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Kim J, Keum H, Albadawi H, Zhang Z, Graf EH, Cevik E, Oklu R. Multi-Functional Biomaterial for the Treatment and Prevention of Central Line-Associated Bloodstream Infections. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2405805. [PMID: 39148150 DOI: 10.1002/adma.202405805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/01/2024] [Indexed: 08/17/2024]
Abstract
Central venous catheters are among the most used medical devices in hospitals today. Despite advances in modern medicine, catheter infections remain prevalent, causing significant morbidity and mortality worldwide. Here, SteriGel is reported, which is a multifunctional hydrogel engineered to prevent and treat central line-associated bloodstream infections (CLABSI). The mechanical properties of SteriGel are optimized to ensure appropriate gelation kinetics, bio-adhesiveness, stretchability, and recoverability to promote durability upon application and to provide persistent protection against infection. In vitro assays demonstrated that SteriGel exhibits long-term antimicrobial efficacy and has bactericidal effects against highly resistant patient-derived pathogens known to be frequently associated with CLABSI. SteriGel outperformed Biopatch, which is a clinically used device for CLABSI, in ex vivo cadaver studies that simulate clinical scenarios. Furthermore, SteriGel has biocompatible, pro-healing, and anti-inflammatory properties in vitro and in a rat subcutaneous injection model, suggesting a potential synergistic effect in the prevention and treatment of CLABSI. SteriGel is a multifunctional adherent biomaterial with potent antimicrobial effects for sustained sterility while promoting healing of the catheter incision site to protect against infection.
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Affiliation(s)
- Jinjoo Kim
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Hyeongseop Keum
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Hassan Albadawi
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Zefu Zhang
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Erin H Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Enes Cevik
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Rahmi Oklu
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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Wang R, Li Y, Xiang L, Chen KJ, Wang X, Mao LL, Wei WS, Wang XF, Chen YM, Wang ML, Liu MH, Yang YQ. Risk factors for skin injuries in cancer patients with peripherally inserted central catheter: A prospective multicenter cohort study. J Vasc Access 2024; 25:1261-1270. [PMID: 36895143 DOI: 10.1177/11297298231158670] [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: 03/11/2023] Open
Abstract
BACKGROUND The risk factors for skin injuries remain poorly understood in cancer patients with peripherally inserted central catheters (PICC). We herein aimed at exploring the effect of clinical factors on the risk of PICC-related skin injuries. METHODS We included 1245 cancer patients with PICC from 16 hospitals in Suzhou, China. The study outcome was in-hospital skin injuries, including contact dermatitis, skin (epidermal) stripping, tension injury, allergic dermatitis, skin tear, maceration, folliculitis, and pressure injury. RESULTS During hospitalization, 274 patients (22.0%) developed skin injuries after prolonged use of an indwelling catheter. Univariable logistic regression analysis identified several risk factors for PICC-related skin injuries; multivariable logistic regression analysis showed that the following factors independently and significantly (p < 0.05) associated with the risk of PICC-related skin injuries: body mass index (BMI, >25 kg/m2 versus <18.5 kg/m2: odds ratio (OR), 1.79; 95% confidence interval (CI), 1.03-3.11), skin condition (humid vs normal: OR, 2.96; 95% CI, 1.62-5.43), skin indentation (OR, 4.67; 95% CI, 3.31-6.58), allergic history (OR, 2.11; 95% CI, 1.21-3.66), history of dermatitis (OR, 3.05; 95% CI, 1.00-9.28), history of eczema (OR, 3.36; 95% CI, 1.20-9.43), catheter insertion site (under elbow vs. upper arm: OR, 3.32; 95% CI, 1.12-9.90), and PICC maintenance interval (4-5 days vs ⩽3 days: OR, 0.06; 95% CI, 0.01-0.50; 5-7 days vs ⩽3 days: OR, 0.07; 95% CI, 0.02-0.31; 7-9 days vs ⩽3 days: OR, 0.10; 95% CI, 0.02-0.57). CONCLUSIONS BMI, skin condition, skin indentation, allergic history, history of dermatitis, history of eczema, catheter insertion site, and PICC maintenance interval were independent risk factors for PICC-related skin injuries in cancer patients. This knowledge will guide future studies with formulating optimal treatment strategies for improving the skin health of cancer patients with PICC.
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Affiliation(s)
- Rong Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan Li
- Stomatology Hospital of Shandong University, Shandong, China
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Ling Xiang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke-Jian Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling-Ling Mao
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen-Shi Wei
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Xi-Feng Wang
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Ya-Mei Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Mei-Ling Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming-Hong Liu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Qun Yang
- The First Affiliated Hospital of Soochow University, Suzhou, China
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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Takashima M, Gibson V, Borello E, Galluzzo L, Gill FJ, Kinney S, Newall F, Ullman AJ. Pediatric invasive device utility and harm: a multi-site point prevalence survey. Pediatr Res 2024; 96:148-158. [PMID: 38200324 PMCID: PMC11257939 DOI: 10.1038/s41390-023-03014-1] [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: 08/22/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND AIMS Invasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals. METHODS In 2022-2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics. RESULTS Of the 285 patients audited, 78.2% had an invasive device (n = 412 devices), with a median of 1 device-per-patient (interquartile range 1-2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices (n = 223; 54.1%), followed by gastrointestinal devices (n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices). CONCLUSIONS The study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings. IMPACT A high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient. The most common devices used in pediatric healthcare are vascular access devices (n = 223; 54.1%), however, 16% (n = 36) of these devices failed, and one-third had complications. The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.
