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Endo H, Sekiguchi R, Kinoshita M, Tanaka K. Peripheral venous dilation using flow-mediated dilation response: A randomized crossover study. J Vasc Access 2024:11297298241273642. [PMID: 39171370 DOI: 10.1177/11297298241273642] [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: 08/23/2024] Open
Abstract
BACKGROUND Venodilation is crucial in enhancing the success rate of peripheral intravenous cannulation. Flow-mediated dilation (FMD) is a vasodilatory response initiated by temporary ischemia followed by reperfusion. This crossover study aimed to test the hypothesis that FMD induces dilation of the peripheral veins of the forearm. METHODS Fifteen healthy volunteers underwent the FMD and control conditions in a randomized order. FMD involved a 5-min occlusion of blood flow in the brachial artery, followed by reperfusion, achieved by inflating and deflating a cuff placed on the upper arm. The control condition involved participants remaining at rest. The primary outcome measure was a change in the cross-sectional area of the cephalic vein post-intervention. The secondary outcomes included changes in venous diameter and perfusion index (PI). RESULTS FMD significantly increased the cross-sectional area of the cephalic vein compared with the control condition (relative change to baseline: 37.7% (31.4) vs 2.2% (11.7)), with a mean difference of 35.4% (95% confidence interval (CI): 16.4-54.5, p = 0.001). Both longitudinal and transverse diameters were significantly expanded with FMD compared to the control (relative change to baseline: 15.7% (15.4) vs 2.6% (3.6), p = 0.004; 18.9% (15.6) vs -0.0 (10.2), p = 0.003, respectively). Additionally, PI significantly increased with FMD compared with the control (relative change to baseline: 77.8% (56.9) vs 14.6% (36.0)), with a mean difference of 63.2% (95% CI: 31.2-95.2, p = 0.001). CONCLUSION FMD application induced dilation of the cephalic vein of the forearm. The findings suggest that FMD is an effective technique for dilating the venous area and potentially improving the success rate of peripheral intravenous cannulation.
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Affiliation(s)
- Hiroya Endo
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Ryo Sekiguchi
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Michiko Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Slosse C, Manneville F, Ricci L, Ostermann A, Klein S, Bouaziz H, Ambroise-Grandjean G. Development and evaluation of an algorithm for peripheral venous catheter placement (ALCOV): protocol for a quasi-experimental study. BMJ Open 2024; 14:e078002. [PMID: 38904139 PMCID: PMC11191775 DOI: 10.1136/bmjopen-2023-078002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Multiple punctures during peripheral venous catheter (PVC) placement increase the risk of complications. Scoring for adult difficult intravenous access (A-DIVA Scale) exists but has never been assessed in the framework of a care algorithm (scoring associated with a new decision-making tree for puncture conditions, the A-DIVA Tree). We seek to implement an catheter placement algorithm to decrease the mean number of punctures per patient. The algorithm will be adjusted based on obstacles and levers revealed by the analysis of clinical data. The benefits of the algorithm will be assessed using a step-by-step implementation of the approach. METHODS AND ANALYSIS 794 PVC placements will be recorded in two inclusion centres (50%/50%). In phase I, 297 PVC placements will be collected, and 16 individual semistructured interviews will be conducted to evaluate the centres' practices. In phase II, 200 PVC placements will be recorded to assess the impact of the A-DIVA Scale alone. The interphase will allow preliminary results based development of the A-DIVA Tree. In phase III, 297 PVC placements will be recorded to assess the impact of the algorithm on the mean number of punctures per patient. ETHICS AND DISSEMINATION The study and related consent forms were approved by an institutional review board (Comité de Protection des Personnes Sud-Méditerranée I) on 25 April 2023 under reference number 2023-A00223-42. The results will be disseminated in the form of original articles, presentations and guidelines. TRIAL REGISTRATION NUMBER NCT05935228.
