
|
47
|
Hlasny J, Alberty R, Hlavac M, Grgac I, Grey MT, Venglarcik M. Comparison of ultrasound-guided and palpation-inserted peripheral venous cannula in -patients before primary hip or knee arthroplasty: study protocol for a randomized controlled trial. Trials 2023; 24:467. [PMID: 37480132 PMCID: PMC10362715 DOI: 10.1186/s13063-023-07459-x] [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: 04/03/2022] [Accepted: 06/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND More than 2 billion peripheral vascular cannulas are introduced globally each year. It is the most frequently performed invasive procedure in medicine worldwide. There is a group of patients with difficult intravenous access (DIVA). In experts' hands, ultrasound-guided vascular access appears to be a significantly better method. Investigators hypothesize that UGVA is superior also in short-term patency of cannula and even for blood draw through cannula. Repeated cannula pricks in the operating room setting not only puts a lot of stress on the patient and medical staff, but they also waste OR time. METHODS This investigator-initiated prospective randomized monocentric controlled trial is designed to randomly allocate 200 patients undergoing elective primary total joint arthroplasty of hip or knee to one of two groups as follows: Group C (control group) - peripheral venous cannula insertion by palpation or Group USG (intervention) - cannula insertion by ultrasound-guided vascular access. Our primary endpoint is to compare the number of attempts for ultrasound-guided insertion of the peripheral venous cannula with common palpation insertion of the peripheral venous cannula in overweight/obese patients (BMI ≥ 25). The secondary endpoint is a failure rate of the peripheral venous cannula to administer intravenous therapy up to 5 days postoperatively. Tertiary endpoints include a portion of long PVCs that are able to ensure blood draw up to 5 days postoperatively, time needed to insert PVC in each group, number of needle tip redirections in both groups, and reinsertion of PVC needed in both groups for any reason. DISCUSSION This study is pragmatic and is looking for clinically relevant data. After completion, it will answer the question of whether it is clinically relevant to use ultrasound-guided vascular access in the context of not only short-term benefit of insertion, but also up to 5 days after insertion. Also, if this method can ensure blood draw through a peripheral vein cannula, it can save resources in the perioperative period - valuable especially considering the ongoing shortage of medical staff worldwide. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of ultrasound-guided peripheral vascular access in the perioperative period. TRIAL REGISTRATION ClinicalTrials.gov NCT05156008. Registered on 13.12.2021.
Collapse
Affiliation(s)
- Jakub Hlasny
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia.
| | - Roman Alberty
- Department of Biology & Ecology, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia
| | - Marian Hlavac
- Orthopedic Department, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
| | - Ivan Grgac
- Institute of Anatomy, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Michael Teodor Grey
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
| | - Michal Venglarcik
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
| |
Collapse
|
48
|
van Rens MF, Vijlbrief D, Braun S, Hugill K, van Loon FH, van de Hoogen A. Peripheral intravenous therapy infiltration/extravasation (PIVIE) risks and the potential for earlier notification of events using a novel sensor technology in a neonatal population. J Vasc Access 2023:11297298231185536. [PMID: 37395292 DOI: 10.1177/11297298231185536] [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: 07/04/2023] Open
Abstract
BACKGROUND Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). OBJECTIVE The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. METHODS The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. RESULTS In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. CONCLUSIONS Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.
Collapse
Affiliation(s)
| | - Daniel Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Sophie Braun
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | | | - Fredericus Hj van Loon
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
- Clinical Health Science at Utrecht University (UU), Utrecht, The Netherlands
| |
Collapse
|
49
|
Dave J, Chand S, Gs R, Raj A, Sp P, Sivaprakasam M. Multispectral Imaging for Vein Localization and Contrast Enhancement. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083397 DOI: 10.1109/embc40787.2023.10341080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Intravenous (IV) catheterization is a common procedure. Still, there is a 26% chance of the first attempt catheterization failure due to the changing visibility of veins because of the patient's skin tone and body fat content. Ultrasound assistive devices help locate deeper veins but are not practical in emergencies, and transillumination assistive devices have a low field of view. Commercial near-infrared (NIR) imaging devices are effective in vein localization but are expensive and are not used in low-cost clinical settings. To overcome this, NIR Multispectral Imaging (MSI) was used to find the optimal wavelength that provides the enhanced visualization of veins for all skin types and Body Mass Index (BMI). The band with the highest vein-to-skin contrast ratio was selected and contrast enhancement was done using our proposed method. The primary blocks of the proposed method are Gamma correction, Contrast Limited Adaptive Histogram Equalization (CLAHE), Adaptive Thresholding, and image Fusion. The optimal spectral range was found to be 814-876 nm and our method increased the contrast by 0.41, 0.375, and 0.39 for fair, brown, and dark brown skin types, respectively, with different BMI.Clinical relevance- From the study, we can develop a potentially low-cost vein localization assistive device for training medical and nursing students and use it in emergencies for venous access to improve confidence in IV catheterization.
Collapse
|
50
|
Feinsmith SE, Amick AE, Feinglass JM, Sell J, Davis EM, Spencer TR, Koepke L, Pastoral J, Wayne DB, Barsuk JH. Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention. J Vasc Access 2023; 24:630-638. [PMID: 34524038 DOI: 10.1177/11297298211044363] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PROBLEM Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures. AIMS The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses. METHODS The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure. RESULTS A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan-Meier survival probabilities than PIVs (p < 0.001). CONCLUSIONS The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.
Collapse
Affiliation(s)
| | - Ashley E Amick
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jordan Sell
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Evan M Davis
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy R Spencer
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lydia Koepke
- Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Diane B Wayne
- Dr. John Sherman Appleman Professor of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Feinberg School of Medicine, Departments of Medicine and Medical Education, Northwestern University, Chicago, IL, USA
| |
Collapse
|