1
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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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2
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Willis M, Colonetti E, Bakir A, Alame YJ, Annetts M, Aygin DT, Daou A, Farooq S, Fine NA, Firat G, Goozee B, Gupta AN, Hubbett C, Loi NSY, Maciejec-Biskup L, Muthukumar MG, Pott J, Bloom BM, Muiesan ML, Harris T. Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department-Convenience or necessity? PLoS One 2024; 19:e0305276. [PMID: 38875242 PMCID: PMC11178163 DOI: 10.1371/journal.pone.0305276] [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: 06/01/2023] [Accepted: 05/27/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary. METHODS The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose. RESULTS A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink. CONCLUSIONS More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis.
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Affiliation(s)
| | - Efrem Colonetti
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | | | | | | | - Deren T Aygin
- Mid and South Essex NHS Foundation Trust, Chelmsford, England
| | - Amina Daou
- Guy's and St Thomas' NHS Foundation Trust, London, England
| | | | | | - Gozde Firat
- The Royal Free London NHS Foundation Trust, London, England
| | | | | | | | | | | | | | | | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
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Seetharam AM, Raju U, Suresh K. A randomized controlled study to compare first stick success with Instaflash technology: The FIRSST study. J Vasc Access 2024; 25:203-209. [PMID: 35220831 DOI: 10.1177/11297298221080369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are frequently used in clinical settings for intravenous access. Multiple attempts of PIVC insertions leads to patient discomfort, delay in treatment, associated complications, and extensive expenditure cost. Reduced number of attempts causes patient/nursing personnel satisfaction and expenditure costs. The present study evaluated performance efficacy of BD Venflon™ I with Instaflash needle technology (investigational device) as compared to the BD Venflon™ without Instaflash needle technology (control device). METHODOLOGY The PIVC insertions were randomized in the ratio 1:1 using either investigational or control device and were monitored for first stick success rate, ease of insertion, and patient satisfaction. Data was analyzed using R 4.0.3 and Microsoft Excel. Chi square test was used to establish association between two categorical variables. RESULTS In total, 1402 patients were analyzed for first attempt insertion success which showed 98.72% success rate in investigational device as compared to 88.87% success rate in case of the control device (p = 0.0004). Marginal differences were observed in ease of insertion in investigational (98.71%) and control devices (99%) signifying high satisfaction levels of nursing personnels. Positive responses were observed in investigational (98.01%) and control devices (99%) underlining satisfactory performances of overall patient experiences. CONCLUSION The present study showed that BD Venflon™ I with Instaflash needle technology enhanced first attempt insertion success rate along with marginal differences in its efficacy in comparison with the BD Venflon™ without Instaflash needle technology thus enhancing patient and nursing personnel satisfaction in turn making it a better alternative to be used in hospitals.
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Affiliation(s)
- Arun Mavaji Seetharam
- Department of Hospital Administration, M S Ramaiah Medical College and Hospitals, Bangalore, India
| | - Umashankar Raju
- Department of Hospital Administration, M S Ramaiah Medical College and Hospitals, Bangalore, India
| | - K Suresh
- Department of Hospital Administration, M S Ramaiah Medical College and Hospitals, Bangalore, India
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Kia A, Waterson J, Bargary N, Rolt S, Burke K, Robertson J, Garcia S, Benavoli A, Bergström D. Determinants of Intravenous Infusion Longevity and Infusion Failure via a Nonlinear Model Analysis of Smart Pump Event Logs: Retrospective Study. JMIR AI 2023; 2:e48628. [PMID: 38875535 PMCID: PMC11041480 DOI: 10.2196/48628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Infusion failure may have severe consequences for patients receiving critical, short-half-life infusions. Continued interruptions to infusions can lead to subtherapeutic therapy. OBJECTIVE This study aims to identify and rank determinants of the longevity of continuous infusions administered through syringe drivers, using nonlinear predictive models. Additionally, this study aims to evaluate key factors influencing infusion longevity and develop and test a model for predicting the likelihood of achieving successful infusion longevity. METHODS Data were extracted from the event logs of smart pumps containing information on care profiles, medication types and concentrations, occlusion alarm settings, and the final infusion cessation cause. These data were then used to fit 5 nonlinear models and evaluate the best explanatory model. RESULTS Random forest was the best-fit predictor, with an F1-score of 80.42, compared to 5 other models (mean F1-score 75.06; range 67.48-79.63). When applied to infusion data in an individual syringe driver data set, the predictor model found that the final medication concentration and medication type were of less significance to infusion longevity compared to the rate and care unit. For low-rate infusions, rates ranging from 2 to 2.8 mL/hr performed best for achieving a balance between infusion longevity and fluid load per infusion, with an occlusion versus no-occlusion ratio of 0.553. Rates between 0.8 and 1.2 mL/hr exhibited the poorest performance with a ratio of 1.604. Higher rates, up to 4 mL/hr, performed better in terms of occlusion versus no-occlusion ratios. CONCLUSIONS This study provides clinicians with insights into the specific types of infusion that warrant more intense observation or proactive management of intravenous access; additionally, it can offer valuable information regarding the average duration of uninterrupted infusions that can be expected in these care areas. Optimizing rate settings to improve infusion longevity for continuous infusions, achieved through compounding to create customized concentrations for individual patients, may be possible in light of the study's outcomes. The study also highlights the potential of machine learning nonlinear models in predicting outcomes and life spans of specific therapies delivered via medical devices.
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Affiliation(s)
- Arash Kia
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
| | - James Waterson
- Medical Affairs, Medication Management Solutions, Becton Dickinson, Dubai, United Arab Emirates
| | - Norma Bargary
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
| | - Stuart Rolt
- Medical Affairs, International Infusion Solutions, Becton Dickinson, Winnersh, United Kingdom
| | - Kevin Burke
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
| | - Jeremy Robertson
- Systems Engineering, International Infusion Solutions, Becton Dickinson, Limerick, Ireland
| | - Samuel Garcia
- Medical Affairs, Medication Management Solutions, Becton Dickinson, Seville, Spain
| | - Alessio Benavoli
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - David Bergström
- Research and Development, Infusion Acute Care, Becton Dickinson, Limerick, Ireland
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Inayat-Hussain A, Falck H, Oorschot S, Picardo S, So K. Peripheral parenteral nutrition: An evaluation of its use, safety and cost implications in a tertiary hospital setting. Clin Nutr ESPEN 2023; 56:215-221. [PMID: 37344076 DOI: 10.1016/j.clnesp.2023.05.020] [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: 02/20/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is a common challenge among hospitalised patients and its associatiation with poor patient health-related outcomes places a significant financial burden on the healthcare system. Total parenteral nutrition (TPN) is the primary means for providing nutrition to individuals in whom enteral feeding is not possible but is costly and requires invasive central venous access. Peripheral parenteral nutrition (PPN) provides a suitable option for early nutrition provision in select patients; however, its routine use has been limited by safety and tolerability concerns, with high rates of phlebitis reported in previous studies. The objectives of this study were to review the use, safety, and costs of PPN in an Australian tertiary hospital. METHODS A single-site, prospective observational study was conducted over 15 months in a tertiary hospital. 139 participants (87 male and 52 female) were enrolled in the study. Data collected assessed the indication for PPN initiation, compliance with the hospital's protocols for PPN, total fasting days, the proportion of the patient's total energy and protein requirements provided by PPN, the incidence of phlebitis and potential cost implications associated with the use of PPN. RESULTS 139 patients (62.6% male), median age 62 years (IQR (interquartile range) 48-74) were enrolled. Most patients had an emergency admission (80.6%) under a general surgical team (84.2%). Forty-eight patients (34.5%) were malnourished, as assessed by the Subjective Global Assessment tool (SGA). Patients fasted for a median of 3 days (IQR 2-5) before PPN commencement, with a median duration of PPN use of 3 days (IQR 2-4). PPN provided an average of 61.6% of the patients' required caloric intake and 46.4% of protein requirements. Progression to TPN was observed in 34.5% of patients. There were low rates of complications with phlebitis observed in 3.7%, extravasation in 1.1%, and no patients developed septicaemia, despite suboptimal compliance with the recommended cannula management guidelines for PPN (66.4% compliant). The cost of PPN was estimated to be AUD$187 per patient day. CONCLUSION PPN is an effective short-term nutrient delivery solution to facilitate early feeding with small numbers of patients requiring transition to TPN. PPN was safe with low rates of cannula complications. Costs were favourable, with potentially significant cost savings as compared with TPN.
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Affiliation(s)
| | - Heather Falck
- Department of Dietetics and Nutrition, Royal Perth Hospital, Perth, WA, Australia.
| | - Sarah Oorschot
- Department of Pharmacy, Royal Perth Hospital, Perth, WA, Australia.
| | - Sherman Picardo
- Department of Gastroenterology, Royal Perth Hospital, Perth, WA, Australia.
| | - Kenji So
- Department of Gastroenterology, Royal Perth Hospital, Perth, WA, Australia.
