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Høvik LH, Gjeilo KH, Ray-Barruel G, Lydersen S, Børseth AW, Gustad LT. Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study. J Clin Nurs 2024; 33:2593-2608. [PMID: 38716868 DOI: 10.1111/jocn.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/03/2024] [Accepted: 04/10/2024] [Indexed: 06/14/2024]
Abstract
AIM To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. DESIGN Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. METHOD Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. RESULTS The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. CONCLUSION This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. IMPACT The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. REPORTING METHOD The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). PATIENT OR PUBLIC CONTRIBUTION A patient representative has been involved in planning this study.
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Affiliation(s)
- Lise Husby Høvik
- Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anita Wang Børseth
- Regional Centre for Infection Prevention and Control, Central Norway Regional Health Authority, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Dobrescu A, Constantin AM, Pinte L, Chapman A, Ratajczak P, Klerings I, Emprechtinger R, Allegranzi B, Zingg W, Grayson ML, Toledo J, Gartlehner G, Nussbaumer-Streit B. Effectiveness and Safety of Measures to Prevent Infections and Other Complications Associated With Peripheral Intravenous Catheters: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:1640-1655. [PMID: 38593192 DOI: 10.1093/cid/ciae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. METHODS We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980-16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. RESULTS 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33-.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49-1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non-chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. CONCLUSIONS Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. CLINICAL TRIALS REGISTRATION The protocol was registered in the Open Science Framework (https://osf.io/exdb4).
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Affiliation(s)
- Andreea Dobrescu
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Larisa Pinte
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Andrea Chapman
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Robert Emprechtinger
- Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - M Lindsay Grayson
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Infectious Diseases Department, Austin Health, Melbourne, Australia
| | - Joao Toledo
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- High Impact Epidemics, WHO Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
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3
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Aceituno L, Nuñez-Conde A, Serra-Pladevall J, Viñado B, Castella E, Escolà-Vergé L, Pigrau C, Falcó V, Len YO. Oral quinolones versus intravenous β-lactam for the treatment of acute focal bacterial nephritis: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04871-2. [PMID: 38856826 DOI: 10.1007/s10096-024-04871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Evidence regarding the best antibiotic regimen and the route of administration to treat acute focal bacterial nephritis (AFBN) is scarce. The aim of the present study was to compare the effectiveness of intravenous (IV) β-lactam antibiotics versus oral quinolones. METHODS This is a retrospective single centre study of patients diagnosed with AFBN between January 2017 and December 2018 in Hospital Universitari Vall d'Hebron, Barcelona (Spain). Patients were identified from the diagnostic codifications database. Patients treated with oral quinolones were compared with those treated with IV β-lactam antibiotics. Therapeutic failure was defined as death, relapse, or evolution to abscess within the first 30 days. RESULTS A total of 264 patients fulfilled the inclusion criteria. Of those, 103 patients (39%) received oral ciprofloxacin, and 70 (26.5%) IV β-lactam. The most common isolated microorganism was Escherichia coli (149, 73.8%) followed by Klebsiella pneumoniae (26, 12.9%). Mean duration of treatment was 21.3 days (SD 7.9). There were no statistical differences regarding therapeutic failure between oral quinolones and IV β-lactam treatment (6.6% vs. 8.7%, p = 0.6). Out of the 66 patients treated with intravenous antibiotics, 4 (6.1%) experienced an episode of phlebitis and 1 patient (1.5%) an episode of catheter-related bacteraemia. CONCLUSIONS When susceptible, treatment of AFBN with oral quinolones is as effective as IV β-lactam treatment with fewer adverse events.
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Affiliation(s)
- L Aceituno
- Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Nuñez-Conde
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Spain
| | | | - B Viñado
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Castella
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Escolà-Vergé
- Infectious Diseases Unit, Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Barcelona, Spain.
| | - C Pigrau
- Infectious diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Falcó
- Infectious diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Y O Len
- CIBERINFEC, Instituto de Salud Carlos III, Barcelona, Spain
- Infectious diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Tian Y, Zhong Z, Dougarem D, Sun L. The ultrasound-guided versus standard technique for peripheral intravenous catheter placement by nurses: A systematic review and meta-analysis. Heliyon 2024; 10:e30582. [PMID: 38765178 PMCID: PMC11098833 DOI: 10.1016/j.heliyon.2024.e30582] [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: 01/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Aim To comprehensively evaluate the efficacy of Ultrasound-guided technique for peripheral intravenous catheter placement by nurses in their daily practice. Background Peripheral intravenous catheter insertion is a common clinical procedure in healthcare settings. Ultrasound-guided peripheral intravenous placement has emerged in recent decades and was recognized as particularly useful in some specific patient groups. Methods Studies that had compared the ultrasound-guided and traditional approaches were eligible for inclusion and further analysis. The primary outcome was the success rate on the first intravenous insertion attempt. The secondary outcomes included the time needed for successful insertion, and the average number of attempts to establish the IV access. We systematically assess all studies using Cochrane Collaboration's Risk of Bias tool and the Newcastle-Ottawa Scale. We calculated the odds ratio and standardized mean difference with 95 % confidence intervals for the outcomes. Data were analyzed and visualized on Review Manager 5.3.4 and Stata 16.0. Results 23 studies were included (17 randomized controlled trials and six cohort studies) with a population of 2051 patients offered ultrasound-assisted technique and 2479 treated with the conventional approach for comparison. The former approach was associated with a higher success rate on the first attempt in comparison (OR = 2.95, 95 % CI: 1.86, 4.69). This technique also took less time and less acupuncture to patients' skin (SMD = -0.62, 95 % CI: 1.01, -0.23; SMD = -0.55, 95 % CI: 0.92, -0.18). In the sub-group analyses, children were more likely to benefit from ultrasound guided technique. Ultrasound guided technique demonstrated consistent and significant benefits in emergency clinical settings. Hospitals from different geographical locations exhibited similar trends in the three outcomes. Year of publication and study design revealed inconsistent and insignificant outcomes. Conclusions Ultrasound-guided technique can be a safer, faster, and more effective alternative to the traditional approach for nurses to establish intravenous access across different clinical settings and age groups.
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Affiliation(s)
- Yishu Tian
- Center for Reproductive Medicine, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Zixing Zhong
- Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Djouhayna Dougarem
- Hospital of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Litao Sun
- Center for Reproductive Medicine, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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Mimoz O, Debonne A, Glanard A, Keita Perse O, Lucet JC. Best practice in the use of peripheral venous catheters: A consensus from French experts. Infect Dis Now 2024; 54:104923. [PMID: 38759732 DOI: 10.1016/j.idnow.2024.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical devices in healthcare. While they are often perceived as innocuous because they are common, this perception does not match their risk factors. In France, 16% of intravenous device-associated bacteremia are due to PIVCs. This consensus document reports the French experience in PIVC management, issues arising from their complications, and a proposed path toward improved PIVC care. METHODS A panel of five French experts discussed this topic based on evidence and personal experience. A consensus process was applied to highlight the issues in need of increased awareness and to suggest possible improvements. PIVC topics were organized as General Statements, Indication, Preparation, Insertion, Maintenance, and Removal. An electronic survey was used to record agreement or disagreement; to expand the dataset, five additional French experts also answered the questions. RESULTS Out of 67 statements, 62 reached a consensus (the 80% agreement threshold was exceeded). Experts are increasingly aware that PIVCs are a significant source of complications, including local and bloodstream infections. Practices need to progress to improve patient outcomes, which will require better education for all personnel involved with the insertion and maintenance of PIVCs. CONCLUSIONS Current practice around PIVCs does not always comply with the recommendations issued. A new surveillance network targeting catheter-related healthcare-associated infections is now in place in France. Simplified, standardized, bundled solutions are needed to reduce avoidable harm from PIVCs. Healthcare practice has changed over time and new educational tools are needed to adapt to increased workload and time constraints.
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Affiliation(s)
- Olivier Mimoz
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
| | - Anne Debonne
- Centre Hospitalier d'Argenteuil, Argenteuil, France.
| | | | | | - Jean-Christophe Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, F-75018 Paris, France; Université Paris Cité, Inserm, IAME, F-75018 Paris, France.
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6
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Watts S, Apte Y, Holland T, Hatt A, Craswell A, Lin F, Tabah A, Ware R, Byrnes J, Anstey C, Keijzers G, Ramanan M. Randomised, controlled, feasibility trial comparing vasopressor infusion administered via peripheral cannula versus central venous catheter for critically ill adults: A study protocol. PLoS One 2024; 19:e0295347. [PMID: 38739611 PMCID: PMC11090297 DOI: 10.1371/journal.pone.0295347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant tissue injury. This practice is not guided by contemporary randomised controlled trial (RCT) evidence. Observational data suggests safety of vasopressor infusion via PIVC. To address this evidence gap, we have designed the "Vasopressors Infused via Peripheral or Central Access" (VIPCA) RCT. METHODS The VIPCA trial is a single-centre, feasibility, parallel-group RCT. Eligible critically ill patients requiring a vasopressor infusion will be identified by emergency department (ED) or intensive care unit (ICU) staff and randomised to receive vasopressor infusion via either PIVC or CVC. Primary outcome is feasibility, a composite of recruitment rate, proportion of eligible patients randomised, protocol fidelity, retention and missing data. Primary clinical outcome is days alive and out of hospital up to day-30. Secondary outcomes will include safety and other clinical outcomes, and process and cost measures. Specific aspects of safety related to vasopressor infusions such as extravasation, leakage, device failure, tissue injury and infection will be assessed. DISCUSSION VIPCA is a feasibility RCT whose outcomes will inform the feasibility and design of a multicentre Phase-3 trial comparing routes of vasopressor delivery. The exploratory economic analysis will provide input data for the full health economic analysis which will accompany any future Phase-3 RCT.
