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Nickel B. Vascular access device selection: Optimizing patient outcomes - Part 1. Nursing 2024; 54:25-37. [PMID: 39186158 DOI: 10.1097/nsg.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT A systematic evaluation of vascular access device (VAD) selection incorporates patient, device, and infusate characteristics to ensure optimal device placement. This article explores VAD selection from the perspective of vessel health and preservation and describes VAD selection options and indications, VAD-related complications, and strategies to reduce those complications.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the 2024 Infusion Nurses Society Standards of Practice Committee chair
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2
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Krath J, Fredskilde J, Christensen SK, Baltsen CD, Valentin K, Offersen R, Juhl-Olsen P. The performance and complications of long peripheral venous catheters: A retrospective single-centre study. Acta Anaesthesiol Scand 2024. [PMID: 39183695 DOI: 10.1111/aas.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. METHODS Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. RESULTS During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). CONCLUSION The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.
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Affiliation(s)
- Julie Krath
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Fredskilde
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Cecilie Dahl Baltsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Kamilla Valentin
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Ryan Offersen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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3
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Pinelli F, Pittiruti M, Annetta MG, Barbani F, Bertoglio S, Biasucci DG, Bolis D, Brescia F, Capozzoli G, D'Arrigo S, Deganello E, Elli S, Fabiani A, Fabiani F, Gidaro A, Giustivi D, Iacobone E, La Greca A, Longo F, Lucchini A, Marche B, Romagnoli S, Scoppettuolo G, Selmi V, Vailati D, Villa G, Pepe G. A GAVeCeLT consensus on the indication, insertion, and management of central venous access devices in the critically ill. J Vasc Access 2024:11297298241262932. [PMID: 39097780 DOI: 10.1177/11297298241262932] [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: 08/05/2024] Open
Abstract
Central venous access devices are essential for the management of critically ill patients, but they are potentially associated with many complications, which may occur during or after insertion. Many evidence-based documents-consensus and guidelines-suggest practical recommendations for reducing catheter-related complications, but they have some limitations. Some documents are not focused on critically ill patients; other documents address only some special strategies, such as the use of ultrasound; other documents are biased by obsolete concepts, inappropriate terminology, and lack of considerations for new technologies and new methods. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to offer an updated compendium of the main strategies-old and new-that should be adopted for minimizing catheter-related complications in the adult critically ill patient. The project has been planned as a consensus, rather than a guideline, since many issues in this field are relatively recent, and few high-quality randomized clinical studies are currently available, particularly in the area of indications and choice of the device. Panelists were chosen between the Italian vascular access experts who had published papers on peer-reviewed journals about this topic in the last few years. The consensus process was carried out according to the RAND/University of California at Los Angeles (UCLA) Appropriateness Methodology, a modification of the Delphi method, that is, a structured process for collecting knowledge from groups of experts through a series of questionnaires. The final document has been structured as statements which answer to four major sets of questions regarding central venous access in the critically ill: (1) before insertion (seven questions), (2) during insertion (eight questions), (3) after insertion (three questions), and (4) at removal (three questions).
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Francesco Barbani
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
| | - Denise Bolis
- Intensive Care Unit, Hospital "A.Manzoni," Lecco, Italy
| | - Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Capozzoli
- Department of Anesthesiology, Hospital of Bolzano, Lehr-Krankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Elisa Deganello
- Anaesthesia and Intensive Care, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Stefano Elli
- Vascular Access Team, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Adam Fabiani
- Cardiac Surgery Intensive Care Unit, Vascular Access Team, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences, University of Milan, "Luigi Sacco" Hospital, Milan, Italy
| | - Davide Giustivi
- Post-Anesthesia Care Unit and Vascular Access Team, Lodi, Italy
| | - Emanuele Iacobone
- Anesthesia and Intensive Care, Hospital of Macerata, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Alberto Lucchini
- Adult and Pediatric Intensive Care Unit, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Bruno Marche
- Department of Hematology, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Valentina Selmi
- Vascular Access Team, Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Davide Vailati
- Department of Anesthesia and Intensive Care, Melegnano Hospital, Milano, Italy
| | - Gianluca Villa
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Gilda Pepe
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
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Fabiani A, Aversana N, Santoro M, Calandrino D, Liotta P, Sanson G. The longer the catheter, the lower the risk of complications: Results of the HERITAGE study comparing long peripheral and midline catheters. Am J Infect Control 2024:S0196-6553(24)00580-7. [PMID: 38944156 DOI: 10.1016/j.ajic.2024.06.019] [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: 04/20/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Although widely used in clinical practice, long peripheral (LPCs) and midline catheters (MCs) are often misclassified because of their similar characteristics. Comparative studies on these devices are lacking. This study aimed to explore complications risks in polyurethane LPCs and MCs. METHODS Prospective cohort study. Catheter-failure within 30days was the primary outcome, catheter-related bloodstream infection (CR-BSI), thrombosis, and fibroblastic sleeve were secondary outcomes. The average number of drugs infused per day was computed to measure the overall intensity of catheters' use. RESULTS The catheter-failure incidence was 5.7 and 3.4/1,000 catheter-days for LPCs and MCs, respectively. MCs were associated with an adjusted lower risk of catheter-failure (hazard ratio 0.311, 95% confidence interval 0.106-0.917, P = .034). The daily number of drugs infused was higher for MCs (P < .001) and was associated with a greater risk catheter-failure risk (P = .021). Sensitivity analysis showed a decreased catheter-failure risk for MCs starting from day-10 from positioning. The incidence of CR-BSI (0.9 vs 0.0/1,000 catheter-days), thrombosis (8.7 vs 3.5/1,000 catheter-days), and fibroblastic sleeve (14.0 vs 8.1/1,000 catheters-days) was higher for LPC catheters. CONCLUSIONS Despite more intensive drug administration, MCs were associated with a longer uncomplicated indwelling time.