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Affiliation(s)
- Côme Slosse
- Anesthesiology and Critical Care Department, Nancy University Hospital Center, Nancy, France
- IADI, INSERM 1254, University of Lorraine, Nancy, Grand Est, France
| | - Florian Manneville
- CHRU-Nancy, INSERM 1433, Université de Lorraine, CIC, Epidémiologie Clinique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Laetitia Ricci
- CHRU-Nancy, INSERM 1433, Université de Lorraine, CIC, Epidémiologie Clinique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Amandine Ostermann
- CHRU-Nancy, INSERM 1433, Université de Lorraine, CIC, Epidémiologie Clinique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Sylvie Klein
- CHRU-Nancy, INSERM 1433, Université de Lorraine, CIC, Epidémiologie Clinique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Hervé Bouaziz
- Anesthesiology and Critical Care Department, Nancy University Hospital Center, Nancy, France
| | - Gaëlle Ambroise-Grandjean
- IADI, INSERM 1254, University of Lorraine, Nancy, Grand Est, France
- Maïeutique department, University of Lorraine, Vandoeuvre-lès-Nancy, Grand Est, France
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Faltoni M, Catho G, Pianca E, Minka-Obama B, Zanella MC, Chraiti MN, Fortchantre L, Harbarth S, Buetti N. Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study. Clin Microbiol Infect 2024; 30:548-551. [PMID: 38142893 DOI: 10.1016/j.cmi.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI. METHODS Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors. RESULTS A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results. DISCUSSION Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI.
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Affiliation(s)
- Matteo Faltoni
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Eva Pianca
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka-Obama
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Nöelle Chraiti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Loïc Fortchantre
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolὸ Buetti
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; IAME U 1137, INSERM, Université Paris-Cité, Paris, France.
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Mitra TP, Coulter-Nile S, Jegathees T, Luong J, Shetty A, Lai K. Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial. J Emerg Med 2024; 66:57-63. [PMID: 38278677 DOI: 10.1016/j.jemermed.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty. OBJECTIVE This study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas. METHODS We conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study-pain experienced by patients and procedural difficulties experienced by clinical staff-were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires. RESULTS Data from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56-1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66-0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively. CONCLUSIONS There was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.
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Affiliation(s)
- Tatum Priyambada Mitra
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; Emergency Department, Westmead Children's Hospital, Sydney, New South Wales, Australia; Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sarah Coulter-Nile
- Westmead Hospital, Sydney, New South Wales, Australia; Royal Hospital for Women, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Thuvarahan Jegathees
- Westmead Hospital, Sydney, New South Wales, Australia; Westmead Children's Hospital, Sydney, New South Wales, Australia
| | - Jason Luong
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Amith Shetty
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; New South Wales Ministry of Health, New South Wales, Australia
| | - Kevin Lai
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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5
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Basak T, Demirtas A, Duman S. The effect of rose oil aromatherapy and hand-holding on pain due to peripheral intravenous catheter insertion. Explore (NY) 2024; 20:62-69. [PMID: 37301653 DOI: 10.1016/j.explore.2023.06.002] [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: 02/23/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The study aimed to evaluate the effectiveness of rose oil (Rosa Damascene Mill.) aromatherapy and hand-holding in reducing pain associated with peripheral intravenous catheter insertion. METHODS A comparative mixed-method design. A total of 126 patients were included in the study. For the study's quantitative data, sociodemographic characteristics of the patients and the Patient Interview Form for the qualitative data of the Numeric Rating Scale were used. In all patients included in the study, PIVC insertion was performed a single time by the same nurse using a standard procedure. Chi-square and Bonferroni tests were used for comparative statistics. RESULTS No statistically significant difference between the groups regarding age, gender, marital status, BMI, and education level (p>0.05). Pain scores: it was 2.40±1.78 in the rose oil group, 3.53±1.98 in the hand-holding group, and 4.88±1.56 in the control group. The difference between the groups regarding pain scores is statistically significant (p=0.001). CONCLUSIONS The study determined that rose oil aromatherapy and hand-holding interventions reduce pain during PIVC. However, rose oil aromatherapy was more effective on pain than the hand-holding intervention. (Clinical Trial ID: NCT05425849).
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Affiliation(s)
- Tulay Basak
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Etlik, Ankara, Turkey.
| | - Ayla Demirtas
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Etlik, Ankara, Turkey
| | - Senem Duman
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Etlik, Ankara, Turkey
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Tanabe H, Oosawa K, Miura M, Mizuno S, Yokota T, Ueda T, Zushi Y, Nagata M, Murayama R, Abe-Doi M, Sanada H. Effect of a thin-tipped short bevel needle for peripheral intravenous access on the compressive deformation and displacement of the vein: A preclinical study. J Vasc Access 2024; 25:265-273. [PMID: 35773962 DOI: 10.1177/11297298221075169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model. METHODS The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion. RESULTS An ex vivo model was created with a vessel diameter of 2.7-3.7 mm and a depth of 2-5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs. CONCLUSION The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.