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Affiliation(s)
| | - Yogesh Apte
- Caboolture Hospital, Caboolture, Australia
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
| | | | - April Hatt
- Caboolture Hospital, Caboolture, Australia
| | - Alison Craswell
- Caboolture Hospital, Caboolture, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Frances Lin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Sunshine Coast Health Institute, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Alexis Tabah
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Queensland Critical Care Research Network, Herston, Australia
| | - Robert Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Christopher Anstey
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Gerben Keijzers
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Australia
- Faculty of Health Sciences and Medicine Bond University, Robina, Australia
| | - Mahesh Ramanan
- Caboolture Hospital, Caboolture, Australia
- Queensland Critical Care Research Network, Herston, Australia
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Kensington, Australia
- Faculty of Health, Queensland of Technology, Brisbane, Australia
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Jiménez-Martínez E, Adamuz J, González-Samartino M, Muñoz-Carmona MA, Hornero A, Martos-Martínez MP, Membrive-Martínez R, Juvé-Udina ME. Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study. PLoS One 2024; 19:e0303152. [PMID: 38722995 PMCID: PMC11081384 DOI: 10.1371/journal.pone.0303152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. METHODS A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. RESULTS Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74). CONCLUSION About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.
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Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | - Jordi Adamuz
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maribel González-Samartino
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria Antonia Muñoz-Carmona
- Nursing Knowledge Management and Information Systems Department, Viladecans Hospital, Viladecans (Barcelona), Barcelona, Spain
| | - Ana Hornero
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | | | - Remedios Membrive-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria-Eulàlia Juvé-Udina
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
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8
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Bakcek Akcelik Ö, Ayhan H. Peripheral Intravenous Catheter-Related Phlebitis and Infiltration in an Emergency Department: A Descriptive Study. JOURNAL OF INFUSION NURSING 2024; 47:155-162. [PMID: 38744240 DOI: 10.1097/nan.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study aims to analyze the incidences of peripheral intravenous catheter-related phlebitis and infiltration and the associated risk factors in emergency departments. This descriptive cross-sectional, nonexperimental study was conducted with 300 participants in the emergency department of a university hospital in Türkiye between January 15 and February 15, 2018. The incidence of peripheral intravenous catheter-related phlebitis was 31%, which was grade 1 in 29.7% and grade 2 in 1.3% of the emergency department participants. Additionally, the incidence of peripheral intravenous catheter-related infiltration was 55.4%, including grades 1, 2, and 3 in 36.0%, 12.7%, and 6.7% of the participants, respectively. Incidences of phlebitis and infiltration were related to age, duration of peripheral intravenous catheterization longer than 24 hours, and repeated use of the catheter insertion site. The findings of this study may draw attention to the factors that trigger phlebitis and infiltration due to peripheral intravenous catheter insertions in the emergency department and may guide practices to prevent these complications before they develop. In this context, the Phlebitis Scale and Infiltration Scale developed by the Infusion Nurses Society are recommended to be used in the emergency department.
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Affiliation(s)
- Özgü Bakcek Akcelik
- Author Affiliations: Operating Room Services Program, Department of Medical Services and Techniques, Vocational School of Health Services, Yuksek Ihtisas University (Bakcek Akcelik); Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Türkiye (Ayhan)
- Özgü Bakcek Akcelik, PhD, RN, is an assistant professor in the Yuksek Ihtisas University Department of Medical Services and Techniques, Operating Room Services Program. She spent 5 years working as an emergency nurse. She has been working as an academician for 2 years. She focuses on peripheral intravenous catheter application and patient safety
- Hatice Ayhan, PhD, RN, is a professor in the University of Health Science, Gulhane Faculty of Nursing Department of Nursing. She spent 3 years working as a nurse in the surgical department. She has been working as an academic for 18 years. She has many national and international publications. Her works focus on ostomy and wound care
| | - Hatice Ayhan
- Author Affiliations: Operating Room Services Program, Department of Medical Services and Techniques, Vocational School of Health Services, Yuksek Ihtisas University (Bakcek Akcelik); Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Türkiye (Ayhan)
- Özgü Bakcek Akcelik, PhD, RN, is an assistant professor in the Yuksek Ihtisas University Department of Medical Services and Techniques, Operating Room Services Program. She spent 5 years working as an emergency nurse. She has been working as an academician for 2 years. She focuses on peripheral intravenous catheter application and patient safety
- Hatice Ayhan, PhD, RN, is a professor in the University of Health Science, Gulhane Faculty of Nursing Department of Nursing. She spent 3 years working as a nurse in the surgical department. She has been working as an academic for 18 years. She has many national and international publications. Her works focus on ostomy and wound care
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9
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Marsh N, Larsen EN, Ullman AJ. Authors' response to "Comment on Marsh et al. (2023) 'Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis'". Int J Nurs Stud 2024; 153:104727. [PMID: 38458125 DOI: 10.1016/j.ijnurstu.2024.104727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Affiliation(s)
- N Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia.
| | - E N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - A J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
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10
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Fernández-Feito A, Del Rocío Fernández-Rodríguez M, Cueto-Cuiñas M, Zurrón-Madera P, Sierra-Velasco JM, Cortizo-Rodríguez JL, González-García M. Ten steps to transform ideas into product innovations: An interdisciplinary collaboration between nursing and engineering. Int Nurs Rev 2024. [PMID: 38661539 DOI: 10.1111/inr.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
AIMS To describe the development process of a device from the conception of the idea to the first contact with the commercial environment, and to demonstrate its practical application through an interdisciplinary collaboration between nursing and engineering for the design of a protective device for peripheral venous catheters. BACKGROUND Nurses are key agents for identifying unresolved needs or problems related to nursing care. To address these needs, creative ideation processes are often triggered among nurses to seek technological answers to these challenges. RESULTS The ten steps to develop a device are presented: (1) detecting an unsatisfied clinical need; (2) searching for preexisting marketed products; (3) searching for patents; (4) maintaining confidentiality throughout the process; (5) obtaining institutional support; (6) forming a multidisciplinary team; (7) developing the idea; (8) applying for a patent; (9) building the prototype; (10) marketing the device. This methodology was applied to design a protective device for peripheral venous catheters in hospitalized patients. CONCLUSIONS Nurses can play a key role in the promotion of healthcare innovation in their field to improve procedures, thanks to their direct contact with patients, and by providing their insight on devices that can enhance patient care. The successful interdisciplinary collaboration between nurses and engineers can provide a response to relevant clinical problems such as the manipulation or removal of peripheral venous catheters. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY A hospital policy is required to encourage the participation of nurses in innovative actions. Furthermore, it is important to support nurse leaders who can play a pivotal role in incorporating creativity into work environments and empowering other nurses to innovatively address clinical issues. NO PATIENT OR PUBLIC CONTRIBUTION This article describes the process for developing a health device.
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Affiliation(s)
- Ana Fernández-Feito
- Área de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Marcos Cueto-Cuiñas
- Oficina de Transferencia de Resultados de Investigación, Universidad de Oviedo, Oviedo, Spain
| | - Paula Zurrón-Madera
- Área de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias, SESPA, Oviedo, Spain
| | - Jose Manuel Sierra-Velasco
- Departamento de Ingeniería Mecánica, Escuela Politécncia de Ingenieria de Gijón, Universidad de Oviedo, Gijón, Spain
| | - Jose Luis Cortizo-Rodríguez
- Departamento de Ingeniería Mecánica, Escuela Politécncia de Ingenieria de Gijón, Universidad de Oviedo, Gijón, Spain
| | - María González-García
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Facultad de Enfermería, Universidad de Oviedo, Gijón, Spain
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11
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Xu HG, Corley A, Ware RS, Nghiem S, Stirling S, Wang C, Marsh N. Using a LOng peripheral intraVEnous catheter with retractable guidewire to optimize first-insertion success for patients with Difficult IntraVenous Access in the emergency department (LOVE-DIVA): a study protocol for a randomized controlled trial. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S28-S34. [PMID: 38578937 DOI: 10.12968/bjon.2024.33.7.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION First-insertion success rates for peripheral vascular access devices (PVADs) in patients with difficult venous access (DIVA) are low, which negatively affects staff workload, patient experience, and organizational cost. There is mixed evidence regarding the impact of a peripheral vascular access device with retractable coiled tip guidewire (GW; AccuCath™, BD) on the first-insertion success rate. The aim of this study is to investigate whether the use of long GW-PVADs, compared with standard PVADs, reduces the risk of first-time insertion failure, in patients admitted to emergency departments (EDs). METHODS AND ANALYSIS A parallel-group, two-arm, randomized controlled trial will be carried out in two Australian EDs to compare long GW-PVADs (5.8 cm length) against standard care PVADs (short or long). Patients ≥18 years of age meeting DIVA criteria will be eligible for the trial. The sample size is 203 participants for each arm. Web-based central randomization will be used to ensure allocation concealment. Neither clinicians nor patients can be blinded to treatment allocation. Primary outcome is the first-insertion success rate. Secondary outcomes include the number of insertion attempts, time to insert PVAD, all-cause failure, dwell-time, patient-reported pain, serious adverse events, complications, subsequent vascular access devices required, patient satisfaction, staff satisfaction, and healthcare costs. Differences between the two groups will be analyzed using Cox proportional hazards regression. Cost-effectiveness analysis will also be conducted. Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION The study is approved by Metro South Ethics Committee (HREC/2022/QMS/82264) and Griffith University (2022/077). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION ACTRN12622000299707.
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Affiliation(s)
- Hui Grace Xu
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Amanda Corley
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Son Nghiem
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Scott Stirling
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Carrie Wang
- Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
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12
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Faltoni M, Catho G, Pianca E, Minka-Obama B, Zanella MC, Chraiti MN, Fortchantre L, Harbarth S, Buetti N. Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study. Clin Microbiol Infect 2024; 30:548-551. [PMID: 38142893 DOI: 10.1016/j.cmi.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI. METHODS Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors. RESULTS A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results. DISCUSSION Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI.