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Hlasny J, Alberty R, Hlavac M, Grgac I, Grey MT, Venglarcik M. Comparison of ultrasound-guided and palpation-inserted peripheral venous cannula in -patients before primary hip or knee arthroplasty: study protocol for a randomized controlled trial. Trials 2023; 24:467. [PMID: 37480132 PMCID: PMC10362715 DOI: 10.1186/s13063-023-07459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND More than 2 billion peripheral vascular cannulas are introduced globally each year. It is the most frequently performed invasive procedure in medicine worldwide. There is a group of patients with difficult intravenous access (DIVA). In experts' hands, ultrasound-guided vascular access appears to be a significantly better method. Investigators hypothesize that UGVA is superior also in short-term patency of cannula and even for blood draw through cannula. Repeated cannula pricks in the operating room setting not only puts a lot of stress on the patient and medical staff, but they also waste OR time. METHODS This investigator-initiated prospective randomized monocentric controlled trial is designed to randomly allocate 200 patients undergoing elective primary total joint arthroplasty of hip or knee to one of two groups as follows: Group C (control group) - peripheral venous cannula insertion by palpation or Group USG (intervention) - cannula insertion by ultrasound-guided vascular access. Our primary endpoint is to compare the number of attempts for ultrasound-guided insertion of the peripheral venous cannula with common palpation insertion of the peripheral venous cannula in overweight/obese patients (BMI ≥ 25). The secondary endpoint is a failure rate of the peripheral venous cannula to administer intravenous therapy up to 5 days postoperatively. Tertiary endpoints include a portion of long PVCs that are able to ensure blood draw up to 5 days postoperatively, time needed to insert PVC in each group, number of needle tip redirections in both groups, and reinsertion of PVC needed in both groups for any reason. DISCUSSION This study is pragmatic and is looking for clinically relevant data. After completion, it will answer the question of whether it is clinically relevant to use ultrasound-guided vascular access in the context of not only short-term benefit of insertion, but also up to 5 days after insertion. Also, if this method can ensure blood draw through a peripheral vein cannula, it can save resources in the perioperative period - valuable especially considering the ongoing shortage of medical staff worldwide. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of ultrasound-guided peripheral vascular access in the perioperative period. TRIAL REGISTRATION ClinicalTrials.gov NCT05156008. Registered on 13.12.2021.
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Affiliation(s)
- Jakub Hlasny
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia.
| | - Roman Alberty
- Department of Biology & Ecology, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia
| | - Marian Hlavac
- Orthopedic Department, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
| | - Ivan Grgac
- Institute of Anatomy, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Michael Teodor Grey
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
| | - Michal Venglarcik
- Department of Anaesthesia and Intensive Care, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovakia
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7
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Alaca A, Yildirim Sari H. Determination of pain experienced by children during intravenous bolus treatments and its causes. J Vasc Access 2023; 24:762-770. [PMID: 34736344 DOI: 10.1177/11297298211046821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The present study aimed to determine the pain experienced by children during intravenous bolus treatment and to identify what causes it. METHOD In the first stage of the study, the first 40 observations were performed by two researchers. The study was continued by a single observer after the Kappa test was performed. In this study, 101 drug treatments were administered by intravenous bolus in patients aged between 1 month and 6 years. The pain experienced during treatment was assessed using pain scales according to the age group the patient was in. RESULTS Pain was observed in 63.4% (n = 64) of the treatments. There was a significant relationship between the type of medication administered and pain experienced during drug administration. There was also a significant correlation between the age of the children and their pain experiences. Given the location of the catheter, there was no significant difference among the children who experienced pain during intravenous treatment. CONCLUSION Intravenous drug therapy may cause pain in children. To minimize such pain, it is recommended to determine the drugs that cause pain during intravenous treatment and to develop application protocols to minimize pain caused by these drugs.
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Affiliation(s)
- Asli Alaca
- İzmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey
| | - Hatice Yildirim Sari
- Faculty of Health Science, Department of Pediatric Nursing, Izmir Katip Celebi University, Izmir, Turkey
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Baracaldo-Santamaría D, Feliciano-Alfonso JE, Ramirez-Grueso R, Rojas-Rodríguez LC, Dominguez-Dominguez CA, Calderon-Ospina CA. Making Sense of Composite Endpoints in Clinical Research. J Clin Med 2023; 12:4371. [PMID: 37445406 DOI: 10.3390/jcm12134371] [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: 05/18/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple drugs currently used in clinical practice have been approved by regulatory agencies based on studies that utilize composite endpoints. Composite endpoints are appealing because they reduce sample size requirements, follow-up periods, and costs. However, interpreting composite endpoints can be challenging, and their misuse is not uncommon. Incorrect interpretation of composite outcomes can lead to misleading conclusions that impact patient care. To correctly interpret composite outcomes, several important questions should be considered. Are the individual components of the composite outcome equally important to patients? Did the more and less important endpoints occur with similar frequency? Do the component endpoints exhibit similar relative risk reductions? If these questions receive affirmative answers, the use and interpretation of the composite endpoint would be appropriate. However, if any component of the composite endpoint fails to satisfy the aforementioned criteria, interpretation can become difficult, necessitating additional steps. Regulatory agencies acknowledge these challenges and have specific considerations when approving drugs based on studies employing composite endpoints. In conclusion, composite endpoints are valuable tools for evaluating the efficacy and net clinical benefit of interventions; however, cautious interpretation is advised.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Raul Ramirez-Grueso
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Luis Carlos Rojas-Rodríguez
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Carlos Alberto Calderon-Ospina
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
- Research Group in Applied Biomedical Sciences (UR Biomed), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
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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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10
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Chen CY, Chen WC, Chen JY, Lai CC, Wei YF. Comparison of clinically indicated replacement and routine replacement of peripheral intravenous catheters: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2022; 9:964096. [PMID: 36035414 PMCID: PMC9411788 DOI: 10.3389/fmed.2022.964096] [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: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background It is unknown whether clinically indicated replacement of peripheral intravenous catheters (PIVCs) increases the risks of PIVC-associated complications and infections compared to routine replacement of PIVCs. Methods We searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) that compare the safety outcomes of routine replacement and clinically indicated replacement of PIVCs were included for meta-analysis. The primary outcome was the incidence of phlebitis, and secondary outcomes included the risks of occlusion, local infection, infiltration, catheter-related bloodstream infection (CRBSI), and accidental removal of the PIVC. Results A total of 9 RCTs involving 10 973 patients were included in this meta-analysis, of whom 5,546 and 5,527 were assigned to the study group (clinically indicated replacement of PIVCs) and control group (routine replacement of PIVCs every 72–96 h), respectively. The incidence of phlebitis in the study group was significantly higher than that in the control group [risk ratio (RR), 1.20; 95% confidence interval (CI), 1.01–1.44, P = 0.04, I2 = 49%]. In addition, the study group was associated with a higher risk of occlusion (RR, 1.45; 95% CI, 1.08–1.95, P = 0.01, I2 = 82%) and infiltration (fluid leaks) (RR, 1.27; 95% CI, 1.06–1.53, P = 0.01, I2 = 72%) than the control group. However, no significant differences were observed in the risks of local infection (RR, 1.75; 95% CI, 0.38–8.16, P = 0.48, I2 = 0%) and CRBSI (RR, 0.61; 95% CI, 0.08–4.68, P = 0.64, I2 = 0%) between the study and control groups. Conclusion The clinically indicated replacement of PIVCs may increase the risks of PIVC-associated phlebitis, infiltration, and occlusion compared to the routine replacement of PIVCs, but did not increase the risk of PIVC-associated infections. Based on these findings, routine replacement of PIVCs every 72–96 h maybe a preferred option than clinically indicated replacement of PIVCs. Systematic review registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022302021].
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Affiliation(s)
- Ching-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Wang-Chun Chen
- Department of Pharmacy, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jung-Yueh Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- *Correspondence: Chih-Cheng Lai,
| | - Yu-Feng Wei
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
- Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Yu-Feng Wei,
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11
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Knowledge and practice of intravenous infusion among nurses in university of Calabar teaching hospital. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns3.6132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed at assessing the knowledge and practice of intravenous infusion among nurses in University of Calabar Teaching Hospital. Two (2) objectives with the corresponding research questions were formulated. A descriptive research design was adopted for the study. The population and sample comprised of 160 registered nurses working in University of Calabar Teaching Hospital. Convenient sampling technique was employed to select 114 nurses to form the sample for this study. A self-developed and structured questionnaire was used to obtain data and analyzed using simple frequency and percentage tables. Findings of Results in table 2 reveals that majority 87(76.3) of the respondents said yes that As a nurse I know that intravenous infusion is carried out in most hospital by both doctors and nurses while 27(23.7%) said no. 114(100) of the respondents said yes that As a nurse I know that most management in the hospital do not allow nurses to carryout intravenous infusion on their patients for fear of replacement.
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12
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Kassahun CW, Abate AT, Tezera ZB, Beshah DT, Agegnehu CD, Getnet MA, Abate HK, Yazew BG, Alemu MT. Incidence and Associated Factors of Failed First Peripheral Intravenous Catheters among Adult Patients at Medical Surgical Wards in Public Referral Hospitals of West Amhara, Ethiopia, 2021. Nurs Res Pract 2022; 2022:8261225. [PMID: 35103104 PMCID: PMC8800617 DOI: 10.1155/2022/8261225] [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: 05/20/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Complications of peripheral intravenous catheters cause problems in clinical practice and bring high costs in terms of morbidity and mortality of patients. Therefore, this study aimed to assess the incidence and associated factors of failed first peripheral intravenous catheters among adult patients in selected Public Referral Hospitals of West Amhara Regional State, Ethiopia, 2021. MATERIALS AND METHODS An institution-based prospective observational study was conducted among 423 adult patients from January to February 2021. Patients were selected using systematic random sampling techniques. The data were collected using interviewer-based, structured questionnaires and observational checklists. EPI-DATA 3.1 and SPSS version-23 were used for data entry and analysis, respectively. Frequency, percentages, and means were calculated. The outcome variable was determined and graded based on phlebitis and infiltration scales. Binary and multivariable logistics regressions were computed. RESULTS Four hundred and seventeen first peripheral cannula sites from 418 patients were followed for 2,565 peripheral catheter hours. A failed first peripheral intravenous catheter was observed in 124 (29.7%, CI: 25.6-34) adult patients. Patients who were female (AOR = 0.4, 95% CI: 0.22-0.74) had cannula duration of 49-72 hours (AOR = 0.31, 95% CI: 0.14-0.7) and 73-96 hours (AOR = 0.39, 95% CI: 0.17-0.9), and patients who had been given electrolytes (AOR = 0.31, 95% CI: 0.11-0.86) were more likely to have failed first peripheral intravenous cannula. CONCLUSIONS Failed first peripheral intravenous cannula is much higher as compared to the acceptable rate of ≤5% by the Infusion Nurses Society. Hence, all patients with peripheral intravenous catheters are screened for catheter failure at least once a day. Providing appropriate nursing care and patient education is also required to reduce the risks.