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Affiliation(s)
- Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia.
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Eloise Borello
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lily Galluzzo
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
| | - Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Sharon Kinney
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Newall
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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Gavin NC, Northfield S, Mihala G, Somerville M, Kleidon T, Marsh N, Larsen E, Campbell J, Rickard CM, Ullman AJ. Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study. Semin Oncol Nurs 2024; 40:151618. [PMID: 38622044 DOI: 10.1016/j.soncn.2024.151618] [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: 10/08/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. METHODS A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. RESULTS Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). CONCLUSION Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. IMPLICATIONS FOR PRACTICE This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.
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Affiliation(s)
- Nicole C Gavin
- Nurse Researcher, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston; Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Adjunct Associate Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Senior Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Senior Research Fellow, School of Medicine, University of Queensland, Herston; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Sarah Northfield
- Clinical Nurse Consultant, Specialist Palliative Care Service, Toowoomba Hospital, Queensland, Australia
| | - Gabor Mihala
- Biostatistician, School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Margarette Somerville
- Clinical Nurse Research, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia Kleidon
- Paediatrics and Neonatal Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Research Fellow, School of Nursing and Midwifery, Griffith University, Nathan; Nurse Practitioner, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- Acute/Critical Care Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Emily Larsen
- Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; School of Nursing and Midwifery, Griffith University, Nathan; Research Fellow, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jill Campbell
- Adjunct Senior Research Fellow, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire M Rickard
- Infection Prevention Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan; Professor, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus; and Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia
| | - Amanda J Ullman
- Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
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5
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Li JY, Li J, Fan YY, Lin XL, Huang CL, Qin HY. Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method. J Vasc Access 2024; 25:759-766. [PMID: 35674111 DOI: 10.1177/11297298221075166] [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
OBJECTIVE To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients. METHODS On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients. RESULTS Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall's harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients. CONCLUSION Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.
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Affiliation(s)
- Ji-Yue Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yu-Ying Fan
- Nasopharyngeal Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xi-Ling Lin
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chun-Li Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Ying Qin
- Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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6
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [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: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Herrera M, Eichenblat S, Campbell E, Shick J, Brown H, Brinkley C, Kester S, Layell J, Passaretti CL, Sampson MM. Beyond the surface: a color-inclusive guide to central line site assessment. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e41. [PMID: 38628376 PMCID: PMC11019580 DOI: 10.1017/ash.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Significant gaps exist in representation of diverse populations in central-line assessment education and tools. We review some of these gaps and provide some real-world guidance on how to assess central line sites in patients of all skin tones.
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Affiliation(s)
- Meredith Herrera
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | | | - Eileen Campbell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Julia Shick
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Heather Brown
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Chelsea Brinkley
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Shelley Kester
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Jessica Layell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Catherine L Passaretti
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mindy M Sampson
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
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Qi M, Qin Y, Meng S, Feng N, Meng Y. Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China. BMJ Open 2024; 14:e080816. [PMID: 38443083 PMCID: PMC11146366 DOI: 10.1136/bmjopen-2023-080816] [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: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This study aims to explore the incidence of, and risk factors for medical adhesive-related skin injury (MARSI) at peripherally inserted central venous catheter (PICC) sites in patients with cancer. DESIGN A prospective observational cohort study was conducted at a tertiary hospital in Shenzhen, China. SETTING This was a single-centre study conducted in a tertiary hospital in Shenzhen, China. PARTICIPANTS A total of 340 patients with cancer and PICC placement from January 2022 to June 2023 were selected using a convenience sampling method. METHODS Factors potentially associated with PICC-related MARSI (PICC-MARSI) were recorded, including patient demographics, and catheter placement and maintenance. Patients were divided into MARSI and non-MARSI groups. Univariate analysis was performed to screen for associated variables, and logistic regression analysis was used to identify independent risk factors for PICC-MARSI. RESULTS Of all 340 patients enrolled, 33 (9.7%) developed PICC-MARSI, including skin tear (8, 24.2%), tension injury (5, 15.2%), irritant contact dermatitis (10, 30.3%), allergic dermatitis (7, 21.2%) and maceration (3, 9.1%). Multivariable analysis showed that age (OR=1.058, p=0.001, 95% CI 1.023-1.094), wet skin (OR=4.873, p=0.003, 95% CI 1.728-13.742), dry skin (OR=6.247, p<0.0001, 95% CI 2.239-17.431), oedema (OR=3.302, p=0.008, 95% CI 1.365-7.985), allergy history (OR=6.044, p=0.001, 95% CI 2.040-17.906), dressing type (OR=3.827, p=0.003, 95% CI 1.595-9.185), body mass index (BMI) <18.5 (OR=4.271, p=0.015, 95% CI 1.327-13.742) and BMI 25-30 (OR=2.946, p=0.027, 95% CI 1.131-7.678) were independent risk factors for PICC-MARSI. CONCLUSIONS Proper catheter maintenance and appropriate dressing selection are crucial for the prevention of this condition.
