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Thushara NL, Singh P, Priyadarshi M, Chaurasia S, Bhat NK, Basu S. Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial. Indian J Pediatr 2024; 91:794-800. [PMID: 37578610 DOI: 10.1007/s12098-023-04756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. METHODS The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC. Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. RESULTS Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. CONCLUSIONS Splint application did not affect functional PIVC duration and its related complications in neonates.
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Affiliation(s)
- Nadella Lakshmi Thushara
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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van Rens MFPT, Spencer TR, Hugill K, Francia ALV, van Loon FHJ, Bayoumi MAA. Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population. J Vasc Access 2024; 25:1229-1237. [PMID: 36794683 PMCID: PMC11308324 DOI: 10.1177/11297298231154629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods. METHODS A retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar. A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG). In the historical cohort, the catheter was secured using a semi-permeable transparent membrane dressing while in the CG cohort, CG was applied at the insertion site on initial insertion and after any dressing change. This was the only variable intervention between both groups. RESULTS A total of 8330 peripheral catheters were inserted. All catheters were inserted and monitored by members of the NeoVAT team. 4457 (53.5%) were secured with just a semi-permeable transparent dressing and 3873 (46.5%) secured a semi-permeable transparent dressing with the addition of CG. The odds ratio for premature failure after securement with CG was 0.59 (0.54-0.65) when compared to the catheters secured with a semi-permeable transparent dressing, which was statistically significant (p < 0.001). The correlation between the occurrence of a complication and the use of CG for device securement was significant (p < 0.001). CONCLUSIONS The risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study's findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.
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Affiliation(s)
| | | | - Kevin Hugill
- Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | - Airene LV Francia
- Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus HJ van Loon
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Mohammad AA Bayoumi
- Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Hinterstein S, Ehrhardt H, Zimmer KP, Windhorst AC, Kappesser J, Hermann C, Schuler R, Waitz M. Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial. Neonatology 2024:1-9. [PMID: 38754396 DOI: 10.1159/000538880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. METHODS Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. RESULTS A total of 559 procedures were analyzed. The success rate at resident's first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists' overall success rate and time to successful cannulation did not differ significantly in both weight strata. CONCLUSION Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.
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Affiliation(s)
- Samantha Hinterstein
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | | | - Judith Kappesser
- Department of Psychology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Christiane Hermann
- Department of Psychology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Rahel Schuler
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Markus Waitz
- Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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Kluckow E, Perera S, Clifford I, Wilks D, Cooper MS. Increased risk of complications in lower versus upper limb peripheral intravenous cannulation in children with severe neurological impairment. Child Care Health Dev 2024; 50:e13250. [PMID: 38529773 DOI: 10.1111/cch.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obtaining peripheral intravenous catheter (PIVC) access in children with severe neurological impairment (SNI) is often challenging and commonly associated with complications, including dislodgement, phlebitis and extravasation. In severe cases, extravasation injury may lead to tissue necrosis, ulceration and long-term morbidity. The aim of this study was to determine the relative incidence of PIVC complications secondary to lower limb cannulation, compared to upper limb, in children with SNI. METHODS A single centre, retrospective, observational review was conducted. Patients with SNI, admitted at a tertiary paediatric centre over 6 months between July and December 2022, were included. RESULTS One-hundred fifty-five PIVC procedures were conducted in 110 children over the study period. Complications were more common in lower limb PIVCs (12/16, 75%) compared to upper limb (58/139, 42%), p = 0.01. CONCLUSION Upper limb cannulation is preferred in children with SNI.
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Affiliation(s)
- Eliza Kluckow
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sajini Perera
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Isaac Clifford
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Daniel Wilks
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
- Facial Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Monica S Cooper
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Özalp Gerçeker G, Yıldırım BG, Önal A, Ören H, Olgun HN, Bektaş M. The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study. Eur J Oncol Nurs 2023; 67:102430. [PMID: 37879193 DOI: 10.1016/j.ejon.2023.102430] [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: 07/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications. METHOD This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed. RESULTS The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication. CONCLUSIONS The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population. CLINICALTRIALS GOV IDENTIFIER NCT05769452.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Büşra Güliz Yıldırım
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Ayşe Önal
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hatice Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
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van Rens MF, Hugill K, Mahmah MA, Francia AL, van Loon FH. Effect of peripheral intravenous catheter type and material on therapy failure in a neonatal population. J Vasc Access 2023; 24:1284-1292. [PMID: 35196909 DOI: 10.1177/11297298221080071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In neonatal settings vascular access devices are essential for treatment. However, their use is not without risks. The design and materials of peripheral vascular access devices have been evaluated amongst adult populations, but contemporary studies in neonatal settings are scant. PURPOSE/OUTCOME MEASURES This research describes the prevalence of peripheral intravenous catheter failure related to three different catheter types with the intent to identify modifiable risks that might be used to evaluate device efficacy, innovate neonatal practice, and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. PARTICIPANTS Neonates who were admitted to the unit requiring intravenous treatment wherefore peripheral intravenous cannulation was indicated, were included in this study. RESULTS The use of different type of catheters resulted in significantly less therapy failures as phlebitis and increased dwell time, compared with the control groups. This remains significant after adjusting for age at insertion, gestational age, birth weight, and catheter type. CONCLUSIONS The study's findings are in accord with international literature concerning adult and pediatric patients concerning the superiority of PUR over PTFE catheters with respect to the risk of phlebitis and longer dwell times. However, the risk of failure of therapy did not differ between catheters. This finding is reassuring and supports practitioner judgment when selecting peripheral catheter devices.
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Affiliation(s)
- Matheus Fpt van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamad Adnan Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus Hj van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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van Rens MF, Vijlbrief D, Braun S, Hugill K, van Loon FH, van de Hoogen A. Peripheral intravenous therapy infiltration/extravasation (PIVIE) risks and the potential for earlier notification of events using a novel sensor technology in a neonatal population. J Vasc Access 2023:11297298231185536. [PMID: 37395292 DOI: 10.1177/11297298231185536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). OBJECTIVE The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. METHODS The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. RESULTS In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. CONCLUSIONS Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.
