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d'Astous ÉV, Dauphin-Ducharme P. Whole blood multiplex measurements using electrochemical aptamer-based biosensors. Chem Commun (Camb) 2024; 60:6419-6422. [PMID: 38828657 DOI: 10.1039/d4cc01452a] [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: 06/05/2024]
Abstract
Simultaneous measurements of various molecules ("multiplex") using electrochemical biosensors typically require multiple electrode implementations, which for neonates, hemophiliacs, etc. is problematic. Here, we introduce the oxazine ATTO 700 into electrochemical aptamer-based biosensors to achieve "true" multiplex, continuous and real-time measurements of two different molecules in undiluted whole blood using a single electrode.
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Affiliation(s)
- Élodie V d'Astous
- Université de Sherbrooke, Département de Chimie, 2500 boul. de l'Université, Sherbrooke, J1K 2R1, Canada.
| | - Philippe Dauphin-Ducharme
- Université de Sherbrooke, Département de Chimie, 2500 boul. de l'Université, Sherbrooke, J1K 2R1, Canada.
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Indarwati F, Munday J, Keogh S. Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study. J Pediatr Nurs 2023; 73:106-112. [PMID: 37659338 DOI: 10.1016/j.pedn.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE This study aimed to assess peripheral intravenous catheter use, maintenance practices, and outcomes of paediatric patients in a developing country setting. DESIGN AND METHODS A point prevalence survey using validated checklist was conducted between March and April 2022 in ten hospitals in Indonesia. A total number of 478 participants were approached during the audit. Data were obtained from site observation and medical records. RESULTS Of the 386 patients surveyed, >90% (362) had one catheter in-situ. The catheters were mostly inserted by nurses (331, 86%), primarily in the dorsum of the hand (207, 54%) with the purpose of delivering intravenous infusions and medications (367, 95%). Simple transparent dressings (176, 46%) with splint and bandage (295, 76%) were predominantly used for securement methods. Insertion sites were not visible for 182 (47%) patients, and 151 (40%) of daily care practices were poorly documented. Complications were documented in the medical record for 166 (43%) catheters. Adjusted analysis indicated that patient diagnosis, ward, catheter size, location, dressings, infusate, and flushing administration were significantly associated with complications. CONCLUSIONS Findings indicate that issues related to paediatric intravenous catheter complications in Indonesia are comparable to developed country settings. Ongoing surveillance is important to evaluate the management practices to benchmark against guidelines, optimise patient safety, and improve outcomes. PRACTICE IMPLICATIONS Results demonstrate low and middle-income countries face similar challenges with catheter insertion and care. The study indicates the importance of applying vascular access needs assessments, providing training for inserters, identifying optimum dressing methods, and optimising documentation.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
| | - Judy Munday
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Nursing Sciences, University of Agder, Grimstad, Norway.
| | - Samantha Keogh
- Queensland University of Technology (QUT), School of Nursing and Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Griffith University, Queensland, Australia.
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Sharp R, Muncaster M, Baring CL, Manos J, Kleidon TM, Ullman AJ. The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study. J Clin Nurs 2023; 32:6690-6705. [PMID: 37204006 DOI: 10.1111/jocn.16759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
AIMS AND OBJECTIVES Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice. BACKGROUND Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice. DESIGN Qualitative description. METHODS A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi-structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis. RESULTS There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress-before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre-determined theme, (4) Recommendations for good clinical practice is also described. CONCLUSIONS Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Michele Muncaster
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Catherine L Baring
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Jacinta Manos
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Tricia M Kleidon
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Lam C, Dunstan L, Sweeny A, Watkins S, George S, Snelling PJ. A survey of paediatric difficult peripheral intravenous access in the emergency department and use of point-of-care ultrasound. Australas J Ultrasound Med 2023; 26:184-190. [PMID: 37701768 PMCID: PMC10493356 DOI: 10.1002/ajum.12353] [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] [Indexed: 09/14/2023] Open
Abstract
Introduction/Purpose Peripheral intravenous catheter (PIVC) insertion can be challenging in children, with point-of-care ultrasound (POCUS) known to increase success rates. The objective of this study was to survey how emergency department (ED) clinicians identify and escalate paediatric patients with difficult intravenous access (DIVA), specifically the use of POCUS. Methods This cross-sectional study was conducted in an Australian academic mixed ED that surveyed resident medical officers (RMOs), registrars, consultants and senior paediatric nurses. A 15 multiple-choice questionnaire evaluated clinicians experience with paediatric PIVC insertion, approach to identifying and managing DIVA and the use of POCUS or other adjuncts. Results Eighty clinicians (34.2% response rate) completed the survey. Poor vein palpability was rated the highest predictor of DIVA. Of the respondents, 19 consultants (86.4%), 28 registrars (90.3%) and 16 RMOs (64.0%) used POCUS as an adjunct for paediatric DIVA patients but 16 consultants (72.8%), 21 registrars (67.8%) and 20 RMOs (80.0%) would use this less than 25% of the time in clinical practice. Discussion This survey suggests more clinicians to prefer using objective factors when identifying paediatric DIVA patients, rather than subjectively using gestalt, which relies on clinician experience. Whilst clearly recognised as a useful tool in our study, POCUS was used infrequently for paediatric DIVA patients. Conclusions There is currently no consistent process for the identification and escalation of paediatric DIVA patients, including the use of adjuncts such as POCUS. Clinician awareness for these issues should be addressed, which should include the development of guidelines and clinician training in POCUS for PIVC insertion in children.