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Affiliation(s)
- Mengying Qi
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yuju Qin
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Siya Meng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Nan Feng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yan Meng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
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9
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Lisova K, Pavelkova K, Matejckova T, Simkova P, Hloch O, Charvat J. The difficult PICC insertion is associated with the significant increase of complications in 1 month follow-up. J Vasc Access 2024:11297298241229868. [PMID: 38337144 DOI: 10.1177/11297298241229868] [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: 02/12/2024] Open
Abstract
BACKGROUND PICC is routinely inserted with assistance of ultrasonography and/or ECG navigation (RI- routine insertion). Only in a minority of patients the insertion of a PICC is difficult and fluoroscopic visualization with introduction of special guidewire is necessary for the success of the procedure (DI-difficult insertion). The aim of the study was to evaluate whether DI can be predicted and associated with a risk of complications during follow-up. METHODS The study included patients who had a PICC insertion in 2022. The number of patients with RI and DI was recorded and the significance of selected parameters during insertion and the frequency of complications during 1 month follow-up was compared. RESULTS About 1404 patients had successful PICC insertion in 2022, RI in 1360 (96.8%) and DI in 44 patients (3.2%). There was no significant effect of age, gender, selected vein, its size, insertion site, and tunneling on the course of PICC insertion. However the number of punctures for needle insertion was higher in DI. The complication rate during 1 month follow-up in DI was 9 (20.4%) versus 101 patients (7.4%) in RI (p = 0.002). CONCLUSION PICC insertion was successful in both RI and DI patients. Of the analyzed parameters, the number of needle punctures was associated with DI, and complications during the 1-month follow-up were more frequently noted in the DI group.
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Affiliation(s)
- Katerina Lisova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Katerina Pavelkova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Tereza Matejckova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Petra Simkova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Ondrej Hloch
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Jiri Charvat
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
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10
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Habihirwe P, Marini H, Wurtz B, Vermeulin T, Lottin M, Gehanno JF, Boulet L, Vergnes H, Edet S, Guet L, Le Roy F, Merle V. Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units. J Hosp Infect 2023; 142:1-8. [PMID: 37734680 DOI: 10.1016/j.jhin.2023.09.007] [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: 05/05/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. METHODS A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. RESULTS In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. CONCLUSIONS Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.
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Affiliation(s)
- P Habihirwe
- Department of Infection Control, CHU Rouen, Rouen, France
| | - H Marini
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | - B Wurtz
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; REIN Registry, Agence de Biomédecine, Paris, France
| | - T Vermeulin
- Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; Comprehensive Cancer Centre Henri Becquerel, UNICANCER, Rouen, France
| | - M Lottin
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | - J F Gehanno
- Department of Occupational Health, CHU Rouen, Rouen, France
| | - L Boulet
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France
| | | | - S Edet
- REIN Registry, Agence de Biomédecine, Paris, France; Department of Nephrology and Haemodialysis, CHU Rouen, Rouen, France; ANIDER Rouen Normandie, Rouen, France
| | - L Guet
- CPIAS Normandie, Rouen, France
| | - F Le Roy
- Department of Nephrology and Haemodialysis, CHU Rouen, Rouen, France
| | - V Merle
- Department of Infection Control, CHU Rouen, Rouen, France; Research Group Dynamiques et Evènements des Soins et des Parcours, CHU Rouen, Rouen, France; REIN Registry, Agence de Biomédecine, Paris, France.
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11
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McIntyre C, August D, Cobbald L, Lack G, Takashima M, Foxcroft K, Marsh N, Smith P, New K, Koorts P, Irwin A, Ullman A. Neonatal Vascular Access Practice and Complications: An Observational Study of 1,375 Catheter Days. J Perinat Neonatal Nurs 2023; 37:332-339. [PMID: 37878518 DOI: 10.1097/jpn.0000000000000589] [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] [Indexed: 11/26/2022]
Abstract
Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28% (n = 82), at an incidence rate of 62.5 per 1000 catheter days (95% confidence interval [CI] 49.7-75.9). Failure was most frequent in PIVCs (37%; n = 68), peripheral arterial catheters (33%; n = 2), and peripherally inserted central catheters (20%; n = 6). Infiltration and extravasation were the most frequent cause of PIVC failure (12%; n = 35). A birth weight less than 1500 g was associated with a significant decrease in PIVC failure (hazard ratio 0.58; 95% CI 0.34-0.99).