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Affiliation(s)
| | - Daniel Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Sophie Braun
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | | | - Fredericus Hj van Loon
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
- Clinical Health Science at Utrecht University (UU), Utrecht, The Netherlands
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Peng Y, Zhou Y. Analysis of influencing factors on the duration of pediatric peripheral intravenous catheter. J Vasc Access 2023; 24:646-652. [PMID: 34538157 DOI: 10.1177/11297298211044024] [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: 11/17/2022] Open
Abstract
BACKGROUND The application of peripheral intravenous catheter has been an effective guarantee for the success of pediatric therapy. We aimed to investigate the correlative factors that impacting the duration of pediatric peripheral intravenous catheter. METHODS From January 2017 to October 2017, 370 cases of pediatric patients in the First Hospital of Hunan University of Chinese Medicine were collected as the research object. Based on the indwelling time, the collected cases were divided into two groups, namely long time group (>72 h) and short time group (<72 h). The general data and laboratory test results of two groups were collected, and the correlation factors of indwelling time were analyzed by single factor and Logistic multiple factors. RESULTS As the results revealed that compared with short time group, patients in long time group had statistically significant differences in puncture site, phlebitis, extravasation of blood vessels, hemoglobin, white blood cells, platelets, and 75% ethanol sterilization (p < 0.05). Logistic multivariate analysis indicated that scalp puncture was the independent protective factors that affecting the duration of pediatric peripheral intravenous catheter. Moreover, phlebitis represented the independent risk factor that influencing the indwelling time of pediatric peripheral intravenous catheter. And the differences were statistically significant (p < 0.05). CONCLUSIONS Analyze factors influencing indwelling time of pediatric peripheral intravenous catheter and enhance the management of relevant factors are of great significance to prolong the indwelling time, reduce the pain of pediatric patients, and facilitate the clinical medication.
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Affiliation(s)
- Yanxian Peng
- The First Hospital of Hunan University of Chinese Medicine, The Domestic First-class Discipline Construction Project of Chinese Medicine of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yawei Zhou
- The First Hospital of Hunan University of Chinese Medicine, The Domestic First-class Discipline Construction Project of Chinese Medicine of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Baye ND, Teshome AA, Ayenew AA, Amare TJ, Mulu AT, Abebe EC, Tiruneh GA, Ayele TM, Muche ZT, Teklemariam AB, Melese BD, Agidew MM, Seid MA. Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study. BMC Nurs 2023; 22:11. [PMID: 36631864 PMCID: PMC9832806 DOI: 10.1186/s12912-022-01164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Peripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia. METHODS AND SETTING An institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed. RESULTS The incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63-6.27), admission unit (AHR = 1.88, 95%CI: 1.07-4.02), sickness (AHR = 0.24, 95% CI: 1.31-4.66), medication type (AHR = 2.04, 95%CI: 1.13-3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02-0.99), clinical experience (AHR = 0.52, CI:0.26-0.84), and flushing (AHR = 0.71, 95%CI: 0.34-0.98) were potential predictors of PIVC complication. CONCLUSION Knowing the predictor factors helps clinicians to provide effective care and to detect complications early.
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Affiliation(s)
- Nega Dagnew Baye
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atalo Agimas Ayenew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadeg Jemere Amare
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anmut Tilahun Mulu
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Ayalew Tiruneh
- grid.510430.3Department of Clinical Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklie Mengie Ayele
- grid.510430.3Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zelalem Tilahun Muche
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Awgichew Behaile Teklemariam
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melese
- grid.510430.3Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Mekonnen Agidew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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van Rens MFPT, Bayoumi MAA, van de Hoogen A, Francia ALV, Cabanillas IJ, van Loon FHJ, Spencer TR. The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes. Front Pediatr 2022; 10:980725. [PMID: 36405839 PMCID: PMC9670536 DOI: 10.3389/fped.2022.980725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. Methods This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. Results The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50-0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82-0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24-1.27) had a significant relationship with outcomes. Conclusions Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.
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Affiliation(s)
- Matheus F. P. T. van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A. A. Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre of Utrecht, Utrecht, Netherlands
| | - Airene L. V. Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Irian J. Cabanillas
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H. J. van Loon
- Department of Science and Technology in Perioperative Nursing, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Timothy R. Spencer
- Nursing Department, Global Vascular Access, LLC, Scottsdale, AZ, United States
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11
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Giardina M, Barillà D, Crimi C, Arone A, Benedetto F, Lucanto C, Natoli R, Messina R, David A, Noto A. Ultrasound-guided placement of long peripheral cannula in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:2060-2066. [PMID: 35574730 PMCID: PMC9545099 DOI: 10.1002/ppul.25978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The natural history of cystic fibrosis (CF) lung disease is a chronic deterioration of lung function with intermittent episodes of pulmonary infectious exacerbations (PExs). Reliable venous access is a milestone of effective management of such exacerbations, managed both in hospital and outpatient chronic therapy. The aim of our study was to analyze the feasibility of ultrasound-guided positioning of long peripheral catheters (LPC) as reliable midterm venous access in children affected by CF. METHODS In this single-center prospective study, over a 60-month period, we included paediatric CF subjects admitted with PExs and undergoing intravenous antibiotic treatment. LPCs were inserted in all participants by paediatric anaesthesiologists with ultrasound guide technique. Prospective data were collected assessing catheter positioning procedure and complications. RESULTS A total of 122 LPC insertions were performed in 55 CF children. Participants had a median age of 6.75 years (interquatile range: 3.7-13.5) at the time of catheter insertion. Implantation was successful on the first attempt in 86% of cases; 2 (1%) major insertion-related complications were reported. Eighty-eight percent of catheters were electively removed at the end of antibiotic therapy without any complication. Seven percent of the catheters were removed electively for occlusion and 2% for local dislodgment. CONCLUSIONS The results of the present study suggest that ultrasound-guided positioning of LPCs are safe alternative means of peripheral venous access in children with chronic diseases such as CF.