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Affiliation(s)
- Adam Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | | | - Marilena Santoro
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Dario Calandrino
- Internal Medicine Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Paolo Liotta
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
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Sánchez García AT, Lozano González J, Canals Candela FJ. Evaluation of vascular accesses in the neonatal intensive care unit. Is the midline catheter a useful long-term alternative? Med Intensiva 2024:S2173-5727(24)00166-8. [PMID: 38937197 DOI: 10.1016/j.medine.2024.05.016] [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: 04/25/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Analyze the usefulness of the midline catheter in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population requiring admission to the NICU. DESIGN Analytical and observational of a prospective cohort (December 2021-November 2023) compared to a historical cohort (January 2020-November 2021). SETTING 9-bed Neonatal Intensive Care Unit (NICU, level III hospital. PATIENTS OR PARTICIPANTS 288, 66 midline group and 222 control group. INCLUSION CRITERIA newborns from 24 to 42 weeks of gestation who required short peripheral or midline cannulation and treatment longer than 3 days. INTERVENTIONS Follow-up during NICU stay and comparison with retrospective data from a historical cohort. MAIN VARIABLES OF INTEREST Sociodemographics, success rate (permanence of the same vascular catheter without complications until finish the prescribed treatment), number of catheters, cannulation rate per patient, indwell time, complications. RESULTS The midline group showed a higher success rate (54.2% vs 5.6%, p < 0.001), a lower number of canalizations per patient (p < 0.001), a longer indwell time (p < 0.001) and a lower number of extravasations (p < 0.001). CONCLUSIONS The midline catheter has advantages over short peripheral catheters, being a useful alternative in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population that requires admission to the NICU.
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Affiliation(s)
- A T Sánchez García
- Servicio de Pediatría, Unidad de Neonatología, Hospital General Universitario de Elche, Alicante, Spain.
| | - J Lozano González
- Servicio de Pediatría, Unidad de Neonatología, Hospital General Universitario de Elche, Alicante, Spain
| | - F J Canals Candela
- Subdirección médica, Hospital General Universitario de Elda, Elda, Alicante, Spain; Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
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Donadoni M, Calloni M, Romano ME, Mutti A, Bartoli A, La Cava L, Celano R, Urso F, Popescu Janu V, Foschi A, Casella F, Taino A, Cogliati C, Zappa P, Masseroli MM, Gidaro A. Long peripheral catheters for intravenous infusions of iloprost or alprostadil therapy in rheumatologic outpatients. J Vasc Access 2024:11297298241252896. [PMID: 38770673 DOI: 10.1177/11297298241252896] [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: 05/22/2024] Open
Abstract
BACKGROUND Long peripheral catheters (LPCs) role in Difficult IntraVenous Access (DIVA) patients admitted to the emergency department has already been studied, resulting in a rapid, safe, and cost-effective procedure. Although their use in outpatient settings is established, there is a lack of studies assessing their benefits. In particular, rheumatologic outpatients affected by scleroderma, especially those affected by digital ulcers, are often treated with intravenous infusions of prostaglandin I2 (PGI2) analog (IV-PGI2A). OBJECTIVE AND METHODS From 1 October 2021 to 31 March 2024, we conducted a prospective study enrolling DIVA outpatients affected by systemic sclerosis or undifferentiated connective tissue disease who needed IV-PGI2A therapy at L. Sacco Hospital in Milan (Italy). Each treatment cycle consisted of four consecutive days of infusion of iloprost or alprostadil. The primary aim was to assess the efficacy and potential complications associated with LPCs for IV-PGI2A. RESULTS Twenty-six patients were enrolled 23 were females (88.5%), and the median age was 72 years (IQR 56-78.7). In total, 97 LPCs were inserted, with a mean number of insertions per patient/year of 2.3. An increase in LPCs insertion during the 30 months of the enrollment period was observed. Eighteen patients required more than one LPC placement, and in 61% of them, the second venipuncture was executed at a different site. No procedural complications were registered (accidental puncture of the brachial artery, accidental median nerve puncture, bleeding) nor late complications (Catheter-Related Thrombosis, Catheter-Related Bloodstream Infections, Accidental Removal). CONCLUSIONS Our experience shows that LPCs could be valuable and safe for rheumatologic outpatients. The increased number of insertions and new and total patients enrolled each year defines the satisfaction of patients and health care professionals.