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Affiliation(s)
- Colette McIntyre
- Women's and Newborns Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia (Mss McIntyre, August, Cobbald, Lack, Foxcroft, and Smith and Mr Koorts); Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Mss August and Takashima and Dr Ullman); School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia (Ms August and Dr Ullman); UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia (Ms Foxcroft); Nursing and Midwifery Centre for Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia (Drs Marsh, New, and Ullman); School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia (Drs Marsh, New, and Ullman); Children's Health Queensland and the University of Queensland, Brisbane, Queensland, Australia (Drs Irwin and Ullman); and School of Nursing, Queensland University of Technology, Kelvin Grove, Australia (Dr Marsh)
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12
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Huang C, Wu Z, Huang W, Zhang X, Lin X, Luo J, Li L, Li J. Identifying the impact of the Zone Insertion Method TM (ZIM TM): A randomized controlled trial. J Vasc Access 2023; 24:729-738. [PMID: 34711086 DOI: 10.1177/11297298211052528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2011, Dawson proposed the Zone Insertion MethodTM (ZIMTM) to identify the optimal peripherally inserted central catheters (PICCs) insertion site in the upper arm. However, data on the effectiveness and safety of the ZIMTM in guiding PICC placement in Chinese population is limited. METHODS In this randomized controlled trial, 120 cancer patients were randomly assigned to the upper portion of the red zone (RZ), the green zone (GZ) and the lower portion of the yellow zone (YZ) groups (at a 1:1:1 ratio). The aim was to compare the degree of patient comfort and the incidence of major PICC complications among the three insertion zones based on the ZIMTM in a Chinese Cancer Center. (Clinical Trials. Gov number, ChiCTR1900024111). RESULTS A total of 118 catheters were inserted in 118 patients (2 patients were lost to follow-up). After the 1-month follow-up, patients randomly assigned to the YZ group had a higher degree of comfort with a lower score than those assigned to the other two zone groups: 30.21±3.16 in the YZ group versus 31.65±2.51 in the RZ group and 31.59±2.92 in the GZ group (P=.046). The incidence of thrombosis (10/40, 25%) and occlusion (4/40, 10%) in the RZ, which were significantly higher than those in the other two zone groups (χ2 =7.368, P=.02; χ2 =5.778, P =.03), whereas the risk in the GZ group was similar to that in the YZ group. The incidence of contact dermatitis in the GZ group was significantly higher than that of the other two zone groups (χ2=12.873, P=.001). CONCLUSIONS This study found that the lower portion of YZ seems to be another suitable PICC insertion site for a higher degree of comfort and a lower risk of occlusion and thrombosis, which broadens the choice of PICC insertion sites in the upper arm for clinical practice.
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Affiliation(s)
- Chunli Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhenming Wu
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Weihua Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xinghong Zhang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xiling Lin
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jielin Luo
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Lihua Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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13
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Corley A, Ullman AJ, Marsh N, Genzel J, Larsen EN, Young E, Booker C, Harris PNA, Rickard CM. A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure. Heart Lung 2023; 57:45-53. [PMID: 36041346 DOI: 10.1016/j.hrtlng.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. OBJECTIVES To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. METHODS In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. EXCLUSIONS laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. PRIMARY OUTCOME feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). SECONDARY OUTCOMES PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. RESULTS Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4-2.7) and 2.1 (95% CI 0.9-5.1) for Bundles 1 and 2, respectively. CONCLUSIONS A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Australia.
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Jodie Genzel
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Emily Young
- Centre for Applied Economics, School of Medicine, Griffith University, Nathan, 4111, Australia.
| | - Catriona Booker
- Workforce Development & Education Unit, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Patrick N A Harris
- Pathology Queensland, Health Support Queensland, Herston, 4006, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
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14
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Rabelo AL, Bordonal J, de Almeida TL, Oliveira PP, Moraes JT. Medical adhesive-related skin injury in adult intensive care unit: scoping review. Rev Bras Enferm 2022; 75:e20210926. [PMID: 36102472 PMCID: PMC9728873 DOI: 10.1590/0034-7167-2021-0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/22/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on preventing medical adhesive-related skin injuries in adult intensive care patients. METHODS this is a scoping review based on PRISMA-ScR recommendations and the technique proposed by Joanna Briggs Institute. PubMed, CINAHL, Web of Science, Scopus, LILACS, and Embase databases were searched using "Injuries AND Adhesives AND Skin AND Medical" descriptors". RESULTS 1,329 studies were identified, and after analysis, the final sample consisted of nine articles. We obtained two experts' consensus, three case studies, two cross-sectional studies, one prospective cohort study, and one literature review regarding the type of studies. FINAL CONSIDERATIONS the synthesized evidence allowed us to list health care measures to prevent medical adhesive-related skin injuries. The professional must know how to identify the skin injuries associated with medical adhesives and the main strategies for their prevention.
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Affiliation(s)
| | - Jéssica Bordonal
- Universidade Federal de São João Del Rei. Divinópolis, Minas Gerais, Brazil
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15
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Matlab AA, Al-Hussami MO, Alkaid Albqoor M. Knowledge and compliance to prevention of central line-associated blood stream infections among registered nurses in Jordan. J Infect Prev 2022; 23:133-141. [PMID: 37256157 PMCID: PMC10226055 DOI: 10.1177/17571774211066778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background Central line-associated bloods tream infections (CLABSIs) are among the most common healthcare-associated infections (HAIs). Aims To assess the rates of CLABSIs and to investigate predictors of knowledge and compliance of registered nurses to central venous catheters (CVCs) maintenance care bundle in intensive care units (ICUs). Methods A cross-sectional correlational design was used. A convenient sample of 114 registered nurses was selected from three hospitals in Jordan. Nurses' knowledge and compliance were measured by previously established measures and an observational checklist developed according to the Center for Disease Control and Prevention (CDC). Findings The rate of CLABSI was the lowest in the hospital that applies the CVC bundle of care. Nurses' knowledge about CLABSI prevention practices was significantly correlated with their compliance to CVCs maintenance care bundle. Nurses' knowledge differed bytheirage, income, experience in ICU, and nurse-to-patient ratio, and in multiple regressions, age was the single predictor of knowledge of CLABSI prevention. Significant differences were also found in nurses' compliance to the CVC care bundle according to the hospital and nurse-to-patient ratio. The nurse-to-patient ratio was the single significant predictor, and it attenuated the effect of age and income on nurse's compliance to the CVC care bundle. Conclusion This study indicated the need to expand the application of the CVC maintenance care bundle in hospitals. Programs that target promoting nurses' knowledge about CLABSI prevention and compliance to CVC care need to consider some factors, such as nurses' age and the circumstances of their work (nurse-to-patient ratio).