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Affiliation(s)
- Massimiliano Giardina
- Division of Anesthesia and Critical CareA. O. U. Policlinico "G. Martino”MessinaItaly
| | - David Barillà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. MartinoUniversity of MessinaMessinaItaly
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico‐San Marco”University HospitalCataniaItaly
| | - Amelia Arone
- IRCCS Policlinico San DonatoSan Donato MilaneseItaly
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. MartinoUniversity of MessinaMessinaItaly
| | - Cristina Lucanto
- Regional Centre for Cystic FibrosisA. O. U. Policlinico G.MartinoMessinaItaly
| | - Rossella Natoli
- School of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
| | - Roberto Messina
- Division of Anesthesia and Critical CareA. O. U. Policlinico "G. Martino”MessinaItaly
| | - Antonio David
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Division of Anesthesia and Critical CareUniversity of MessinaMessinaItaly
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Division of Anesthesia and Critical CareUniversity of MessinaMessinaItaly
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12
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Fatores de risco para extravasamento em cateteres periféricos em crianças com câncer. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao005996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Harris DL, Schlegel M, Markovitz A, Woods L, Miles T. Securing peripheral intravenous catheters in babies without applying adhesive dressings to the skin: a proof-of-concept study. BMC Pediatr 2022; 22:291. [PMID: 35585521 PMCID: PMC9116013 DOI: 10.1186/s12887-022-03345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Most babies admitted to a Neonatal Intensive Care Unit (NICU) require a peripheral intravenous catheter (PIVC). PIVCs are secured using splints and adhesive dressings applied to the skin. Removing the dressings causes skin injury, pain, and risks infection. We designed the Pēpi Splint, which supports PIVCs without the application of adhesive dressings to the skin. We sought to determine the effectiveness and acceptability of the Pēpi Splint using a proof-of-concept design. METHODS Eligible babies were > 1000 g and > 30 weeks' corrected gestation admitted to Wellington Regional NICU and who required a PIVC. All babies received the same care as those not in the study, with the addition of the Pēpi Splint. Primary outcomes were the proportion of babies in which the Pēpi Splint secured the PIVC for the required time and proportion of babies who experience an adverse event. Secondary outcomes were the acceptability of the Pēpi Splint as reported by the parents. RESULTS Thirty-eight babies, median (range) birth weight 2625 g (396-4970) and gestation 37wk (22-41). When the Pēpi was applied the postnatal weight was 2969 g (1145 - 4970) and gestation 37wk (29 - 41). The Pēpi Splint held the PIVC secure for 34/38 babies (89%), for a duration of 37 h (6 to 97). There were no adverse events. Of the four babies reported to have unsecure PIVCs, two were due to the securement two were displaced during feeding. Fifty-eight parents responded to a questionnaire (32 mothers, 26 fathers). Of these parents 52 (90%) would participate again and 52 (90%) would recommend participating to others. Overall, clinicians reported the Pēpi Splint was easy to use 33/38 (87%). CONCLUSION The Pēpi Splint safely secures PIVCs without adhesive dressings being applied to the skin and is acceptable to both parents and clinicians. Our findings provide support for a larger multicentred randomised controlled trial. TRIAL REGISTRATION Registered with the Australian and New Zealand Clinical Trials Registry Reference ACTRN12620001335987 .
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Affiliation(s)
- Deborah L Harris
- School of Nursing, Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, PO Box 7625, Newtown, Wellington, 6242, New Zealand.
- Newborn Intensive Care Unit, Capital Coast District Health Board, Wellington, New Zealand.
- Waikato District Health Board, Hamilton, New Zealand.
| | - Melissa Schlegel
- Newborn Intensive Care Unit, Capital Coast District Health Board, Wellington, New Zealand
| | - Anna Markovitz
- School of Nursing, Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, PO Box 7625, Newtown, Wellington, 6242, New Zealand
| | - Lisa Woods
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, New Zealand
| | - Tamara Miles
- Waikato District Health Board, Hamilton, New Zealand
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van Rens M, Hugill K, Francia AL, Abdelwahab AH, Garcia KL. Treatment of a neonatal peripheral intravenous infiltration/extravasation (PIVIE) injury with hyaluronidase: a case report. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S31-S36. [PMID: 35439074 DOI: 10.12968/bjon.2022.31.8.s31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents' wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population. CASE DESCRIPTION A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects. CONCLUSION This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology. HIGHLIGHTS In a neonatal population peripheral infusion therapy-related complication rates have been reported to be as high as 75% Peripheral IV infiltration and extravasation (PIVIE) is implicated in up to 65% of IV-related complications PIVIE injury has the potential to cause serious harm Prompt recognition and timely appropriate intervention can mitigate many of these risks Adhering to the 5Rs for vascular access optimizes infusion therapy and potentially reduces complications.
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Affiliation(s)
- Matheus van Rens
- Nursing and Vascular Access, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Vascular Access and Neonatal Transport, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Krisha Lp Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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15
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Tawhai P, van den Boom J, Cama J. Chylothorax associated with a PICC line in a very low birth weight infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Santos LMD, Figueredo IB, Silva CSGE, Catapano UO, Silva BSM, Avelar AFM. Risk factors for infiltration in children and adolescents with peripheral intravenous catheters. Rev Bras Enferm 2022; 75:e20210176. [DOI: 10.1590/0034-7167-2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: to estimate the incidence of infiltration and the factors associated with its occurrence in children and adolescents in the operative period and with peripheral intravenous catheters. Methods: a longitudinal and prospective study with children and adolescents using peripheral intravenous catheters, conducted at the surgical clinic unit of a pediatric hospital in Feira de Santana, State of Bahia, from April 2015 to December 2016. The study used Pearson’s chi-square and Fisher’s exact test for the analysis. It also applied multiple analyses using Poisson regression with robust variance. Results: the incidence of infiltration was 31.2% and was associated with female sex (RR=0.53; CI=[0.30-0.96]), non-eutrophic children (RR=2.27; CI=[1.25-4.20]), who used non-irritating and non-vesicant drugs (RR=1.72; CI=[1.03-2.87]), vesicant drugs (RR=1.84; CI=[1.05-3.22]) and irritating/vesicant electrolytes (RR=2.35; CI=[1.38-3.97]). Conclusions: the study suggests the development of strategies that will help in the prevention of this adverse event through the knowledge of the associated factors.