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Affiliation(s)
- Matteo Faltoni
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Eva Pianca
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka-Obama
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Nöelle Chraiti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Loïc Fortchantre
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolὸ Buetti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; IAME U 1137, INSERM, Université Paris-Cité, Paris, France.
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13
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Wiesen B, Atwell M, Leavitt C, Clark N, Kessler E, Lam E, Flaig T, Kukreja J, Kim S, Maroni P, Cost NG. Use of Peripheral Intravenous Access in Patients Undergoing Chemotherapy for Testicular Cancer. JCO Oncol Pract 2024; 20:361-369. [PMID: 38127812 DOI: 10.1200/op.23.00580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Systemic chemotherapy, depending on the regimen, can be administered through peripheral intravenous (pIV) access or through central venous access devices (CVADs). There is no current best practice regarding optimal access for chemotherapy for patients with testicular cancer (TC). We retrospectively evaluated patients undergoing systemic chemotherapy for TC and compared baseline characteristics and complications of patients using pIV versus CVADs. METHODS We included patients with TC who underwent first-line systemic chemotherapy at the University of Colorado Hospitals from 2005 to 2020. Data were collected on demographics, cancer characteristics, type, duration of chemotherapy, pIV or CVAD use, and associated complication rates. We then performed univariate and multivariate regression analyses to compare complication rates and risk factors for each group. RESULTS One hundred fifty-four patients met inclusion criteria. Ninety-two (60%) patients used CVADs, and 62 patients (40%) used pIV for their initial treatment. Only six (9.7%) of 62 patients transitioned from pIV to CVADs during therapy. Similarly, 10 of 92 (10.9%) patients with initial CVAD needed to transition to a different type of CVAD or to pIV (P = .81). There were a greater number of venous access-related complications (48 of 92 patients, 52.2%) and overall thrombotic events (33 of 92 patients, 35.9%) for the CVAD group (P > .001) when compared with the pIV group. We observed an association between the following factors and venous access-related complications during chemotherapy: higher stage TC, increased total chemotherapy cycles, and delayed therapy. CONCLUSION Peripheral IV use for first-line nonvesicant chemotherapy in patients with TC appears to be well tolerated with high rates of therapy completion and lower rates of complications when compared with CVADs. These data support our preferred treatment approach and provide evidence that pIV access is a safe and effective way to deliver chemotherapy for patients with TC.
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Affiliation(s)
- Brett Wiesen
- The University of Colorado, Division of Urology, Aurora, CO
| | - Michael Atwell
- The University of Colorado, Division of Urology, Aurora, CO
| | - Colton Leavitt
- The University of Utah, Department of Urology, Salt Lake City, UT
| | - Nathan Clark
- The University of Colorado, Division of Urology, Aurora, CO
| | - Elizabeth Kessler
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Elaine Lam
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Thomas Flaig
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Janet Kukreja
- The University of Colorado, Division of Urology, Aurora, CO
| | - Simon Kim
- The University of Colorado, Division of Urology, Aurora, CO
| | - Paul Maroni
- The University of Colorado, Division of Urology, Aurora, CO
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14
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Kaphan K, Auypornsakul S, Somno J, Wongwattananan W, Jamsittikul K, Baicha W, Somsri S, Sawatrak T. The Prevalence and Associated Factors of Peripheral Intravenous Complications in a Thai Hospital. JOURNAL OF INFUSION NURSING 2024; 47:120-131. [PMID: 38422405 PMCID: PMC10916754 DOI: 10.1097/nan.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Complications of peripheral intravenous catheters (PIVCs) remain a major contributor to health care costs and are a patient safety problem. The objective of this cross-sectional descriptive study was to examine the prevalence of complications and factors associated with complications from peripheral intravenous fluid administration. The study was conducted at a tertiary care hospital in Thailand. The instruments were developed from the literature review. Data were analyzed using SPSS statistics, version 22. The study examined 441 patients with a total of 497 PIVC sites. Phlebitis (level 1 and 2 only) occurred at 2.41% of all sites; infiltration (level 1 and 2 only) occurred at 1.01% of all sites, and extravasation (mild and moderate only) occurred at 0.60% of all sites. Factors associated with the occurrence of infiltration complications included receiving intravenous (IV) crystalloids (P = .03) and receiving IV analgesic drugs (P = .001). Age was statistically significantly related to extravasation complications (P = .001). Nurses should be aware of possible complications from peripheral intravenous fluid administration, especially in older patients and those receiving IV crystalloids or analgesic drugs.
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Affiliation(s)
- Kraiwan Kaphan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Siriporn Auypornsakul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Jenjira Somno
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Watsaporn Wongwattananan
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Kamonthip Jamsittikul
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Wilaiporn Baicha
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Saowanuch Somsri
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
| | - Thanyanan Sawatrak
- Pediatric Nursing Section (Kaphan), Academic Work and Nursing Development Section (Auypornsakul), General Private Nursing Section (Somno), Surgery and Rehabilitation Nursing Section (Wongwattananan), Obstetrics and Gynecology Nursing Section (Jamsittikul), General Nursing Section (Baicha), Outpatient and Emergency Nursing Section (Somsri), and Medicine Nursing Section (Sawatrak), Chiang Mai University Hospital, Thailand
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15
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Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
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16
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Ertaş Akyüz G, Turan N. Association between peripheral intravenous catheters and clinical characteristics in the development of phlebitis. J Vasc Access 2024:11297298231226426. [PMID: 38336606 DOI: 10.1177/11297298231226426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Serious complications can develop from erroneous insertion of a peripheral intravenous catheter (PIVC). Successful PIVC insertion has a great place in the continuation of IV treatment without causing complications that may require the removal of the PIVC. METHODS The population for this prospective observational study included patients who had undergone PIVC insertion in the surgical, intensive care, and inpatient units of a large teaching and research hospital in Istanbul. Data were collected via a patient information form, a PIVC and treatment information form, the Visual Infusion Phlebitis (VIP) scale, and a PIVC nurse observation form. The SPSS 24 software package was used to analyze the data. RESULTS Of the 168 patients enrolled, 64.9% (n = 109) were male, and the mean age was 56.71 ± 17.97 years. The mean PIVC dwell time was 73.46 ± 21.57 h, and 32.7% (n = 55) of the catheters were removed due to discharge from hospital. Overall, 29.2% (n = 49) of the cases developed phlebitis, with half of the cases (51%, n = 25) developing grade 2 phlebitis and developed within 48 h in 38.8% of cases (n = 19). The mean PIVC dwell time was significantly lower in patients with phlebitis than in those with no phlebitis (p < 0.05). CONCLUSIONS It was determined that PIVC dwell time could be increased by routine surveillance to monitor for phlebitis regularly. It is recommended that education programs for nurses be developed to prevent PIVC-related complications.
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Affiliation(s)
- Gonca Ertaş Akyüz
- Graduate Education Institute, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nuray Turan
- Department of Fundamentals of Nursing, Faculty of Nursing, Istanbul University, Fatih, Istanbul, Turkey
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17
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Torné-Ruiz A, Reguant M, Sanromà-Ortiz M, Piriz M, Roca J, García-Expósito J. Assessment, Treatment, and Follow-Up of Phlebitis Related to Peripheral Venous Catheterisation: A Delphi Study in Spain. Healthcare (Basel) 2024; 12:378. [PMID: 38338263 PMCID: PMC10855708 DOI: 10.3390/healthcare12030378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Phlebitis related to peripheral venous catheters (PVCs) is a common complication in patients who require these devices and can have important consequences for the patients and the healthcare system. The management and control of the PVC-associated complications is related to nursing competency. The present study aims to determine, at the national level in Spain, the consensus on the assessment, treatment, and follow-up of PVC-related phlebitis and the importance of the actions taken. METHOD A three-round Delphi technique was used with clinical care nurses who are experts in the field of in-hospital intravenous treatment in Spain. For this, an online questionnaire was developed with three open-ended questions on the dimensions of phlebitis assessment, treatment, and follow-up. For the statistical analysis of the results, frequencies and percentages were used to determine consensus, and the measures of central tendency (mean, standard deviation, and the coefficient of variation) were used to rank importance. The coefficient of variation was set as acceptable at ≤30%. RESULTS The final sample was 27 expert nurses. At the conclusion of round 3, actions were ranked according to their importance, with six items included in the PVC-related phlebitis assessment (symptomatology/observation, redness, the Maddox scale, induration, temperature, and pain), two in treatment (catheter removal, pentosan polysulphate sodium ointment + application of cold), and just one in follow-up (general monitoring + temperature control). CONCLUSIONS There is a major disparity in relation to the PVC-related phlebitis assessment, treatment, and follow-up actions. More clinical studies are therefore needed to minimise the complications associated with the use of PVCs, given their impact on the quality of care and patient safety and their economic cost.
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Affiliation(s)
- Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Hospital Fundació Althaia, Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Mercedes Reguant
- Department of Research Methods and Diagnosis in Education, University of Barcelona, 08035 Barcelona, Spain;
| | - Montserrat Sanromà-Ortiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Blanquerna School of Health Science, Ramon Llull University, 08025 Barcelona, Spain
| | - Marta Piriz
- Infectious Diseases Division, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Judith García-Expósito
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (M.S.-O.); (J.G.-E.)
