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Felipe MDAA, Peterlini MAS, Ullman A, Pedreira MDLG. Michigan appropriateness guide for intravenous catheters in pediatrics - miniMAGIC-Brasil: translation into Brazilian portuguese. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023159. [PMID: 38747843 PMCID: PMC11095236 DOI: 10.1590/1984-0462/2024/42/2023159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/25/2023] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. METHODS Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master's and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, "not equivalent"; 2, "inequivalent"; 3, "cannot assess"; 4, "quite equivalent"; 5, "totally equivalent". The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. RESULTS The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. CONCLUSIONS The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.
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Costa SPD, Silveira RED, Monteiro DAT, Contim D, Toffano SEM. Quality of care in peripheral venous catheterization: A scoping review. Rev Bras Enferm 2023; 76:e20220578. [PMID: 38055472 DOI: 10.1590/0034-7167-2022-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To map the current status of parameters and tools to assess quality of care related to peripheral venous catheter use in adults. METHODS Scoping review, conducted in 2022 in the MEDLINE, LILACS, CINAHL and SCOPUS databases and with a publication time limit from 2013 to 2022. RESULTS The sample consisted of 15 articles, summarized in the following categories: Indication, documentation and registration, coverage assessment, connection, stabilization and signs and symptoms inherent to the catheter. The use of a complete instrument, with the domains observed in this review, may have a positive impact on a more effective and safe clinical practice. CONCLUSIONS The present review mapped the evidence about the insertion and maintenance of peripheral venous catheters that can be improved with training of good practices and the quality of the team, regarding the use of tools, materials and instruments for the evaluation of care.
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Affiliation(s)
| | | | | | - Divanice Contim
- Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
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Ray-Barruel G, Chopra V, Fulbrook P, Lovegrove J, Mihala G, Wishart M, Cooke M, Mitchell M, Rickard CM. The impact of a structured assessment and decision tool (I-DECIDED®) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study. Int J Nurs Stud 2023; 148:104604. [PMID: 37801935 DOI: 10.1016/j.ijnurstu.2023.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. OBJECTIVE To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions. DESIGN Prospective, interrupted time-series study. SETTINGS Seven adult inpatient wards in three Australian hospitals. PARTICIPANTS 825 adults with 867 peripheral intravenous catheters. METHODS Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. RESULTS Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). CONCLUSIONS Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ANZCTR TRIAL REGISTRATION ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. TWEETABLE ABSTRACT #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Gabor Mihala
- Centre for Health Services Research, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Michael Wishart
- Infection Prevention and Control, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; National Health & Medical Research Council Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
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Blanco-Mavillard I, Personat-Labrador C, Castro-Sánchez E, Rodríguez-Calero MÁ, Fernández-Fernández I, Carr PJ, Armenteros-Yeguas V, Parra-García G, de Pedro-Gómez J. Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation. J Infect Public Health 2023; 16:1994-2000. [PMID: 37890222 DOI: 10.1016/j.jiph.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Around 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international consensus on relevance and feasibility of clinical practice guideline recommendations to reduce PIVC failure. METHODS e-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals. FINDINGS Over 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3). CONCLUSION We provide an international consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital de Manacor, Implementation, Research, and Innovation Unit, Manacor, Spain; Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Celia Personat-Labrador
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Health Public Office, Balearic Islands Health Service, Palma, Spain
| | - Enrique Castro-Sánchez
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom; Universitat de les Illes Balears, Global Health and Lifestyles (EVES) Group, Palma, Spain.
| | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Hospital Universitario Torrecárdenas, Almeria, Spain
| | | | - Peter J Carr
- School of Nursing and Midwifery at the National University of Ireland Galway (NUIG), Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) group, Australia
| | - Victoria Armenteros-Yeguas
- Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain; Bioaraba, Vascular Care Research Group, Vitoria-Gasteiz, Spain
| | | | - Joan de Pedro-Gómez
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Torné-Ruiz A, García-Expósito J, Bonet A, Masot O, Roca J, Selva-Pareja L. Evolution of Scientific Production on Phlebitis Secondary to Vascular Access: A 71-Year Bibliometric Analysis. NURSING REPORTS 2023; 13:1635-1647. [PMID: 37987414 PMCID: PMC10661289 DOI: 10.3390/nursrep13040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Phlebitis secondary to vascular access is one of the most frequent complications in hospital care. This study aims to evaluate the scientific activity related to this complication through a bibliometric analysis. The search was performed on a single day, 23 January 2023, to ensure the inclusion of all articles and to avoid bias caused by the daily updates of the open access database. The data were recovered from Web of Science. The sample comprised a total of 1596 publications that met the inclusion criteria. The United States was the country with the largest number of publications, citations, and international cooperation with respect to phlebitis and vascular access. The most important author was Rickard CM. Of all the publications selected, a total of 1586 (99.37%) were original articles. The highest number of articles on the subject was recorded in 2021, and the most common research areas were General Internal Medicine and Nursing. The analysis of the clusters (KeyWords Plus and Author keywords) and co-occurrences enabled identification of areas of interest and their possible development. These areas included the prevention, risk, and associated complications of catheter-associated phlebitis. Other aspects that are a priori relevant, such as assessment and treatment, were found to be little investigated. While research on this subject is increasing internationally, more collaborations are still required between researchers, as well as new approaches related to the management of catheter-associated phlebitis. The dimensions that should continue to be considered in new research, according to the findings of this review, are instruments for phlebitis assessment and their validation, and the treatments to follow in the case of established phlebitis. For this reason, the bibliometric information presented is key for new or consolidated researchers in the field, especially because of its practical and clinical implications for patient safety.
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Affiliation(s)
- Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Hospital Fundació Althaia, Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Judith García-Expósito
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Group Preving (Vitaly), 03003 Alicante, Spain
| | - Aida Bonet
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
| | - Laia Selva-Pareja
- Department of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain; (A.T.-R.); (A.B.); (O.M.); (L.S.-P.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198 Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), 25199 Lleida, Spain
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Yilmaz DU, Yilmaz D, Karaman D. Clinical nurses' knowledge and practices on routine care related to the prevention of complications of peripheral intravenous therapy: A cross-sectional study. J Vasc Access 2023; 24:277-283. [PMID: 34278851 DOI: 10.1177/11297298211033380] [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: 11/16/2022] Open
Abstract
AIM The aim of this descriptive and cross-sectional study was to determine the knowledge and practices of nurses related to the prevention of peripheral intravenous therapy (PIT) complications, and to identify the influencing factors. METHODS The study adopted a cross-sectional and descriptive design and was conducted between April and August of 2018 with a total of 214 clinical nurses. The data collection tools employed were a 12-item sociodemographic questionnaire and a 16-item questionnaire on knowledge and practices related to the prevention of peripheral intravenous therapy complications. RESULTS The mean knowledge scores of the nurses were found to be 81.54 ± 12.06 (min: 50, max: 100). No statistically significant difference was found to exist between the scores, and the variables of the nurses' gender, length of employment in the health profession, type of work, training received related to PIT complications, and self-competence level in PIT complications. CONCLUSION The nurses were found to have high knowledge levels; however, their practices for preventing PIT complications differed. Standardized practice procedures and workplace training are needed in order to transform nurses' knowledge into practice with regard to the prevention of PIT complications.
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Affiliation(s)
- Derya Uzelli Yilmaz
- Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Yilmaz
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, Bursa, Turkey
| | - Dilek Karaman
- Department of Health Care Services, Ahmet Erdogan Health Services Vocational School, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Ray-Barruel G, Alexander M. CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. Am J Nurs 2023; 123:32-37. [PMID: 37718967 DOI: 10.1097/01.naj.0000905568.37179.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.
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Affiliation(s)
- Gillian Ray-Barruel
- Gillian Ray-Barruel is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health. Mary Alexander is chief executive officer of the Infusion Nurses Society in Norwood, MA. Contact author: Gillian Ray-Barruel, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Ray-Barruel G. I-DECIDED ®-a decision tool for assessment and management of invasive devices in the hospital setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S37-S43. [PMID: 35439078 DOI: 10.12968/bjon.2022.31.8.s37] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.