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Affiliation(s)
- Hidenori Tanabe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Kousuke Oosawa
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Manabu Miura
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Shinichi Mizuno
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Takayuki Yokota
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Takehiko Ueda
- Kofu Factory, Terumo Corporation, Nakakoma-gun, Yamanashi, Japan
| | - Yasunobu Zushi
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Misako Nagata
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Liuyue W, Juxin G, Chunlan H, Junli L, Liucui C, Xialu Z, Qiujiao L, Fangyin L. Status and influencing factors of patients with kinesiophobia after insertion of peripherally inserted central catheter: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29529. [PMID: 35905238 PMCID: PMC9333528 DOI: 10.1097/md.0000000000029529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the current status and influencing factors of kinesiophobia in patients after insertion of peripherally inserted central catheter (PICC). A total of 240 patients with PICC were included. Their postinsertion status and influencing factors were investigated using the general information questionnaire, Tampa Scale of Kinesiophobia (TSK), Medical Coping Modes Questionnaire, Numerical Rating Scale, and Self-rating Anxiety Scale. The mean TSK score was 36.49 ± 4.19 points, and 89 patients (37.08%) had kinesiophobia. Multiple linear regression analysis showed that factors such as education level, age, monthly income level, catheterization history, face, pain level, anxiety, and number of needle insertions influenced postoperative kinesiophobia in patients with PICC (P < .05). The total variation in the TSK score was 71.8%. The incidence of kinesiophobia was relatively high after PICC insertion. The medical staff needs to undertake targeted intervention measures to help minimize kinesiophobia after PICC insertion, allowing patients to perform scientifically correct functional exercises and attain physical recovery.
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Affiliation(s)
- Wang Liuyue
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
| | - Gong Juxin
- School of Clinical Medicine, Youjiang Medical University for Nationalities, Baise, China
| | - Huang Chunlan
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Li Junli
- Department of PICC Clinic, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Chen Liucui
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
| | - Zhang Xialu
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
| | - Liao Qiujiao
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Liu Fangyin
- School of Nursing, Youjiang Medical University for Nationalities, Baise, China
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- *Correspondence: Liu Fangyin, Department of Nursing, Mainly research in surgical nursing, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China (e-mail: )
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Padded Dressing with Lidocaine HCL for Reducing Pain during Intravenous Cannulation in Adult Patients: A Randomized Controlled Clinical Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6128557. [PMID: 35502334 PMCID: PMC9056181 DOI: 10.1155/2022/6128557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Objective. In this study, we aimed to evaluate the effect of administering lidocaine as a local anesthetic at the puncture site prior cannulation on reduction of pain during intravenous cannulation (IVC). Methods. A total of 77 patients were divided into two groups as the patients who received a local anesthetic prior IVC procedure (
) and the control group (
). Patients’ demographic data, including age, gender, height, weight and body mass index, IV gauge, IV site, heart rate (HR), and oxygen saturation (SpO2) were recorded and analyzed. Patients in both groups scored the pain they felt during IVC through the visual analog scale (VAS) and the verbal descriptor scale (VDS). Results. No statistically significant difference was found between the two groups in terms of the demographic features. There was no significant difference between the two groups in terms of the cannula gauges and site of IVC. The mean post-IVC HR value was statistically significantly higher compared to pre-IVC in the control group (
), while no difference was found between the mean pre- and postprocedure HR in the lidocaine group. The mean VAS score was significantly lower in the lidocaine group compared to the control group (
). There was a significant difference between the groups in terms of the current VDSs. The rate of the patients reporting mild pain was statistically significantly higher in the lidocaine group compared to the control subjects (
). Conclusion. According to the results of this study, lidocaine HCL-impregnated padded dressing prior IV cannulation significantly reduced pain sensation during IVC.