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Affiliation(s)
- Chanyalew Worku Kassahun
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addisu Taye Abate
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewdu Baye Tezera
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debrewok Tesgera Beshah
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- Community Nursing Unit, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehmmed Adem Getnet
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie Abate
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Mahlet Temesgen Alemu
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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13
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Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z, Zhang F, Lyu Y, Lin F. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. J Clin Nurs 2021; 31:2959-2970. [PMID: 34779070 DOI: 10.1111/jocn.16129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. BACKGROUND Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. DESIGN A multisite randomised controlled trial. METHODS The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. RESULTS The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients' first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. CONCLUSIONS In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. RELEVANCE TO CLINICAL PRACTICE In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.
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Affiliation(s)
- Jing Li
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Peking University School of Nursing, Beijing, China
| | - Peiying Zhang
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, China.,Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | | | - Yang Lyu
- Beijing Chao-Yang Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia.,School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
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14
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Buetti N, Abbas M, Pittet D, de Kraker MEA, Teixeira D, Chraiti MN, Sauvan V, Sauser J, Harbarth S, Zingg W. Comparison of Routine Replacement With Clinically Indicated Replacement of Peripheral Intravenous Catheters. JAMA Intern Med 2021; 181:1471-1478. [PMID: 34533191 PMCID: PMC8561330 DOI: 10.1001/jamainternmed.2021.5345] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events. OBJECTIVE To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement every 96 hours to clinically indicated replacement. DESIGN, SETTING, AND PARTICIPANTS This institution-wide, observational cohort study evaluated all patients hospitalized at a large university-affiliated hospital with 10 sites in Western Switzerland with a PVC insertion between January 1, 2016, and February 29, 2020. EXPOSURES Peripheral intravenous catheters were routinely replaced every 96 hours until March 31, 2018 (baseline period). Between April 1, 2018, and October 15, 2019, PVCs were replaced if clinically indicated (intervention period). From October 16, 2019, PVCs were again routinely replaced every 96 hours (reversion period). MAIN OUTCOMES AND MEASURES The PVC-BSI rates and PVC-BSI incidence rate ratios (IRRs) during each period. RESULTS A total of 412 631 PVCs with documented catheter duration were included (164 331 patients; median [interquartile range] patient age, 51 [33-72] years; 88 928 [54.1%] female): 241 432 PVCs at baseline, 130 779 at intervention, and 40 420 at reversion. Eleven PVC-BSIs were observed during the baseline period, 46 during the intervention, and 4 during the reversion period. Although the monthly number of PVC-days remained stable during all study periods, the number of monthly inserted PVCs decreased during the intervention period. The number of PVCs still in place more than 4 or more than 7 days was higher during the intervention period compared with the baseline and reversion periods. A significantly increased IRR of PVC-BSIs was observed for the intervention period (IRR, 7.20; 95% CI, 3.65-14.22; P < .001) compared with baseline, whereas during the reversion period there was no significant increase (IRR, 1.35; 95% CI, 0.30 6.17; P = .69). CONCLUSIONS AND RELEVANCE The results of this cohort study using a large, prospective surveillance database suggest that replacement of PVCs only when clinically indicated may be associated with an increased risk of PVC-BSI compared with routine replacement. Even if PVC-associated BSI is a rare event, the use of PVCs in most patients makes this outcome relevant.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Unité Mixte de Recherche ( UMR ) 1137 , Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM, Université de Paris, Paris, France
| | - Mohamed Abbas
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlieke E A de Kraker
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Teixeira
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Noëlle Chraiti
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Valérie Sauvan
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Julien Sauser
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Walter Zingg
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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15
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Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
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16
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Reducing the incidence of phlebitis in medical adult inpatients with peripheral venous catheter care bundle: a best practice implementation project. JBI Evid Implement 2021; 19:68-83. [PMID: 33570335 DOI: 10.1097/xeb.0000000000000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization. AIMS The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates. METHODS A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed. RESULTS One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P < 0.001) but no significant improvement in Criterion 2 (P > 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P < 0.05). An interesting finding was that the number of reported occurrences of phlebitis increased after implementing the PVC care bundle. DISCUSSION The increase in phlebitis rates could be attributed to the care bundle facilitating prompt and early identification of phlebitis. Despite the initial increase in occurrences 1 month post implementation, the general effectiveness of the care bundle in reducing occurrences of phlebitis was seen 6 months post implementation. The effectiveness of the care bundle to reduce phlebitis rates may be even more evident across a longer implementation period. CONCLUSION The current study showed that the implementation of a standardized PVC care bundle can significantly enhance the assessment and identification process of phlebitis and can aid in reducing the incidence of phlebitis. The nurses' compliance in practicing the PVC care bundle was determined by the post and preimplementation audits, thus, the audit approach was beneficial in translating evidence into practice.
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Armenteros-Yeguas V, Tomás-López MA, Miranda-Serrano E, Moraza-Dulanto I, Meléndez-Fernández L, Merino-Romero E, Cristóbal-Domínguez E, Gárate-Echenique L. Vascular access care in patients with multimorbidity. ACTA ACUST UNITED AC 2021; 30:S26-S35. [PMID: 33876690 DOI: 10.12968/bjon.2021.30.8.s26] [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
BACKGROUND More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups. METHODS A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ2, Student's t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA. RESULTS We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596. CONCLUSIONS Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts.
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Affiliation(s)
| | | | | | | | | | | | - Estíbaliz Cristóbal-Domínguez
- Bioaraba Health Research Institute, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Araba, Spain
| | - Lucía Gárate-Echenique
- General Directorate of the Basque Health Service, Osakideza, Vitoria-Gasteiz, Araba, Spain
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18
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Elizabeth Gómez-Neva M, Alonso Rondon Sepulveda M, Buitrago-Lopez A. Lifespan of peripheral intravenous short catheters in hospitalized children: A prospective study. J Vasc Access 2021; 23:730-737. [PMID: 33845674 DOI: 10.1177/11297298211005299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the recommended lifespan of 223 peripheral intravenous accesses in pediatric services. METHOD In this cohort study, we monitored the time of intravenous catheter between insertion and removal in children aged up to 15 years old in a Hospital from Bogotá-Colombia. The routine catheter observations was registered in questionnaires during nursing shifts. Survival analyses were performed to analyze the lifespan of the catheter free of complications. RESULTS The median lifespan of peripheral intravenous catheters without complications was 129 h (IQR 73.6-393.4 h). This median time free from complications was much lower for children ⩽1 year 98.3 h (IQR 63-141 h), than for participants aged >1 year 207.4 h (IQR 100-393 h). Catheters of 24 G (gauge) caliber had a median complication free time of 128 h (IQR 69-207 h) and 22 G calibers 144 h (IQR 103-393 h). CONCLUSIONS In this study, 75% of peripheral indwell catheters remained free from complications for 74 h, the other extreme 25% of these patients could remain up to 393 h.
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Affiliation(s)
- Maria Elizabeth Gómez-Neva
- Faculty of Nursing, Department of Clinical Nursing, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Martin Alonso Rondon Sepulveda
- Faculty of Medicine, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Adriana Buitrago-Lopez
- Faculty of Medicine, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
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Stanley AK, Barnett-Vanes A, Reed MJ. Peripheral Intravenous Cannula Usage in the Emergency Department. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.9205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.
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Mechanism of pulsatile flushing technique for saline injection via a peripheral intravenous catheter. Clin Biomech (Bristol, Avon) 2020; 80:105103. [PMID: 32698096 DOI: 10.1016/j.clinbiomech.2020.105103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The underlying mechanism of pulsatile flushing technique has not been fully elucidated, and the partial understanding of the mechanism has been confined to hydrodynamic simulation, ignoring the dynamic interaction among the catheter, blood vessel, blood stream, and saline. METHODS The peripheral intravenous catheter and vein models and their internal flow fields were assessed using a commercial software. The parameters of both fluid and structural mechanics were calculated and compared in the push and pause phase. The effect of different flushing volumes per bolus before each pause (0.5, 1.0, 1.5, and 2.0 mL) were compared, respectively corresponding to group (A, B, C and D). FINDINGS In groups C and D, the wall shear stress value (≥2 Pa) and enhanced shear rates (peaks up to 10,000 s-1) were higher in the vessel wall near the catheter tip, which may be at risk of vascular endothelial injury. Furthermore, extraluminal flushing might be attributed to the recirculation of jet from the catheter outlet. The vortices of all groups faded away in an extremely short period (≤0.1 s) if the push was suddenly discontinued. Finally, overlarge displacement of the catheter tip in groups C and D (0.91 and 1.1 mm, respectively) caused the peripheral intravenous catheters to angle with the venous wall. INTERPRETATION The pulsatile flushing technique can facilitate intra- and extraluminal flushing of peripheral intravenous catheters. Furthermore, an insufficient volume per bolus can lead to inefficient flushing, and an overdose of single push may cause mechanical endothelial injury.