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Affiliation(s)
- Clayton Lam
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Lucy Dunstan
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
| | - Amy Sweeny
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Stuart Watkins
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Shane George
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Children's Critical Care UnitGold Coast University HospitalSouthportQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | - Peter J. Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research (Sonar) GroupSouthportQueenslandAustralia
- Child Health Research CentreUniversity of QueenslandSouth BrisbaneQueenslandAustralia
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Kleidon TM, Schults J, Rickard C, Ullman AJ. Ultrasound-guided PIVC insertion: a randomised controlled trial protocol. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S28. [PMID: 37495404 DOI: 10.12968/bjon.2023.32.14.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is an alternative to traditional anatomical landmark-based insertion. However, data on its performance in paediatric patients of varying levels of difficult intravenous access are limited. The researchers hypothesise that ultrasound-guided PIVC insertion will increase first-attempt success compared with landmark technique. This randomised, parallel-group, single-centre, superiority trial commenced recruiting in July 2021, including hospitalised children (aged 0 (>37 weeks gestation) to 18 years) requiring a PIVC. It will recruit 180 children, stratified by degree of perceived difficulty, and centrally randomised into two groups (ratio 1:1). The primary outcome is first-attempt PIVC insertion success. Secondary outcomes include total number of PIVC insertion attempts, PIVC insertion failure, post-insertion complications, dwell time, patient/parent satisfaction, and healthcare costs. The current study will inform the superiority of ultrasound-guided PIVC insertion in comparison with landmark technique. Adoption by healthcare facilities might improve patient outcomes and decrease healthcare costs.
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Affiliation(s)
- Tricia M Kleidon
- Nurse Practitioner, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Jessica Schults
- Senior Research Fellow, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Professor of Paediatric Nursing, Children's Health, Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
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Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, Young E, Hall L, Keijzers G, Cullen L, Calleja P, McTaggart S, Peters N, Watkins S, Corley A, Brown C, Lin Z, Williamson F, Burgess L, Macfarlane F, Cooke M, Battley C, Rickard CM. Improving difficult peripheral intravenous access requires thought, training and technology (DART 3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23:587. [PMID: 37286977 DOI: 10.1186/s12913-023-09499-0] [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: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities. METHODS A stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie's Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention. DISCUSSION Study findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities. TRIAL REGISTRATION Prospectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).
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Affiliation(s)
- Jessica A Schults
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia.
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia.