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Baril L, Nguyen E, Dufresne-Santerre L, Émond V, Émond M, Berthelot S, Gagnon AP, Nadeau A, Carmichael PH, Mercier E. Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study. Emerg Med J 2021; 38:825-829. [PMID: 34344731 DOI: 10.1136/emermed-2020-210535] [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: 08/24/2020] [Accepted: 07/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED. METHODS We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1-3), moderate (4-6) or severe pain (7-10). RESULTS A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0-3)), intravenous catheters (n=240, NRS 2 (IQR 0-4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2-6)), cervical collars (n=50, NRS 5 (IQR 0-8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0-8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain. CONCLUSIONS Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.
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Affiliation(s)
- Laurence Baril
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Elisabeth Nguyen
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Virginie Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Simon Berthelot
- Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Ann-Pier Gagnon
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Alexandra Nadeau
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
| | | | - Eric Mercier
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada .,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
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10
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Kearney L, Craswell A, Massey D, Marsh N, Nugent R, Alexander C, Smitheram C, McLoughlin A, Ullman A. Peripheral intravenous catheter management in childbirth (PICMIC): A multi-centre, prospective cohort study. J Adv Nurs 2021; 77:4451-4458. [PMID: 34118163 DOI: 10.1111/jan.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision-making during insertion and perceptions of women. METHODS This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non-participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. RESULTS Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18-gauge catheter was considered more painful than a 16-gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18-gauge catheters mostly in hand or wrist (66%). Decision-making about site, catheter gauge, dressing and attempts varied. Thirty-four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non-dominant arm as key reasons for the location of PIVC. CONCLUSIONS Regular use of a large-gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Debbie Massey
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Nicole Marsh
- Royal Brisbane Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Rachael Nugent
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Catherine Alexander
- Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, QLD, Australia
| | - Carmel Smitheram
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Anthea McLoughlin
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.,Children's Health Queensland, Brisbane, QLD, Australia
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11
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van Loon FHJ, Korsten HHM, Dierick-van Daele ATM, Bouwman ARA. The impact of the catheter to vein ratio on peripheral intravenous cannulation success, a post-hoc analyses. PLoS One 2021; 16:e0252166. [PMID: 34029356 PMCID: PMC8143382 DOI: 10.1371/journal.pone.0252166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Intravenous cannulation is usually the first procedure performed in modern healthcare, although establishing peripheral intravenous access is challenging in some patients. The impact of the ratio between venous diameter and the size of the inserted catheter (catheter to vein ratio, CVR) on the first attempt success rate can be of added value in clinical. This study tries to give insight into the consideration that must be made when selecting the target vein and the type of catheter, and proved the null hypothesis that an optimal CVR would not be associated with increased first attempt cannulation success. Methods This was a post-hoc analyses on adult patients admitted for peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines, by applying the traditional landmark approach. The CVR was calculated afterwards for each individual patient by dividing the external diameter of the inserted catheter by the diameter of the target vein, which was multiplied by 100%. Results In total, 610 patients were included. The median CVR was 0.39 (0.15) in patients with a successful first attempt, whereas patients with an unsuccessful first attempt had a median CVR of 0.55 (0.20) (P<0.001). The optimal cut-off point of the CVR was 0.41. First attempt cannulation was successful in 92% of patients with a CVR<0.41, whereas as those with a CVR>0.41 had a first attempt success rate of 65% (P<0.001). Conclusion This first introduction of the CVR in relation to cannulation success should be further investigated. Although, measuring the venous diameter or detection of a vein with a specific diameter prior to cannulation may increase first attempt cannulation success.
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Affiliation(s)
- Fredericus H J van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.,Department of Science and Technology in Anesthesia Nursing Practice, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Hendrikus H M Korsten
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
| | - Angelique T M Dierick-van Daele
- Department of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R A Bouwman
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands.,Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
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12
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Hosseini SJ, Eidy F, Kianmehr M, Firouzian AA, Hajiabadi F, Marhamati M, Firooz M. Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial. J Caring Sci 2021; 10:84-88. [PMID: 34222117 PMCID: PMC8242293 DOI: 10.34172/jcs.2021.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency. Methods: In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1). Results: The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups. Conclusion: There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.