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Affiliation(s)
| | | | - Maha Alkaid Albqoor
- Department of Community Health, School of
Nursing, The University of Jordan, Jordan
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16
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Pearse I, Corley A, Larsen EN, Rickard CM, Ware RS, Campbell J, Coyer F, Alexandrou E, O'Brien C, Marsh N. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial. Trials 2022; 23:390. [PMID: 35549750 PMCID: PMC9097412 DOI: 10.1186/s13063-022-06322-9] [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: 11/18/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. METHODS This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) 'standard' (in accordance with local hospital policy) CVAD dressings (control) or (2) 'standard' dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is 'dressing failure' defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). DISCUSSION This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021.
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Affiliation(s)
- India Pearse
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia. .,Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Australia. .,School of Nursing and Midwifery, Griffith University, Brisbane, Australia. .,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Herston, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jill Campbell
- National Health and Medical Research Council Centre for Research Excellence, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Fiona Coyer
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia.,Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- AVATAR Group, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery and Centre for Applied Nursing Research, Western Sydney University, Penrith, Australia.,Department of Intensive Care, Liverpool Hospital, Liverpool, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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17
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Liu M, Zheng C, Guan X, Ke Z, Zou P, Yang Y. Development of central venous access device-associated skin impairment assessment instrument. Nurs Open 2022; 9:2095-2107. [PMID: 35502576 PMCID: PMC9190675 DOI: 10.1002/nop2.1220] [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: 06/30/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/12/2022] Open
Abstract
AIM To develop an assessment tool to assess the severity and healing of skin impairment with the central venous access device. DESIGN Delphi technique. METHODS The instrument domain list was developed through a systematic literature review and semi-structured interviews. Experts from China evaluated the relevance and significance of these items in assessing the degree of skin impairment surrounding central venous access device sites through two Delphi rounds. The APA Style JARS checklist for this article was used. RESULTS For the systematic literature review, 28 articles were included to develop the wound assessment instrument. From the articles and interview contents, 15 criteria were selected based on reporting frequency. After further screening via in-depth discussion, the central venous access devices associated with the skin impairment assessment tool were refined to include 14 major domains. Through a two-phase Delphi process, 71 items in 12 domains were ultimately retained.
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Affiliation(s)
- Min Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chonghao Zheng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiangyun Guan
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ziwei Ke
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, Canada
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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18
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Corley A, Marsh N, Ullman AJ, Rickard CM. Peripheral intravenous catheter securement: An integrative review of contemporary literature around medical adhesive tapes and supplementary securement products. J Clin Nurs 2022; 32:1841-1857. [PMID: 35118759 DOI: 10.1111/jocn.16237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
AIM To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure. DESIGN Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement. DATA SOURCES The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000-21 September 2020. REVIEW METHODS Studies enrolling hospitalised participants >16 years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists. RESULTS Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence. CONCLUSION Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications; multiproduct dressing and securement bundles were prevalent; and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
| | - Amanda J Ullman
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
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19
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Rabelo AL, Bordonal J, Almeida TLD, Oliveira PP, Moraes JT. Lesão de pele relacionada a adesivo médico em unidade de terapia intensiva adulto: scoping review. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0926pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: identificar e sintetizar evidências científicas sobre prevenção de lesões de pele relacionadas a adesivo médico nos pacientes adultos em terapia intensiva. Métodos: trata-se de uma scoping review desenvolvida com base nas recomendações do PRISMA-ScR e no método proposto por Joanna Briggs Institute. Realizaram-se buscas nas bases de dados PubMed, CINAHL, Web of Science, Scopus, LILACS e Embase, utilizando os descritores “Injuries AND Adhesives AND Skin AND Medical”. Resultados: identificaram-se 1.329 estudos; após análise, a amostra final foi composta por nove artigos. Quanto ao tipo de estudos, obtiveram-se dois consensos de especialistas, três estudos de caso, dois estudos transversais, um de coorte prospectivo e uma revisão de literatura. Considerações Finais: as evidências sintetizadas possibilitaram elencar cuidados para prevenção de lesões de pele relacionadas a adesivos médicos. É importante que o profissional saiba identificar tanto as lesões de pele relacionadas aos adesivos médicos quanto as principais estratégias para prevenção destas.