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17
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Huang LS, Huang Y, Hu J. Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses' knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study. BMC Nurs 2021; 20:236. [PMID: 34814906 PMCID: PMC8609804 DOI: 10.1186/s12912-021-00758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses' knowledge, attitude, and practice (KAP) concerning PIVC fixation. METHODS An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses' KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. RESULTS The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses' knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). CONCLUSION PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses' KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients.
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Affiliation(s)
- Li-Sha Huang
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yan Huang
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Deceases of Woman and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Juan Hu
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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18
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van Rens MFPT, Hugill K, Mahmah MA, Bayoumi M, Francia ALV, Garcia KLP, van Loon FHJ. Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study. BMJ Open 2021; 11:e047788. [PMID: 34497079 PMCID: PMC8438911 DOI: 10.1136/bmjopen-2020-047788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Infants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population. DESIGN This was a retrospective observational study. SETTING The study was performed on the neonatal intensive care unit of the Women's Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study. PARTICIPANTS This study included 12 978 neonates who required intravenous therapy. OUTCOME MEASUREMENTS The main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy. RESULTS A mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors. CONCLUSION Most infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad A Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Krisha L P Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - F H J van Loon
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
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Resnick O, Abu Ahmad W, Bancovsky D, Rogachev S, Ashash A, Ohana Sarna Cahan L, Rekhtman D, Hashavya S, Gross I. Predicting factors for complications in peripheral intravenous catheters in the pediatric population. Acta Paediatr 2021; 110:1639-1644. [PMID: 33226669 DOI: 10.1111/apa.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
AIM To characterise the association between peripheral intravenous catheter (PIVC) gauge (G), the patient's age, insertion site and complication incidence. METHODS This prospective study was performed in Hadassah Medical Center, Jerusalem, Israel, between June 2018 and March 2019. Children with PIVC admitted to the paediatric departments were included. PIVCs were evaluated daily. RESULTS A total of 113 children with 132 PIVCs were included in the study. The most common site of insertion was the antecubital fossa (43.9%). PIVCs were most commonly used for intravenous (IV) antibiotics (46.6%). Complications were observed for 40.9% PIVCs. Dislodgement was the most common complication. The complication rate was higher for the lower limbs (60%) and external jugular veins (100%) p = 0.002. In infants younger than 12 months, the complication rate was higher for 22 G PIVCs or larger (58.7% versus 27.5%; p = 0.05). In contrast, for the 1-6 years age group, PIVCs smaller than 24 G had a higher complication rate (p = 0.004). Patients with comorbidities had a higher complication rate (p = 0.003). CONCLUSION Risk factors for complications are comorbidities and sites of insertion other than the upper limbs. In infants, 24 G PIVC or smaller should be inserted, whereas 22 G PIVC or larger are superior for 1- to 6-year-old children.
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Affiliation(s)
- Ortal Resnick
- Department of Pediatrics Hadassah Medical Center Jerusalem Israel
| | - Wiessam Abu Ahmad
- Hadassah School of Public Health and Community Medicine University Hebrew University Jerusalem Israel
| | - Daniel Bancovsky
- Department of Pediatrics Hadassah Medical Center Jerusalem Israel
| | | | - Amit Ashash
- Faculty of Medicine Hebrew University Jerusalem Israel
| | | | - David Rekhtman
- Department of Pediatric Emergency Medicine Hadassah Medical Center Jerusalem Israel
| | - Saar Hashavya
- Department of Pediatric Emergency Medicine Hadassah Medical Center Jerusalem Israel
| | - Itai Gross
- Department of Pediatric Emergency Medicine Hadassah Medical Center Jerusalem Israel
- Department of Pediatric Emergency Medicine Queensland Children's Hospital Brisbane QLD Australia
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20
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Neubauer HC, Hall M, Lopez MA, Cruz AT, Queen MA, Foradori DM, Aronson PL, Markham JL, Nead JA, Hester GZ, McCulloh RJ, Wallace SS. Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome. J Hosp Med 2021; 16:149-155. [PMID: 33617441 PMCID: PMC7929614 DOI: 10.12788/jhm.3529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Controversy exists regarding the optimal antibiotic regimen for use in hospitalized children with staphylococcal scalded skin syndrome (SSSS). Various regimens may confer toxin suppression and/or additional coverage for methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA). OBJECTIVES To describe antibiotic regimens in hospitalized children with SSSS and examine the association between antistaphylococcal antibiotic regimens and patient outcomes. DESIGN/METHODS Retrospective cohort study of children hospitalized with SSSS using the Pediatric Health Information System database (2011-2016). Children who received clindamycin monotherapy, clindamycin plus MSSA coverage (eg, nafcillin), or clindamycin plus MRSA coverage (eg, vancomycin) were included. The primary outcome was hospital length of stay (LOS); secondary outcomes were treatment failure and cost. Generalized linear mixed-effects models were used to compare outcomes among antibiotic groups. RESULTS Of 1,259 children included, 828 children received the most common antistaphylococcal antibiotic regimens: clindamycin monotherapy (47%), clindamycin plus MSSA coverage (33%), and clindamycin plus MRSA coverage (20%). Children receiving clindamycin plus MRSA coverage had higher illness severity (44%) compared with clindamycin monotherapy (28%) and clindamycin plus MSSA (32%) (P =.001). In adjusted analyses, LOS and treatment failure did not differ among the 3 regimens (P =.42 and P =.26, respectively). Cost was significantly lower for children receiving clindamycin monotherapy and highest in those receiving clindamycin plus MRSA coverage (mean, $4,839 vs $5,348, respectively; P <.001). CONCLUSIONS In children with SSSS, the addition of MSSA or MRSA coverage to clindamycin monotherapy was associated with increased cost and no incremental difference in clinical outcomes.