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Affiliation(s)
| | - Fereshteh Eidy
- Department of Biostatistics, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Majid Kianmehr
- Department of Basic Sciences, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | | | - Fatemeh Hajiabadi
- Department of Medical Surgical, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Marhamati
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Mahbobeh Firooz
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
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13
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Obuchowska I, Ługowska D, Mariak Z, Konopińska J. Subjective Opinions of Patients About Step-by-Step Cataract Surgery Preparation. Clin Ophthalmol 2021; 15:713-721. [PMID: 33658752 PMCID: PMC7917310 DOI: 10.2147/opth.s298876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose We analyzed the subjective feelings and opinions of patients regarding modified cataract phacoemulsification procedures. Patients and Methods A consecutive case series of patients undergoing phacoemulsification of cataracts, who completed questionnaires designed by the authors to evaluate their subjective opinions about hospital admission, medical examination, and intraoperative procedures carried out at the operating theater. Results Two hundred patients (82 men and 118 women) were included in the study. Subjects aged ≥65 years more often than younger respondents presented negative opinions about hospital admission procedures (15% vs. 2.5%, p=0.032) and were less satisfied with physicians’ explanations about the matter of phacoemulsification (71.3% vs. 92.5%, p=0.004), type of artificial lens to be implanted (43.8% vs. 85%, p<0.001), and potential complications (69.4% vs. 95%, p<0.001). The most unpleasant intraoperative experiences included venipuncture (35.5%), artificial lens implantation (30.5%), and peeling off of a sterile surgical drape (24%). Conclusion Persons aged ≥65 years presented with negative opinions about routine procedures related to phacoemulsification. Older age seems to be associated with less tolerance to time-consuming bureaucratic procedures and a lesser understanding of the specific stages of the surgery. Older patients should be notified in advance about all routine procedures to be carried out and provided with a rationale for these activities. Trial Registration The study was registered on clinicaltrials. gov (NCT04327856).
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Affiliation(s)
- Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Dorota Ługowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
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14
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van Loon FH, Timmerman R, den Brok GP, Korsten EH, Dierick-van Daele AT, Bouwman AR. The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial. J Vasc Access 2021; 23:295-303. [PMID: 33530828 DOI: 10.1177/1129729821990217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Peripheral intravenous cannulation is the preferred method to obtain vascular access, but not always successful on the first attempt. Evidence on the impact of the intravenous catheter itself on the success rate is lacking. Faster visualization of blood flashback into the catheter, as a result of a notched needle, is thought to increase first attempt success rate. The current study aimed to assess if inserting a notched peripheral intravenous catheter will increase first attempt cannulation success up to 90%, when compared to inserting a catheter without a notched needle. DESIGN In this block-randomized trial, adult patients in the intervention group got a notched peripheral intravenous catheter inserted, patients in the control group received a traditional non-notched catheter. The primary objective was the first attempt success rate of peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines and hospital policy. RESULTS About 328 patients were included in the intervention group and 330 patients in the control group. First attempt success was 85% and 79% for the intervention and control group respectively. First attempt success was remarkably higher in the intervention group regarding patients with a high risk for failed cannulation (29%), when compared to the control group (10%). CONCLUSION This study was unable to reach a first attempt success of 90%, although first attempt cannulation success was higher in patients who got a notched needle inserted when compared to those who got a non-notched needle inserted, unless a patients individual risk profile for a difficult 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, Catharina Hospital, Eindhoven, The Netherlands
| | - Ricky Timmerman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Ph den Brok
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik Hm Korsten
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
| | - Angelique Tm Dierick-van Daele
- Department of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur Ra Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
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15
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Ye F, Liu Y, Yu P, Li N, Wang Y, Xie X, Tang J. Intraoperative ipsilateral subclavian port catheter implantation in resectable breast cancer patients: A novel, safe, and convenient clinical practice. Cancer Med 2020; 9:8970-8978. [PMID: 33145946 PMCID: PMC7724495 DOI: 10.1002/cam4.3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Port catheter (PC) is a classical route of administering chemotherapy for breast cancer patients. We established a standard operating procedure (SOP) of intraoperative ipsilateral subclavian PC implantation in selected resectable breast cancer patients. Methods We conducted a prospective clinical study to assess its safety and complications. A total of seventy six resectable breast cancer patients were included for intraoperative ipsilateral subclavian PC implantation. Thirty patients receiving conventional percutaneous contralateral PC implantation under local anesthesia at the same period were recruited as control group. The time consuming of implantation, and PC‐related complications were recorded. Visual analog scale questionnaires were used to assess patients’ satisfaction. Results Compared with conventional contralateral PC implantation under local anesthesia, SOP for intraoperative ipsilateral subclavian PC implantation significantly shortens the time consuming (11.6 vs. 28.6 min, p < 0.001). With a median retention time of 6.3 months, the overall incidence rate of PC‐related complications is 21%, of which the most common complications are infections and venous thromboembolism (7.9% for each). Most patients (86.8%) with intraoperative ipsilateral subclavian PC implantation have completed the whole chemotherapy successfully. Due to the general anesthesia and shorter time consuming, intraoperative implantation gains significantly more patients' satisfaction. Conclusions In the present study, we develop a SOP for intraoperative ipsilateral subclavian PC implantation in resectable breast cancer patients, which is noval, convenient, and safe. In selected breast cancer patients with indications for adjuvant chemotherapy, this practice could significantly shorten the time consuming of PC implantation and improve the degree of patients' satisfaction.