- Group Preving, 03003 Alicante, Spain
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Malinverni S, Kreps B, Lucaccioni T, Bouazza FZ, Bartiaux M, Plumacker A, Pascu A, Youatou Towo P. Effect of intranasal sufentanil on acute post-traumatic pain in the emergency department: a randomised controlled trial. Emerg Med J 2024; 41:83-88. [PMID: 37770120 DOI: 10.1136/emermed-2023-213353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Intranasal sufentanil is a potent opioid which can be used in patients with traumatic injuries presenting to the ED. Although previous studies have demonstrated the superiority of intranasal sufentanil over intravenous morphine in terms of pain relief, its clinical superiority in patients with traumatic injuries receiving adequate multimodal analgesia with acetaminophen and non-steroidal anti-inflammatory drugs is uncertain. We compared pain relief offered by intranasal sufentanil with that offered by oral and intravenous opioids in patients with acute traumatic injuries also receiving a specified regimen of non-opioid treatment. METHODS In this single-centre, open-label, parallel-group, randomised controlled superiority trial conducted between January 2020 and February 2022, trauma patients presenting to the ED with a pain score of ≥7 on a visual analogue scale (VAS) were randomised to receive either intranasal sufentanil or other oral/intravenous opioids alongside oral/intravenous acetaminophen and non-steroidal anti-inflammatory drugs. The primary outcome was reduction in VAS score 15-20 min after randomisation. RESULTS An intention-to-treat analysis included 170 out of 205 patients screened for inclusion. The intranasal sufentanil group (83 patients) showed a significantly greater reduction in pain when compared with the oral/intravenous opioid group (87 patients) 15-20 min after randomisation (reduction in VAS score 3.0 (IQR 1.7-5.0) vs 1.5 (IQR 0.9-3.0); p<0.001). Similarly, a greater reduction in pain was observed in the intranasal sufentanil group 60 min after randomisation (5.0 (IQR 3.0-7.0) vs 3.0 (IQR 2.0-5.3); p<0.001). However, side effects were more frequent in the intervention group (71.1% vs 23%; p<0.001). CONCLUSIONS Intranasal sufentanil was associated with more effective pain relief than oral/intravenous opioids in patients with traumatic injuries treated with coanalgesia. Intranasal sufentanil could be considered for the management of pain in patients with traumatic injuries associated with severe pain. TRIAL REGISTRATION NUMBER NCT04137198.
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Affiliation(s)
- Stefano Malinverni
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Bernard Kreps
- Emergency Department, Clinique Saint-Jean, Bruxelles, Belgium
| | - Thibault Lucaccioni
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Fatima-Zohra Bouazza
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Magali Bartiaux
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Alain Plumacker
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Andreea Pascu
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pierre Youatou Towo
- Emergency Department, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
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19
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Costa SPD, Silveira RED, Monteiro DAT, Contim D, Toffano SEM. Quality of care in peripheral venous catheterization: A scoping review. Rev Bras Enferm 2023; 76:e20220578. [PMID: 38055472 DOI: 10.1590/0034-7167-2022-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To map the current status of parameters and tools to assess quality of care related to peripheral venous catheter use in adults. METHODS Scoping review, conducted in 2022 in the MEDLINE, LILACS, CINAHL and SCOPUS databases and with a publication time limit from 2013 to 2022. RESULTS The sample consisted of 15 articles, summarized in the following categories: Indication, documentation and registration, coverage assessment, connection, stabilization and signs and symptoms inherent to the catheter. The use of a complete instrument, with the domains observed in this review, may have a positive impact on a more effective and safe clinical practice. CONCLUSIONS The present review mapped the evidence about the insertion and maintenance of peripheral venous catheters that can be improved with training of good practices and the quality of the team, regarding the use of tools, materials and instruments for the evaluation of care.
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Affiliation(s)
| | | | | | - Divanice Contim
- Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
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20
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Hearon CM, Peters K, Dias KA, Macnamara JP, Marshall JET, Campain J, Martin D, Marshal‐Goebel K, Levine BD. Assessment of venous pressure by compression sonography of the internal jugular vein during 3 days of bed rest. Exp Physiol 2023; 108:1560-1568. [PMID: 37824038 PMCID: PMC10988448 DOI: 10.1113/ep091372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
Compression sonography has been proposed as a method for non-invasive measurement of venous pressures during spaceflight, but initial reports of venous pressure measured by compression ultrasound conflict with prior reports of invasively measured central venous pressure (CVP). The aim of this study is to determine the agreement of compression sonography of the internal jugular vein (IJVP) with invasive measures of CVP over a range of pressures relevant to microgravity exposure. Ten healthy volunteers (18-55 years, five female) completed two 3-day sessions of supine bed rest to simulate microgravity. IJVP and CVP were measured in the seated position, and in the supine position throughout 3 days of bed rest. The range of CVP recorded was in line with previous reports of CVP during changes in posture on Earth and in microgravity. The correlation between IJVP and CVP was poor when measured during spontaneous breathing (r = 0.29; R2 = 0.09; P = 0.0002; standard error of the estimate (SEE) = 3.0 mmHg) or end-expiration CVP (CVPEE ; r = 0.19; R2 = 0.04; P = 0.121; SEE = 3.0 mmHg). There was a modest correlation between the change in CVP and the change in IJVP for both spontaneous ΔCVP (r = 0.49; R2 = 0.24; P < 0.0001) and ΔCVPEE (r = 0.58; R2 = 0.34; P < 0.0001). Bland-Altman analysis of IJVP revealed a large positive bias compared to spontaneous breathing CVP (3.6 mmHg; SD = 4.0; CV = 85%; P < 0.0001) and CVPEE (3.6 mmHg; SD = 4.2; CV = 84%; P < 0.0001). Assessment of absolute IJVP via compression sonography correlated poorly with direct measurements of CVP by invasive catheterization over a range of venous pressures that are physiologically relevant to spaceflight. However, compression sonography showed modest utility for tracking changes in venous pressure over time. NEW FINDINGS: What is the central question of this study? Compression sonography has been proposed as a novel method for non-invasive measurement of venous pressures during spaceflight. However, the accuracy has not yet been confirmed in the range of CVP experienced by astronauts during spaceflight. What is the main finding and its importance? Our data show that compression sonography of the internal jugular vein correlates poorly with direct measurement of central venous pressures in a range that is physiologically relevant to spaceflight. However, compression sonography showed modest utility for tracking changes in venous pressure over time.
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Affiliation(s)
- Christopher M. Hearon
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Kirsten Peters
- University Medical CenterRadboud UniversityNijmegenthe Netherlands
| | - Katrin A. Dias
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - James P. Macnamara
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - John E. T. Marshall
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Joseph Campain
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | | | | | - Benjamin D. Levine
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
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21
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Blanco-Mavillard I, Personat-Labrador C, Castro-Sánchez E, Rodríguez-Calero MÁ, Fernández-Fernández I, Carr PJ, Armenteros-Yeguas V, Parra-García G, de Pedro-Gómez J. Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation. J Infect Public Health 2023; 16:1994-2000. [PMID: 37890222 DOI: 10.1016/j.jiph.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Around 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international consensus on relevance and feasibility of clinical practice guideline recommendations to reduce PIVC failure. METHODS e-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals. FINDINGS Over 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3). CONCLUSION We provide an international consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital de Manacor, Implementation, Research, and Innovation Unit, Manacor, Spain; Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Celia Personat-Labrador
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Health Public Office, Balearic Islands Health Service, Palma, Spain
| | - Enrique Castro-Sánchez
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom; Universitat de les Illes Balears, Global Health and Lifestyles (EVES) Group, Palma, Spain.
| | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Hospital Universitario Torrecárdenas, Almeria, Spain
| | | | - Peter J Carr
- School of Nursing and Midwifery at the National University of Ireland Galway (NUIG), Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) group, Australia
| | - Victoria Armenteros-Yeguas
- Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain; Bioaraba, Vascular Care Research Group, Vitoria-Gasteiz, Spain
| | | | - Joan de Pedro-Gómez
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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22
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Torné-Ruiz A, García-Expósito J, Bonet A, Masot O, Roca J, Selva-Pareja L. Evolution of Scientific Production on Phlebitis Secondary to Vascular Access: A 71-Year Bibliometric Analysis. NURSING REPORTS 2023; 13:1635-1647. [PMID: 37987414 PMCID: PMC10661289 DOI: 10.3390/nursrep13040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Phlebitis secondary to vascular access is one of the most frequent complications in hospital care. This study aims to evaluate the scientific activity related to this complication through a bibliometric analysis. The search was performed on a single day, 23 January 2023, to ensure the inclusion of all articles and to avoid bias caused by the daily updates of the open access database. The data were recovered from Web of Science. The sample comprised a total of 1596 publications that met the inclusion criteria. The United States was the country with the largest number of publications, citations, and international cooperation with respect to phlebitis and vascular access. The most important author was Rickard CM. Of all the publications selected, a total of 1586 (99.37%) were original articles. The highest number of articles on the subject was recorded in 2021, and the most common research areas were General Internal Medicine and Nursing. The analysis of the clusters (KeyWords Plus and Author keywords) and co-occurrences enabled identification of areas of interest and their possible development. These areas included the prevention, risk, and associated complications of catheter-associated phlebitis. Other aspects that are a priori relevant, such as assessment and treatment, were found to be little investigated. While research on this subject is increasing internationally, more collaborations are still required between researchers, as well as new approaches related to the management of catheter-associated phlebitis. The dimensions that should continue to be considered in new research, according to the findings of this review, are instruments for phlebitis assessment and their validation, and the treatments to follow in the case of established phlebitis. For this reason, the bibliometric information presented is key for new or consolidated researchers in the field, especially because of its practical and clinical implications for patient safety.