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Nicole Marsh
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tricia M Kleidon
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Emily Young
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Pauline Calleja
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Australia
| | - Steven McTaggart
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nathan Peters
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
| | - Amanda Corley
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Christine Brown
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Zhen Lin
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Luke Burgess
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fiona Macfarlane
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
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Effective Use of Extended Dwell Peripheral Intravenous Catheters in Neonatal Intensive Care Patients. Adv Neonatal Care 2023; 23:93-101. [PMID: 36700682 DOI: 10.1097/anc.0000000000000989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Implementing innovative approaches to vascular access can be challenging in the newborn intensive care unit (NICU). PURPOSE The purpose of this project was to describe the implementation of extended dwell peripheral intravenous (EPIV) catheters, a vascular access device not widely used in the NICU. The implementation involved (1) designing clinical criteria for EPIV catheter use, (2) education of vascular access NICU nurses, and (3) comparing clinical outcomes between vascular access devices (ie, PIV and EPIV catheters). METHODS We developed evidence-based clinical criteria guiding the use of vascular access devices. We then developed an educational plan for NICU nurses focused on vascular access. Finally, we collected and compared demographic characteristics and clinical data on catheter type and placement attempts, dwell time, and clinical complications associated with each catheter. RESULTS EPIV catheters were implemented according to evidence-based criteria by a vascular access NICU nursing team. Fifteen percent of PIV catheter placements required 3 or more attempts compared with just 1% of EPIV catheter placement attempts. EPIV catheters had a longer median dwell time (3.5 vs 1 day) and fewer complications than PIV catheters (P < .001). IMPLICATIONS FOR PRACTICE AND RESEARCH Implementation of an evidence-based approach to vascular access by a team of NICU nurses may improve clinical outcomes. EPIV catheters may be an appropriate alternative device to PIV catheters due to fewer placement attempts, longer dwell times, and overall fewer complications during use. Future vascular access research in the NICU may include a greater focus on innovative placement strategies, optimal maintenance and infection control, and prevention of complications.
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Kanaley RL, Gillette C, Schriefer J, Gottfried JA, Bramley J. Evaluation of the difficult intravenous access (DIVA) scoring in hospitalized pediatric patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S18-S26. [PMID: 36715519 DOI: 10.12968/bjon.2023.32.2.s18] [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
HIGHLIGHTS The DIVA scoring tool has previously been validated in the pediatric ED setting. Our project applied DIVA to an inpatient pediatric sample. DIVA may not predict likelihood of PIV success in the inpatient setting. Background: First-attempt success rate for placing pediatric peripheral intravenous (PIV) catheters ranges from to 24% to 52%. Multiple attempts can increase risk of deleterious outcomes. It is essential to screen pediatric patients appropriately to identify those who will require additional resources for successful PIV placement. Methods: A convenience sample of hospitalized pediatric patients 0 to 18 years of age on a general care unit was used in this performance improvement project. Prior to attempting PIV access, nurses completed a data collection tool that included elements of established difficult intravenous access (DIVA) tools as well as first attempt successful PIV placement. The primary outcome measure was to determine if each DIVA scoring tool is accurate in predicting the need for additional resources to achieve successful first-attempt PIV placement. The secondary outcome measure was to compare the predictive value of each DIVA scoring tool among an inpatient pediatric population. Following data exploration and cleaning, a correlation analysis was performed with logistic regression to assess DIVA score effectiveness in predicting success of PIV insertion on the first attempt. Results: Out of 133 children, 167 PIV attempts were analyzed with 150 PIV attempts included in the final data analysis. Of the 150 PIV attempts analyzed, 60% (n=90) were successful on the first attempt. Performance of prediction for first-time insertion success was comparable among all 4 DIVA scoring tools. Conclusions: None of the 4 DIVA scoring tools were superior in predicting first-time PIV placement among hospitalized children. Vein palpability was more predictive, although not statistically significant.
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Affiliation(s)
| | | | - Jan Schriefer
- University of Rochester Medical Center, Golisano Children's Hospital, Rochester, NY
| | - Julie Albright Gottfried
- University of Rochester Medical Center, Golisano Children's Hospital, Rochester, NY; University of Rochester School of Nursing, Rochester, NY
| | - John Bramley
- MS, University of Rochester Medicine Quality Institute, Rochester, NY
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Good RJ, Diaz E, Thomas R, Wathen B, Carpenter TC. Ultrasound assessment of peripheral intravenous catheters by nurses in the pediatric intensive care unit. J Vasc Access 2023; 24:71-75. [PMID: 34121499 DOI: 10.1177/11297298211024805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA. DESIGN Prospective observational cohort study. SETTING PICU within a children's hospital. PATIENTS PICU patients with a PIV. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0-13.8) and median weight was 15.0 kg (IQR 9.6-59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28-0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p < 0.0001). In 106 PIVs with a UA that indicated the PIV was intravascular (i.e. negative UA), the median survival was 50.0 h (IQR 21.8-100.3). CONCLUSIONS Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.