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Corley A, Ullman AJ, Marsh N, Emily N. L, Mihala G, Harris PNA, Rickard CM. SECUREment bundles to prevent peripheral intravenous catheter failure—the SECURE-PIVC trial: study protocol for a pilot randomized controlled trial. ACTA ACUST UNITED AC 2020; 29:S40-S46. [DOI: 10.12968/bjon.2020.29.19.s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Peripheral intravenous catheters (PIVCs) are widely used, but failure is unacceptably common with up to 69% failing before treatment is complete. PIVC securement reduces failure, but the optimal way to achieve this is unclear. Tapes and supplementary securement products are widely used, however rigorous testing of these to reduce PIVC failure remains unexplored. Methods and analysis In adult medical-surgical wards at a tertiary hospital, this pilot randomized controlled trial tests standard care (bordered polyurethane dressing plus nonsterile tape over the extension tubing) against two securement interventions (intervention one: standard care plus two sterile tape strips over the PIVC hub; intervention two: intervention one plus a tubular bandage). Patients >18 years of age requiring a PIVC for >24 hours are eligible. Patients with laboratory-confirmed positive blood cultures within 24 hours of screening, known allergy to study products, current or high-risk of skin tear, or non-English speaking without interpreter are excluded. Sample size is 35 per trial arm, and central randomization is computer-generated with allocation concealed until entry. Patients and clinical staff cannot be blinded to treatment allocation. However, infection outcomes are assessed by a blinded investigator. Primary outcome is study feasibility. Secondary outcomes (PIVC failure, dwell time, skin adverse events, PIVC colonization, and cost) are compared between groups. Feasibility outcomes are reported descriptively. Ethics and trial commencement Ethical approvals were received from Royal Brisbane and Women's Hospital (HREC/18/QRBW/44571) and Griffith University (2018/1000). Trial commencement was May 2019. Trial registration: ACTRN12619000026123.
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Affiliation(s)
- Amanda Corley
- Adjunct Senior Research Fellow position with the AVATAR group at Menzies Health Institute QLD, Griffith University
| | - Amanda J Ullman
- NHMRC Fellow and Associate Professor at Griffith University, and Honorary Research Fellow at the Queensland Children's Hospital and the Royal Brisbane and Women's Hospital
| | - Nicole Marsh
- Nursing Director, Research, The Royal Brisbane and Women's Hospital
| | - Larsen Emily N.
- Senior Research Assistant with the AVATAR Group, Griffith University, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics (CAHE) and the AVATAR Group
| | - Patrick N. A. Harris
- Infectious Disease Physician, Medical Microbiologist and NHMRC Early Career Fellow at The University of Queensland Centre for Clinical Research (UQCCR)
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Marsh N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, Rickard CM. Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis. J Adv Nurs 2020; 76:3346-3362. [DOI: 10.1111/jan.14565] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Joan Webster
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Amanda J. Ullman
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Medicine Griffith University Brisbane Queensland Australia
- Centre for Applied Health Economics Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Division of Hospital Medicine Department of Medicine University of Michigan Ann Arbor Michigan USA
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Brisbane Queensland Australia
- Alliance for Vascular Access Teaching and Research Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Australia
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Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study. Support Care Cancer 2020; 29:1487-1496. [PMID: 32710173 DOI: 10.1007/s00520-020-05643-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To identify modifiable and non-modifiable risk factors for peripheral intravenous catheter (PIV) failure among patients requiring intravenous treatment for oncology and haematology conditions. METHODS A single-centre prospective cohort study was conducted between October 2017 and February 2019. Adult in-patients requiring a PIV for therapy were prospectively recruited from two cancer units at a tertiary hospital in Queensland, Australia. The primary outcome was a composite of complications leading to PIV failure (local and bloodstream infection; occlusion; infiltration/extravasation; leakage; dislodgement; and/or phlebitis). Secondary outcomes were (i) PIV dwell time; (ii) insertion and (iii) failure of a CVAD; (iv) adverse events; (v) length of hospital stay. Outcomes were investigated using Bayesian multivariable linear regression modelling and survival analysis. RESULTS Of 200 participants, 396 PIVs were included. PIV failure incidence was 34.9%; the most common failure type was occlusion/infiltration (n = 74, 18.7%), then dislodgement (n = 33, 8.3%), and phlebitis (n = 30, 7.6%). While several patient and treatment risk factors were significant in univariable modelling, in the final multivariable model, only the use of non-sterile tape (external to the primary dressing) was significantly associated with decreased PIV dislodgement (hazard ratio 0.06, 95% confidence interval 0.01, 0.48; p = 0.008). CONCLUSION PIV failure rates among patients receiving cancer treatment are high, the sequelae of which may include delayed treatment and infection. Larger studies on risk factors and interventions to prevent PIV failure in this population are needed; however, the use of secondary securements (such as non-sterile tape) to provide further securement to the primary PIV dressing is particularly important. TRIAL REGISTRATION Study methods were registered prospectively with the Australian New Zealand Clinical Trials Registry on the 27th March 2017 (ACTRN12617000438358); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true.
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25
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Atay S, Yilmaz Kurt F. Effectiveness of transparent film dressing for peripheral intravenous catheter. J Vasc Access 2020; 22:135-140. [PMID: 32529940 DOI: 10.1177/1129729820927238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The intravenous applications are the most common type of such interventions. It is underlined that in cases where the peripheral intravenous catheter is not properly secured in place, even a minor movement inside the vein would result in injury of vein. OBJECTIVE The insertion of peripheral intravenous catheter is a common practice. This is a randomized controlled prospective study aiming at investigating the effectiveness of use of transparent film dressing for peripheral intravenous catheter. METHODS The universe of this study included inpatients in the Internal Diseases clinic of a University Hospital, and the sample included a total of 110 peripheral intravenous catheters that were calculated by power analysis. The patient identification form, the peripheral venous catheter and treatment information form, and the visual infusion phlebitis identification scale were used to collect data. The forms were completed by the investigators on the basis of daily observations. The data were assessed by the percentage, chi-square test, and logistic regression analysis via the software SPSS 20.00. RESULTS The individuals in the study group and the control group included in the sample are comparable in terms of gender, having/not having a chronic disease, the site of peripheral intravenous catheter, use of antibiotics, intravenous fluid therapy, and mean age. There were no statistically significant differences between the groups. There was a significant relationship between the dwell time for the catheter and development of any complications and the groups. CONCLUSION The use of transparent film dressing for insertion of peripheral intravenous catheter can be recommended as it increases the dwell time for the catheter and reduces incidence of complications.
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Affiliation(s)
- Selma Atay
- Nursing Department at Faculty of Health Science, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Fatma Yilmaz Kurt
- Nursing Department at Faculty of Health Science, Çanakkale Onsekiz Mart University, Canakkale, Turkey
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Bush K, Odunayo A, Hedges K, Guieu LV, Smith R, Okafor C. Peripheral Intravenous Catheter Complications in Hospitalized Cats: An Observational Pilot Study. Top Companion Anim Med 2020; 41:100456. [PMID: 32823155 DOI: 10.1016/j.tcam.2020.100456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES There is little information about complications associated with peripheral catheter use in cats. The primary objective of this study was to determine the main reason for catheter removal in cats hospitalized in the Intensive Care Unit at a university teaching hospital. The secondary objective was to describe catheter-associated complications in cats hospitalized. METHODS All feline patients with peripheral intravenous catheters admitted to the Intensive Care Unit between June and August 2017 were prospectively enrolled in this study. All catheters were evaluated at least 3 times a day per institutional Intensive Care Unit protocol. The catheters were monitored throughout the cat's hospitalization period for development of complications, including occlusion, phlebitis and extravasation. Data collected included patient signalment, reason for hospitalization, catheter size and location, number of hours the catheter remained in place, reason for removal and if the catheter was replaced once removed. RESULTS Thirty-four cats were enrolled in the study, and a total of 42 catheters were placed in those cats. Median peripheral IV catheter duration was 23.8 hours (interquartile range [IQR] 13.8-41.3 hours). The most frequent reason for catheter removal was patient discharge from the hospital (24/42, 57.1%). Overall catheter complication rate was 21.4% (9/42). Complications observed included phlebitis, extravasation, patient removal, occlusion, and edema formation. CLINICAL SIGNIFICANCE The results of this study conclude that the majority of peripheral IV catheters in cats are removed due to discharge from hospitalization. More studies with a larger population of cats are needed to see if there is a relationship between length of indwelling catheterization and risk of catheter-associated complications.
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Affiliation(s)
- Kaleigh Bush
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA.
| | - Katherine Hedges
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Liz-Valérie Guieu
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Rebecca Smith
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Chika Okafor
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
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Steere L, Ficara C, Davis M, Moureau N. Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit With Lean Multimodal Strategy: the PIV5Rights™ Bundle. ACTA ACUST UNITED AC 2020. [DOI: 10.2309/j.java.2019.003.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
HighlightsLean leadership for process improvement. Prospective comparator multimodal design study. Vascular access specialty team (VAST group 2) versus generalist nursing model (group 1). First stick success of 96%. Statistically significant improvement in dwell time with VAST versus generalist nursing model (89% versus 15% lasting until end of therapy). Projected 2.9 million in savings annually. Peripheral intravenous catheter team centralized proposal to Chief Nursing Officer (CNO) with acceptance based on outcomes. Reduction in cost per bed per year using a vascular access specialty team of $3376.AbstractBackground: Peripheral intravenous catheter (PIVC) sales per year exceed that of the number of people in the United States (US), 350 million. With only 37 million US hospital patient admissions per year, these data indicate an average usage of 10 PIVCs per patient admission, suggesting a very high failure, very low success rate, and excess cost associated with PIVC insertions. Patients often complain of multiple catheter insertion attempts, and published data reveal up to 53% of PIVCs fail before therapy ends.Methods: Hartford Hospital (Hartford, CT) conducted a prospective comparator single-center clinical superiority design study to determine the impact of bundled practices including device insertions using vascular access specialty team (VAST) intravenous trained nurses versus current practice. The study used a 5 step multimodal best practice intervention strategy designated as the PIV5Rights Bundle with an aim to determine if the intervention outcomes and dwell time improved over current PIVC practices. The study group applied a Lean health care standard work process with a Six Sigma design, define, measure, analyze, improve, control approach that included VAST PIVC dwell time, complications, and economic impact compared with current state general nursing practice.Results: Outcomes of the PIV5Rights Bundle in Group 2 (experimental) using a trained vascular access nursing team for insertion and management achieved a statistically significant result of 89% of catheters achieving end of therapy with a cost saving per bed of $3376 ($1405 versus $4781) per year as compared to standard practice (Group 1; control). Results of Group 1 reflected PIVC dwell time to end of treatment in only 15% of catheters. Prestudy catheter consumption analysis was 4.4 catheters per patient hospital admissions, reflecting waste within labor and supply costs for PIVC insertion and usage. Peripheral intravenous catheter retrospective audits for current practice demonstrated more than 50% catheters failed within the first 24 hours. This application of Lean methodology by Hartford Hospital with infusion therapy resulted in a projected $2.9 million annual savings of $3376 per bed per year for house-wide application.Conclusions: Implementation of the PIV5Rights™ Bundle with a dedicated VAST proved to be a successful model, both from a patient and financial perspective. The journey to nursing excellence included identification of core measures and best practice evidence for PIVC placements as a procedure that affects nearly every patient entering a hospital. By centralizing ownership of vascular access with the team for insertion, management, and securement, the PIV Five Rights is the right approach to achieve the right results in transformation of hospital infusion therapy practices. Bundled approaches have often been used for central catheter infection reduction. This is the first study the authors have identified focusing on 1 PIVC per patient visit as a result of an evidence-based bundle and VAST.