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Affiliation(s)
- Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Hospital Fundació Althaia, Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Judith García-Expósito
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Group Preving (Vitaly), 03003 Alicante, Spain
| | - Aida Bonet
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Laia Selva-Pareja
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
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23
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Schultz B, Bertenshaw C, Parker L. Out-of-hospital intravenous catheter insertion: Now is not the time to sit idle. Am J Infect Control 2023; 51:1292-1293. [PMID: 37737746 DOI: 10.1016/j.ajic.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Brendan Schultz
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.
| | - Claire Bertenshaw
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia
| | - Lachlan Parker
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia
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24
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Marsh N, Larsen E, O'Brien C, Peach H, Keogh S, Davies K, Mihala G, Hewer B, Booker C, McCarthy AL, Flynn J, Rickard CM. Controlling peripheral intravenous catheter failure by needleless connector design: A pilot randomised controlled trial. J Clin Nurs 2023; 32:7909-7919. [PMID: 37587796 DOI: 10.1111/jocn.16852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
AIM To test the feasibility of a study protocol that compared the efficacy of neutral- and negative-pressure needleless connectors (NCs). DESIGN A single-centre, parallel-group, pilot randomised control trial. METHODS Our study compared neutral-(intervention) and negative-pressure (control) NCs among adult patients in an Australian hospital. The primary feasibility outcome was measured against predetermined criteria (e.g. eligibility, attrition). The primary efficacy outcome was all-cause peripheral intravenous catheter failure, analysed as time-to-event data. RESULTS In total, 201 (100 control; 101 intervention) participants were enrolled between March 2020 and September 2020. All feasibility criteria were met except eligibility, which was lower (78%) than the 90% criterion. All-cause peripheral intravenous catheter failure was significantly higher in the intervention group (39%) compared to control (19%). CONCLUSION With minor modifications to participant screening for eligibility, this randomised control trial is feasible for a large multicentre randomised control trial. The neutral NC was associated with an increased risk of peripheral intravenous catheter failure. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There are several NC designs available, often identified by their mechanism of pressure (positive, negative and neutral). However, NCs can contribute to peripheral intravenous catheter failure. This is the first randomised controlled trial to compare neutral and negative NC designs. Negative pressure NCs had lower PIVC failure compared to neutral NCs, however the results might not be generalisable to other brands or treatment settings. Further high-quality research is needed to explore NC design. REPORTING METHOD Study methods and results reported in adherence to the CONSORT Statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Emily Larsen
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Hannah Peach
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Samantha Keogh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - Karen Davies
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Catriona Booker
- Nursing and Midwifery Research Centre, Internal Medicine Services, Workforce Development and Education Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Mater Research Institute, Brisbane, Queensland, Australia
| | - Julie Flynn
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, School of Medicine and Dentistry, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
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25
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Matthews R, Gavin NC, Marsh N, Marquart-Wilson L, Keogh S. Peripheral intravenous catheter material and design to reduce device failure: A systematic review and meta-analysis. Infect Dis Health 2023; 28:298-307. [PMID: 37419781 DOI: 10.1016/j.idh.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Patients require vascular access for medical treatments, diagnostic procedures and symptom management. Current failure rates of peripheral intravascular catheters (PIVCs) are unacceptably high (40-50%). This systematic review aimed to determine the effect of different PIVC materials and designs on the incidence of PIVC failure. METHODS A systematic search was conducted in November 2022 using CINAHL, PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Randomised controlled trials that compared PIVC novel PIVC material/design and standard material/design were included. The primary outcome was all causes of PIVC failure, any reason for device removal due to cessation of device function; and secondary outcomes included individual PIVC complications and infection (local or systemic), and dwell times. Quality appraisal was conducted using the Cochrane risk of bias tool. A meta-analysis was performed using random effects model. RESULTS Seven randomised controlled trials were eligible for inclusion. In meta-analysis, the impact of material and design on PIVC failure in the studies favoured the intervention arms (RR 0.71, 95% CI 0.57-0.89), however there was substantial heterogeneity (I2 = 81%, 95% CI 61-91%). Through subgroup analyses, a significant difference on PIVC failure favoured the closed system over the open system (RR 0.85, 95% CI 0.73 to 0.99; I2 = 23%, 95% CI 0-90%). CONCLUSION Catheter material and design can impact PIVC outcome. Conclusive recommendations are limited due to the small number of studies and inconsistent reporting of clinical outcomes. Further rigorous research of PIVC types is necessary to improve clinical practice and device selection pathways should reflect the resulting evidence.
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Affiliation(s)
- Robyn Matthews
- Cancer Nursing Professorial Precinct, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Nicole C Gavin
- Cancer Nursing Professorial Precinct, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Redcliffe Hospital, Brisbane, Queensland, Australia.
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Louise Marquart-Wilson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia; QIMR Berghofer, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia. https://twitter.com/S2Keogh
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26
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Fraifeld A, Thompson JA. Incorporating Near Infrared Light Vein Visualization Technology Into Peripheral Intravenous Access Protocols. JOURNAL OF INFUSION NURSING 2023; 46:313-319. [PMID: 37920105 DOI: 10.1097/nan.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Placement of peripheral intravenous catheters (PIVCs) is a frequent occurrence. Yet, PIVCs consistently require multiple attempts for successful cannulation, leading to an increased use of resources and risk of complications. Even though hospitals have established vascular access teams to improve outcomes and increase longevity of PIVCs, not every facility has one, and some struggle to meet demand. In these cases, PIVC placement depends on the confidence and skills of bedside nurses. Difficult access risk identification tools, as well as vein visualization technologies, like near infrared (nIR), have been developed to assist nurses with cannulation. This study sought to explore how hospitals are using vein visualization technology in nurse-driven protocols and to evaluate whether the technology is being meaningfully integrated into venous assessment and PIVC access protocols. In a survey sent to facilities utilizing nIR technology, 48% of respondents incorporated nIR in nurse-driven protocols. Of these respondents, 88% reported improvement in patient satisfaction, 92% saw a reduction in escalations, and 79% reported a reduction in hospital-acquired infections associated with PIVC placement. Integrating vein visualization technology into nurse-driven PIVC placement protocols has the potential to make a positive impact but requires future research to reproduce these findings in clinical studies.
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Affiliation(s)
- Anna Fraifeld
- Anna Fraifeld, DNP, CRNA, is a certified registered nurse anesthetist from South Carolina. She has been in health care for nearly a decade after completing a Bachelor of Public Health from the University of North Florida, Bachelor of Science in Nursing from Johns Hopkins University, and Doctor of Nursing Practice from Duke University. Her previous areas of experience include intensive care unit care, code and rapid response teams, and emergent vascular access, and she has served on nursing shared governance committees to improve patient care. She currently works in South Carolina as a staff nurse anesthetist in a level 1 trauma center and focuses her areas of research on waste management and vascular access
- Julie A.Thompson, PhD, is a consulting associate from North Carolina. She is a National Institutes of Health-funded researcher with over 15 years of methodological and statistical consulting. Her initial work focused on pediatric populations in the neonatal intensive care unit (ICU), pediatric ICU, and transitional units at Duke Children's Hospital, which expanded to encompass adult, medical/surgical, and behavioral health research domains. She is currently a study design and data analysis consultant for doctoral student and faculty projects at Duke University School of Nursing
| | - Julie A Thompson
- Anna Fraifeld, DNP, CRNA, is a certified registered nurse anesthetist from South Carolina. She has been in health care for nearly a decade after completing a Bachelor of Public Health from the University of North Florida, Bachelor of Science in Nursing from Johns Hopkins University, and Doctor of Nursing Practice from Duke University. Her previous areas of experience include intensive care unit care, code and rapid response teams, and emergent vascular access, and she has served on nursing shared governance committees to improve patient care. She currently works in South Carolina as a staff nurse anesthetist in a level 1 trauma center and focuses her areas of research on waste management and vascular access
- Julie A.Thompson, PhD, is a consulting associate from North Carolina. She is a National Institutes of Health-funded researcher with over 15 years of methodological and statistical consulting. Her initial work focused on pediatric populations in the neonatal intensive care unit (ICU), pediatric ICU, and transitional units at Duke Children's Hospital, which expanded to encompass adult, medical/surgical, and behavioral health research domains. She is currently a study design and data analysis consultant for doctoral student and faculty projects at Duke University School of Nursing
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Matula E, Mastrocco A, Prittie J, Weltman J, Keyserling C. Microorganism colonization of peripheral venous catheters in a small animal clinical setting. J Vet Emerg Crit Care (San Antonio) 2023; 33:509-519. [PMID: 37585353 DOI: 10.1111/vec.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To compare the incidence of microorganism colonization of peripheral venous catheters (PVCs) placed in the Emergency Department (ED) to those placed in a routine preoperative setting. The relationship between catheter tip colonization and patient urgency (as assessed by triage priority) was also evaluated. DESIGN Prospective, observational study from January 2021 to October 2021. SETTING Emergency room and clinical areas of a large, urban, tertiary referral center. ANIMALS Three hundred dogs and 94 cats with a PVC in place for a minimum of 24 hours were enrolled in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred and eighty-eight PVCs were placed in the ED and 106 were placed preoperatively. The overall colonization rate was 10.4% (41/394). Sixteen bacterial and 1 fungal genera were cultured. Eight of these bacterial genera (25/51 [49%] bacterial isolates) were resistant to at least 1 antimicrobial class. Twenty-nine of 288 (10.1%) catheters positive for colonization were placed in the ED, whereas 12 of 106 (11.3%) were placed preoperatively. There was no association between microorganism growth on catheters and clinical area of catheter placement. There was also no association between ED patient urgency and positive catheter tip culture. No significant risk factors were identified predisposing to colonization of PVCs. CONCLUSIONS The overall incidence of microorganism colonization of PVCs in this study population was equivalent to, or lower than, previously reported in veterinary literature. There was no statistical difference between the catheters placed in the ED and those placed for routine surgical procedures. Patient urgency did not affect the incidence of positivity of peripheral catheter tip cultures.
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Affiliation(s)
- Erica Matula
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Alicia Mastrocco
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Jennifer Prittie
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Joel Weltman
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
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Borgonovo F, Quici M, Gidaro A, Giustivi D, Cattaneo D, Gervasoni C, Calloni M, Martini E, La Cava L, Antinori S, Cogliati C, Gori A, Foschi A. Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review. Antibiotics (Basel) 2023; 12:1338. [PMID: 37627758 PMCID: PMC10451375 DOI: 10.3390/antibiotics12081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.