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Affiliation(s)
- Ryan J Good
- Department of Pediatrics, Section of Critical Care, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Diaz
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Robin Thomas
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Beth Wathen
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Todd C Carpenter
- Department of Pediatrics, Section of Critical Care, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, USA
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Öntürk ZK, İsabetli S, Bahadır M, Doğru E. The effect of "pediatric peripheral intravenous access (PPIVA) pathway" on the success of vascular access in children. J Pediatr Nurs 2022; 69:e32-e38. [PMID: 36494235 DOI: 10.1016/j.pedn.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Determine the affects of the developed "Pediatric Peripheral Intravenous Access (PPIVA) Pathway" on the success of the vascular access in children. DESIGN AND METHODS A quantitative approach was used using a quasi-experimental single-group post-test design involved pediatric patients. The patients who were first attempted for peripheral vascular access were subjected to the procedure in accordance with the "PPIVA Pathway". The data was collected via a form on which we recorded down the patients' characteristics alongside their procedural data, as well as the Difficult Intravenous Access (DIVA) Score. For statistical analysis, the R vers. 2.15.3 program was utilized. RESULTS The patients who applied to the pediatric observation clinic had a mean age of 8.14 ± 5.01 years. The DIVA total mean score of the patients was 1.73 ± 1.79. 89.1% (n = 163) of pediatric peripheral intravenous procedures were successfully completed on the first access. The logistic regression analysis model was found to be statistically significant to identify the factors that affect pediatric peripheral intravenous success on the first attempt (χ2 = 24.701; p < 0.001). A one-point increase in the DIVA score was found to reduce the likelihood of success on the first attempt by 56.1% [OR (95% CI) = 0.439 (0.280, 0.686), p < 0.001]. CONCLUSIONS Using an algorithm to perform a peripheral intravenous intervention in children increases the likelihood of success on the first attempt. PRACTICE IMPLICATIONS Using PPIVA Pathway shall improve the provision of atraumatic care for children, as the success rate of pediatric peripheral intravenous access on the first attempt is high.
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Affiliation(s)
- Zehra Kan Öntürk
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Department of Nursing, Acıbadem Mehmet Ali Aydınlar Üniversitesi Kerem Aydınlar Kampüsü, Kayışdağı Cad. No:32 Ataşehir, İstanbul, Turkey.
| | - Serpil İsabetli
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Merve Bahadır
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Ebru Doğru
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
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11
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Rizvi MB, Silver EJ, Khine H, Sellinger C. Modified DIVA Score: An Improved Clinical Predictive Tool for Detecting Difficult Access in Children. Pediatr Emerg Care 2022; 38:e1646-e1649. [PMID: 36173437 DOI: 10.1097/pec.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to validate the DIVA (Difficult Intravenous Access) score in our population and to identify any additional patient characteristics that may be associated with difficult access in children. METHODS This was a cross-sectional study in an urban quaternary pediatric emergency department with patients younger than 21 years and Emergency Severity Index ≥2 who require intravenous (IV) access for their management. In addition to patient characteristics comprising the DIVA score, data were collected on patient "history of difficult access," hydration status, skin shade, history of sickle cell disease or diabetes, technology dependence, and body mass index. The number of IV cannulation attempts and total time taken were recorded for each patient. "Difficult access" was defined as ≥2 or more attempts or time >30 minutes to achieve successful IV cannulation. RESULTS A convenience sample of 300 pediatric patients was enrolled. The DIVA score had a sensitivity of 51% (95% confidence interval [CI], 40.8%-61.14%) and a specificity of 82.99% (95% CI, 76.95%-87.99%) for predicting "difficult access" in our population. Among all patient characteristics examined in this study, only "history of difficult access" improved the identification of "difficult access" patients. The "history of difficult access" variable had a sensitivity of 61% (95% CI, 50.7%-70.6%) and a specificity of 75.7% (95% 95% CI, 69.12%-81.62%) in predicting "difficult access." With the addition of "history of difficult access" to the original DIVA score, we developed a "modified DIVA score (m-DIVA)." The m-DIVA score had a sensitivity of 78% (95% CI, 68.6%-85.6%) and specificity of 67% (95% CI, 59.9%-73.58%), representing a 52.9% improvement in correctly identifying "difficult access" patients over the original DIVA score. CONCLUSIONS The m-DIVA score, which incorporates prior history, increases the screening test's sensitivity in identifying "difficult access" patients and should be further investigated as clinical tool.