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Affiliation(s)
- Hannah C Neubauer
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Corresponding Author: Hannah C Neubauer, MD; ; Telephone: 832-824-0671
| | - Matthew Hall
- Children’s Hospital Association, Lenexa, Kansas, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Mary Ann Queen
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Dana M Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Paul L Aronson
- Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L Markham
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer A Nead
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York
| | | | - Russell J McCulloh
- Department of Pediatrics, University of Nebraska Medical Center and Children’s Hospital & Medical Center, Omaha, Nebraska
| | - Sowdhamini S Wallace
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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21
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Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Standard Versus Long Peripheral Catheters for Multiday IV Therapy: A Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-000877. [PMID: 33446506 DOI: 10.1542/peds.2020-000877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In children, intravenous therapy (IVT) is generally administered via peripheral intravenous catheters (PIVCs) (2-6 cm in length). There is evidence that PIVCs are unreliable after 2 days. Long peripheral catheters (LPCs) (6-15 cm in length) could improve the delivery of IVT. The aim of this trial was to determine if LPCs could decrease catheter failure and the number of catheters in children receiving multiday IVT. METHODS This was an open-label randomized controlled trial conducted at Monash Children's Hospital in Melbourne, Australia. Participants were from the ages of 1 to 17 years, undergoing surgery and requiring >48 hours of postoperative IVT. Participants were randomly assigned to a 2.5-cm 22G PIVC or an 8-cm 22G LPC. RESULTS Seventy-two children were randomly assigned, 36 received PIVCs, and 36 received LPCs. The median duration of IVT was 5.1 days and was similar between groups (P = .9). Catheter failure was higher for PIVCs than LPCs (66.7% vs 19.4%; relative risk [RR]: 3.4; P = .0001 or 187.9 vs 41.0 failures per 1000 catheter-days). Infiltration was the most common reason for PIVC failure (33.3% vs 2.8%; RR: 12.0; P = .001). LPCs exhibited superior life span (4.7 vs 3.5 days [median]; P = .01). Children with LPCs were twice as likely to complete therapy with a single catheter (80.6% vs 38.9%; RR: 2.1; P = .0006). CONCLUSIONS LPCs reduce catheter failure and total catheters in children. They should be considered as the first-line device for peripheral access in any child receiving prolonged IVT.
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Affiliation(s)
- Kirby R Qin
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Nicholas Ensor
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Richard Barnes
- Anaesthesia, Monash Children's Hospital, Melbourne, Australia
| | - Anna Englin
- Anaesthesia, Monash Children's Hospital, Melbourne, Australia
| | - Ramesh M Nataraja
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; and
| | - Maurizio Pacilli
- Departments of Paediatric Surgery and .,Departments of Paediatrics and.,Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; and
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Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing. Pediatr Qual Saf 2020; 6:e381. [PMID: 33409433 PMCID: PMC7781297 DOI: 10.1097/pq9.0000000000000381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022] Open
Abstract
The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.
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Vandenhouten CL, Owens AK, Hunter MR, Raynak A. Peripheral Intravenous Education in North American Nursing Schools: A Call to Action. J Nurs Educ 2020; 59:493-500. [DOI: 10.3928/01484834-20200817-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
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Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature. J Vasc Access 2020; 22:767-777. [PMID: 32529915 DOI: 10.1177/1129729820927272] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long peripheral catheters are peripheral intravenous catheters of 6-15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. METHODS We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: 'long', 'Seldinger', 'guidewire', 'peripheral', 'venous', 'intravenous', 'IV', 'vascular', 'cannula' and 'catheter'. RESULTS Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/16) were conducted in acute care settings, (emergency department, n = 6; intensive care unit, n = 3; high dependency unit, n = 1; surgical unit, n = 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3-52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. CONCLUSION Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy.
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Affiliation(s)
- Kirby R Qin
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicholas Ensor
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Anna Englin
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Liew DD, Zhou L, Chin LY, Davies-Tuck M, Malhotra A. Elective replacement of peripheral intravenous cannulas in neonates. J Vasc Access 2020; 22:121-128. [PMID: 32524888 DOI: 10.1177/1129729820927235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Newborns admitted to neonatal units often require vascular access. Peripheral intravenous cannulas allow essential medication, fluids, and/or parenteral nutrition to be delivered. Peripheral intravenous cannulas are often associated with complications, such as extravasation, infiltration, phlebitis, leakage, spontaneous dislodgement, and catheter-associated blood stream infection. METHODS A secondary analysis of a randomized controlled trial evaluating standard replacement versus elective replacement (72-96 h) of peripheral intravenous cannula was conducted in a tertiary-level neonatal unit in Melbourne, Australia. The main outcome of this analysis was to assess the risk of combined adverse events associated with elective replacement of peripheral intravenous cannula. A cost analysis of the intervention was also conducted. RESULTS Combined adverse outcomes noted per infant were 48 (87.27%) in the standard replacement group versus 44 (75.86%) in the elective replacement group (RR 0.87; 95% CI 0.71-1.04, p = 0.15). In terms of combined adverse outcome per 1000 intravenous hours, there was a significant risk ratio of 0.81 in the elective group compared with the standard group (95% CI 0.65-0.98, p = 0.04). Gestation (adjusted odds ratio (AOR) 0.58; 95% CI 0.35-0.96, p = 0.03), male gender (AOR 4.65; 95% CI 1.07-20.28, p = 0.04), elective replacement (AOR 0.12; 95% CI 0.03-0.68, p = 0.01), and the total number of re-sites (AOR 27.84; 95% CI 4.61-168.18, p < 0.001) were significant risk factors associated with adverse events. There were also significantly higher costs involved with elective replacement. CONCLUSION Elective replacement of peripheral intravenous cannulas was not shown to reduce the risk of combined adverse events. Elective peripheral intravenous cannula replacement also incurred a higher cost.