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Indarwati F, Munday J, Keogh S. Nurse knowledge and confidence on peripheral intravenous catheter insertion and maintenance in pediatric patients: A multicentre cross-sectional study. J Pediatr Nurs 2022; 62:10-16. [PMID: 34798582 DOI: 10.1016/j.pedn.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients. DESIGN AND METHODS An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score. RESULTS A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p < 0.05). CONCLUSION Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance. PRACTICE IMPLICATIONS The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
| | - Judy Munday
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia.
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Takahashi T, Murayama R, Abe-Doi M, Miyahara M, Kanno C, Nakagami G, Sanada H. Catheter failure in the administration of hyperosmotic drugs through a peripheral vein and vascular selection: A retrospective cohort study. Drug Discov Ther 2021; 15:236-240. [PMID: 34719604 DOI: 10.5582/ddt.2021.01080] [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: 11/05/2022]
Abstract
This study aimed to determine whether the placement of a peripheral intravenous catheter (PIVC) in the cephalic vein of the forearm could prevent PIVC failure in patients receiving hyperosmotic drugs through the peripheral vein. This retrospective cohort study included patients aged ≥ 20 years who had received infusion therapy via a PIVC in our institution between July and November 2017. Patients were divided into groups according to PIVC insertion into the cephalic, basilic, and medial veins. PIVCs used to administer drugs with osmotic pressure ratios > 2.0 were included. The primary outcome was survival time to catheter failure. Catheter failure was defined as accidental and unplanned catheter removal. We set the cephalic vein and other veins, including the medial and basilic veins, in the forearm as cohort groups. We used the Kaplan-Meier survival curves to compare the time until catheter failure in the cohort groups. The Cox proportional hazard models were fitted, and the hazard ratios were calculated. A total of 46 catheters with hyperosmotic agents were included in the analysis. Catheter failure was observed in 25 (54.3%) cases. Time to catheter failure in patients receiving high-dose drugs via the cephalic vein was significantly longer than that in the other two groups (p < 0.01). Thus, the cephalic vein, which has a high blood flow, is the ideal site of PIVC insertion in patients receiving high drug concentrations to prevent catheter failure.
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Affiliation(s)
- Toshiaki Takahashi
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Advanced Nursing Technology, 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
- 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
| | - Gojiro Nakagami
- 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
| | - 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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Abstract
TOPIC This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter-related bloodstream infections is likely as high as and may surpass the number of central venous catheter-related bloodstream infections, with significant associated morbidity and mortality. PURPOSE OF PAPER Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. CONTENT COVERED This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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Hallam C, Denton A, Weston V, Dunn H, Jackson T, Keeling S, Hill S. UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020. J Infect Prev 2021; 22:147-155. [PMID: 34295375 PMCID: PMC8274140 DOI: 10.1177/1757177420976806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.
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Affiliation(s)
- Carole Hallam
- AC Independent Nursing Consultants, Huddersfield, UK
| | - Andrea Denton
- AC Independent Nursing Consultants, Huddersfield, UK
| | - Valya Weston
- Alder Hey Children’s NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Helen Dunn
- Great Ormond Street Hospital for Children, London, UK
| | - Tim Jackson
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | - Steve Hill
- The Christie NHS Foundation Trust, Manchester, UK
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Silk T, Windheim J, Chugh S. Rethinking Routine Peripheral Intravenous Line Placement: A Teachable Moment. JAMA Intern Med 2021; 181:845-846. [PMID: 33871537 DOI: 10.1001/jamainternmed.2021.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tarik Silk
- NYU Grossman School of Medicine, New York, New York
| | | | - Somil Chugh
- NYU Grossman School of Medicine, New York, New York
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Guanche-Sicilia A, Sánchez-Gómez MB, Castro-Peraza ME, Rodríguez-Gómez JÁ, Gómez-Salgado J, Duarte-Clíments G. Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective. Healthcare (Basel) 2021; 9:healthcare9050611. [PMID: 34069674 PMCID: PMC8160666 DOI: 10.3390/healthcare9050611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 12/03/2022] Open
Abstract
The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.