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Pediatric central venous access devices: practice, performance, and costs. Pediatr Res 2022; 92:1381-1390. [PMID: 35136199 PMCID: PMC9700519 DOI: 10.1038/s41390-022-01977-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthcare delivery is reliant on a functional central venous access device (CVAD), but the knowledge surrounding the burden of pediatric CVAD-associated harm is limited. METHODS A prospective cohort study at a tertiary-referral pediatric hospital in Australia. Children <18 years undergoing insertion of a CVAD were screened from the operating theatre and intensive care unit records, then assessed bi-weekly for up to 3 months. Outcomes were CVAD failure and complications, and associated healthcare costs (cost of complications). RESULTS 163 patients with 200 CVADs were recruited and followed for 6993 catheter days, with peripherally inserted central catheters most common (n = 119; 60%). CVAD failure occurred in 20% of devices (n = 30; 95% CI: 15-26), at an incidence rate (IR) of 5.72 per 1000 catheter days (95% CI: 4.09-7.78). CVAD complications were evident in 43% of all CVADs (n = 86; 95% CI: 36-50), at a rate of 12.29 per 1000 catheter days (95% CI: 9.84-15.16). CVAD failure costs were A$826 per episode, and A$165,372 per 1000 CVADs. Comparisons between current and recommended practice revealed inconsistent use of ultrasound guidance for insertion, sub-optimal tip-positioning, and appropriate device selection. CONCLUSIONS CVAD complications and failures represent substantial burdens to children and healthcare. Future efforts need to focus on the inconsistent use of best practices. IMPACT Current surveillance of central venous access device (CVAD) performance is likely under-estimating actual burden on pediatric patients and the healthcare system. CVAD failure due to complication was evident in 20% of CVADs. Costs associated with CVAD complications average at $2327 (AUD, 2020) per episode. Further investment in key diverse practice areas, including new CVAD types, CVAD pathology-based occlusion and dislodgment strategies, the appropriate use of device types, and tip-positioning technologies, will likely lead to extensive benefit.
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Polyhexamethylene biguanide discs versus unmedicated dressings for prevention of central venous catheter-associated infection in the intensive care unit: A pilot randomised controlled trial to assess protocol safety and feasibility. Aust Crit Care 2021; 35:512-519. [PMID: 34321181 DOI: 10.1016/j.aucc.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Central venous catheters are prone to infectious complications, affecting morbidity, mortality and healthcare costs. Polyhexamethylene biguanide-impregnated discs at the catheter insertion site may prevent local and bloodstream infection; however, efficacy has not been established in a critical care setting. OBJECTIVE The objective of this study was to pilot test polyhexamethylene biguanide-impregnated discs compared to standard unmedicated dressings for central venous catheter infection prevention in critically ill patients. METHODS This was a single-centre pilot randomised controlled trial. Adults admitted to intensive care requiring a central venous catheter for >72 h were eligible. Patients with a current bloodstream infection, concurrent central venous catheter, chlorhexidine or polyhexamethylene biguanide allergy, or sensitive skin were excluded. Patients were randomised to receive standard central venous catheter dressings with/without polyhexamethylene biguanide discs. OUTCOME MEASURES The primary outcome was feasibility, defined by patient eligibility, recruitment, retention, protocol adherence, missing data, and staff satisfaction. Secondary outcomes included: central line-associated infection; primary bloodstream infection; local infection; skin complications; device/dressing dwell time; serious adverse events, and cost-effectiveness. RESULTS Of 309 patients screened, 80 participants were recruited with 98% (n = 78) receiving an internal jugular catheter which dwelled for a median of 5 days (interquartile range = 4.0, 6.0). Feasibility criteria were predominantly met (recruitment 88%; retention 100%; protocol fidelity 91%); however, eligibility criteria were not met (32%; most commonly owing to short predicted catheter dwell). Staff acceptability criteria were met, with 83% of staff scoring dressing application and removal ≥7 on a numerical rating scale. There were no central line-associated bloodstream infections and no local infections. Insertion site itch occurred in 4% (control [n = 0], intervention [n = 3]) of participants, while 32% (24/76) reported pain, and 46% (35/76) tenderness. CONCLUSIONS Polyhexamethylene biguanide discs appear safe for central venous catheter infection prevention. Feasibility of a large efficacy trial was established with some modifications to screening processes. Large, adequately powered randomised controlled trials are needed to test the infection prevention hypotheses.
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Alcântara CMP, Oliveira ELDS, Campanili TCGF, Santos RSDCS, Santos VLCDG, Nogueira PC. Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units. Rev Esc Enferm USP 2021; 55:e03698. [PMID: 34037199 DOI: 10.1590/s1980-220x2019035503698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 10/20/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify and analyze the point prevalence of medical adhesive-related skin injury in patients hospitalized in cardiac Intensive Care Units and demographic and clinical factors associated to their occurrence. METHOD Cross-sectional study conducted in Intensive Care Units of two public hospitals, reference centers for cardiology, located in São Paulo city, with 123 patients. Demographic and clinical data from patients' medical records were collected and lesions were identified through skin inspection. The data were analyzed through descriptive statistics and bivariate and multivariate analysis (Classification and Regression Tree). RESULTS Medical adhesive-related skin injury was presented by 28 patients, which amounts to a 22.7% prevalence. Its main causative agent was transparent polyurethane film (46.9%) and the cervical region was the most affected area (25.1%). From the multivariate analysis, the associated factors were found to be the presence of serum urea higher than or equal to 48.5 mg/dL and platelets lower than 193,500 mm3 or platelets higher than or equal to 193,500 mm3 and systolic blood pressure higher than or equal to 122 mmHg. CONCLUSION This study has contributed to knowledge related to the epidemiology of this type of injury, favoring preventive care planning.