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Affiliation(s)
- Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Massimiliano Quici
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Antonio Gidaro
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Davide Giustivi
- Emergency Department and Vascular Access Team ASST Lodi, 26900 Lodi, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Calloni
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Elena Martini
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Leyla La Cava
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Chiara Cogliati
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
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Zingg W, Barton A, Bitmead J, Eggimann P, Pujol M, Simon A, Tatzel J. Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. Infect Prev Pract 2023; 5:100271. [PMID: 36910422 PMCID: PMC9995289 DOI: 10.1016/j.infpip.2023.100271] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device in health care with an overall failure rate of 35-50%. Most complications are non-infectious, but local site and bloodstream infections can also occur. Even if PIVC-related infections are rare, the total number of affected patients and the preponderance of Staphylococcus aureus as related pathogen due to the frequent use of these devices are relevant arguments to implement preventive strategies. The aim of this document is to raise awareness that infections caused by PIVCs are a relevant problem that can be reduced by practice change. Methods A panel of experts discussed this topic based on evidence and proposed practice points by consensus. Discussion Despite published evidence-based guidelines, current practice concerning aseptic techniques during insertion and care of PIVCs often are substandard. These devices have become commonplace and tend to be perceived as safe. An overall lack of awareness about the true risks associated with the use of PIVCs results in limited surveillance and prevention efforts. Conclusion Successful insertion and maintenance bundles in central venous lines are a blueprint to the implementation of adapted bundle strategies in the prevention of PIVC-associated infections. There is a need for studies to specifically investigate infection prevention in PIVCs and to agree on effective and implementable bundles.
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Affiliation(s)
- Walter Zingg
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrew Barton
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - James Bitmead
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Miquel Pujol
- University Hospital de Bellvitge, Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Arne Simon
- Saarland University Clinic, Homburg, Germany
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Caramia R, Recchia N, Santoro S, Ammirabile L, Fedele P. A late spontaneous peripherally inserted central catheter migration: two cases series. Arch Clin Cases 2023; 10:61-65. [PMID: 37220597 PMCID: PMC10194171 DOI: 10.22551/2023.39.1002.10242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
A central venous catheter is a flexible catheter that is inserted into a vein and ends close to the superior vena cava. It may be inserted through a vein in the neck, chest, or arm. It's also called a central venous line or central line. Peripherally inserted central venous catheters (PICCs) are usually implanted in arm veins such as the basilic vein, the brachial veins or in some cases in the cephalic vein. PICCs can remain in place for up to six months or more. If properly managed, they last even more than a year. PICCs offer the advantage of greater safety for infusion of vesicants/irritants and hyperosmolar solutions and enable the administration of antibiotics, prolonged parenteral nutrition, and chemotherapy agents. They are however, associated with some adverse events such as spontaneous late migration. The reasons for these complications are not yet fully understood. There are now established causes and in some cases hypotheses to explain these phenomena. We describe two clinical cases in which apparently correctly positioned PICCs migrated spontaneously from their original position. The identification of the migration of the vascular catheter was accidental in the two patients, and they did not developed complications. One of the two patients had a pacemaker. The remote migration of a PICC is an event that can occur, and the causes are not definitively clarified in all cases.
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Affiliation(s)
- Remo Caramia
- Anesthesia, Resuscitation and Pain Therapy Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Nicola Recchia
- Radiology Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Silvia Santoro
- Radiology Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Lorenzo Ammirabile
- Day Service General Surgery - Endoscopy, “Umberto I” Hospital, Fasano, (BR), Italy
| | - Pietro Fedele
- Anesthesia, Resuscitation and Pain Therapy Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
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Corley A, O'Brien C, Larsen E, Peach H, Rickard C, Hewer B, Pearse I, Fenn M, Cocksedge R, Marsh N. Does longer peripheral intravenous catheter length optimise antimicrobial delivery? Protocol for the LEADER study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S24-S30. [PMID: 37027419 DOI: 10.12968/bjon.2023.32.7.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Hospitalised patients receiving intravenous antimicrobial therapy require a reliable device through which this is delivered. Short peripheral intravenous catheters (PIVCs) are the default device for antimicrobial therapy but up to half fail before therapy completion, leading to suboptimal drug dosing, patient distress from repeated insertions, and increased healthcare costs. This study will investigate the use of long PIVCs to determine if they are more reliable at delivering antimicrobial therapy. METHODS A two-arm, parallel randomised controlled trial of hospitalised adults requiring at least 3 days of peripherally compatible intravenous antimicrobials. Participants will be randomised to a short (<4 cm) or long (4.5-6.4 cm) PIVC. After interim analysis ( n=70) for feasibility and safety, 192 participants will be recruited. Primary outcome is disruption to antimicrobial administration from all-cause PIVC failure. Secondary outcomes include: number of devices to complete therapy, patient-reported pain and satisfaction, and a cost analysis. Ethical and regulatory approvals have been received.
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Affiliation(s)
- Amanda Corley
- Research Fellow (Clinician Researcher), School of Nursing and Midwifery, Griffith University, Nathan, Australia/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Catherine O'Brien
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Emily Larsen
- Research Fellow (Vascular Access), School of Nursing and Midwifery, Griffith University/Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Hannah Peach
- Clinical Research Nurse, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia/Herston Infectious Diseases Institute, Metro North Health, Herston, Australia
| | - Barbara Hewer
- Clinical Nurse Consultant, Vascular Access and Surveillance and Education, Royal Brisbane and Women's Hospital
| | - India Pearse
- Nurse Researcher, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital
| | - Mary Fenn
- Senior Research Assistant, School of Nursing and Midwifery, Griffith University
| | - Ruth Cocksedge
- Senior Research Assistant, School of Medicine and Dentistry, Griffith University
| | - Nicole Marsh
- Nursing and Midwifery Director, Research, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital/Professor, School of Nursing and Midwifery, Griffith University
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Drugeon B, Guenezan J, Pichon M, Devos A, Fouassin X, Neveu A, Boinot L, Pratt V, Mimoz O. Incidence, complications and costs of peripheral venous catheter-related bacteraemia: A retrospective, single centre study. J Hosp Infect 2023; 135:67-73. [PMID: 36918069 DOI: 10.1016/j.jhin.2023.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
The aim of the present study was to estimate the current incidence, complications and costs of BSI attributable to PVC. Patients with PVC-related BSI (cases) were matched with patients without PVC-related BSI (controls). From January 1st, 2018 to March 31th, 2020 9,833 out of 113,068 patients visiting the emergency department (9%) were hospitalised in a medical ward after insertion of a PVC. Among them, 581 (6%) had at least one positive blood culture (BC). Twenty-five (4%) of these were judged as having a PVC-related BSI. Major complications were noted in nine patients. One patient presented severe sepsis requiring admission to intensive care unit for eleven days followed by thoracic (T4 to T7) spondylodiscitis requiring prolonged antimicrobial therapy. Another patient developed mitral valve endocarditis also requiring prolonged antimicrobial therapy. One patient developed a pre-sacral abscess three months after initial PVC infection and required hospital readmission for 19 days for drainage. Median [IQR] hospital stay costs were €11,597 [€8,479-€23,759] for cases and €6,789 [€4,019-€10,764] for controls, leading to median additional costs of €5,587. In conclusion, even though the risk of developing PVC-related BSI in patients admitted to medical wards may seem low, complications of PVC-related BSI are severe, and the associated mortality remains high. The financial resources used to treat these complications could be better spent on prevention, including the use of high-quality materials and technologies, and improved training of health care providers.
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Affiliation(s)
- B Drugeon
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France
| | - J Guenezan
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France
| | - M Pichon
- Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; CHU de Poitiers, Département des Agents Infectieux, Laboratoire de Bactériologie-Hygiène, Poitiers, France
| | - A Devos
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France
| | - X Fouassin
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - A Neveu
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - L Boinot
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - V Pratt
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - O Mimoz
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France.
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Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters. Heart Lung 2023; 60:39-44. [PMID: 36898280 DOI: 10.1016/j.hrtlng.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices. OBJECTIVES To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location. METHODS Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis. RESULTS In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location - not the catheter itself - was an independent predictor of a catheter failure (HR 6.762; p = 0.023). CONCLUSIONS The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste 34148, Italy.
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Woo S, Nah S, Kim G, Han S. Fracture of an Intravenous Cannula in the Hand: A Case Report. J Emerg Nurs 2023; 49:156-161. [PMID: 36588071 DOI: 10.1016/j.jen.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intravenous cannula insertion is important, given that it is the most common invasive procedure in the emergency department for blood sampling, fluid resuscitation, and intravenous drug administration. Complications of intravenous catheterization include pain, phlebitis, extravasation, inflammation, and embolization. Fracture of an intravenous cannula is rare, but delayed removal may result in secondary damage, such as vasculitis or embolization, with critical consequences. Here, we report a case of intravenous cannula fracture that occurred in our emergency department. CASE PRESENTATION A 63-year-old woman with a history of left ovarian cancer visited our emergency department owing to poor oral intake and general weakness. Intravenous catheterization using an 18 gauge cannula was attempted for intravenous fluid administration by a skilled operator, but it failed owing to collapsed veins and poor skin condition. After several attempts, a vein in the patient's hand was ruptured, and the patient complained of severe pain. The cannula was removed, but one-third of the cannula tip could not be seen. X-ray imaging was performed to locate the fragment of the cannula, and venotomy was performed for removal of the foreign body in the emergency department. CONCLUSION Emergency physicians and nurses should be vigilant about potential risk factors that can cause fracture of an intravenous cannula, and after the fracture is discovered, rapid removal of the cannula tip should be performed in the emergency department.