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Affiliation(s)
- Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ping Yu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yan Wang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jun Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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16
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The Effectiveness of Local Hot and Cold Applications on Peripheral Intravenous Catheterization: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:597-602. [PMID: 32843284 DOI: 10.1016/j.jopan.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This study was conducted to examine the effect of local hot and cold applications on pain, anxiety level, insertion time, and vein evaluation before peripheral venous catheter (PVC) insertion. DESIGN This randomized controlled trial was conducted with 90 patients who were hospitalized in the cardiology department of a university hospital. METHODS All the data were collected using a patient information form, the Numeric Rating Scale, and Vein Assessment Scale for the assessment of pain and anxiety. Before PVC was inserted, the researcher applied a hot application or a cold application to the catheter insertion site for 1 minute. FINDINGS Pain level was found to be significantly lower in the hot and cold application groups than the control group, and no difference was determined between the hot and cold application groups. The anxiety levels of the patients were significantly lower in the hot application group than the cold application and control groups (P < .05). CONCLUSIONS Applying local hot and cold application before inserting the PVC reduced both pain and anxiety levels of the patients. However, hot application increased vein visibility and patient satisfaction and shortened the insertion time, whereas cold application decreased vein visibility, prolonged the insertion time, and decreased patient satisfaction.
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17
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Bell JA, Spencer TR. Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes. J Vasc Access 2020; 22:81-89. [DOI: 10.1177/1129729820924554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.
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18
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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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19
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Rodriguez-Calero MA, de Pedro-Gomez JE, Molero-Ballester LJ, Fernandez-Fernandez I, Matamalas-Massanet C, Moreno-Mejias L, Blanco-Mavillard I, Moya-Suarez AB, Personat-Labrador C, Morales-Asencio JM. Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study. J Clin Med 2020; 9:E799. [PMID: 32183475 PMCID: PMC7141318 DOI: 10.3390/jcm9030799] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician's experience in this context. METHODS Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients' clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified. RESULTS The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event. CONCLUSION The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.
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Affiliation(s)
- Miguel Angel Rodriguez-Calero
- Nurse Director Office, Health System of the Balearic Islands (Ib-Salut), Carrer de la Reina Esclaramunda, 9. Piso 3, 07003 Palma Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Joan Ernest de Pedro-Gomez
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Luis Javier Molero-Ballester
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ismael Fernandez-Fernandez
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Catalina Matamalas-Massanet
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Luis Moreno-Mejias
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ana Belén Moya-Suarez
- Costa del Sol Hospital, Endoscopy & digestive medicine unit. Autovia A-7, Km. 187, 29603 Marbella, Spain;
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
| | - Celia Personat-Labrador
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
| | - José Miguel Morales-Asencio
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
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20
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Thomas C, Cabilan CJ, Johnston ANB. Peripheral intravenous cannula insertion and use in a tertiary hospital emergency department: A cross-sectional study. Australas Emerg Care 2020; 23:166-172. [PMID: 32139321 DOI: 10.1016/j.auec.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Peripheral intravenous cannula is often a first line invasive intervention for patients in the emergency department. It is used to facilitate blood sampling, deliver essential fluids, blood products and medication. However, the insertion and use of the peripheral intravenous cannula is not without complication. This study surveyed the number of peripheral intravenous cannulas inserted in the emergency department and identify the level of and reason for use. METHODS A cross-sectional study was conducted in the emergency department of a large tertiary hospital in Queensland. Descriptive and inferential statistics were used to describe peripheral intravenous cannula use and to explore associations. RESULTS Of the 224 patients assessed, 159 (71%) had at least one peripheral intravenous cannula inserted in emergency department. Of the 159 peripheral intravenous cannulas inserted, 54 (34%) remained unused while the patient was in the emergency department. For patients classified as Australasian Triage Scale categories 3, 4 and 5, 40% of peripheral intravenous cannulas remained unused. Overall, poor documentation was observed with 29% of peripheral intravenous cannulas insertions not documented at all. CONCLUSION This study identified a high proportion of unused peripheral intravenous cannulass in the emergency department and inadequate documentation. An intervention to promote best practice, raise awareness of the risks of peripheral intravenous cannulas use, possible alternatives therapies, and improve documentation is required.