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Affiliation(s)
| | - Lindsay Zhou
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Li Yen Chin
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
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Development of an Alarm Algorithm, With Nanotechnology Multimodal Sensor, to Predict Impending Infusion Failure and Improve Safety of Peripheral Intravenous Catheters in Neonates. Adv Neonatal Care 2020; 20:233-243. [PMID: 31815770 DOI: 10.1097/anc.0000000000000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peripheral intravenous catheters connected to an infusion pump are necessary for the delivery of fluids, nutrition, and medications to hospitalized neonates but are not without complications. These adverse events contribute to hospital-acquired patient harm. An artificial intelligence theory called fuzzy logic may allow the use of appropriate variables to predict infusion failure. PURPOSE This innovative study aimed to develop an intravenous infusion nanotechnology monitoring system that would alert the nurse to impending peripheral intravenous infusion failure. METHODS An intravenous infusion nanotechnology monitoring system, using predictor variables of pressure, pH, and oxygen saturation used in a fuzzy logic alarm algorithm was developed to alert the nurse to impending peripheral intravenous infusion failure. FINDINGS The developed intravenous infusion nanotechnology monitoring system is composed of a peripheral intravenous catheter with nanotechnology multimodal sensor, an intravenous pump, a fuzzy logic algorithm, and alarm. For example, using this system, an elevated in-line pressure, a low pH, and a low venous oxygen level would generate an alarm for possible impending infusion failure. IMPLICATIONS FOR PRACTICE With further development, this technology may help nurses predict and prevent adverse outcomes from intravenous infusions. This work shows how nurses can be content experts and innovators of technology that they use to make clinical decisions. IMPLICATIONS FOR RESEARCH After regulatory approval, a randomized controlled trial may be performed to investigate whether interventions at the time of an alarm would result in fewer adverse outcomes and improve safety.
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta analysis. Int J Nurs Stud 2020; 102:103488. [DOI: 10.1016/j.ijnurstu.2019.103488] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
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Kotinatot S, Shankar S, Ba'Ath ME, Almaazmi MM. Unexplained abdominal distention in a neonate: culprit femoral central venous line extravasation. BMJ Case Rep 2019; 12:12/12/e232537. [PMID: 31801783 DOI: 10.1136/bcr-2019-232537] [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: 11/04/2022] Open
Abstract
Central venous lines are an essential part of neonatal intensive care and are used for infusion of medications and parenteral nutrition (PN). PN is usually given via either peripherally inserted central lines or umbilical venous lines. Occasionally, central venous catheters (CVCs) are inserted in the femoral veins. Extravasation of femoral venous catheter leading to ascites is a rare entity. This report describes the case of a neonate with a femoral CVC, who developed ascites as a result of extravasation of PN. Ascites resolved following the removal of the catheter.
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Affiliation(s)
- Suresh Kotinatot
- Neonatology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Shiva Shankar
- Neonatology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Muhammad Eyad Ba'Ath
- Neonatology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
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Monasor-Ortolá D, Cortés-Castell E, Martínez-Pascual C, Esteve-Ríos A, Rizo-Baeza MM. Factors Influencing the Success of Peripheral Venous Access in Neonates. J Pediatr Nurs 2019; 47:e30-e35. [PMID: 31031059 DOI: 10.1016/j.pedn.2019.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE In neonatal units, the use of peripheral venous catheters is a commonly used technique involving risks and local complications. Catheter duration and viability is limited and may involve multiple insertion attempts. Catheterization was considered successful when there were no local complications and the catheter was removed owing to completion of treatment. The aim of the study was to determine the optimal location and instruments to reduce the number of catheter insertion attempts and to increase time without complications. DESIGN AND METHODS A cross-sectional descriptive study was undertaken to analyze all the catheters inserted in the neonatal intermediate care unit of Vinalopó University Hospital (Elche, Spain). Between 2013 and 2017 the following variables were collected: sex, age, gestational age, and venipuncture site, as well as catheter type, number of insertion attempts, duration and complications. RESULTS A total of 929 catheters were analyzed with a mean duration of 46.5 ± 33.9 h, and were removed upon completion of treatment (success 38.3%). The preferred site was the dorsal hand (48.2%) followed by the cubital fossa (20.1%). In both sites the success of the catheter and its duration was higher than the mean (42.4%; 43.9% and 49.4 ± 35.7; 50.3 ± 33.4 h respectively). The most frequent complications were extravasation (47.0%) and phlebitis (5.9%). Just one attempt was needed for 63.8% of cannulations of the dorsal hand, followed by 38.9% in the forearm. No significant differences were found in fixation type, sex, weight, gestational age or infusion type (continuous/intermittent). CONCLUSIONS The success of the technique is low. The preferred insertion sites with fewer complications, longer duration and fewer attempts were the dorsal hand and cubital fossa. With fewer attempts required for cannulation, better results were achieved on the dorsal hand.
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Affiliation(s)
- David Monasor-Ortolá
- Vinalopó University Hospital (Elche), Spain; Nursing Department, University of Alicante, Spain
| | - Ernesto Cortés-Castell
- Department of Pharmacology, Pediatric and Organic Chemistry, University of Miguel Hernández, Spain.
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Aldakauskienė I, Tamelienė R, Marmienė V, Rimdeikienė I, Šmigelskas K, Kėvalas R. Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial. ACTA ACUST UNITED AC 2019; 55:medicina55040082. [PMID: 30925739 PMCID: PMC6524051 DOI: 10.3390/medicina55040082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.