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Affiliation(s)
| | - Evellyn Lima da Silva Oliveira
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, São Paulo, SP, Brazil
| | | | | | | | - Paula Cristina Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil
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Wang Y, Li J, Wang Y, Wang L, Xiang Y, Huang M, Wang D, He L. The influential factors and intervention strategies that engage malignant cancer patients in health-promoting behaviors during PICC line maintenance. Am J Transl Res 2021; 13:5208-5215. [PMID: 34150110 PMCID: PMC8205709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze the influential factors and intervention strategies involved in engaging health-promoting behaviors (EHPD) during peripheral central venous catheter (PICC) line maintenance in malignant tumor patients. METHODS 120 patients with malignant tumors who underwent PICC line maintenance in our hospital were prospectively analyzed. They were divided into a low and moderate level group (HPLP-II score ≤137) and a high level group (HPLP-II score >137) according to their Health Promoting Lifestyle Profile II (HPLP-II) questionnaire scores. Single-factor and multifactor analyses were performed to identify the factors influencing the patients' engagement in self-health-promoting behaviors. The one hundred and twenty patients with malignant tumors were randomly divided into two groups (n=60 in each group). The control group and the intervention group underwent routine nursing care and patient education. The two groups were compared in terms of the changes in their HPLP-II scores, their Cancer Patients PICC Self-management Scale (CPPSM) scores, their SAS and their SDS scores before and after the intervention, as well as their maintenance compliance rates, their complication rates during catheter placement, and their lack of PICC maintenance. RESULTS Literacy, place of residence, duration of catheter use, self-management abilities of PICCs, social support, and anxiety were risk factors (OR>1, P<0.05). Compared with their pre-intervention scores, the HPLP-II and CPPSM scores were increased in both groups (P<0.05), and the SAS and SDS scores were decreased in both groups after the intervention (P<0.05), and the intervention group had higher scores than the control group (P<0.05). The intervention group exhibited a higher maintenance compliance rate than the control group (P<0.05). The incidence of complications and the lack of PICC maintenance in the intervention group were lower than they were in the control group (P<0.05). CONCLUSION The influential factors during PICC maintenance for EHPD in malignant cancer patients include literacy, place of residence, duration of PICC use, etc. Patient education can promote patients' EHPD and self-management abilities, relieve their anxiety and depression, reduce their complications, and improve their compliance.
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Affiliation(s)
- Yanling Wang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Jun Li
- Endoscopic Center, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Yanyan Wang
- Department of Medical Records Management Division, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Lina Wang
- Department of General Surgery, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Ying Xiang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Meizhu Huang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Danxin Wang
- Department of Nursing, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
| | - Li He
- Department of Breast and Thoracic Tumors Surgery, The First Affiliated Hospital of Hainan Medical UniversityHaikou 570100, Hainan Province, China
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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Comparison of PICC and TIVAP in chemotherapy for patients with thyroid cancer. Oncol Lett 2020; 20:1657-1662. [PMID: 32724407 PMCID: PMC7377162 DOI: 10.3892/ol.2020.11732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Peripherally inserted central catheters (PICC) and totally implantable venous-access ports (TIVAP) were compared in chemotherapy for patients with thyroid cancer. A retrospective analysis was performed on the clinical data of patients with thyroid cancer who were treated with PICC and TIVAP for chemotherapy in Qingdao Municipal Hospital from January 2013 to March 2018. Patients in the PICC and TIVAP groups were compared in terms of the success rate, indwelling time, complications, quality of life and nursing satisfaction. There was no statistically significant difference in the success rate between the two groups (P>0.05). The indwelling time in the TIVAP group was significantly longer than that in the PICC group (P<0.05). The incidence rate of complications in the TIVAP group (0%) was significantly lower than that in the PICC group (14.58%) (P<0.05). The quality of life score in the PICC group was significantly lower than that in the TIVAP group (P<0.05). There was no statistically significant difference in the nursing satisfaction score between the two groups (P>0.05). In conclusion, as an ideal venous access to chemotherapy for thyroid cancer, TIVAP has longer indwelling time and fewer adverse reactions and improves the quality of life of the patients.
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Barton A. Medical adhesive-related skin injuries associated with vascular access: minimising risk with Appeel Sterile. ACTA ACUST UNITED AC 2020; 29:S20-S27. [DOI: 10.12968/bjon.2020.29.8.s20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.
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Affiliation(s)
- Andrew Barton
- Advanced Nurse Practitioner IV Therapy and Vascular Access, IVAS Lead Nurse, Frimley Health NHS Foundation Trust; Chair, National Infusion and Vascular Access Society (NIVAS)
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Innovation in Central Venous Access Device Security: A Pilot Randomized Controlled Trial in Pediatric Critical Care. Pediatr Crit Care Med 2019; 20:e480-e488. [PMID: 31274778 DOI: 10.1097/pcc.0000000000002059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Central venous access devices enable many treatments during critical illness; however, 25% of pediatric central venous access devices fail before completion of treatment due to infection, thrombosis, dislodgement, and occlusion. This is frequently attributed to inadequate securement and dressing of the device; however, high-quality research evaluating pediatric central venous access device securement innovation to prevent central venous access device failure is scarce. This study aimed to establish the feasibility of a definitive randomized control trial examining the effectiveness of current and new technologies to secure central venous access devices in pediatrics. DESIGN Single-center, parallel group, superiority, pilot randomized control trial. SETTING Anesthetic and intensive care departments of a tertiary pediatric hospital SUBJECTS:: One-hundred eighty pediatric patients with nontunneled central venous access device INTERVENTIONS:: Participants were randomized to receive central venous access device securement via standard care (bordered polyurethane dressing, with prolene sutures, chlorhexidine gluconate disc), tissue adhesive (Histoacryl, B Braun, Melsungen, Germany) in addition to standard care; or integrated dressing securement (SorbaView SHIELD [Centurion Medical Products, Franklin, MA], with prolene sutures and chlorhexidine gluconate disc). OUTCOMES Primary: Feasibility (including effect size estimates, acceptability); central venous access device failure; central venous access device complications; secondary: individual central venous access device complications, skin damage, dressing performance, and product cost. MEASUREMENTS AND MAIN RESULTS Feasibility criteria were achieved as recruitment occurred with acceptable eligibility, recruitment, missing data, and attrition rates, as well as good protocol adherence. Family members and staff-reported comparable levels of acceptability between study arms; however, tissue adhesive was reported as the most difficult to apply. Overall, 6% of central venous access devices failed, including 6% (3/54; incident rate, 13.2 per 1,000 catheter days) standard care, 2% (1/56; incident rate, 3.65 per 1,000 catheter days) integrated, and 8% (5/59; 25.0 per 1,000 catheter days) tissue adhesive. CONCLUSIONS It is feasible to conduct an efficacy randomized control trial of the studied interventions. Further research is required to definitively identify clinical, cost-effective methods to prevent central venous access device failure by examining new dressing and securement technologies and techniques.