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Affiliation(s)
- Mattia Donadoni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Eva Romano
- Department of Rheumatology, "Luigi Sacco" Hospital, Milan, Italy
| | - Alessandra Mutti
- Department of Rheumatology, "Luigi Sacco" Hospital, Milan, Italy
| | - Arianna Bartoli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Leyla La Cava
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Rosita Celano
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Urso
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Valentina Popescu Janu
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, "Luigi Sacco" Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Alba Taino
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Paolo Zappa
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Matteo Maria Masseroli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
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Qin KR, Ensor N, D'Amore M, Barnes R, Nataraja RM, Pacilli M. A pilot workshop for ultrasound-guided insertion of long peripheral catheters. J Vasc Access 2024; 25:1031-1032. [PMID: 36750764 DOI: 10.1177/11297298221125270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Kirby R Qin
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nicholas Ensor
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Matthew D'Amore
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Health, Clayton, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
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Fabiani A, Aversana N, Santoro M, Sanson G. Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection. Thromb Res 2024; 236:117-126. [PMID: 38422981 DOI: 10.1016/j.thromres.2024.02.022] [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: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. METHODS Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. RESULTS Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. CONCLUSIONS A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes.
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Affiliation(s)
- Adam Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata - Via Montpellier 1, Rome, Italy; Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Nicola Aversana
- School of Nursing, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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Östlund Å, Fläring U, Norberg Å, Kaiser S, Frisk T, Larsson P, Andersson A. Complications of Pediatric Midline Catheters: A Prospective Observational Pilot Study. Anesth Analg 2024; 138:572-578. [PMID: 36729761 DOI: 10.1213/ane.0000000000006328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Midline catheters are peripheral intravenous (IV) catheters in which the tip of the catheter does not reach the central circulation. In children, the use of midline catheters could lead to decreased complications from central venous catheters. To validate the safety of midline catheter use in children, we aimed to describe the complications and dwell time of pediatric midline catheters. The primary outcome was the incidence of catheter-related venous thromboembolism (VTE). METHODS We conducted an observational, prospective study including consecutive patients at a tertiary multidisciplinary pediatric hospital. One hundred pediatric midline catheters were followed for thrombotic, infectious, and mechanical complications. After catheter removal, Doppler ultrasonography was performed to detect asymptomatic VTE. RESULTS The mean age was 6.0 years (standard deviation [SD], 4.7), and median catheter dwell time was 6 (4-8) days. Most midline catheters were inserted in arm veins, most commonly in the basilic vein (56%). Catheter-related VTE was diagnosed in 30 (30%; 95% confidence interval [CI], 21%-40%) cases, corresponding to an incidence rate of 39 (95% CI, 26-55) cases per 1000 catheter days. Eight of 14 saphenous vein catheters were complicated by VTE compared to 22 of 86 arm vein catheters, suggesting an imbalance in favor of arm vein insertion site. Two patients needed anticoagulation therapy due to catheter-related VTE. Thirty (30%) catheters were removed unintentionally or due to complications, 22 of these needed additional IV access to complete the intended therapy. No catheter-related bloodstream infection (95% CI, 0%-4%) occurred. Mechanical complications occurred in 33 (33%; 95% CI, 24%-43%) midline catheters. CONCLUSIONS In children, thrombotic and mechanical complications of midline catheters are common, but only few VTEs are severe enough to warrant anticoagulation therapy. Systemic infectious complications are rare. Seventy-eight percent of patients did not need additional venous access to complete short-term IV therapy. Considering the rate of clinically relevant complications and the catheter dwell time, pediatric midline catheters could be an alternative to central venous access for short-term (5-10 days) IV therapy.