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Affiliation(s)
- Ilona Aldakauskienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Rasa Tamelienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Vitalija Marmienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Inesa Rimdeikienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Kastytis Šmigelskas
- Department of Health Psychology, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
- Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
| | - Rimantas Kėvalas
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
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Hunter MR, Vandenhouten C, Raynak A, Owens AK, Thompson J. Addressing the Silence: a Need for Peripheral Intravenous Education in North America. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background: Greater than 90% of hospitalized patients receive some form of peripheral intravenous therapy for the delivery of fluids, medication, or parenteral nutrition. Nurses are the largest group of clinicians responsible for the placement and management of peripheral intravenous therapies. The literature suggests that many graduate nurses lack the confidence, knowledge, and ability to not only place peripheral intravenous catheters, but also adequately maintain peripheral intravenous sites. This fact, combined with the increasing acuity of hospitalized patients with multiple comorbidities, makes peripheral intravenous placement and management even more challenging. This drove a team of researchers to explore the current state of peripheral intravenous education in health care institutions and examine potential gaps in ongoing professional development and competency assessment.
Methods: A convenience sample of United States and Canadian health care institution representatives were recruited to participate in a 12-item web-based questionnaire regarding peripheral intravenous education and staff competency. Participants were recruited via the Association for Vascular Access listserv, newsletter, and annual meeting. Members were also asked to forward the recruitment e-mail to other health care institutions to ensure a representative sample.
Results: A total of 611 health care institution representatives participated in the study. The large majority (80%) worked in a health care institution with more than 150 beds. Over half (67%) indicated that they provide peripheral intravenous education to their staff using varying modalities to deliver the education. The majority (54%) of health care institutions reported spending between 1 and 5 hours on peripheral intravenous education while, alarmingly, 38% reported spending less than 1 hour on peripheral intravenous education for their staff. Despite these numbers, over half of the participants (58%) believe peripheral intravenous education is a shared responsibility between pre-licensure nursing schools and health care institutions.
Discussion: The study highlights the varying level of peripheral intravenous education and competency evaluation of staff working in health care institutions. The results suggest the need for an evidence-based, standardized peripheral intravenous curriculum that could be used in both health care institutions and nursing education programs.
Conclusion: Currently, there are inconsistencies in the peripheral intravenous education and competency programs used in health care institutions. The authors will use the results of this study to design and examine the effects of a standardized, evidence-based peripheral intravenous curriculum to assist health care professionals responsible for peripheral intravenous education and competency assessment. Given the risk for complications from peripheral intravenous therapy, it is hoped that improved peripheral intravenous education will reduce potential complications and improve patient outcomes.
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Affiliation(s)
| | | | - Andrea Raynak
- Chronic Disease Prevention & Management, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Andrea K. Owens
- Leighton School of Nursing, Marian University, Indianapolis, IN
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Kolaček S, Puntis JWL, Hojsak I. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access. Clin Nutr 2018; 37:2379-2391. [PMID: 30055869 DOI: 10.1016/j.clnu.2018.06.952] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- S Kolaček
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | | | - I Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia
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Braga LM, Parreira PMDSD, Arreguy-Sena C, Carlos DM, Mónico LDSM, Henriques MAP. TAXA DE INCIDÊNCIA E O USO DO FLUSHING NA PREVENÇÃO DAS OBSTRUÇÕES DE CATETER VENOSO PERIFÉRICO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018002810017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar a incidência cumulativa de obstrução do cateter venoso periférico e identificar o uso do flushing para prevenção das obstruções. Método: método misto, com estudo de coorte descritivo com seguimento de 110 pacientes de uma clínica médica de Portugal. A coleta de dados envolveu entrevistas com 22 enfermeiros, análise documental e observação participante. Realizada análise temática dos achados qualitativos e análise descritiva para os dados quantitativos. Resultados: a incidência cumulativa de obstrução foi 50%. As categorias temáticas desvelaram que o flushing era um cuidado para prevenção da obstrução do cateter venoso e realizado antes e/ou após a administração dos medicamentos. O volume de solução fisiológica utilizado no flushing variou entre 3 e 10 ml. Verificaram-se, também, situações de não adesão ao flushing e fatores que influenciavam nesta adesão, a saber: o tempo para realizar os cuidados, a complexidade e o grau de dependência dos pacientes, o volume de trabalho e o número de enfermeiros para prestar os cuidados. Conclusão: o flushing é um cuidado de enfermagem para a prevenção da obstrução do cateter venoso periférico, no entanto, as práticas de enfermagem para implementação não são uniformes quanto a frequência e volume de solução fisiológica. A ausência de um protocolo de enfermagem, a complexidade e o grau de dependência dos pacientes, o volume de trabalho e o número de enfermeiros são fatores capazes de influenciar na adesão à prática do flushing e consequentemente na incidência de obstrução do cateter venoso periférico e na segurança do paciente e qualidade dos cuidados.
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Ben Abdelaziz R, Hafsi H, Hajji H, Boudabous H, Ben Chehida A, Mrabet A, Boussetta K, Barsaoui S, Sammoud A, Hamzaoui M, Azzouz H, Tebib N. Peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study. BMC Pediatr 2017; 17:208. [PMID: 29258474 PMCID: PMC5735659 DOI: 10.1186/s12887-017-0965-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
Background Peripheral venous catheterization (PVC) is frequently used in children. This procedure is not free from potential complications. Our purpose was to identify the types and incidences of PVC complications in children and their predisposing factors in a developing country. Methods We conducted a prospective observational multicenter study in five pediatric and pediatric surgery departments over a period of 2 months. Two hundred fifteen PVC procedures were conducted in 98 children. The times of insertion and removal and the reasons for termination were noted, and the lifespan was calculated. Descriptive data were expressed as percentages, means, standard deviations, medians and interquartile ranges. The Chi2 test or the Fisher test, with hazard ratios and 95% confidence intervals (CI95%), as well as Student’s t test or the Mann-Whitney U test were used to compare categorical and quantitative variables, respectively, in groups with and without complications. The Spearman test was used to determine correlations between the lifespan and the quantitative variables. The Kruskal Wallis test was used to test for differences in the median lifespan within 3 or more subgroups of a variable. Linear regression and logistic binary regression were used for multivariate analysis. A p-value <0.05 was considered significant. Results The mean lifespan was 68.82 ± 35.71 h. A local complication occurred in 111 PIVC (51.9%) cases. The risk factors identified were a small catheter gauge (24-gauge) (p = 0.023), the use of a volume-controlled burette (p = 0.036), a longer duration of intravenous therapy (p < 0.001), a medical diagnosis of respiratory or infectious disease (p = 0.047), the use of antibiotics (p = 0.005), including cefotaxime (p = 0.024) and vancomycin (p = 0.031), and the use of proton pump inhibitors (p = 0.004).The lifespan of the catheters was reduced with the occurrence of a complication (p < 0.001), including the use of 24-gauge catheters (p = 0.001), the use of an electronic pump or syringe(p = 0.036) and a higher rank of the intravenous device in each patient (p = 0.010). Conclusions PVC complications were frequent in our pediatric departments and are often associated with misuse of the device. These results could engender awareness among both doctors and nurses regarding the need for rationalization of the use of PVC and better adherence to the recommendations for the use of each drug and each administration method.