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Paterson RS, Larsen EN, Cooke M, Rickard CM, Walker RM, Marsh N. Integrated versus non-integrated peripheral intravenous catheters: a cross-sectional survey of nurse experiences. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S6-S16. [PMID: 36715520 DOI: 10.12968/bjon.2023.32.2.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Integrated peripheral intravenous catheters (PIVCs) demonstrate clinical efficacy, however, device complexity and design differences may be a potential barrier to implementation. AIMS To assess nurse acceptability of integrated PIVC systems. METHODS A cross-sectional survey was nested within a multicentre randomised controlled trial. One hundred nurses caring for patients with integrated and non-integrated PIVCs completed a 17-item survey about key differences between devices (eg function and appearance, perceived patient comfort and skin injuries). FINDINGS Most nurses reported the integrated PIVC wings prevented device movement (80%), achieved patient comfort in areas of flexion (78%), and no patients developed skin injuries (100%). Nurses rated the ease of accessing and overall confidence using the integrated PIVC as significantly higher than the non-integrated design (P<0.001). CONCLUSION The integrated PIVC received positive feedback from nurses and had few barriers to implementation.
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Affiliation(s)
- Rebecca S Paterson
- Senior Research Assistant, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Emily N Larsen
- Research Fellow, Vascular Access, Griffith University and Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marie Cooke
- Professor Emeritus, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- Professor, Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Rachel M Walker
- Associate Professor, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole Marsh
- Professor and Nursing and Midwifery Director (Research), Griffith University and Royal Brisbane and Women's Hospital, Brisbane, Australia
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Walker RM, Pires MPO, Ray-Barruel G, Cooke M, Mihala G, Azevedo SS, Peterlini MAS, Felipe MDAA, Álvarez CP, Quintanilla M, Corzo MC, Villareal GC, Cigarroa EN, Pedreira MLG, Rickard CM. Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study. Front Med (Lausanne) 2023; 9:1039232. [PMID: 36687407 PMCID: PMC9846050 DOI: 10.3389/fmed.2022.1039232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Peripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs. Methods In 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement. Results A total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8-72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant. Conclusion Given the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.
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Affiliation(s)
- Rachel M. Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maria Paula Oliveira Pires
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,*Correspondence: Maria Paula Oliveira Pires,
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Silvia Schoenau Azevedo
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Cirlia Petrona Álvarez
- Infection Control Service, Asociación de Terapia de Infusión y Seguridad del Paciente (ATISPA), Buenos Aires, Argentina
| | | | | | - Gabriela Cortez Villareal
- National Institute of Cardiology Ignacio Chávez, Directorate of Quality and Health Education of the Ministry of Health of Mexico, Ciudad de México, Mexico
| | - Eliazib Nataren Cigarroa
- Dr. Jesús Gilberto Gómez Maza Hospital, Health Services of the State of Chiapas, Tuxtla Gutiérrez, Mexico
| | - Mavilde L. G. Pedreira
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| | - Claire M. Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
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Bahl A, Gibson SM, Jankowski D, Chen NW. Short peripheral intravenous catheter securement with cyanoacrylate glue compared to conventional dressing: A randomized controlled trial. J Vasc Access 2023; 24:52-63. [PMID: 34112019 DOI: 10.1177/11297298211024037] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Short peripheral intravenous catheters (PIVCs) fail prior to completion of therapy in up to 63% of hospitalizations. This unacceptably high rate of failure has become the norm for the most common invasive procedure in all of medicine. Securement strategies may improve PIVC survival. METHODS We conducted a prospective, single-site, parallel, two-arm randomized controlled investigation with a primary outcome of catheter failure comparing securement with standard semi-permeable dressing and clear tape (SPD) to standard semipermeable dressing and clear tape with cyanoacrylate glue (SPD + CG). Adult emergency department patients with a short PIVC and anticipated hospital duration ⩾ 48 h were enrolled and followed until IV failure or completion of therapy for up to 7 days. Secondary outcomes included complications and cost comparisons between groups. Primary outcome was assessed by intention to treat and per protocol analyses. FINDINGS 350 patients were enrolled between November 2019 and October 2020. PIVC survival for SPD + CG was similar to SPD group with the absolute risk difference of IV failure in the intention-to-treat (-5.8%, p = 0.065) population and improved in the per protocol (-8.1%, p = 0.04) population, respectively. Kaplan-Meier survival analysis indicated there was a significant benefit of the SPD + CG at greater than 2 days of hospitalization (p = 0.04). Prior to 48 h, there was no survival enhancement to either group (p = 0.98) in the intention to treat population. In a multivariable analysis with piecewise Cox regression, when the IV was functional greater than 48 h, the risk of IV failure in the SPD + CG was 43% less than the SPD group (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34 to 0.97; p = 0.04). Cumulative cost related to IV during hospitalization was similar between groups with a lower incremental rescue cost in the SPD + CG group. INTERPRETATION SPD combined with cyanoacrylate glue provides similar benefit to patients compared to SPD alone and potentially improves short PIVC survival when the IV was inserted >48 h. As this strategy is cost neutral, it could be considered in admitted patients, particularly those with longer anticipated hospital durations.
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Affiliation(s)
- Amit Bahl
- Beaumont Hospital, Royal Oak, MI, USA
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Rickard CM, Larsen E, Walker RM, Mihala G, Byrnes J, Saiyed M, Cooke M, Finucane J, Carr PJ, Marsh N. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med 2023; 18:21-32. [PMID: 36372995 PMCID: PMC10099685 DOI: 10.1002/jhm.12995] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Emily Larsen
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Rachel M Walker
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing Professional Development Unit, Division of Surgery, Princess Alexandra Hospital, Buranda, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Masnoon Saiyed
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Julie Finucane
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro South Hospitals and Health Service, Queen Elizabeth II Hospital, Nathan, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Nursing and Midwifery Research Centre, Herston Infectious Diseases Institute, Metro North Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Corley A, Ullman AJ, Marsh N, Genzel J, Larsen EN, Young E, Booker C, Harris PNA, Rickard CM. A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure. Heart Lung 2023; 57:45-53. [PMID: 36041346 DOI: 10.1016/j.hrtlng.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. OBJECTIVES To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. METHODS In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. EXCLUSIONS laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. PRIMARY OUTCOME feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). SECONDARY OUTCOMES PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. RESULTS Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4-2.7) and 2.1 (95% CI 0.9-5.1) for Bundles 1 and 2, respectively. CONCLUSIONS A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Australia.
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Jodie Genzel
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Emily Young
- Centre for Applied Economics, School of Medicine, Griffith University, Nathan, 4111, Australia.
| | - Catriona Booker
- Workforce Development & Education Unit, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Patrick N A Harris
- Pathology Queensland, Health Support Queensland, Herston, 4006, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
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Ray-Barruel G, Alexander M. CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. Am J Nurs 2023; 123:32-37. [PMID: 37718967 DOI: 10.1097/01.naj.0000905568.37179.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.
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Affiliation(s)
- Gillian Ray-Barruel
- Gillian Ray-Barruel is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health. Mary Alexander is chief executive officer of the Infusion Nurses Society in Norwood, MA. Contact author: Gillian Ray-Barruel, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Hematology and coagulation preanalytics for clinical chemists: Factors intrinsic to the sample and extrinsic to the patient. Clin Biochem 2022; 115:3-12. [PMID: 36493884 DOI: 10.1016/j.clinbiochem.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
In hematology and coagulation, diligence in the preanalytical phase of testing is of critical importance to obtaining reliable test results. If the sample used for testing is unsuitable, even outstanding analytical procedures and technology cannot produce a clinically-reliable result. Therefore, the intent of this manuscript is to review preanalytical factors intrinsic to the sample that affect the hematology and coagulation testing. Factors intrinsic to the sample (excluding in vivo anomalies) can be controlled, theoretically, by phlebotomists (including nurses) and laboratorians in the preanalytical phase of testing. Furthermore, the management and prevention of such factors is highlighted. Erroneous control of preanalytical factors can produce laboratory errors.
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Marsh N, Larsen EN, O'Brien C, Ware RS, Kleidon TM, Groom P, Hewer B, Alexandrou E, Flynn J, Woollett K, Rickard CM. Safety and efficacy of midline catheters versus peripheral intravenous catheters: A pilot randomized controlled trial. Int J Nurs Pract 2022; 29:e13110. [PMID: 36303515 DOI: 10.1111/ijn.13110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite pervasive need for peripheral intravenous catheters, insertion is often difficult, and approximately two thirds fail prematurely. Midline catheters are an alternative long peripheral catheter, inserted in the upper arm, ideal for patients with difficult access. AIM The aim of this study is to test feasibility of the protocol and compare the efficacy and safety of midline catheters to peripheral intravenous catheters. DESIGN A parallel-group, pilot randomized controlled trial of adult medical/surgical hospitalized patients, from a single Australian referral hospital. METHODS Participants with difficult vascular access (≤2 palpable veins) and/or anticipated ≥5 days of peripherally compatible intravenous therapy were recruited between May 2019 and March 2020. Participants were randomized to (1) peripheral intravenous catheter or (2) midline catheter. Primary feasibility outcome measured eligibility, recruitment, protocol adherence, retention and attrition. Primary clinical outcomes measured device insertion failure and post-insertion failure. RESULTS In total, n = 143 participants (71 peripheral intravenous catheters and 72 midline catheters) were recruited; n = 139 were analysed. Most feasibility criteria were met. Peripheral intravenous catheters had shorter functional dwell time, with higher incidence of post-insertion failure compared to midline catheters. CONCLUSION Midline catheters appear to be superior for patients with difficult vascular access or receiving prolonged intravenous therapy; a large, multi-centre trial to confirm findings is feasible.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
- School of Nursing Queensland University of Technology Kelvin Grove Queensland Australia
| | - Emily N. Larsen
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Robert S. Ware
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
| | - Tricia M. Kleidon
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- Queensland Children's Hospital South Brisbane Queensland Australia
| | - Peter Groom
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Evan Alexandrou
- Liverpool Hospital, Department of Intensive Care Liverpool New South Wales Australia
- School of Nursing and Midwifery Western Sydney University New South Wales Australia
| | - Julie Flynn
- School of Nursing and Midwifery University of Southern Queensland Ipswich Queensland Australia
| | - Kaylene Woollett
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
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Marsh N, Ray-Barruel G, Adzemovic T, Larsen EN, Rickard CM, Pelecanos A, Hadikusumo S, Chopra V. Awareness of Peripheral Intravenous Catheters Among Nurses, Physicians, and Students. J Patient Saf 2022; 18:e1041-e1046. [PMID: 35588379 DOI: 10.1097/pts.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Peripheral intravenous catheters (PIVCs) are frequently used to meet patients' short-term health care needs. However, many PIVCs are not promptly removed at the completion of treatment, placing patients at risk of avoidable harm from serious complications including local and systemic infection. This study aims to report the proportion and accuracy of health care staff/students awareness of the presence of their patient's PIVC. METHODS We asked staff/students to recall the presence or absence of a PIVC in a patient under their care, as well as details of the date of insertion and PIVC location. We recorded concordance of responses with direct observations. To achieve this, face-to-face interviews were conducted with clinical staff/students at 2 adult hospitals. RESULTS Overall, 90% (n = 216) of staff responses (94% of nurses, 100% of nursing students, 76% of medical staff) correctly identified the presence/absence of a PIVC. Clinicians correctly identified the PIVC location 55% (n = 71) of the time. CONCLUSIONS Health care services must recognize the implications of this lack of awareness and implement and evaluate tailored quality improvement efforts to address this.