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Affiliation(s)
- Åsa Östlund
- From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Urban Fläring
- From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Åke Norberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Sylvie Kaiser
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Tony Frisk
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Larsson
- From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Andersson
- From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
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Sykes S, Ulloa J, Steward D. Midline Catheter Use in the Neonatal Intensive Care Unit. Crit Care Nurs Clin North Am 2024; 36:111-118. [PMID: 38296369 DOI: 10.1016/j.cnc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially those born preterm. Access is required for implementing management strategies such as stabilization, medications, fluids, nutrition, and transfusion of blood products. However, achieving and maintaining venous access in these neonates can be difficult, especially in preterm infants due to a myriad of contributing factors. Peripheral intravenous (PIV) catheters and peripherally inserted central catheters (PICC) are 2 common vascular access approaches used in the NICU and have traditionally been the most studied in the neonatal literature. Both options offer advantages and disadvantages. An alternative to PIVs and PICCs is the midline peripheral catheter (MPC), which in the literature may also be referred to as extended dwell peripheral intravenous catheters. Depending on the intended use, the MPC offers a venous access approach between a PIV and PICC. Usage of MPCs in the NICU is slowly increasing with the limited published evidence suggesting they are viable option when considering the need for vascular access. The purpose of this article is to present the advantages and disadvantages of MPCs as an alternative approach for venous access in neonates when appropriate.
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Affiliation(s)
- Stephanie Sykes
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA.
| | - Jodi Ulloa
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
| | - Deborah Steward
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
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Gilardi E, Grandi T, Giannuzzi R, Valletta F, Fugger S, Mazzaroppi S, Petrucci M, Piano A, Piccioni A, WoldeSellasie K, Sambuco F, Travaglino F. Long peripheral cannula in COVID-19 patients: 769 catheter days experience from a semi-intensive respiratory COVID unit. J Vasc Access 2024; 25:498-503. [PMID: 36065094 PMCID: PMC9445629 DOI: 10.1177/11297298221115002] [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: 07/01/2021] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the daily management of peripheral venous access, the health emergency linked to the COVID-19 pandemic led to re-examining the criteria for choosing, positioning and maintaining the different types of peripheral venous access. OBJECTIVES This study aimed to observe the dwell time of long peripheral cannula (LPC, also known as mini-midline) in patients affected by COVID 19 related pneumonia. The secondary objective is to study any complications due to mini-midline insertion. MATERIALS AND METHODS We conducted a prospective observational study on COVID19 patients who arrived at our Semi-Intensive Respiratory Unit from territorial ED between January and April 2021, to whom were positioned an LPC at the time of admission following the SIPUA protocol (Safe Insertion of Peripheral Ultrasound-guided Access). We used Vygon™ Leader-Cath© 18G in polyethylene and 8 cm long catheter. RESULTS We enrolled 53 consecutive patients, reaching 769 catheter days. The procedure was performed without immediate complications in 37 patients out of 53 (69.8%). In 14 patients (26.4%), we observed a local hematoma (no one led to a failure or early removal of the device) and in two patients (3.7%) was not possible to draw blood. The average catheter dwell time was 14.5 days, from 3 to 41 days. In 42 patients (79.2%), the device was removed at the end of use. In 11 patients out of 53 (20.8%), the device was removed early due to complications: seven accidental removals, one obstruction, two vein thrombosis, and one superficial thrombophlebitis. CONCLUSIONS The ultrasound-guided implantation of an 18G LPC in COVID19 patients, regardless of the state of their venous heritage, would seem to be an excellent strategy for these patients, reducing the number of venipunctures and CVC implantation, as well as allowing multiple and high pressure (contrast) infusions.
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Affiliation(s)
- Emanuele Gilardi
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Tommaso Grandi
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | | | - Fabio Valletta
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Solange Fugger
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Mazzaroppi
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Martina Petrucci
- Emergency Medicine Department,
Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Rome, Italy
| | - Alfonso Piano
- Emergency Medicine Department,
Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Rome, Italy
| | - Andrea Piccioni
- Emergency Medicine Department,
Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Rome, Italy
| | - Kidane WoldeSellasie
- Emergency Medicine Department,
Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Rome, Italy
| | - Federica Sambuco
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Travaglino
- Emergency Medicine Department,
Semi-Intensive Respiratory Covid Unit - Campus Covid Center, Policlinico
Universitario Campus Bio-Medico di Roma, Rome, Italy
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12
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Romitti MG, Perez CR, Pezzotti E, Motta M, Risso FM. Long peripheral catheters in neonates: filling the gap between short peripheral catheters and epicutaneous-caval catheters? J Vasc Access 2023; 24:920-925. [PMID: 34789024 DOI: 10.1177/11297298211057377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Non-critically ill neonates at times require venous access to provide peripherally compatible infusions for a limited period (more than 3 days). In such a situation, short peripheral cannulas are not appropriate as their average duration is about 2 days, while-on the other hand-epicutaneous-caval catheters may be too invasive. In these patients, insertion of long peripheral cannulas may be an effective option. METHODS In this observational retrospective study, we revised all "long" peripheral catheters (4 and 6 cm long) inserted by direct Seldinger technique in our neonatal intensive care unit when peripheral venous access was required for more than 3 days. RESULTS We inserted 52 2Fr polyurethane catheters, either 4 cm long (n = 25) or 6 cm long (n = 27) in 52 patients. Mean dwelling time was 4.17 days (range 1-12). Most devices were inserted in the cephalic vein (n = 18, 35%), and the rest in the saphenous vein (n = 11, 21%) and other superficial veins. There was no significant correlation between the duration of the device and type of infusion (p = 0.40). The main complications were infiltration (n = 16, 31%) and phlebitis (n = 8, 15%). The rate of removal due to complications was significantly higher (p < 0.01) in neonates with bodyweight <2000 g at the time of insertion. CONCLUSION In our experience, 2 Fr 4-6 cm long peripheral catheters may be a valid option for neonates requiring peripherally compatible infusions for more than 3 days. The limits of this study are the necessity of training in the technique of insertion and the small size of our sample. The longest dwell was observed in neonates weighing >2000 g at the time of LPC insertion.
