Prevalence of idle peripherally inserted central catheters in adult patients: A multicenter cross-sectional study

Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review

BACKGROUND

Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation.

METHODS

A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data.

RESULTS

From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies.

CONCLUSION

Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.

How common are indwelling devices in hospitalized adults? A contemporary point prevalence study in a tertiary care hospital

BACKGROUND

Healthcare associated infections are associated with indwelling devices. Yet, data regarding prevalence of indwelling devices in noncritically ill hospitalized patients remains scant.

METHODS

Adult, noncritically ill patients on general care, telemetry, and surgical floors at our quaternary care hospital were surveyed on 2 separate days. Data regarding presence of indwelling vascular, urinary, and gastrointestinal devices, as well as nurse to patient ratio on each unit were collected.

RESULTS

There were 1,229 devices observed among the 857 patients surveyed across 2 days. Of the surveyed patients, 780 (91.0%) had at least 1 indwelling device. Among all devices, intravenous catheters were the most common (90.1%), followed by gastrointestinal devices (12.8%) and urinary catheters (10.2%). The most prevalent device was peripheral intravenous catheters. The median nurse to patient ratio was 3 patients to 1 nurse; no difference in nurse to patient ratio based on the number of devices present was observed.

CONCLUSIONS

Indwelling device use appears highly prevalent in general care settings and variation among devices is common. Healthcare associated infections prevention strategies targeting these devices are necessary.

Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study

Background: Peripherally inserted central catheters (PICCs) facilitate the treatment of several diseases. Here, we assessed the clinical course of elderly patients with dementia using PICCs. Methods: This retrospective observational study was conducted at a single dementia treatment center. PICCs were used in elderly inpatients with dementia who required (a) intravenous therapy, supplemental parenteral nutrition, and dysphagia rehabilitation during acute illness; (b) end-of-life care; (c) total parenteral nutrition (TPN); or (d) an alternative to peripheral vascular (PV) access. Results: Fifty-nine patients were enrolled (83.5 ± 6.9 years): 61% were in the acute treatment group, and 17% were in the end-of-life care group. The median catheter lifespan was 42 (23-87.5) days. The incidence of catheter-related bloodstream infection was 0.22 per 1,000 PICC-days, and that of deep venous thrombosis was 0.66 per 1,000 PICC-days. Among the patients in acute treatment group, 19% resumed sufficient oral intake after the treatment using PICC, and 36% resumed oral intake of gelatin-like food. Among the patients in the end-of-life care group, 91% received intravenous fluids continuously until death by initially inserted PICC. Conclusion: In elderly patients with dementia, PICCs might be one of the options during the treatment of acute illness as well as for prolonged support during end-of-life care.