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Heng SY, Yap RTJ, Tie J, McGrouther DA. Peripheral Vein Thrombophlebitis in the Upper Extremity: A Systematic Review of a Frequent and Important Problem. Am J Med 2020; 133:473-484.e3. [PMID: 31606488 DOI: 10.1016/j.amjmed.2019.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The acceptable incidence of thrombophlebitis following intravenous cannulation is 5%, as recommended by the Intravenous Nurses Society guidelines, but publications have reported startling figures of 20% to 80%. Given the frequency of intravenous lines, this presents a potential clinical problem. We aimed to determine the predisposing patient, catheter, and health care-related factors of peripheral vein thrombophlebitis in the upper extremity. METHODS In this systematic review, we used a comprehensive search strategy to identify risk factors of thrombophlebitis from inception to May 20, 2019. Studies reporting risk factors of peripheral vein thrombophlebitis of adult patients admitted to the hospital and receiving an intravenous cannulation were included. The Quality of Prognostic Studies tool was used in the assessment for risk of bias to determine the study quality. RESULTS Of the 6910 studies initially identified, 25 were eligible for inclusion. Qualitative syntheses revealed that patient-related factors that confer a higher risk included intercurrent illness, immunocompromised state, comorbidities such as diabetes mellitus, malignancy, previous thrombophlebitis, burns, and higher hemoglobin levels. Catheter-related risk factors included catheter size, duration, and site of insertion. Intravenous antibiotics and potassium chloride predisposed to thrombophlebitis. Cannulation by an intravenous therapy team and more nursing care were associated with a decreased risk. A P-value < .5 was considered to be statistically significant. CONCLUSION Recognition of the predisposing factors would allow for targeted strategies to aid in the prevention of this iatrogenic infection, which may include closer monitoring of patients who are identified to be vulnerable. Based on this systematic review, we developed an algorithm to guide clinical management. Further research is warranted to validate this algorithm.
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Affiliation(s)
- Shu Yun Heng
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Robert Tze-Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Joyce Tie
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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Heng SY, Yap RTJ, McGrouther DA. Innovative Solutions and Insights to Phlebitis Prevention. Am J Med 2020; 133:261-264. [PMID: 31442390 DOI: 10.1016/j.amjmed.2019.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Shu Yun Heng
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Robert Tze-Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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Takahashi T, Murayama R, Abe-Doi M, Miyahara-Kaneko M, Kanno C, Nakamura M, Mizuno M, Komiyama C, Sanada H. Preventing peripheral intravenous catheter failure by reducing mechanical irritation. Sci Rep 2020; 10:1550. [PMID: 32005839 PMCID: PMC6994694 DOI: 10.1038/s41598-019-56873-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022] Open
Abstract
Peripheral intravenous catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic “pre-scan” for selecting a large-diameter vein before catheterization, a “post-scan” for confirming the catheter tip position after catheterization with ultrasonography, and the use of a flexible polyurethane catheter to reduce the mechanical irritation that contributes to the incidence of catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was catheter failure, which was defined as accidental and unplanned catheter removal. We used Kaplan-Meier survival curves to compare rates of time until catheter failure. We analysed 189 and 233 catheters in the intervention and control groups, respectively. In the control group, 68 catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for catheter failure was 0.60 (95% CI: 0.47–0.71). Care protocols, including assessment of vein diameter, vein depth, and catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce catheter failure incidence.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maki Miyahara-Kaneko
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chiho Kanno
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Nakamura
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Mizuno
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Kleidon TM, Keogh S, Flynn J, Schults J, Mihala G, Rickard CM. Flushing of peripheral intravenous catheters: A pilot, factorial, randomised controlled trial of high versus low frequency and volume in paediatrics. J Paediatr Child Health 2020; 56:22-29. [PMID: 31033046 DOI: 10.1111/jpc.14482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
Abstract
AIM To test the feasibility of an efficacy trial comparing different flushing frequencies and volumes to reduce peripheral intravenous cannula (PIVC) failure in paediatric inpatients. METHODS Pilot, 2 × 2 factorial, randomised controlled trial comparing PIVC flushing techniques in intervention pairs: (i) low volume (3 mL) versus high volume (10 mL); and (ii) low frequency (24 hourly) versus high frequency (6 hourly). Patients were excluded if: fluids were restricted, weight < 5 kg, PIVC already in situ for >24 h or continuous infusion. The primary end-point was feasibility (eligibility, recruitment, retention, protocol adherence, missing data and sample size estimates) of a large trial. Secondary end-points were PIVC failure (composite and individual), bloodstream infection and mortality. RESULTS A total of 919 children were screened from April to November 2015, with 55 enrolled. Screening feasibility criteria were not met, mainly due to continuous infusions and PIVCs in situ >24 h or planned for imminent removal. However, 80% of eligible participants consented, 2% withdrew, protocol adherence was 100%, and there was no missing primary end-point data. PIVC failure was significantly higher (hazard ratio = 2.90, 95% confidence interval: 1.11-7.54) in the 3 mL compared to the 10 mL group. There was no difference in failure between frequency groups (hazard ratio = 0.91, 95% confidence interval: 0.36-2.33). There was no interaction effect (P = 0.22). CONCLUSION Trial feasibility proved challenging due to eligibility criteria, which could be improved with additional recruiting staff. Firm conclusions cannot be made based on this small sample, but flush volume may impact PIVC failure.
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Affiliation(s)
- Tricia M Kleidon
- Department of Anaesthetics, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Flynn
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Department of Anaesthetics, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Heath Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Ruiz-Giardin JM, Ochoa Chamorro I, Velázquez Ríos L, Jaqueti Aroca J, García Arata MI, SanMartín López JV, Guerrero Santillán M. Blood stream infections associated with central and peripheral venous catheters. BMC Infect Dis 2019; 19:841. [PMID: 31615450 PMCID: PMC6794764 DOI: 10.1186/s12879-019-4505-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. Methods This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. Results In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4%), p < 0.001. The accuracy was greater for PB (75%) than for CB (66. 2%), Coagulase-negative staphylococci were the most frequent microorganisms in both groups but occurred 1.57 times more frequently in CB (64.1%/40.6%) (p = 0.004), while Staphylococcus aureus (23. 4%/9.5%) (p = 0.02) and Enterobacteriae species (15.6%/6. 3%) (p = 0.003) were 2.5 times more frequent in PB. The CB patients stayed at the hospital for an average of 7.44 days longer than did the PB patients; more CB patients had active neoplasia (70. 4%/32.8%), more had surgery in the previous week (29. 2%/8. 3%), and fewer received adequate empirical treatment (53.9%/ 62.5%). Catheter was not removed in 8. 2% of CB and 3.7% of PB. On the other hand, the CB and PB patients had similar Pitt scores at blood extraction (median 0.89 versus 0.84 points, respectively; p = 0.8) and similar survival rates at hospital discharge (91.1% versus 90. 2%; p = 0.81). Conclusions Central catheters were more frequent sources of bacteraemias than were peripheral catheters. There were important differences in the microbiological aetiology as well. PB patients received correct empirical antibiotic treatment more frequently and had a higher initial rate of correct determination of the suspected source of bacteraemia. Differences in the microbiological aetiology and empirical antibiotic treatment received, and probably catheter removal and time to catheter removal could explain why CB and PB patients had similar survival rates .
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Affiliation(s)
- Jose Manuel Ruiz-Giardin
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Iciar Ochoa Chamorro
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Laura Velázquez Ríos
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Jeronimo Jaqueti Aroca
- Clinical Analysis Department, Microbiology Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Maria Isabel García Arata
- Clinical Analysis Department, Microbiology Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Juan Víctor SanMartín López
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
| | - Marta Guerrero Santillán
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Camino del Molino nº 2, 28942, Fuenlabrada, Madrid, Spain
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Lodzinska J, Leigh H, Parys M, Liuti T. Vascular ultrasonographic findings in canine patients with clinically diagnosed phlebitis. Vet Radiol Ultrasound 2019; 60:745-752. [PMID: 31515890 PMCID: PMC6899573 DOI: 10.1111/vru.12805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/06/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non‐pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non‐pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.