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Affiliation(s)
- Maria Grazia Romitti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Carmen Rodriguez Perez
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elena Pezzotti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Motta
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
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13
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Fu J, Zhao L, Tian Y, Liu Y, Zhang H, Li H. Impact of terminal tip location of midline catheters on catheter-related complications and indwelling duration in elderly patients. Nurs Open 2023; 10:2349-2356. [PMID: 36385582 PMCID: PMC10006645 DOI: 10.1002/nop2.1490] [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: 01/04/2022] [Revised: 09/21/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
AIM To investigate the relationship between the position of the midline catheter tip and the frequency and type of complications associated with its placement. DESIGN A cohort study was performed on patients between May 2018 and December 2021 who underwent midline catheter placement at our institution. Patients were divided into two groups, superficial implementation and deep implementation, based on the midline catheter tip location relative to the clavicle. METHODS Clinical data and outcome parameters, including the numbers and types of midline catheter-related complications, day of occurrence and catheter indwell duration, were recorded. RESULTS Catheter-related complications occurred in 14 individuals. Compared with the superficial implementation group, the incidence of complications in the deep catheterization group was significantly reduced, with a delayed first occurrence time, and a prolonged catheter indwelling time. The results suggested that locating the midline catheter tip in the distal segment of the axillary vein may reduce catheter-related complication incidence and prolong the indwelling duration.
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Affiliation(s)
- Jing Fu
- Department of Geriatrics & The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, China
| | - Lingling Zhao
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, China.,Department of Nursing, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yingmei Tian
- Department of Geriatrics & The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, China
| | - Yinmeng Liu
- Department of Geriatrics & The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, China
| | - Hongyu Zhang
- Department of Geriatrics & The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Haijun Li
- Department of Geriatrics & The Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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14
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Murayama R, Abe-Doi M, Masamoto Y, Kashiwabara K, Komiyama C, Sanada H, Kurokawa M. Verification study on the catheterization of an upper arm vein using the new long peripheral intravenous catheter to reduce catheter failure incidence: A randomized controlled trial. Drug Discov Ther 2023; 17:52-59. [PMID: 36858623 DOI: 10.5582/ddt.2022.01108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Intravenous infusion using a peripheral intravenous catheter (PIVC) is often complicated by catheter failure (CF). We hypothesized that catheterization of an upper arm vein instead of a forearm vein may help prevent CF. This study was designed to compare the incidence of CF in patients receiving hyper-stimulant drugs when catheters are placed in the forearm using short PIVCs (SPCs) with that when catheters are placed in the upper arm using the new long PIVCs. Patients admitted to a university hospital in Tokyo, Japan were enrolled in this study and were assigned to the SPC or the new long PIVC group. The primary outcome was the incidence of CF until 7 days. The secondary outcomes were the number of CFs per 1,000 days, the duration of the indwelling catheter, and the presence of thrombi and subcutaneous edema. Forty-seven patients were analyzed (median age, 67.0 years). The incidence of CF was 0% in the new long PIVCs and 32.0% (8 catheters) in the SPCs (p = 0.007), and the number of CF per 1,000 days was 0/1,000 and 81.7/1,000 days, respectively (p = 0.001). A significant difference in the duration of the indwelling catheter until CF occurrence was observed between the two groups (p = 0.004). Thrombi and subcutaneous edema were observed more frequently in the SPC group (p < 0.001). Catheterization of an upper arm vein using the new long PIVC to administer a hyper-stimulant drug might reduce CF compared with catheterization of a forearm vein using SPC.