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Ullman AJ, Kleidon TM, Turner K, Gibson V, Dean A, Cattanach P, Pitt C, Woosley J, Marsh N, Gavin N, Takashima M, Rickard CM. Skin Complications Associated With Pediatric Central Venous Access Devices: Prevalence, Incidence, and Risk. J Pediatr Oncol Nurs 2019; 36:343-351. [PMID: 31104548 DOI: 10.1177/1043454219849572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Central venous access devices (CVADs) are vital to enable treatment for children with cancer and other complex health conditions. However, complications effecting the CVAD wound are commonly reported. This study aimed to identify the incidence and prevalence of CVAD-associated skin complications current management, and characteristics associated with complication development, in pediatrics. A prospective observational study performed across medical, oncology, and hematology departments at a tertiary pediatric hospital in Australia, between April and July 2017. Children admitted with CVADs were assessed twice weekly for CVAD-associated skin complications and associated signs and symptoms. The data were analyzed using descriptive statistics (i.e., proportions, frequency) and time-to-event multivariable regression (i.e., hazard ratios [HRs]). Two hundred and seventy-one CVADs were reviewed over 43,787 catheter days, with over one eighth of participants (14%; n = 37) having a CVAD-associated skin complication during their admission (0.95 per 1,000 catheter days, 95% confidence interval [CI; 0.61, 1.17]), most commonly contact dermatitis (11%; n = 29; 0.72 per 1,000 catheter days 95% CI [0.50, 1.04]). Within biweekly checks the median point prevalence of complications varied between 0.4% and 11% and clinical management was wide-ranging. A primary diagnosis of oncology (HR 2.89, 95% CI [1.10, 7.62]) or medical/surgical (HR 2.55, 95% CI [1.04, 6.22]) conditions; plain, nonbordered polyurethane dressings (HR 4.92, 95% CI [2.00, 12.13]); and poor dressing integrity (HR 2.64, 95% CI [1.18, 5.92]) were significantly associated with contact dermatitis. In conclusion, substantial numbers of pediatric patients experience CVAD-associated skin complications, and innovations are necessary to identify, prevent, and treat these health care-associated injuries.
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Affiliation(s)
- Amanda J Ullman
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,2 Griffith University, Nathan, Queensland, Australia.,3 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Karen Turner
- 4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Victoria Gibson
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anna Dean
- 4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Paula Cattanach
- 4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Colleen Pitt
- 4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Julieta Woosley
- 4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,2 Griffith University, Nathan, Queensland, Australia.,3 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicole Gavin
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,3 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mari Takashima
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Claire M Rickard
- 1 Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, Queensland, Australia.,2 Griffith University, Nathan, Queensland, Australia.,3 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,4 Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Ullman AJ, Mihala G, O'Leary K, Marsh N, Woods C, Bugden S, Scott M, Rickard CM. Skin complications associated with vascular access devices: A secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2018; 91:6-13. [PMID: 30658228 DOI: 10.1016/j.ijnurstu.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. OBJECTIVES To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. DESIGN Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. SETTINGS Six hospitals (metropolitan and regional) in Queensland, Australia. PARTICIPANTS The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. ANALYSIS Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. RESULTS Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1-50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5-306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296; 2.9%), and dermatitis for central devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. CONCLUSIONS Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Kate O'Leary
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Christine Woods
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Simon Bugden
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Mark Scott
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia
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Ullman A, Marsh N, Rickard C. Securement for vascular access devices: looking to the future. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S24-S26. [PMID: 28453328 DOI: 10.12968/bjon.2017.26.8.s24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda Ullman
- Senior Lecturer, School of Nursing and Midwifery, Griffith University, Alliance for Vascular Access Teaching and Research
| | - Nicole Marsh
- Nurse Researcher and PhD Candidate, Royal Brisbane and Women's Hospital, Alliance for Vascular Access Teaching and Research Group, Griffith University
| | - Claire Rickard
- Professor of Nursing, School of Nursing and Midwifery, Griffith University, Alliance for Vascular Access Teaching and Research, Australia
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