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Affiliation(s)
- Aitana Guanche-Sicilia
- University Hospital Nuestra Señora de Candelaria, Canary Islands Health Service, 38010 Tenerife, Spain;
| | - María Begoña Sánchez-Gómez
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
| | - María Elisa Castro-Peraza
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 092301 Guayaquil, Ecuador
- Correspondence: ; Tel.: +34-959219700
| | - Gonzalo Duarte-Clíments
- University School of Nursing Nuestra Señora de Candelaria, University of La Laguna, 38001 Tenerife, Spain; (M.B.S.-G.); (M.E.C.-P.); (G.D.-C.)
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Mielke N, Johnson S, Karabon P, Bahl A. A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis. J Vasc Access 2021; 23:754-763. [PMID: 33860710 DOI: 10.1177/11297298211009019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. METHODS We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. RESULTS A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) p = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) p = 0.0116] were associated with increased likelihood of thrombophlebitis. CONCLUSIONS Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.
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Affiliation(s)
- Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Amit Bahl
- Beaumont Hospital, Royal Oak, MI, USA
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Massey D, Craswell A, Ray-Barruel G, Ullman A, Marsh N, Wallis M, Cooke M. Undergraduate nursing students' perceptions of the current content and pedagogical approaches used in PIVC education. A qualitative, descriptive study. NURSE EDUCATION TODAY 2020; 94:104577. [PMID: 32947210 DOI: 10.1016/j.nedt.2020.104577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The peripheral intravenous catheter (PIVC) is the most frequently used invasive medical device. PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, delays in treatment, increased health care costs and even death. Undergraduate nurses assess and manage PIVCs as part of their clinical learning. To date, no study has explored undergraduate nurses' perceptions of the education they receive about PIVCs. AIM We sought to critically explore the current state of education regarding PIVCs from the perspectives of undergraduate nurses. METHODS This qualitative study involved semi-structured interviews with third-year undergraduate nurses. Data were collected across two sites in Queensland, Australia. Fourteen face-to-face interviews were conducted and a modified 5-step qualitative content analysis was used to analyze the data. FINDINGS We identified three key domains relating to participants' experiences of PIVC education: 1) Universities provide foundational knowledge about PIVC assessment, management and removal; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about PIVCs; and 3) inconsistencies in clinical practice and between individual clinicians impedes learning and knowledge translation about PIVCs. CONCLUSION Nursing students benefit from theoretical content delivered in the university setting. Practical application of theory and skill development whilst on clinical placement is variable. The current undergraduate curriculum, related to management of patients with a PIVC, is disjointed and inconsistent and this inconsistency may negatively impact patient safety.
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Affiliation(s)
- Debbie Massey
- School of Health and Social Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland 4225, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, 90 Sippy Downs Drive, Sippy Downs, Queensland 4556, Australia
| | - Gillian Ray-Barruel
- QEII Jubilee Hospital, Alliance for Vascular Access, Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland 4556, Australia; Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Kessels Rd, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan, Queensland, Australia
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vendramim P, Avelar A, Rickard C, Pedreira M. The RESPECT trial–Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: A randomized, controlled, non-inferiority trial. Int J Nurs Stud 2020; 107:103504. [DOI: 10.1016/j.ijnurstu.2019.103504] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 02/04/2023]
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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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Welyczko N. Peripheral intravenous cannulation: reducing pain and local complications. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S12-S19. [PMID: 32324463 DOI: 10.12968/bjon.2020.29.8.s12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.