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Affiliation(s)
- Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research Center for Implementation Nursing Science Initiative, Fujita Health University, Aichi, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Komiyama
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan.,Lifelong Learning Center IUHW, International University of Health and Welfare, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
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15
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Burek AG, Liljestrom T, Dundon M, Shaughnessy EE, Suelzer E, Ullman A. Long peripheral catheters in children: A scoping review. J Hosp Med 2022; 17:1000-1009. [PMID: 36165458 DOI: 10.1002/jhm.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Long peripheral catheters (LPCs) are emerging vascular access devices used for short-medium term vascular access needs. Literature in adults suggests LPCs have longer dwell-times than peripheral intravenous catheters (PIVs) and lower rates of serious complications than peripherally inserted central catheters (PICCs). The role of LPCs in children is less established. The objective of this scoping review is to describe and synthesize the existing literature on the effectiveness and safety of LPCs in children. METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were done in MEDLINE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Scopus, CINAHL (Ebsco), and Google Scholar most recently on February 22, 2022. Studies were included if published in English on or after 2000 and included patients <18 years of age. RESULTS Twenty-one studies were included. The body of literature is variable in quality, measurements, and reported outcomes. Median dwell-time ranged from 5 to 14 days. The rate of completion of therapy ranged from 20% to 86%. Dislodgement, occlusion, and infiltration were the most common complications reported (0%-31%). Venous thromboembolism rates ranged from 0% to 13%. The rate of catheter-related bloodstream infection was 0% in 9 of 10 studies. Less than 50% of studies reported comparative outcomes. CONCLUSION LPCs show promising outcomes in select populations, with longer dwell-time than PIVs and possibly lower rates of serious complications than PICCs. However, more research is needed to clarify the optimal use of LPCs in pediatrics.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tracey Liljestrom
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Melanie Dundon
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin E Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama, USA
| | - Elizabeth Suelzer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amanda Ullman
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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16
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Berlanga-Macías C, Díez-Fernández A, Martínez-Hortelano JA, Sequí-Domínguez I, Saz-Lara A, Pozuelo-Carrascosa D, Martínez-Vizcaíno V. Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review. BMC Nurs 2022; 21:307. [DOI: 10.1186/s12912-022-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction.
Methods
An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low.
Results
Twelve systematic reviews with a range of 75–1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported.
Conclusions
The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical.
Trial registration
PROSPERO: CRD42021290824.
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17
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Sheng Y, Wu T, Fan C, Hao H, Gao W. Factors influencing the optimal selection of central venous access devices: A qualitative study of health care team members' perspectives. Int J Nurs Sci 2022; 9:445-452. [PMID: 36285077 PMCID: PMC9587387 DOI: 10.1016/j.ijnss.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to explore health care team members' understanding of the factors influencing the optimal selection of central venous access devices (CVADs). Methods The data of the study was collected using semi-structured interviews. Twenty-six hospital medical staff (four hospital manager, 15 head nurses, 7 nurse) with experience in peripheral or central catheterization from four regions (Northern China, Southern China, Northwest China, and Qinghai-Tibet China) in China were interviewed between June and October 2021. Content analysis was used to analyze the data. Results The results revealed five themes and 14 sub-themes. Patients: concerns, resources, requirements, and evaluation (security concerns, support resources, life requirements, evaluation among patients); nurses: awareness, knowledge, and popularizing methods (awareness of intravenous therapy, understanding of professional knowledge, forms of popularizing methods); doctors: support and involvement (support for decision-making, involvement in intravenous work); hospital managers: authority, quality control and continuing education (management of catheterization authority, quality control of intravenous infusion, investment in continuing education) and environment: differences and commonalities (differences in social support, and current commonalities). Conclusion Nurses and other healthcare team members' understanding, selection, use, and recommendation of CVADs have an indirect effect on patients' decision-making. Therefore, hospital managers and government departments can indirectly strengthen medical team cooperation and improve learning education in order to improve the safety of patients receiving intravenous infusions.
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Affiliation(s)
- Yuan Sheng
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Tinglan Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Chunmei Fan
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Haixia Hao
- Department of PICCs Clinic, Qilu Hospital, Shandong Univerisity, Jinan, China
| | - Wei Gao
- Department of PICCs Clinic, Qilu Hospital, Shandong Univerisity, Jinan, China
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18
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Giardina M, Barillà D, Crimi C, Arone A, Benedetto F, Lucanto C, Natoli R, Messina R, David A, Noto A. Ultrasound-guided placement of long peripheral cannula in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:2060-2066. [PMID: 35574730 PMCID: PMC9545099 DOI: 10.1002/ppul.25978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The natural history of cystic fibrosis (CF) lung disease is a chronic deterioration of lung function with intermittent episodes of pulmonary infectious exacerbations (PExs). Reliable venous access is a milestone of effective management of such exacerbations, managed both in hospital and outpatient chronic therapy. The aim of our study was to analyze the feasibility of ultrasound-guided positioning of long peripheral catheters (LPC) as reliable midterm venous access in children affected by CF. METHODS In this single-center prospective study, over a 60-month period, we included paediatric CF subjects admitted with PExs and undergoing intravenous antibiotic treatment. LPCs were inserted in all participants by paediatric anaesthesiologists with ultrasound guide technique. Prospective data were collected assessing catheter positioning procedure and complications. RESULTS A total of 122 LPC insertions were performed in 55 CF children. Participants had a median age of 6.75 years (interquatile range: 3.7-13.5) at the time of catheter insertion. Implantation was successful on the first attempt in 86% of cases; 2 (1%) major insertion-related complications were reported. Eighty-eight percent of catheters were electively removed at the end of antibiotic therapy without any complication. Seven percent of the catheters were removed electively for occlusion and 2% for local dislodgment. CONCLUSIONS The results of the present study suggest that ultrasound-guided positioning of LPCs are safe alternative means of peripheral venous access in children with chronic diseases such as CF.
