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Roland van Rens MFPT, Ton van Boxtel AJH, Mermel LA. Comment on: Central-line-associated bloodstream infection (CLABSI) burden among Dutch neonatal intensive care units. J Hosp Infect 2024:S0195-6701(24)00194-4. [PMID: 38823644 DOI: 10.1016/j.jhin.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | | | - Leonard A Mermel
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; Lifespan Hospital System, 167 Point St, Providence, RI 02903, USA
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Kluckow E, Perera S, Clifford I, Wilks D, Cooper MS. Increased risk of complications in lower versus upper limb peripheral intravenous cannulation in children with severe neurological impairment. Child Care Health Dev 2024; 50:e13250. [PMID: 38529773 DOI: 10.1111/cch.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obtaining peripheral intravenous catheter (PIVC) access in children with severe neurological impairment (SNI) is often challenging and commonly associated with complications, including dislodgement, phlebitis and extravasation. In severe cases, extravasation injury may lead to tissue necrosis, ulceration and long-term morbidity. The aim of this study was to determine the relative incidence of PIVC complications secondary to lower limb cannulation, compared to upper limb, in children with SNI. METHODS A single centre, retrospective, observational review was conducted. Patients with SNI, admitted at a tertiary paediatric centre over 6 months between July and December 2022, were included. RESULTS One-hundred fifty-five PIVC procedures were conducted in 110 children over the study period. Complications were more common in lower limb PIVCs (12/16, 75%) compared to upper limb (58/139, 42%), p = 0.01. CONCLUSION Upper limb cannulation is preferred in children with SNI.
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Affiliation(s)
- Eliza Kluckow
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sajini Perera
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Isaac Clifford
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Daniel Wilks
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
- Facial Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Monica S Cooper
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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van Rens MF, Hugill K, Mahmah MA, Francia AL, van Loon FH. Effect of peripheral intravenous catheter type and material on therapy failure in a neonatal population. J Vasc Access 2023; 24:1284-1292. [PMID: 35196909 DOI: 10.1177/11297298221080071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In neonatal settings vascular access devices are essential for treatment. However, their use is not without risks. The design and materials of peripheral vascular access devices have been evaluated amongst adult populations, but contemporary studies in neonatal settings are scant. PURPOSE/OUTCOME MEASURES This research describes the prevalence of peripheral intravenous catheter failure related to three different catheter types with the intent to identify modifiable risks that might be used to evaluate device efficacy, innovate neonatal practice, and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. PARTICIPANTS Neonates who were admitted to the unit requiring intravenous treatment wherefore peripheral intravenous cannulation was indicated, were included in this study. RESULTS The use of different type of catheters resulted in significantly less therapy failures as phlebitis and increased dwell time, compared with the control groups. This remains significant after adjusting for age at insertion, gestational age, birth weight, and catheter type. CONCLUSIONS The study's findings are in accord with international literature concerning adult and pediatric patients concerning the superiority of PUR over PTFE catheters with respect to the risk of phlebitis and longer dwell times. However, the risk of failure of therapy did not differ between catheters. This finding is reassuring and supports practitioner judgment when selecting peripheral catheter devices.
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Affiliation(s)
- Matheus Fpt van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamad Adnan Mahmah
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus Hj van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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Hugill K, van Rens MFPT, Alderman A, Kaczmarek L, Lund C, Paradis A. Safe and effective removal of cyanoacrylate vascular access catheter securement adhesive in neonates. Front Pediatr 2023; 11:1237648. [PMID: 37691778 PMCID: PMC10492643 DOI: 10.3389/fped.2023.1237648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Neonatal vascular access continues to pose challenges. Recent times have seen considerable innovations in practice and the design and manufacture of materials used to provide infusion-based therapies with the intent of reducing the incidence and severity of vascular access-related complications. However, despite these efforts, vascular access-related complication rates remain high in this patient group and research evidence remains incomplete. In neonates, a medical-grade formulation of cyanoacrylate adhesive is widely used to secure percutaneously inserted central venous catheters and is beginning to establish a role in supporting the effective securement of other devices, such as umbilical and peripheral intravenous catheters. This Perspective article considers issues specific to the removal of cyanoacrylate used to secure vascular access devices from neonatal skin before its bonding releases due to natural skin exfoliation processes. The aim of this information is to ensure the safe and effective removal of octyl-cyanoacrylate adhesive-secured vascular access catheters from neonatal skin and stimulate professional discussion.
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Affiliation(s)
- Kevin Hugill
- Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Angela Alderman
- NICU, Carilion Children’s Hospital, Roanoke, VA, United State
| | | | - Carolyn Lund
- NICU, UCSF Benioff Children's Hospital, Oakland, CA, United State
- School of Nursing, University of California, San Francisco, CA, United State
| | - Amy Paradis
- NICU, CNS Doctors Medical Center, Modesto, CA, United State
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Thushara NL, Singh P, Priyadarshi M, Chaurasia S, Bhat NK, Basu S. Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial. Indian J Pediatr 2023:10.1007/s12098-023-04756-w. [PMID: 37578610 DOI: 10.1007/s12098-023-04756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. METHODS The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC. Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. RESULTS Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. CONCLUSIONS Splint application did not affect functional PIVC duration and its related complications in neonates.