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Affiliation(s)
- Joanna Lodzinska
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Hannah Leigh
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Magdalena Parys
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Tiziana Liuti
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
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Blanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control 2019; 8:124. [PMID: 31367345 PMCID: PMC6647274 DOI: 10.1186/s13756-019-0581-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices among inpatients. Catheter-related bloodstream infections (CRBSI) are serious yet preventable events for patients. Although the contribution of PIVCs towards these infections is gradually being recognised, its role in the Spanish setting is yet to be determined. We aimed to estimate the rate and incidence of PIVC failure at Manacor hospital (Spain) as baseline within a wider quality improvement initiative. Methods Tips from all PIVC removed during December 2017 and January 2018 in hospital wards were cultured semiquantitatively. The study population included all PIVCs inserted in adult patients admitted to any of three medical and one surgical wards, emergency department, critical care unit and operating rooms. Clinical, microbiological and ward information was collected by clinical researchers for each PIVC from insertion to removal on the study sites. CRBSI was defined per international guidelines (i.e., Centers for Disease Control and Prevention, USA). Data was analysed descriptively. Results Seven hundred and eleven tips were cultured, with 41.8% (297/711) reported as PIVC failure. The PIVC failure rate density-adjusted incidence for hospital length of stay (HLOS) was 226.2 PIVC failure/1000 HLOS. 5.8% (41/711) tips yielded positive isolates, with most frequent microorganisms Staphylococcus spp (S. epidermidis 29/41, 70.7%, S. aureus 2/41, 4.9%, S. hominis 2/41, 4.9%), and Acinetobacter baumannii (1/41, 2.4%). One S. aureus isolate was methicillin-resistant. 53.6% (22/41) positive cultures were obtained from patients with local signs and symptoms compatible with catheter-related infection (CRI), 2.4% (1/41) were compatible with CRBSI type 2 and that clinical signs improve within 48 h of catheter removal (density-adjusted incidence for hospital stays of 16.7 PIVC-CRI/1000 hospital-stays and 0.76 PVC-BSI/1000 hospital-stays respectively) and no patients were diagnosed CRBSI type 3 with a bacterial growth concordant in tip and blood cultures. Most cases responded favourably to catheter removal and management. Conclusions Our findings show that almost 42% PIVCs resulted in unplanned removal, amplifying the importance in terms of morbidity, mortality and patient safety. A high number of positive tip cultures without clinical signs and symptoms was observed. We underpin the importance to remove unnecessary PIVCs for the prevention of CRBSI.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- 2Servei de Salut de les Illes Balears, Palma, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Joan de Pedro-Gómez
- 3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | | | - Ismael Fernández-Fernández
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain
| | - Enrique Castro-Sánchez
- 6NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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Osti C, Khadka M, Wosti D, Gurung G, Zhao Q. Knowledge and practice towards care and maintenance of peripheral intravenous cannula among nurses in Chitwan Medical College Teaching Hospital, Nepal. Nurs Open 2019; 6:1006-1012. [PMID: 31367425 PMCID: PMC6650670 DOI: 10.1002/nop2.288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
AIM The study is mainly concerned about the care and maintenance of peripheral intravenous cannulation: to determine the knowledge and practice of nurses towards care and maintenance of IV cannula and to find out the obstacles encountered in caring and maintaining IV cannula. Intravenous cannulation is a common procedure performed by nurses in every hospital and closely associated with the risk of nosocomial infections if standard care is not provided. DESIGN A descriptive cross-sectional study design was carried out. METHODS Nurses' knowledge and practice towards care and maintenance of peripheral intravenous cannula were assessed using a validated semi-structured self-administered questionnaire through the census method. Data were analysed through SPSS program. The comparison was done between knowledge and practice. RESULTS The findings revealed that 84.72% respondents were doing correct practices despite the fact that only 82.47% respondents had proper knowledge. Most nurses have good knowledge of caring and maintaining peripheral intravenous cannulation but there were some without proper knowledge and practice. This could be a potential risk factor for patient safety.
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Affiliation(s)
- Chadani Osti
- Department of NursingChongqing Medical University First Affiliated HospitalChongqingChina
| | - Menuka Khadka
- Department of NursingKathmandu Valley HospitalKathmanduNepal
| | - Deepa Wosti
- College of NursingChitwan Medical CollageBharatpurNepal
| | - Ganga Gurung
- College of NursingChitwan Medical CollageBharatpurNepal
| | - Qinghua Zhao
- Department of NursingChongqing Medical University First Affiliated HospitalChongqingChina
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Blauw M, Foxman B, Wu J, Rey J, Kothari N, Malani AN. Risk Factors and Outcomes Associated With Hospital-Onset Peripheral Intravenous Catheter-Associated Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2019; 6:ofz111. [PMID: 30949543 PMCID: PMC6441569 DOI: 10.1093/ofid/ofz111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral venous catheters (PVCs) are common in hospitals, but the literature surrounding PVC-associated bacteremia is lacking. We describe incidence rates, risk factors, and outcomes related to PVC-associated Staphylococcus aureus bacteremia (SAB), a common cause of hospital-onset (HO) SAB. Methods This is a retrospective case–control study conducted at a 537-bed teaching community hospital during 2015–2016. Cases were adult inpatients with HO SAB with infectious diseases documentation of the PVC as the only source of bacteremia. Cases were matched 1:2 with controls on approximate PVC insertion date, age, mortality prediction score, and insurance type. Odds ratios (ORs) were estimated using conditional logistic regression. PVC utilization was estimated by a point-prevalence survey from July 2017. Results Of 205 SAB episodes, 160 were community-onset and 45 were HO; 16 (36%) HO cases were PVC-associated. Cases (n = 16) were more likely than controls (n = 32) to have a PVC placed in the antecubital area (odds ratio [OR], 11.9; 95% confidence interval [CI], 1.5–95.7; P = .02) and PVC duration ≥4 days (OR, 4.0; 95% CI, 1.1–15.2; P = .04). The point prevalence of at least 1 PVC in adult inpatients was 86%, and the incidence density of HO PVC–associated SAB was 0.15 per 1000 PVC-days. The mean length of stay for cases was 13.2 days. All cases successfully completed parenteral antibiotics with a mean treatment length of 23.6 days. Conclusions PVC-associated SAB is a common cause of HO SAB that results in significant morbidity. PVC placement in the antecubital area and line duration should be minimized to reduce HO SAB.
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Affiliation(s)
- Mica Blauw
- Department of Infection Prevention and Control, Ann Arbor, Michigan
| | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Juan Wu
- Department of Academic Research, Ann Arbor, Michigan
| | - Janice Rey
- Department of Infection Prevention and Control, Ann Arbor, Michigan
| | - Neelay Kothari
- Section of Infectious Diseases, Department of Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Anurag N Malani
- Department of Infection Prevention and Control, Ann Arbor, Michigan.,Section of Infectious Diseases, Department of Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Webster J, Osborne S, Rickard CM, Marsh N. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019; 1:CD007798. [PMID: 30671926 PMCID: PMC6353131 DOI: 10.1002/14651858.cd007798.pub5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection. Costs associated with routine replacement may be considerable. This is the third update of a review first published in 2010. OBJECTIVES To assess the effects of removing peripheral intravenous catheters when clinically indicated compared with removing and re-siting the catheter routinely. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 18 April 2018. We also undertook reference checking, and contacted researchers and manufacturers to identify additional studies. SELECTION CRITERIA We included randomised controlled trials that compared routine removal of PIVC with removal only when clinically indicated, in hospitalised or community-dwelling patients receiving continuous or intermittent infusions. DATA COLLECTION AND ANALYSIS Three review authors independently reviewed trials for inclusion, extracted data, and assessed risk of bias using Cochrane methods. We used GRADE to assess the overall evidence certainty. MAIN RESULTS This update contains two new trials, taking the total to nine included studies with 7412 participants. Eight trials were conducted in acute hospitals and one in a community setting. We rated the overall certainty of evidence as moderate for most outcomes, due to serious risk of bias for unblinded outcome assessment or imprecision, or both. Because outcome assessment was unblinded in all of the trials, none met our criteria for high methodological quality.Primary outcomesSeven trials (7323 participants), assessed catheter-related bloodstream infection (CRBSI). There is no clear difference in the incidence of CRBSI between the clinically indicated (1/3590) and routine change (2/3733) groups (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.08 to 4.68), low-certainty evidence (downgraded twice for serious imprecision).All trials reported incidence of thrombophlebitis and we combined the results from seven of these in the analysis (7323 participants). We excluded two studies in the meta-analysis because they contributed to high heterogeneity. There is no clear difference in the incidence of thrombophlebitis whether catheters were changed according to clinical indication or routinely (RR 1.07, 95% CI 0.93 to 1.25; clinically indicated 317/3590; 3-day change 307/3733, moderate-certainty evidence, downgraded once for serious risk of bias). The result was unaffected by whether the infusion was continuous or intermittent. Six trials provided thrombophlebitis rates by number of device days (32,709 device days). There is no clear difference between groups (RR 0.90, 95% CI 0.76 to 1.08; clinically indicated 248/17,251; 3-day change 236/15,458; moderate-certainty evidence, downgraded once for serious risk of bias).One trial (3283 participants), assessed all-cause blood stream infection (BSI). We found no clear difference in the all-cause BSI rate between the two groups (RR 0.47, 95% CI 0.15 to 1.53; clinically indicated: 4/1593 (0.02%); routine change 9/1690 (0.05%); moderate-certainty evidence, downgraded one level for serious imprecision).Three trials (4244 participants), investigated costs; clinically indicated removal probably reduces device-related costs by approximately AUD 7.00 compared with routine removal (MD -6.96, 95% CI -9.05 to -4.86; moderate-certainty evidence, downgraded once for serious risk of bias).Secondary outcomesSix trials assessed infiltration (7123 participants). Routine replacement probably reduces infiltration of fluid into surrounding tissues compared with a clinically indicated change (RR 1.16 (95% CI 1.06 to 1.26; routine replacement 747/3638 (20.5%); clinically indicated 834/3485 (23.9%); moderate-certainty evidence, downgraded once for serious risk of bias).Meta-analysis of seven trials (7323 participants), found that rates of catheter failure due to blockage were probably lower in the routine-replacement group compared to the clinically indicated group (RR 1.14, 95% CI 1.01 to 1.29; routine-replacement 519/3733 (13.9%); clinically indicated 560/3590 (15.6%); moderate-certainty evidence, downgraded once for serious risk of bias).Four studies (4606 participants), reported local infection rates. It is uncertain if there are differences between groups (RR 4.96, 95% CI 0.24 to 102.98; clinically indicated 2/2260 (0.09%); routine replacement 0/2346 (0.0%); very low-certainty evidence, downgraded one level for serious risk of bias and two levels for very serious imprecision).One trial (3283 participants), found no clear difference in the incidence of mortality when clinically indicated removal was compared with routine removal (RR 1.06, 95% CI 0.27 to 4.23; low-certainty evidence, downgraded two levels for very serious imprecision).One small trial (198 participants) reported no clear difference in device-related pain between clinically indicated and routine removal groups (MD -0.60, 95% CI -1.44 to 0.24; low-certainty evidence, downgraded one level for serious risk of bias and one level for serious imprecision).The pre-planned outcomes 'number of catheter re-sites per patient', and 'satisfaction' were not reported by any studies included in this review. AUTHORS' CONCLUSIONS There is moderate-certainty evidence of no clear difference in rates of CRBSI, thrombophlebitis, all-cause BSI, mortality and pain between clinically indicated or routine replacement of PIVC. We are uncertain if local infection is reduced or increased when catheters are changed when clinically indicated. There is moderate-certainty evidence that infiltration and catheter blockage is probably lower when PIVC are changed routinely; and moderate-certainty evidence that clinically indicated removal probably reduces device-related costs. The addition of two new trials for this update found no further evidence to support changing catheters every 72 to 96 hours. Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. This would provide significant cost savings, spare patients the unnecessary pain of routine re-sites in the absence of clinical indications and would reduce time spent by busy clinicians on this intervention. To minimise PIVC-related complications, staff should inspect the insertion site at each shift change and remove the catheter if signs of inflammation, infiltration, occlusion, infection or blockage are present, or if the catheter is no longer needed for therapy.