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Affiliation(s)
- Massimiliano Giardina
- Division of Anesthesia and Critical CareA. O. U. Policlinico "G. Martino”MessinaItaly
| | - David Barillà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. MartinoUniversity of MessinaMessinaItaly
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico‐San Marco”University HospitalCataniaItaly
| | - Amelia Arone
- IRCCS Policlinico San DonatoSan Donato MilaneseItaly
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. MartinoUniversity of MessinaMessinaItaly
| | - Cristina Lucanto
- Regional Centre for Cystic FibrosisA. O. U. Policlinico G.MartinoMessinaItaly
| | - Rossella Natoli
- School of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
| | - Roberto Messina
- Division of Anesthesia and Critical CareA. O. U. Policlinico "G. Martino”MessinaItaly
| | - Antonio David
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Division of Anesthesia and Critical CareUniversity of MessinaMessinaItaly
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Division of Anesthesia and Critical CareUniversity of MessinaMessinaItaly
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19
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Little A, Jones DG, Alsbrooks K. A narrative review of historic and current approaches for patients with difficult venous access: considerations for the emergency department. Expert Rev Med Devices 2022; 19:441-449. [PMID: 35786122 DOI: 10.1080/17434440.2022.2095904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Timely placement of vascular access devices is critical during emergent clinical situations; however, challenges in peripheral access can be a common occurrence. Historically, emergency teams have used various approaches to gain peripheral vascular access in situations where traditional means were not feasible; these options have included peripheral venous cutdown, ultrasound-guided peripheral intravenous catheters (PIVs), longer PIVs, central catheters, and intraosseous devices. Each of these options have associated strengths and limitations depending on the clinical situation. AREAS COVERED This narrative review reports on the burden of difficult venous access situations and discusses the evidence, and strengths and limitations of vascular access options to help address this challenge. Although first puncture success rates can be high when using alternative methods, significant challenges can include increased procedure time and greater risk of complications. The Easy-Internal Jugular (Easy-IJ) technique is a newer alternative option for patients with difficult venous access that is demonstrated to be safe and effective in emergency care. EXPERT OPINION Moving forward, additional clinical studies are required to fully characterize the outcomes associated with the Easy-IJ technique and guidewire-assisted intravenous catheters, as well as to inform guideline development for more comprehensive recommendations on managing challenging or difficult peripheral access situations.
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Affiliation(s)
- Andrew Little
- Department of Emergency Medicine, AdventHealth Central Florida, Orlando, FL, USA
| | - Drew G Jones
- Department of Emergency Medicine, AdventHealth Central Florida, Orlando, FL, USA
| | - Kimberly Alsbrooks
- b Medical Affairs, Becton, Dickinson and Company (BD), Franklin Lakes, NJ, USA
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20
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Development and Implementation of an Ultrasound-Guided Peripheral Intravenous Catheter Education Program for Critical Care Nurses. Dimens Crit Care Nurs 2022; 41:182-189. [PMID: 35617582 DOI: 10.1097/dcc.0000000000000528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ultrasound-guided (US-guided) peripheral intravenous (PIV) insertion is a skill used by specially trained nurses for patients with difficult vascular access. It can result in potential complications such as occlusive thrombus, phlebitis, infiltration, and pain. Complications can be prevented or minimized with clinical training to achieve competency. Current research shows that the most effective approach to US-guided PIV training consists of a comprehensive structured educational program that includes didactic, hands-on training and skills application. OBJECTIVES This study aimed to develop and implement a US-guided PIV education program for critical care nurses. METHODS Structured education was developed using a step-wise method. Critical care nurse practitioners in the intensive care unit (ICU) developed training materials including hands-on training, ultrasound reference material, and supervised skills application. Afterward, US-guided PIV-trained critical care nurses were enabled to train other nurses in the ICU. RESULTS The total number of US-guided PIV-trained registered nurses in the ICU increased from 5.8% to 26% of staff, but represents only 20% of those trained at current staffing levels. The percentage of US-guided PIV-trained nightshift/weekend staff increased from 3.9% to 24%, but represents 14% at current staffing levels. One hundred five US-guided PIVs showed a 97% success rate of US-guided PIV placement during an 11-month timeframe, similar to success rates published in the literature that ranged from 86% to 100%. There was 1.9% complication rate for occlusive thrombus, which is below published rates ranging up to 10%. DISCUSSION Critical care nurse practitioners in the ICU collaborated with vascular nursing and hospital clinical education to successfully develop and implement a US-guided PIV training program to meet patient needs within a growing community facility. The results of the training program yielded similar success and complication rates as those reported in the literature. Ongoing training is essential for program sustainability. CONCLUSIONS Critical care nurse practitioners training registered nurses in US-guided PIV placement is an effective approach to training. Critical care nurses trained in US-guided PIV insertion can safely and effectively train other critical care nurses in US-guided PIV insertion.