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Ray-Barruel G, Cooke M, Chopra V, Mitchell M, Rickard CM. The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation. BMJ Open 2020; 10:e035239. [PMID: 31969371 PMCID: PMC7044901 DOI: 10.1136/bmjopen-2019-035239] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making. DESIGN AND SETTING I-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases. METHODS Initial face validity was confirmed with a vascular access working group. Next, content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, the USA and Canada. Finally, inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 peripheral intravenous catheter (PIVC) assessments. Assessments were timed to ensure feasibility, and the second rater was blinded to the first's findings. Content validity index (CVI), mean item-level CVI (I-CVI), internal consistency, mean proportion of agreement, observed and expected inter-rater agreements, and prevalence-adjusted bias-adjusted kappas (PABAK) were calculated. Ethics approvals were obtained from university and hospital ethics committees. RESULTS The I-DECIDED tool demonstrated strong content validity among international vascular access experts (n=7; mean I-CVI=0.91; mean proportion of agreement=0.91) and clinicians (n=11; mean I-CVI=0.93; mean proportion of agreement=0.94), and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%, with PABAK for each principle ranging from 0.5882 ('patient education') to 1.0000 ('document the decision'). Time to complete assessments averaged 2 min, and nurse-reported acceptability was high. CONCLUSION This is the first comprehensive, evidence-based, valid and reliable PIVC assessment and decision tool. We recommend studies to evaluate the outcome of implementing this tool in clinical practice. TRIAL REGISTRATION NUMBER 12617000067370.
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Affiliation(s)
- Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Nursing Research, Queen Elizabeth II Jubilee Hospital, Princess Alexandra Hospital, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Division of Hospital Medicine, Patient Safety Enhancement Program, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
| | - Marion Mitchell
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Nursing Research & Development, and Critical Care Research Group, Royal Brisbane & Women's Hospital, Princess Alexandra Hospital, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Corley A, Ullman AJ, Mihala G, Ray-Barruel G, Alexandrou E, Rickard CM. Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters. Int J Nurs Stud 2019; 100:103409. [PMID: 31629208 DOI: 10.1016/j.ijnurstu.2019.103409] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/09/2019] [Accepted: 08/22/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND With over 2 billion peripheral intravenous catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective catheter dressing and securement is a key nursing strategy to reduce catheter failure and resultant patient harm. OBJECTIVES To describe global catheter dressing and securement practices and policy; and identify factors associated with catheter insertion site complications, and suboptimal dressing and securement. DESIGN Secondary analysis of a global cross-sectional study of peripheral intravenous catheter characteristics, management and outcomes. SETTING Four hundred and seven rural, regional and metropolitan hospitals in 51 countries. PARTICIPANTS Paediatric and adult patients with 40,637 catheters. METHODS Patient-, catheter-, and institution-related factors which could be associated with catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in catheter dressing and securement policy and practice were described. Potential predictors of catheter and dressing complications were explored using logistic regression. RESULTS Dressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50-0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59-0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22-2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51-1.75). Two 'bundled' dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1-3 days were associated with better catheter dressing integrity. CONCLUSION Modifiable risk factors for peripheral intravenous catheter site and dressing complications were identified and are amendable to further interventional testing.
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Affiliation(s)
- Amanda Corley
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; The Prince Charles Hospital, Level 3 CSB, Rode Rd, Chermside, Queensland 4032, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.
| | - Amanda J Ullman
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.
| | - Gabor Mihala
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; Centre for Applied Health Economics, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; School of Medicine, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia.
| | - Gillian Ray-Barruel
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; QEII Jubilee Hospital, Kessels Rd & Troughton Rd, Coopers Plains, Queensland 4108, Australia.
| | - Evan Alexandrou
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; Department of Intensive Care, Liverpool Hospital, 75 Elizabeth St, Liverpool, New South Wales 2170, Australia; School of Nursing and Midwifery, Western Sydney University, 161-169 Macquarie St, Parramatta, New South Wales 2150, Australia.
| | - Claire M Rickard
- AVATAR Group, Menzies Health Institute QLD, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia; The Prince Charles Hospital, Level 3 CSB, Rode Rd, Chermside, Queensland 4032, Australia; Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland 4006, Australia.