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Affiliation(s)
| | - Ellen J Silver
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Hnin Khine
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Catherine Sellinger
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
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12
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Schults JA, Ball DL, Sullivan C, Rossow N, Ray-Barruel G, Walker RM, Stantic B, Rickard CM. Mapping progress in intravascular catheter quality surveillance: An Australian case study of electronic medical record data linkage. Front Med (Lausanne) 2022; 9:962130. [PMID: 36035426 PMCID: PMC9403736 DOI: 10.3389/fmed.2022.962130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background and significanceIntravascular (IV) catheters are the most invasive medical device in healthcare. Localized priority-setting related to IV catheter quality surveillance is a key objective of recent healthcare reform in Australia. We sought to determine the plausibility of using electronic health record (EHR) data for catheter surveillance by mapping currently available data across state-wide platforms. This work has identified barriers and facilitators to a state-wide EHR surveillance initiative.Materials and methodsData variables were generated and mapped from routinely used EHR sources across Queensland, Australia through a systematic search of gray literature and expert consultation with clinical information specialists. EHR systems were eligible for inclusion if they collected data related to IV catheter insertion, care, or outcomes of hospitalized patients. Generated variables were mapped against international recommendations for IV catheter surveillance, with data linkage and data export capacity narratively summarized.ResultsWe identified five EHR systems, namely, iEMR, MetaVision ICU®, Multiprac, RiskMan, and the Nephrology Registry. Systems were used across jurisdictions and hospital wards. Data linkage was not evident across systems. Extraction processes for catheter data were not standardized, lacking clear and reliable extraction techniques. In combination, EHR systems collected 43/50 international variables recommended for catheter surveillance, however, individual systems collected a median of 24/50 (IQR 22, 30) variables. We did not identify integrated clinical analytic systems (incorporating machine learning) to support clinical decision making or for risk stratification (e.g., catheter-related infection).ConclusionCurrent data linkage across EHR systems limits the development of an IV catheter quality surveillance system to provide timely data related to catheter complications and harm. To facilitate reliable and timely surveillance of catheter outcomes using clinical informatics, substantial work is needed to overcome existing barriers and transform health surveillance.
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Affiliation(s)
- Jessica A. Schults
- Alliance for Vascular Access Teaching and Research Group, Nathan, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Metro North Health, Herston Infectious Disease Institute, Herston, QLD, Australia
- School of Information and Communication Technology, Griffith University, Nathan, QLD, Australia
- *Correspondence: Jessica A. Schults,
| | - Daner L. Ball
- Alliance for Vascular Access Teaching and Research Group, Nathan, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Metro North Health, Herston Infectious Disease Institute, Herston, QLD, Australia
| | - Clair Sullivan
- Digital Metro North, Metro North Hospital and Health Service, Herston, QLD, Australia
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Nick Rossow
- Digital Solutions, Griffith University, Nathan, QLD, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research Group, Nathan, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Metro North Health, Herston Infectious Disease Institute, Herston, QLD, Australia
- School of Information and Communication Technology, Griffith University, Nathan, QLD, Australia
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Rachel M. Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Bela Stantic
- School of Information and Communication Technology, Griffith University, Nathan, QLD, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Group, Nathan, QLD, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Metro North Health, Herston Infectious Disease Institute, Herston, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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13
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Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies. PLoS One 2022; 17:e0269788. [PMID: 35749443 PMCID: PMC9231778 DOI: 10.1371/journal.pone.0269788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US). Methods Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies. Results In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) ‘Escalation’ is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward–‘measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use. Conclusion(s) DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.
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Kleidon TM, Schults J, Paterson R, Rickard CM, Ullman AJ. Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: A systematic review and meta-analysis. J Paediatr Child Health 2022; 58:953-961. [PMID: 35441751 PMCID: PMC9321813 DOI: 10.1111/jpc.15985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric peripheral intravenous catheter (PIVC) insertion using traditional landmark insertion technique can be difficult. AIM To systematically review the evidence comparing landmark to ultrasound guidance for PIVC insertion in general paediatric patients. STUDY DESIGN Cochrane methodology to systematically search for randomised controlled trials comparing landmark to ultrasound-guided PIVC insertion. DATA SOURCES Cochrane Central Register of Controlled Trials, US National Library of Medicine, Cumulative Index to Nursing and Allied Health, Embase. DATA EXTRACTION English-language, paediatric trials published after 2000, reporting first-attempt insertion success, overall PIVC insertion success, and/or time to insert were included. Central venous, non-venous and trials including only difficult intravenous access were excluded. Data were independently extracted and critiqued for quality using GRADE by three authors, and analysed using random effects, with results expressed as risk ratios (RR), mean differences (MD) and 95% confidence intervals (CI). Registration (CRD42020175314). RESULTS Of 70 titles identified, 5 studies (995 patients; 949 PIVCs) were included. There was no evidence of an effect of ultrasound guidance, compared to landmark, for first-attempt insertion success (RR 1.27; 95% CI 0.90-1.78; I2 = 88%; moderate quality evidence), overall insertion success (RR 1.14; 95% CI 0.90-1.44; I2 = 82%; low quality evidence), or time to insertion (mean difference -3.03 min; 95% CI -12.73 to 6.67; I2 = 92%; low quality evidence). LIMITATIONS Small sample sizes, inconsistent outcomes and definitions in primary studies precluded definitive conclusions. CONCLUSIONS Large clinical trials are needed to explore the effectiveness of ultrasound guidance for PIVC insertion in paediatrics. Specifically, children with difficult intravenous access might benefit most from this technology.