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Affiliation(s)
| | | | - Tessa Adzemovic
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Queensland, Herston
| | - Stephanie Hadikusumo
- From the Nursing and Midwifery Research Centre, Centre for Medical Officer Recruitment and Education, Royal Brisbane and Women's Hospital, Herston, Queensland
| | - Vineet Chopra
- Department of Medicine, Colorado University School of Medicine, Aurora, Colorado
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Santos-Costa P, Alves M, Sousa C, Sousa LB, Paiva-Santos F, Bernardes RA, Ventura F, Salgueiro-Oliveira A, Parreira P, Vieira M, Graveto J. Nurses' Involvement in the Development and Usability Assessment of an Innovative Peripheral Intravenous Catheterisation Pack: A Mix-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11130. [PMID: 36078842 PMCID: PMC9517819 DOI: 10.3390/ijerph191711130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Guaranteeing peripheral venous access is one of the cornerstones of modern healthcare. Recent evidence shows that the lack of adequate clinical devices can result in the provision of substandard care to patients who require peripheral intravenous catheterization (PIVC). To address this challenge, we aimed to develop a PIVC pack for adult patients and assess the usability of this new device. METHODS Following a mix-method design, the PIVC pack development and usability assessment were performed in two phases with the involvement of its potential end-users (nurses). In phase one (concept and semi-functional prototype assessment), focus group rounds were conducted, and a usability assessment questionnaire was applied at each stage. In phase two (pre-clinical usability assessment), a two-arm crossover randomised controlled trial (PIVC pack versus traditional material) was conducted with nurses in a simulated setting. Final interviews were conducted to further explore the PIVC pack applicability in a real-life clinical setting. RESULTS High average usability scores were identified in each study phase. During the pre-clinical usability assessment, the PIVC pack significantly reduced procedural time (Z = -2.482, p = 0.013) and avoided omissions while preparing the required material (Z = -1.977, p = 0.048). The participating nurses emphasised the pack's potential to standardise practices among professionals, improve adherence to infection control recommendations, and enhance stock management. CONCLUSIONS The developed pack appears to be a promising device that can assist healthcare professionals in providing efficient and safe care to patients requiring a PIVC. Future studies in real clinical settings are warranted to test its cost-effectiveness.
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Affiliation(s)
- Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Mariana Alves
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Carolina Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Filipe Paiva-Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Filipa Ventura
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Margarida Vieira
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
- Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João Graveto
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
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Fukunaga T. Catheter Malposition into the Internal Thoracic Vein. Chonnam Med J 2022; 58:140-141. [PMID: 36245778 PMCID: PMC9535108 DOI: 10.4068/cmj.2022.58.3.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/07/2022] Open
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Bolela F, Lima RD, Souza ACD, Moreira MR, Lago AJDO, Simino GPR, Araújo JSD. Cancer patients in Palliative Care: occurrences related to venipuncture and hypodermoclysis. Rev Lat Am Enfermagem 2022; 30:e3623. [PMID: 35976356 DOI: 10.1590/1518-8345.5825.3623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. METHOD an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. RESULTS the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). CONCLUSION the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.
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Affiliation(s)
- Fabiana Bolela
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Roberta de Lima
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Hospital do Câncer IV, Rio de Janeiro, RJ, Brasil
| | - Ana Carolina de Souza
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Michele Rocha Moreira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Ana Julia de Oliveira Lago
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | | | - Jakeline Silva de Araújo
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Catarino F, Lourenço C, Correia C, Dória J, Dixe M, Santos C, Sousa J, Mendonça S, Cardoso D, Costeira CR. Nursing Care in Peripheral Intravenous Catheter (PIVC): Protocol of a Best Practice Implementation Project. NURSING REPORTS 2022; 12:515-519. [PMID: 35894039 PMCID: PMC9326554 DOI: 10.3390/nursrep12030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The use of a peripheral intravenous catheters (PIVC) is a common invasive practice in healthcare settings. It is estimated that about 70% of people with PIVCs will develop associated complications, such as infections. It is the consensus that best practices could reduce the appearance of such complications and reduce the length of stay in hospital. Methods: A project will be applied to implement the best approach in peripheral venous catheterization, provided by clinical nurses from an inland hospital in Portugal. The Joanna Briggs Institute methodology will be used on evidence implementation projects, which will be developed in three phases. First, a baseline audit will be performed. The second phase implements corrective measures, and the third phase is a follow-up audit. Conclusions: This project will improve the practice of the nursing team on peripheral venous catheterization nursing cares, positively influencing the quality of nursing care and patient safety. The implementation and dissemination of this project could boost its replication in other centres.
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Affiliation(s)
- Fernando Catarino
- Cova da Beira University Hospital Center, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal; (F.C.); (C.L.); (C.C.); (J.D.)
| | - Cristina Lourenço
- Cova da Beira University Hospital Center, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal; (F.C.); (C.L.); (C.C.); (J.D.)
| | - Célia Correia
- Cova da Beira University Hospital Center, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal; (F.C.); (C.L.); (C.C.); (J.D.)
| | - João Dória
- Cova da Beira University Hospital Center, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal; (F.C.); (C.L.); (C.C.); (J.D.)
| | - Maria Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal; (M.D.); (C.S.); (J.S.); (S.M.)
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Cátia Santos
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal; (M.D.); (C.S.); (J.S.); (S.M.)
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Joana Sousa
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal; (M.D.); (C.S.); (J.S.); (S.M.)
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Susana Mendonça
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal; (M.D.); (C.S.); (J.S.); (S.M.)
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Daniela Cardoso
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, 3000 Coimbra, Portugal;
| | - Cristina R. Costeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal; (M.D.); (C.S.); (J.S.); (S.M.)
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
- Correspondence:
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Evidence-Informed Development of a Bundle for Peripheral Intravenous Catheterization in Portugal: A Delphi Consensus Study. NURSING REPORTS (PAVIA, ITALY) 2022; 12:498-509. [PMID: 35894037 PMCID: PMC9326523 DOI: 10.3390/nursrep12030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/25/2022]
Abstract
Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses’ clinical decision-making in this scope. Methods: Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward’s nurses. Results: After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter’s functionality and performance at each shift. Conclusion: The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.
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Noel F, Hoang P, Truchot J, Bard AS, Yordanov Y, Thiebaud PC. An educational intervention to reduce unjustified peripheral intravenous infusions in the emergency department. Intern Emerg Med 2022; 17:1225-1227. [PMID: 34800237 PMCID: PMC8605468 DOI: 10.1007/s11739-021-02896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Florent Noel
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Phan Hoang
- Emergency Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
- Ilumens, Université de Paris, Paris, France
| | - Anne-Sophie Bard
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Pierre-Clément Thiebaud
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
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Santos-Costa P, Paiva-Santos F, Sousa LB, Bernardes RA, Ventura F, Fearnley WD, Salgueiro-Oliveira A, Parreira P, Vieira M, Graveto J. Nurses’ Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study. J Pers Med 2022; 12:jpm12020151. [PMID: 35207640 PMCID: PMC8874472 DOI: 10.3390/jpm12020151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
A significant number of adult oncology patients require at least one peripheral intravenous catheter to fulfill their therapeutic plan. Recent evidence indicates that catheter failure rates are high in this cohort, impacting care outcomes and patient experience during cancer treatment. This reality represents a challenge to nurses worldwide since in most international settings they are responsible for delivering quality care during the insertion and maintenance of such devices. This study aims to explore current nursing practices regarding the insertion, maintenance, and surveillance of peripheral intravenous catheters in oncology patients. A two-phase mix-method study was conducted with the nursing team from the surgical ward of a large oncology hospital in Portugal. In phase one (observational prospective study), nurses’ practices during catheter insertion and maintenance were observed by the research team and recorded using standardized instruments and validated scales. In phase two, three online focus groups were conducted with the nursing team to present the results observed in phase one and explore their perceptions of current practices. All ethical principles were assured throughout the study. Significant divergent practices were observed and identified by the nurses, especially concerning patient involvement, nurses’ adherence to the aseptic, non-touch technique, catheter stabilization and dressing, and catheter flushing and locking. Such practices may partially explain the high complication rate found (26%) and substantiate the need for future intervention in this field.
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Affiliation(s)
- Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
- Correspondence:
| | - Filipe Paiva-Santos
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Liliana B. Sousa
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Rafael A. Bernardes
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | | | - Anabela Salgueiro-Oliveira
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Pedro Parreira
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
| | - Margarida Vieira
- Instituto Ciências da Saúde, Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João Graveto
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; (F.P.-S.); (L.B.S.); (R.A.B.); (F.V.); (A.S.-O.); (P.P.); (J.G.)
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