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Affiliation(s)
- Joan Webster
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- The University of QueenslandSchool of Nursing and MidwiferyBrisbaneQueenslandAustralia
- Royal Brisbane and Women's HospitalNursing and Midwifery Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Sonya Osborne
- Queensland University of TechnologySchool of Public Health and Social Work, Institute of Health and Biomedical InnovationKelvin Grove Campus69 Musk AveBrisbaneQueenslandAustralia4059
| | - Claire M Rickard
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustraliaQueensland 4029
| | - Nicole Marsh
- Griffith UniversityNational Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
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Abstract
Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.
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Marsh N, Larsen E, Genzel J, Mihala G, Ullman AJ, Kleidon T, Cadigan S, Rickard CM. A novel integrated dressing to secure peripheral intravenous catheters in an adult acute hospital: a pilot randomised controlled trial. Trials 2018; 19:596. [PMID: 30376880 PMCID: PMC6208178 DOI: 10.1186/s13063-018-2985-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of peripheral intravenous catheter (PIV) failure has been as high as 69%. This is in part due to inadequate stabilisation or securement to the skin, which allows micro-motion of the catheter within the vein. METHODS A pilot open randomised controlled trial of 300 patients was conducted in the medical and surgical wards of a large tertiary hospital. A superiority parallel pragmatic design was used. Eligible patients over the age of 16 years were randomised using a centralised service (randomly varied block sizes and 1:1 ratio) to have PIV dressings of either (i) a bordered polyurethane dressing (BPU, standard care) or (ii) the integrated securement device (ISD). Allocation was concealed until entry. The primary outcome of feasibility addressed eligibility, consent, protocol adherence and retention rates. All-cause PIV failure was an additional primary outcome. This was a composite of infection (laboratory-confirmed local or bloodstream infection), occlusion or infiltration, dislodgement, phlebitis and thrombosis. Group comparisons were by proportions, incidence rates per 1000 PIV days and hazard ratios. Secondary outcomes were local or bloodstream infection, occlusion or infiltration, dislodgement, phlebitis, thrombosis, PIV dwell time, safety and adverse events and patient satisfaction with study products. Analysis was by intention to treat and the patient was the unit of measurement. Multivariable modelling was undertaken. RESULTS Feasibility outcomes were 91% of screened patients were eligible, 98% of invited patients consented, 100% of randomised participants received the allocated intervention on insertion and 1/300 (< 1%) were lost to follow-up. In total, 792 PIV days were studied. PIV failure occurred in 43/150 BPU patients (29%) and 40/150 ISD patients (27%) (119 vs 93 per 1000 PIV days; incidence rate ratio 0.78, 95% confidence interval, CI 0.50-1.23). In the multivariate model, ISD (hazard ratio 0.51, 95% CI 0.29-0.89) and admission for a surgical emergency were significantly associated with decreased failure, while female gender, wound, hand insertion and more frequent PIV use were significantly associated with increased PIV failure. CONCLUSION ISDs were significantly associated with decreased failure in the multivariable modelling. Feasibility outcomes were supportive of the need to undertake a larger trial to confirm these results. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000984493 . Registered 27 July 2016.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Emily Larsen
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Jodie Genzel
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD Australia
| | - Amanda J. Ullman
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Sue Cadigan
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
| | - Claire M. Rickard
- Royal Brisbane and Women’s Hospital, Herston, QLD Australia
- School of Nursing and Midwifery, Griffith University, Nathan, QLD Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD Australia
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Ghali H, Ben Rejeb O, Bouafia N, Ammar A, Njah M, Ernez S, Mahdhaoui A, Jeridi G. Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study. Ann Cardiol Angeiol (Paris) 2018; 68:207-214. [PMID: 30293799 DOI: 10.1016/j.ancard.2018.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
AIM The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital. PATIENTS AND METHODS We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05. RESULTS Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042). CONCLUSION Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.
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Affiliation(s)
- H Ghali
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - O Ben Rejeb
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
| | - N Bouafia
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Infection Control Consultant, King Faycal Medical Complex, Taif, Saudi Arabia.
| | - A Ammar
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - M Njah
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - S Ernez
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - A Mahdhaoui
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
| | - G Jeridi
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
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Rickard CM, Marsh N, Webster J, Runnegar N, Larsen E, McGrail MR, Fullerton F, Bettington E, Whitty JA, Choudhury MA, Tuffaha H, Corley A, McMillan DJ, Fraser JF, Marshall AP, Playford EG. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial. Lancet 2018; 392:419-430. [PMID: 30057103 DOI: 10.1016/s0140-6736(18)31380-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Two billion peripheral intravenous catheters (PIVCs) are used globally each year, but optimal dressing and securement methods are not well established. We aimed to compare the efficacy and costs of three alternative approaches to standard non-bordered polyurethane dressings. METHODS We did a pragmatic, randomised controlled, parallel-group superiority trial at two hospitals in Queensland, Australia. Eligible patients were aged 18 years or older and required PIVC insertion for clinical treatment, which was expected to be required for longer than 24 h. Patients were randomly assigned (1:1:1:1) via a centralised web-based randomisation service using random block sizes, stratified by hospital, to receive tissue adhesive with polyurethane dressing, bordered polyurethane dressing, a securement device with polyurethane dressing, or polyurethane dressing (control). Randomisation was concealed before allocation. Patients, clinicians, and research staff were not masked because of the nature of the intervention, but infections were adjudicated by a physician who was masked to treatment allocation. The primary outcome was all-cause PIVC failure (as a composite of complete dislodgement, occlusion, phlebitis, and infection [primary bloodstream infection or local infection]). Analysis was by modified intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000769987. FINDINGS Between March 18, 2013, and Sept 9, 2014, we randomly assigned 1807 patients to receive tissue adhesive with polyurethane (n=446), bordered polyurethane (n=454), securement device with polyurethane (n=453), or polyurethane (n=454); 1697 patients comprised the modified intention-to-treat population. 163 (38%) of 427 patients in the tissue adhesive with polyurethane group (absolute risk difference -4·5% [95% CI -11·1 to 2·1%], p=0·19), 169 (40%) of 423 of patients in the bordered polyurethane group (-2·7% [-9·3 to 3·9%] p=0·44), 176 (41%) of 425 patients in the securement device with poplyurethane group (-1·2% [-7·9% to 5·4%], p=0·73), and 180 (43%) of 422 patients in the polyurethane group had PIVC failure. 17 patients in the tissue adhesive with polyurethane group, two patients in the bordered polyurethane group, eight patients in the securement device with polyurethane group, and seven patients in the polyurethane group had skin adverse events. Total costs of the trial interventions did not differ significantly between groups. INTERPRETATION Current dressing and securement methods are commonly associated with PIVC failure and poor durability, with simultaneous use of multiple products commonly required. Cost is currently the main factor that determines product choice. Innovations to achieve effective, durable dressings and securements, and randomised controlled trials assessing their effectiveness are urgently needed. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Naomi Runnegar
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
| | - Fiona Fullerton
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Emilie Bettington
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Jennifer A Whitty
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia; University of East Anglia, Norwich, UK
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia
| | - Haitham Tuffaha
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia
| | | | - John F Fraser
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Andrea P Marshall
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, Australia
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Urbanetto JDS, Freitas APCD, Oliveira APRD, Santos JDCRD, Muniz FDOM, Silva RMD, Schilling MCL. Risk factors for the development of phlebitis: an integrative review of literature. Rev Gaucha Enferm 2018; 38:e57489. [PMID: 29933415 DOI: 10.1590/1983-1447.2017.04.57489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/12/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the scientific evidence published in literature regarding the risk factors for the development of phlebitis. METHOD Integrative literature review with the inclusion of 14 original articles found in the LILACS, Scielo and Pubmed bases from January 2004 to April 2015, analyzed by levels of evidence and frequency, associated factors, degree and treatment of phlebitis. RESULTS The frequency / incidence / minimum rate of phlebitis was 3% and the maximum was 59.1%. Most articles (57.14%) reported an association of phlebitis with risk factors, including the dwell time, puncture site and / or anatomical region, hospitalization period, number of accesses, reason for removal, sex, antibiotics, intermittent maintenance and emergency insertion. CONCLUSIONS The need for standardizing the quantification of this event and a weak connection between the risk factors associated with phlebitis were identified. Further studies need to be developed in order to grant a real understanding of this disease in the daily routines of a hospital.