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Affiliation(s)
- Tricia M Kleidon
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia,Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia,School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia,School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Jessica Schults
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia,Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia,School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia,School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Rebecca Paterson
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia,Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia,Faculty of MedicineThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Claire M Rickard
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia,Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia,School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia,School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
| | - Amanda J Ullman
- Department of AnaesthesiaQueensland Children's HospitalBrisbaneQueenslandAustralia,Alliance for Vascular Access Teaching and Research GroupMenzies Health Institute QueenslandGold CoastQueenslandAustralia,School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia,School of Nursing, Midwifery and Social WorkThe University of QueenslandSt. LuciaQueenslandAustralia
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15
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Heydinger G, Shafy SZ, O’Connor C, Nafiu O, Tobias JD, Beltran RJ. Characterization of the Difficult Peripheral IV in the Perioperative Setting: A Prospective, Observational Study of Intravenous Access for Pediatric Patients Undergoing Anesthesia. Pediatric Health Med Ther 2022; 13:155-163. [PMID: 35548373 PMCID: PMC9081190 DOI: 10.2147/phmt.s358250] [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: 01/13/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Various criteria exist for defining difficult intravenous access (DIVA) in infants and children. The current study evaluated the factors associated with DIVA in a prospective cohort of over 1000 infants and children presenting for anesthetic care. Methods This was a prospective, observational study of patients aged 0 to 18 years undergoing elective surgical or radiologic procedures under general anesthesia. Prior to the initial attempt at peripheral intravenous (PIV) cannulation, the anticipated difficulty of PIV catheter placement was determined by the provider using a visual analogue scale (VAS) from 1 to 10. The number of attempts was recorded as well as the time required to achieve PIV access. DIVA was defined as requiring three or more attempts. After successful cannulation, the actual difficulty of the PIV placement was assessed by the provider and recorded using the same VAS. Patient characteristics, including age, race, body mass index (BMI), American Society of Anesthesiologists (ASA) physical classification, and history of difficult PIV placement, were evaluated as covariates. Results In our cohort of 1002 pediatric patients, 78% of patients were successfully cannulated in a single attempt and 91% of patients were successfully cannulated in two or fewer attempts. Factors associated with requiring three or more PIV attempts included younger age (OR 8.73; 95% CI: 3.38, 22.6 for age <1 year and OR 4.93; 95% CI: 2.05, 11.8 for age 1-3 years), higher ASA physical classification (OR 1.95; 95% CI: 1.10, 3.46 for ASA II), and prior history of difficult PIV placement (OR 3.46; 95% CI: 1.70, 7.08). BMI, racial category or gender were not independent predictors of DIVA. Conclusion We found that approximately 9% of patients required three or more attempts at IV placement in the operating room. Patients that required multiple PIV attempts were more likely to be younger, have a higher ASA classification or a history of difficult PIV placement.