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Affiliation(s)
- Nadella Lakshmi Thushara
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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van Rens MF, Vijlbrief D, Braun S, Hugill K, van Loon FH, van de Hoogen A. Peripheral intravenous therapy infiltration/extravasation (PIVIE) risks and the potential for earlier notification of events using a novel sensor technology in a neonatal population. J Vasc Access 2023:11297298231185536. [PMID: 37395292 DOI: 10.1177/11297298231185536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). OBJECTIVE The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. METHODS The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. RESULTS In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. CONCLUSIONS Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.
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Affiliation(s)
| | - Daniel Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Sophie Braun
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | | | - Fredericus Hj van Loon
- Department of Perioperative Care and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
- Clinical Health Science at Utrecht University (UU), Utrecht, The Netherlands
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7
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Lee CC. Reducing complications and extending the lifespan of peripheral intravenous catheters in newborns-simple and feasible methods. Pediatr Neonatol 2023; 64:229-230. [PMID: 37085426 DOI: 10.1016/j.pedneo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Affiliation(s)
- Chien-Chung Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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van Rens MF, Spencer TR, Hugill K, Francia AL, van Loon FH, Bayoumi MA. Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population. J Vasc Access 2023:11297298231154629. [PMID: 36794683 DOI: 10.1177/11297298231154629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods. METHODS A retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar. A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG). In the historical cohort, the catheter was secured using a semi-permeable transparent membrane dressing while in the CG cohort, CG was applied at the insertion site on initial insertion and after any dressing change. This was the only variable intervention between both groups. RESULTS A total of 8330 peripheral catheters were inserted. All catheters were inserted and monitored by members of the NeoVAT team. 4457 (53.5%) were secured with just a semi-permeable transparent dressing and 3873 (46.5%) secured a semi-permeable transparent dressing with the addition of CG. The odds ratio for premature failure after securement with CG was 0.59 (0.54-0.65) when compared to the catheters secured with a semi-permeable transparent dressing, which was statistically significant (p < 0.001). The correlation between the occurrence of a complication and the use of CG for device securement was significant (p < 0.001). CONCLUSIONS The risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study's findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.
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Affiliation(s)
| | | | - Kevin Hugill
- Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | - Airene Lv Francia
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus Hj van Loon
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.,PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Mohammad Aa Bayoumi
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Baye ND, Teshome AA, Ayenew AA, Amare TJ, Mulu AT, Abebe EC, Tiruneh GA, Ayele TM, Muche ZT, Teklemariam AB, Melese BD, Agidew MM, Seid MA. Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study. BMC Nurs 2023; 22:11. [PMID: 36631864 PMCID: PMC9832806 DOI: 10.1186/s12912-022-01164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Peripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia. METHODS AND SETTING An institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed. RESULTS The incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63-6.27), admission unit (AHR = 1.88, 95%CI: 1.07-4.02), sickness (AHR = 0.24, 95% CI: 1.31-4.66), medication type (AHR = 2.04, 95%CI: 1.13-3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02-0.99), clinical experience (AHR = 0.52, CI:0.26-0.84), and flushing (AHR = 0.71, 95%CI: 0.34-0.98) were potential predictors of PIVC complication. CONCLUSION Knowing the predictor factors helps clinicians to provide effective care and to detect complications early.
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Affiliation(s)
- Nega Dagnew Baye
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Assefa Agegnehu Teshome
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atalo Agimas Ayenew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadeg Jemere Amare
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anmut Tilahun Mulu
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Ayalew Tiruneh
- grid.510430.3Department of Clinical Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklie Mengie Ayele
- grid.510430.3Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zelalem Tilahun Muche
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Awgichew Behaile Teklemariam
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melese
- grid.510430.3Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Mekonnen Agidew
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- grid.510430.3Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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van Rens M, Hugill K, Gaffari MAK, Francia AV, Ramkumar T, Garcia KLP, van Loon FHJ. Outcomes of establishing a neonatal peripheral vascular access team. Arch Dis Child Fetal Neonatal Ed 2023; 108:88-89. [PMID: 34620683 DOI: 10.1136/archdischild-2021-322764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Matheus van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Airene V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Thiruveni Ramkumar
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Krisha L P Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H J van Loon
- Anaesthesiology and Intensive Care, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
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11
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van Rens MFPT, Bayoumi MAA, van de Hoogen A, Francia ALV, Cabanillas IJ, van Loon FHJ, Spencer TR. The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes. Front Pediatr 2022; 10:980725. [PMID: 36405839 PMCID: PMC9670536 DOI: 10.3389/fped.2022.980725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. METHODS This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. RESULTS The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50-0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82-0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24-1.27) had a significant relationship with outcomes. CONCLUSIONS Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A A Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre of Utrecht, Utrecht, Netherlands
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Irian J Cabanillas
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H J van Loon
- Department of Science and Technology in Perioperative Nursing, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Timothy R Spencer
- Nursing Department, Global Vascular Access, LLC, Scottsdale, AZ, United States
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