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Affiliation(s)
- Janete de Souza Urbanetto
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ana Paula Christo de Freitas
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ana Paula Ribeiro de Oliveira
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Jessica de Cassia Ramos Dos Santos
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Franciele de Oliveira Minuto Muniz
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Renata Martins da Silva
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Cristina Lore Schilling
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Enfermagem, Nutrição e Fisioterapia (FAENFI), Curso de Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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Carr PJ, Higgins NS, Cooke ML, Mihala G, Rickard CM. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev 2018; 3:CD011429. [PMID: 29558570 PMCID: PMC6353147 DOI: 10.1002/14651858.cd011429.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Most people admitted to hospitals worldwide require a vascular access device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes. OBJECTIVES To compare the use of the vascular access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, device failure, and cost-effectiveness. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018. SELECTION CRITERIA We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management. MAIN RESULTS We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication. AUTHORS' CONCLUSIONS This systematic review failed to locate relevant published RCTs to support or refute the assertion that vascular access specialist teams are superior to the generalist model. A vascular access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of vascular access devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for vascular access devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a vascular access specialist team approach for vascular access device insertion and care for the prevention of failure.
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Affiliation(s)
- Peter J Carr
- School of Medicine, The University of Western AustraliaEmergency Medicine2nd Floor, R Block, QE11 Medical CentreNedlandsAustralia6009
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
| | - Niall S Higgins
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Queensland University of Technology & Royal Brisbane and Women's Hospital, Metro North Hospital and Health ServiceSchool of NursingVictoria Park RoadKelvin GroveBrisbaneQueenslandAustralia4059
| | - Marie L Cooke
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneAustralia
| | - Gabor Mihala
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- School of Medicine, Griffith UniversityCentre for Applied Health Economics, Menzies Health Institute QueenslandUniversity DriveMeadowbrookQueenslandAustralia4131
| | - Claire M Rickard
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute QueenslandBrisbaneAustralia
- Griffith UniversitySchool of Nursing and MidwiferyBrisbaneAustralia
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Cooke M, Ullman AJ, Ray-Barruel G, Wallis M, Corley A, Rickard CM. Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS One 2018; 13:e0193436. [PMID: 29489908 PMCID: PMC5831386 DOI: 10.1371/journal.pone.0193436] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/09/2018] [Indexed: 11/21/2022] Open
Abstract
Peripheral intravascular cannula/catheter (PIVC) insertion is a common invasive procedure, but PIVC failure before the end of therapy is unacceptably high. As PIVC failure disrupts treatment and reinsertion can be distressing for the patient, prevention of PIVC failure is an important patient outcome. Consumer participation in PIVC care to prevent failure is an untapped resource. This study aimed to understand consumers’ PIVC experience; establish aspects of PIVC insertion and care relevant to them; and to compare experiences of adult consumers to adult carers of a child. An international, web-based, cross-sectional survey was distributed via social media inviting adult consumers and adult carers of a child under 18 years who had experienced having a PIVC in the last five years (one survey each for adults and adult carers) to complete a 10-item survey. As such, sampling bias is a limitation and results should be carefully considered in light of this. There were 712 respondents from 25 countries, mainly female (87.1%) and adults (80%). A little over 50% of adults described insertion as moderately painful or worse, with level of insertion difficulty (0–10 scale) identified as moderate (median 4, IQR 1, 7). Adult carers reported significantly more pain during insertion and insertion difficulty (both p < 0.001). Rates of first insertion attempt failure were higher in children compared with adults (89/139 [64%] vs 221/554 [40%]; p < 0.001), and 23% of children required ≥ 4 attempts, compared with 9% of adults (p < 0.0001). Three themes from open-ended question emerged: Significance of safe and consistent PIVC care; Importance of staff training and competence; and Value of communication. The PIVC experience can be painful, stressful and frustrating for consumers. Priorities for clinicians and policy makers should include use of pain relief as standard practice to reduce the pain associated with PIVC insertion and developing strategies to increase first PIVC insertion attempt success particularly for children and older consumers.
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Affiliation(s)
- Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- * E-mail:
| | - Amanda J. Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Marianne Wallis
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Marsh N, Webster J, Larson E, Cooke M, Mihala G, Rickard CM. Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients: A Multivariable Analysis of Peripheral Intravenous Catheter Failure. J Hosp Med 2018; 13:83-89. [PMID: 29073316 DOI: 10.12788/jhm.2867] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE To identify risk factors associated with PIV failure. DESIGN A single center, prospective, cohort study. SETTING Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS Adult patients requiring a PIV. MEASUREMENTS Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal. RESULTS We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06).Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)-(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% C-0.46)-(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
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Affiliation(s)
- Nicole Marsh
- 1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia
| | - Joan Webster
- 1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Emily Larson
- 1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia
| | - Marle Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Brisbane, Queensland, Australia
| | - Claire M Rickard
- 1Nursing & Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia
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Sou V, McManus C, Mifflin N, Frost SA, Ale J, Alexandrou E. A clinical pathway for the management of difficult venous access. BMC Nurs 2017; 16:64. [PMID: 29176933 PMCID: PMC5693534 DOI: 10.1186/s12912-017-0261-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/10/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by increasing first attempt success with ultrasound guidance. The emphasis was to provide a solution for hospitalised patients after business hours by training the after-hours clinical support team in ultrasound guided cannulation. METHODS Inception cohort study of patients referred to the after-hours clinical support team including outcomes such as number of attempts at cannulation before and after referral, insertion site, type of device inserted and recorded pain score for attempts prior to referral and for attempts by the after-hours clinical support team. RESULTS Between January and December 2016, 379 patients were referred to the after-hours clinical support team for placement of a peripheral intravenous catheter under ultrasound guidance. The median number of unsuccessful attempts before referral was 2 (IQR 2, 4), this ranged between 1 attempt to 10 attempts compared to only 1 attempt (IQR 1, 1, p < 0.001) with no more than 2 attempts in total by the after-hours clinical support team. The first time success rate by the after-hours clinical support team was 93% (n = 348). The median pain score for attempts with ultrasound use was 2/10 (IQR 1-3) compared to 7/10 (IQR 5-9) for previous attempts without ultrasound (p < 0.001). CONCLUSION The use of ultrasound guidance for peripheral intravenous catheter insertion by the after-hours clinical support team for patients with difficult venous access has been successful at our institution with 9 out of every 10 catheters inserted at first attempt with significantly lower recorded pain scores.
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Affiliation(s)
- Vanno Sou
- Liverpool Hospital, Liverpool, Australia
| | | | | | - Steven A. Frost
- Liverpool Hospital, Liverpool, Australia
- Western Sydney University, Building EB, Ground Level Room 44, Parramatta South Campus, Locked Bag 1797, Penrith South. DC 1797, NSW 2751 Australia
- Simpson Centre for Health Services Research and Centre for Applied Nursing Research, Sydney, Australia
- South Western Sydney Clinical School & Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Julie Ale
- Liverpool Hospital, Liverpool, Australia
| | - Evan Alexandrou
- Liverpool Hospital, Liverpool, Australia
- Western Sydney University, Building EB, Ground Level Room 44, Parramatta South Campus, Locked Bag 1797, Penrith South. DC 1797, NSW 2751 Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- South Western Sydney Clinical School & Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, Australia
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Bolcato M, Russo M, Donadello D, Rodriguez D, Aprile A. Disabling Outcomes After Peripheral Vascular Catheter Insertion in a Newborn Patient: A Case of Medical Liability? AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1126-1129. [PMID: 29056746 PMCID: PMC5665609 DOI: 10.12659/ajcr.904736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, newborn Final Diagnosis: Loss of falange of the hand Symptoms: Manual disability • Pain Medication: Ampicilline Clinical Procedure: Insert vascular catheter Specialty: Forenscic Medicine
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Affiliation(s)
| | - Marianna Russo
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Damiano Donadello
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Daniele Rodriguez
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Anna Aprile
- Department of Molecular Medicine, University of Padova, Padova, Italy
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Xu L, Hu Y, Huang X, Fu J, Zhang J. Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults: A nonblinded, cluster-randomized trial in China. Int J Nurs Pract 2017; 23. [PMID: 28990241 DOI: 10.1111/ijn.12595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Lichun Xu
- School of Nursing; Fudan University; Shanghai China
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Yan Hu
- School of Nursing; Fudan University; Shanghai China
| | - Xiaojin Huang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jianguo Fu
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
| | - Jinhui Zhang
- Zhongshan Hospital Affiliated to Xiamen University; Xiamen China
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Göransson K, Förberg U, Johansson E, Unbeck M. Measurement of peripheral venous catheter-related phlebitis: a cross-sectional study. LANCET HAEMATOLOGY 2017; 4:e424-e430. [DOI: 10.1016/s2352-3026(17)30122-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
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