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21
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Murayama R, Oyama H, Abe-Doi M, Masamoto Y, Kashiwabara K, Tobe H, Komiyama C, Sanada H, Kurokawa M. Safety verification of a new peripheral intravenous catheter placed in the upper arm vein for administration of drugs with high irritant potential. Drug Discov Ther 2022; 16:128-134. [PMID: 35753769 DOI: 10.5582/ddt.2022.01034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite the widespread use of peripheral intravenous catheters, unscheduled catheter failure before completion of treatment occurs frequently. If a large vein is selected, catheter failures may be prevented despite administering a highly irritant drug. In this study, we attempted to use a catheter that can be placed in a large upper arm vein. The new catheter was 88 mm long but had no guidewire to reduce contamination risk. This study aimed to evaluate the safety of the first-in-human trial for the new catheter with the administration of highly irritant drugs. This study was conducted at a university hospital in Tokyo, Japan. Eight Japanese adults were hospitalized adults with planned administration of non-cancer drugs with high irritant potential using a peripheral catheter. A trained nurse catheterized with the new catheter in the upper arm using ultrasonography. The catheterization site was monitored by staff and a research nurse once every 24 hours for up to 7 days. No adverse events or catheter failure occurred and the catheter placement success rate was 100%. In two patients, a temporary occlusion alarm of the infusion pump occurred, possibly due to the flexion of the catheter base. The new peripheral intravenous catheter did not interrupt medical treatments as is common after placement, but safety administered the irritant drugs. However, because this catheter may be easily affected by the contraction of the muscle at the fixation position, the position and method of catheter fixation in the upper arm need to be carefully considered.
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Affiliation(s)
- Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hajime Oyama
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Tobe
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chieko Komiyama
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
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22
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Stagg P. Difficult intravenous access: the Vygon Leadercath as an introducer for wider-bore cannula. BMJ Case Rep 2021; 14:e247521. [PMID: 34969811 PMCID: PMC8719145 DOI: 10.1136/bcr-2021-247521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Phil Stagg
- Department of Anaesthetics, Pindara Private Hospital, Benowa, Queensland, Australia
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23
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Thiyagarajan S, Ravindran C. Conventional central venous catheters as tunnelled mid-clavicular midline catheters: Description of novel application and outcome analysis. J Vasc Access 2020; 23:98-104. [PMID: 33349144 DOI: 10.1177/1129729820982870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long peripheral catheters are the ideal devices for intermediate venous access (1-4 weeks). However due to non-availability and cost constraints, these lines are not widely adapted in developing countries. In this clinical report we describe a technique of using conventional Central Venous Catheters as Midclavicular midlines for intermediate venous access and present the outcome analysis of such catheters in the last 2 years from our institute. METHODS A single lumen conventional central venous catheter (5 Fr, 20 cm) was introduced through the deep veins of the upper arm, 1 to 1.5 cm distal to the axillary crease. The catheter was tunnelled for a distance of 5 to 7 cm to exit from Dawson's green zone to reduce the incidence of Midline Associated Blood Stream Infection. Patients were followed up by trained staff nurses and outcome parameters were recorded. RESULTS Seventy six patients were enrolled and 72 patients underwent successful cannulation and completed the outcome analysis. Administration of intravenous antibiotics and chemotherapy were the commonest indications. The device served the intended duration of therapy in 66 (92%) patients for a median number of 12 (6-20) catheter days. Device related blood stream infection was 1.24/1000 catheter days and catheter related thrombosis rate was 8.3%. CONCLUSION Conventional Central Venous Catheters can be effectively used as tunnelled Midclavicular midline catheters in low resource settings. The successful outcome analysis has to be confirmed by larger studies.
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Affiliation(s)
- Sivashanmugam Thiyagarajan
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed University, Puducherry 607402, India
| | - Charulatha Ravindran
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed University, Puducherry 607402, India
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24
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Qin KR, Pittiruti M, Nataraja RM, Pacilli M. Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists. J Vasc Access 2020; 22:905-910. [DOI: 10.1177/1129729820966226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.
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Affiliation(s)
- Kirby R Qin
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, Austin Health, Melbourne, Australia
| | - Mauro Pittiruti
- Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children’s Hospital, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children’s Hospital, Melbourne, Australia
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