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van Loon FHJ, Willekens FJP, Buise MP, Korsten HHM, Bouwman ARA, Dierick-van Daele ATM. Clinical use of electrical stimulation with the Veinplicity®device and its effect on the first attempt success rate of peripheral intravenous cannulation: A non-randomized clinical trial. J Vasc Access 2019; 20:621-629. [DOI: 10.1177/1129729819838093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:Peripheral intravenous cannulation is one of the most frequently performed medical procedures. Venodilation, which can be achieved with different techniques, is an important factor for first attempt success. The objective of this study was to compare the first attempt success rates upon peripheral intravenous cannulation after applying a tourniquet, with venous dilation by electrical stimulation using the Veinplicity®device, or a combination of both techniques, in participants at moderate risk of a difficult peripheral intravenous access.Methods:This non-randomized clinical trial was carried out in adult patients divided into three parallel study groups, consisting of cannulation with a tourniquet (control group), cannulation after electrical stimulation without using a tourniquet (intervention group 1), and cannulation after applying electrical stimulation followed by the application of a tourniquet on the selected upper extremity (intervention group 2). The primary outcome was the first attempt success rate of peripheral intravenous catheter placement.Results:In all, 141 participants were included in this study, with an overall success rate of 86%. Success rates of 78%, 88%, and 92% were observed in the control group, intervention group 1, and intervention group 2, respectively ( p = 0.25, χ2 = 2.771, df = 2). A higher first attempt success rate was detected in participants in intervention group 2, when compared to the control group ( p = 0.04, χ2 = 4.63, df = 1).Conclusion:Increase in first attempt success was clinically relevant when electrical stimulation with the Veinplicity®device was combined with the application of a tourniquet in participants at moderate risk of a difficult peripheral intravenous access.
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Affiliation(s)
- Fredericus HJ van Loon
- Department of Technical and Anesthesia Nursing Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Freek JP Willekens
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc P Buise
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Hendrikus HM Korsten
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
- Department of Signal Processing Systems and Electrical Engineering, TU/e Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arthur RA Bouwman
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
- Department of Signal Processing Systems and Electrical Engineering, TU/e Eindhoven University of Technology, Eindhoven, The Netherlands
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Short Peripheral Catheter Performance Following Adoption of Clinical Indication Removal. JOURNAL OF INFUSION NURSING 2019; 42:81-90. [DOI: 10.1097/nan.0000000000000318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bakan AB, Arli SK. Development of the peripheral and central venous catheter-related bloodstream infection prevention knowledge and attitudes scale. Nurs Crit Care 2019; 26:35-41. [PMID: 30815969 DOI: 10.1111/nicc.12422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/24/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because of the necessities of modern medicine, catheters are frequently used for patients today. Mistakes made in catheter implementation frequently cause nosocomial infections. AIMS AND OBJECTIVES The purpose of this study was to develop a scale to be used for the evaluation of nurses' knowledge and attitudes about peripheral and central venous catheter-related bloodstream infection prevention. DESIGN AND METHODS This methodological study was conducted between July 2016 and December 2017, with 150 nurses who worked in intensive care units and surgical, internal and paediatric clinics in hospitals located in two different cities in the eastern part of Turkey and who consented to participate in the study. RESULTS Item total correlation values of the scale ranged between 0.515 and 0.703. Correlation coefficient between the two measurements as a result of the test-retest reliability was found to be 0.64, and there was a linear relationship between the measurements. The Kaiser-Meyer-Olkin (KMO) value was found to be0.875, which indicates the adequacy of the sample. Barlett's test results indicated a correlation between the items (P < .01). Cronbach's alpha value of the scale was found to be 0.86. CONCLUSIONS Results showed that the 5-point Likert scale was formed with 14 items and two factors, which included "general precautions" and "catheter care." Scale total score is obtained by collecting all the items. Higher scores indicate higher knowledge and attitudes. This scale could be used for assessing the knowledge and attitudes of nurses about peripheral and central venous catheter-related bloodstream infection prevention precautions. RELEVANCE TO CLINICAL PRACTICE The Peripheral and Central Venous Catheter-Related Bloodstream Infection Prevention Knowledge and Attitudes Scale could be used for infection prevention in the assessment of the knowledge and attitudes of nurses with a view of preventing infections. The scale can be used in intensive care units and surgical, internal and paediatric clinics in order to assess nurses' knowledge and attitudes.
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Affiliation(s)
- Ayse B Bakan
- Department of Nursing, Agri Ibrahim Cecen University School of Health, Agri, Turkey
| | - Senay K Arli
- Department of Nursing, Agri Ibrahim Cecen University School of Health, Agri, Turkey
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