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Affiliation(s)
- Grant Heydinger
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shabana Z Shafy
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Colin O’Connor
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Olubukola Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ralph J Beltran
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2022; 33:67-76. [PMID: 35562260 DOI: 10.1016/j.enfie.2021.03.006] [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: 05/14/2020] [Accepted: 03/22/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
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17
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Schults JA, Kleidon TM, Gibson V, Ware RS, Monteagle E, Paterson R, Charles K, Keys A, McBride CA, McTaggart S, Lawton B, Macfarlane F, Sells C, Rickard CM, Ullman AJ. Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key. BMC Health Serv Res 2022; 22:220. [PMID: 35177041 PMCID: PMC8851754 DOI: 10.1186/s12913-022-07605-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics. METHODS Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia. RESULTS Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February-April 2020) involving 21 stakeholders culminating in the co-production of the "DIVA Key". The DIVA Key was evaluated between May-December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63-0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2-27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8-10]; 8 [8-10 respectively). CONCLUSION The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
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Affiliation(s)
- Jessica A Schults
- The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia. .,Herston Infectious Diseases Institute (HEiDI), Metro North Hospital and Health Service, Brisbane, Australia. .,Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia. .,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
| | - Tricia M Kleidon
- The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia.,Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Victoria Gibson
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Robert S Ware
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Emily Monteagle
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Rebecca Paterson
- The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Karina Charles
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Adam Keys
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Craig A McBride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Steven McTaggart
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Benjamin Lawton
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Emergency Medicine, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Fiona Macfarlane
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Chloe Sells
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Claire M Rickard
- The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia.,Herston Infectious Diseases Institute (HEiDI), Metro North Hospital and Health Service, Brisbane, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia.,Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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18
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Davis MBH, Takashima M, Girgenti C, Ullman AJ. An international survey of pediatric and neonatal clinicians' vascular access practice: PediSIG assessment of vascular access, education, and support (PAVES) catheter selection. ACTA ACUST UNITED AC 2021; 29:S40-S48. [PMID: 32697633 DOI: 10.12968/bjon.2020.29.14.s40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HIGHLIGHTS There is a wide variance in neonatal and pediatric vascular access workforce models, training, and competency assessments. Pain control during procedures is critical for children, yet it is not consistently used. Procedural support has shown improved patient outcomes, yet is not standardly used for every distressful procedure. Core standards are needed to ensure proper training and support for the pediatric and neonatal vascular access clinicians. BACKGROUND Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients. OBJECTIVE Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access. DESIGN Cross-sectional, electronic survey using convenience sampling. SETTINGS International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients. METHODS An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training. RESULTS There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% (n = 69) of respondents. Less than half of the responses (47%; n = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds (n = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% (n = 23) and 15% (n = 27), respectively, self-reporting that they always followed the protocol. CONCLUSIONS The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control.
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Affiliation(s)
- Mary Beth Hovda Davis
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, Alliance for Vascular Access Teaching
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith, University, Queensland, Australia
| | | | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Queensland, Australia, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith, University, Queensland, Australia
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2021; 33:S1130-2399(21)00057-2. [PMID: 34246557 DOI: 10.1016/j.enfi.2021.03.007] [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: 05/14/2020] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
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Archer-Jones A, Sweeny A, Schults JA, Rickard CM, Johnson L, Gunter A, Watkins S. Evaluating an ultrasound-guided peripheral intravenous cannulation training program for emergency clinicians: An Australian perspective. Australas Emerg Care 2020; 23:151-156. [PMID: 31926958 DOI: 10.1016/j.auec.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The primary objective of this study was to identify the proportion of clinicians using ultrasound guidance (USG) to insert peripheral intravenous cannulas (PIVCs) in the emergency department (ED) following attendance at a hospital-based USG PIVC training program. METHODS Over 12-months, USG cannulation training sessions were offered to nurses and doctors competent in standard PIVC insertion (landmark technique), working in the ED. Surveys pre and post-training captured participants' self-reported confidence with cannulation and USG cannulation using a 5-point Likert scale. Supplemental data from observation periods before and after the trainings assessed departmental cannulation practices overall. Data were analysed using descriptive statistics and associations analysed using chi-square tests. RESULTS Overall, 195 participants attended training; 58% completed follow-up surveys. Forty-three percent reported using USG cannulation the following month. The median confidence score amongst workshop participants increased from 1 to 3 (p<.001). Post-implementation, use of USG cannulation increased from 0.7% to 6.0% post-training (p<.001), although the overall number of attempts at PIVC placement did not change. CONCLUSIONS USG cannulation training increased this practice in the short-term. However, no significant difference in the number of attempts was observed. Further investigation in controlled settings is needed to inform the widespread implementation of USG cannulation training packages.
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Affiliation(s)
- Amy Archer-Jones
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
| | - Amy Sweeny
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia; Griffith University School of Medicine, Gold Coast, Queensland, Australia.
| | - Jessica A Schults
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Laura Johnson
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Ashleigh Gunter
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
| | - Stuart Watkins
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
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