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Affiliation(s)
- Rim Ben Abdelaziz
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia. .,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia. .,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia. .,Department of Pediatrics, La Rabta Hospital Jabbari, 1007, Tunis, Tunisia.
| | - Habiba Hafsi
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia
| | - Hela Hajji
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia
| | - Hela Boudabous
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Amel Ben Chehida
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Ali Mrabet
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics B, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Khadija Boussetta
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics A, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Sihem Barsaoui
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatrics C, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Azza Sammoud
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Department of Pediatric Surgery A, Hôpital d'enfants Béchir Hamza de Tunis, Tunis, Tunisia
| | - Mourad Hamzaoui
- Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Department of Pediatrics, La Rabta Hospital Jabbari, 1007, Tunis, Tunisia
| | - Hatem Azzouz
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
| | - Néji Tebib
- Department of Pediatrics, La Rabta Hospital, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; LR12SPO2 les maladies héréditaires du métabolisme investigation et prise en charge, Tunis, Tunisia.,Université Tunis El Manar, Faculté de Médecine de Tunis; Military General Directorate of Health, department of Epidemiology and Public Health, Tunis, Tunisia
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Freire MHDS, Arreguy-Sena C, Müller PCDS. Cross-cultural adaptation and content and semantic validation of the Difficult Intravenous Access Score for pediatric use in Brazil. Rev Lat Am Enfermagem 2017. [PMCID: PMC5614233 DOI: 10.1590/1518-8345.1785.2920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: present the cross-cultural adaptation and content and semantic validation of the
Difficult Intravenous Access Score for current use in Brazil. Method: cross-cultural adaptation and validation study, structured in six phases: initial
translation, synthesis of translations, back-translation, assessment of documents
by expert committee of specialized judges, pretest and presentation of the
documents to the expert judges and to the author of the original instrument.
Twenty health professionals were randomly recruited from a public hospital in the
South of Brazil, working in pediatrics, in order to assess the agreement level
with the variables in the instrument. In addition, a convenience sample of 30
pediatric patients was selected for the face validation of the same instrument.
Cronbach’s alpha coefficient, simple and percentage frequencies, the Shapiro-Wilk
and Fisher’s exact tests were used for the data analysis and reliability measures.
Results: the cross-cultural adaptation phases were executed with totally clear translated
variables, demonstrating satisfactory results in the content and semantic
validation process. Conclusions: the Difficult Intravenous Access Score was adapted and its content and semantics
were validated. External clinical validity, measuring equivalence and
reproducibility analyses are needed.
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38
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Affiliation(s)
- Kevin Hugill
- Director of Nursing, Hamad Medical Corporation, Doha Qatar
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Flores Moreno M, Pueblas Bedoy KS, Ojeda Sánchez A, Zurita-Cruz J. [Risk factors associated with complications that required the removal of peripherally inserted central venous catheters in a tertiary pediatric hospital]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2017; 74:289-294. [PMID: 29382518 DOI: 10.1016/j.bmhimx.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30% to 40% of cases, with the most frequent risk factors being the age of the patient and the location of PICC. The aim of this study was to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications. METHODS Prospective cohort study. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed. RESULTS Two hundred and twenty-five patients were included. In 33.02%, PICC were withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. It was identified that only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI)95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) only to the withdrawal of PICC due to suspected phlebitis. CONCLUSIONS PICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.
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Affiliation(s)
- Miriam Flores Moreno
- Clínica de catéteres, Departamento de Enfermería, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Karina Saray Pueblas Bedoy
- Clínica de catéteres, Departamento de Enfermería, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Aurelia Ojeda Sánchez
- Clínica de catéteres, Departamento de Enfermería, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Jessie Zurita-Cruz
- Área de Apoyo a la Investigación Clínica, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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Schuster C, Stahl B, Murray C, Keleekai NL, Glover K. Development and Testing of a Short Peripheral Intravenous Catheter Insertion Skills Checklist. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.java.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from − 0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99–0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.
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Hugill K. Is there an optimal way of securing peripheral IV catheters in children? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S20-S21. [PMID: 27792430 DOI: 10.12968/bjon.2016.25.19.s20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kevin Hugill, Director of Nursing Education, Hamad Medical Corporation, Doha, Qatar, explains why the answer to this question might not be as simple as people think-and urges more reflection among practitioners.
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Förberg U, Unbeck M, Wallin L, Johansson E, Petzold M, Ygge BM, Ehrenberg A. Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care--a cluster randomised study. Implement Sci 2016; 11:10. [PMID: 26818599 PMCID: PMC4728777 DOI: 10.1186/s13012-016-0375-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION Current Controlled Trials ISRCTN44819426.
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Affiliation(s)
- Ulrika Förberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden.
| | - Maria Unbeck
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Max Petzold
- Centre for Applied Biostatistics, Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Karolinska Institutet, ICHAR, Stockholm, Sweden
| | - Britt-Marie Ygge
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Elevhemmet H2:00, 171 76, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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