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Affiliation(s)
- Clare Thomas
- Emergency Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia.
| | - C J Cabilan
- Emergency Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Amy N B Johnston
- Emergency Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia
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21
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Oliveira RL, Soares JH, Moreira CM, Silva CP, Carrasco LP, Souza HJ. The effects of lidocaine-prilocaine cream on responses to intravenous catheter placement in cats sedated with dexmedetomidine and either methadone or nalbuphine. Vet Anaesth Analg 2019; 46:492-495. [PMID: 31129046 DOI: 10.1016/j.vaa.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the reaction to cephalic intravenous (IV) catheter placement with or without lidocaine-prilocaine cream in cats sedated with dexmedetomidine and methadone or nalbuphine. STUDY DESIGN Prospective, randomized, blind study. ANIMALS A group of 24 female mixed breed cats. METHODS Cats were randomly allocated to one of the two sedation protocols: dexmedetomidine (0.01 mg kg-1) and methadone (0.3 mg kg-1; DEXMET) or dexmedetomidine (0.01 mg kg-1) and nalbuphine (0.3 mg kg-1; DEXNALB). Sedation was scored 30 minutes later using a visual analog scale. Subsequently, a 2 × 3.5 cm area of the antebrachium over the cephalic vein was clipped, and half the cats within each protocol were randomly assigned for topical lidocaine-prilocaine cream (treatment), whereas no cream was applied to other cats (control). After 20 minutes, an attempt was made to place a 24 gauge catheter into the cephalic vein and the reaction of the cats to this procedure was scored using a numeric scale 0-3. Sedation and catheterization reaction scores were compared between sedation protocols and whether cats were administered lidocaine-prilocaine cream or not using the Friedman test followed by the Bonferroni procedure. A p value < 0.05 was considered significant. RESULTS Sedation scores were not different between sedation protocols or between treatment and control cats within each protocol. All cats administered lidocaine-prilocaine cream showed no reaction to IV catheter placement. Among the control cats, no response was observed in one cat in DEXNALB. Catheterization reaction score was lower in the treatment cats in both the sedation protocols when compared with their respective controls. CONCLUSIONS AND CLINICAL RELEVANCE Lidocaine-prilocaine cream applied for 20 minutes abolished the reaction to catheterization in cats sedated with dexmedetomidine and nalbuphine or methadone. Facilitation of IV catheter placement occurred within 20 minutes of lidocaine-prilocaine application.
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Affiliation(s)
- Renato Ls Oliveira
- Graduate Program in Veterinary Medicine (Pathology and Clinical Sciences), Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil.
| | - Joao Hn Soares
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, CA, USA
| | - Clarissa Mr Moreira
- Graduate Program in Veterinary Medicine (Pathology and Clinical Sciences), Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
| | - Camile Pp Silva
- Residency Program in Professional Health Area - Veterinary Medicine (Veterinary Anesthesiology), Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
| | - Lara Ps Carrasco
- Graduate Program in Veterinary Medicine (Pathology and Clinical Sciences), Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
| | - Heloisa Jm Souza
- Department of Veterinary Medicine and Surgery, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil
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22
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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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23
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The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study. J Clin Med 2019; 8:jcm8020144. [PMID: 30691137 PMCID: PMC6406455 DOI: 10.3390/jcm8020144] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant’s individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.
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