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Zaforteza-Lallemand C, Blanco-Mavillard I, Pol-Castañeda S, Villafáfila-Gomila CJ, Ferrer-Cruz F, Rodríguez-Calero MÁ. Strategies for knowledge mobilization by advanced practice nurses in three hospitals in Spain: a qualitative study. BMC Nurs 2024; 23:440. [PMID: 38926719 PMCID: PMC11202328 DOI: 10.1186/s12912-024-02095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Evidence-based practice, in conjunction with optimum care quality, improves patients' clinical outcomes. However, its implementation in daily clinical practice continues to present difficulties. The aim of this study was to identify the strategies applied by Advanced Practice Nurses (APNs) to foster adherence to clinical practice guideline recommendations. METHODS An exploratory qualitative study was conducted with six focus groups at three public hospitals belonging to the Balearic Islands Health Care Service (Spain). The study participants were 32 ward nurses and 5 advanced practice nurses working routinely with inpatients at these hospitals. The study was conducted from November 2020 to January 2021, using thematic analysis, based on the COREQ checklist. RESULTS Four major themes related to the facilitation process were identified either by RNs and APNs: the context of the project, APN contribution to nursing team management, healthcare provision on the ward, and the acquisition and application of knowledge. CONCLUSIONS The APNs adapted their actions to the characteristics and needs of the local context, employing strategies aimed at improving teamwork, healthcare, and knowledge management. Each of these contributions enhanced the sustainability of the changes made.
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Affiliation(s)
- Concha Zaforteza-Lallemand
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Balearic Islands Health Services, Palma, Balearic Islands, 07003, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain.
- Healthcare Implementation and Research Unit, Hospital Regional Universitario de Málaga, Avd. de Carlos Haya, 84. Málaga 29010, Málaga, 29010, Spain.
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain.
| | - Sandra Pol-Castañeda
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Hospital Son Llàtzer, Palma, Balearic Islands, 07198, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | - Carlos Javier Villafáfila-Gomila
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Balearic Islands Health Services, Palma, Balearic Islands, 07003, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | | | - Miguel Ángel Rodríguez-Calero
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
- Quality Department, Torrecárdenas University Hospital, Almería, 04003, Spain
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Privitera D, Geraneo A, Li Veli G, Parravicini G, Mazzone A, Rossini M, Sanfilippo M, Gubertini A, Airoldi C, Capsoni N, Busca E, Bassi E, Langer T, Dal Molin A. Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03651-2. [PMID: 38805082 DOI: 10.1007/s11739-024-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata Rome, Rome, Italy.
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Greta Li Veli
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Parravicini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Sanfilippo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Gubertini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Busca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
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Doyle BJ, Kelsey LJ, Shelverton C, Abbate G, Ainola C, Sato N, Livingstone S, Bouquet M, Passmore MR, Wilson ES, Colombo S, Sato K, Liu K, Heinsar S, Wildi K, Carr PJ, Suen J, Fraser J, Li Bassi G, Keogh S. Design, development and preliminary assessment in a porcine model of a novel peripheral intravenous catheter aimed at reducing early failure rates. J Vasc Access 2024; 25:790-799. [PMID: 36281219 DOI: 10.1177/11297298221127760] [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: 02/18/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet despite best efforts by end-users, PIVCs experience unacceptably high early failure rates. We aimed to design a new PIVC that reduces the early failure rate of in-dwelling PIVCs and we conducted preliminary tests to assess its efficacy and safety in a porcine model of intravenous access. METHODS We used computer-aided design and simulation to create a PIVC with a ramped tip geometry, which directs the infused fluid away from the vein wall; we called the design the FloRamp™. We created FloRamp prototypes (test device) and tested them against a market-leading device (BD Insyte™; control device) in a highly-controlled setting with five insertion sites per device in four pigs. We measured resistance to infusion and visual infusion phlebitis (VIP) every 6 h and terminated the experiment at 48 h. Veins were harvested for histology and seven pathological markers were assessed. RESULTS Computer simulations showed that the optimum FloRamp tip reduced maximum endothelial shear stress by 60%, from 12.7 Pa to 5.1 Pa, compared to a typical PIVC tip and improved the infusion dynamics of saline in the blood stream. In the animal study, we found that 2/5 of the control devices were occluded after 24 h, whereas all test devices remained patent and functional. The FloRamp created less resistance to infusion (0.73 ± 0.81 vs 0.47 ± 0.50, p = 0.06) and lower VIP scores (0.60 ± 0.93 vs 0.31 ± 0.70, p = 0.09) than the control device, although neither findings were significantly different. Histopathology revealed that 5/7 of the assessed markers were lower in veins with the FloRamp. CONCLUSIONS Herein we report preliminary assessment of a novel PIVC design, which could be advantageous in clinical settings through decreased device occlusion and reduced early failure rates.
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Affiliation(s)
- Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, UK
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sebastiano Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Cardiovascular Research Institute Basel, University Hospital of Basel and University Basel, Switzerland
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
- Intensive Care Unit, The Wesley Hospital, Uniting Care Hospitals, Auchenflower, Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Spring Hill, Queensland, Australia
- Intensive Care Unit, The Wesley Hospital, Uniting Care Hospitals, Auchenflower, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Marsh N, Larsen EN, Ullman AJ. Authors' response to "Comment on Marsh et al. (2023) 'Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis'". Int J Nurs Stud 2024; 153:104727. [PMID: 38458125 DOI: 10.1016/j.ijnurstu.2024.104727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Affiliation(s)
- N Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia.
| | - E N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - A J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, the University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
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5
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Karabey T, Karagözoğlu Ş. The effect of new device on pain and comfort levels in individuals undergoing peripheral intravenous cannula insertion. J Vasc Access 2024; 25:432-438. [PMID: 35903016 DOI: 10.1177/11297298221113685] [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: 11/15/2022] Open
Abstract
AIM AND OBJECTIVES The purpose of this study is to see how ShotBlocker® affects the pain and comfort level associated with short peripheral intravenous cannula (PIV) insertion. METHODS The study was conducted on a single sample group using a pre-post design. Individuals in the sample group who underwent a brief PIV insertion procedure served as both the study's control and intervention groups. In the sample group, the same nurse inserted a peripheral intravenous catheter into the cephalic veins of the right and left forearms using a standard insertion and ShotBlocker®. The pain and comfort levels were assessed using the VAS and Comfort Scale. RESULTS When the distribution of the average pain and comfort scores of the individuals treated with the peripheral intravenous catheter was examined, it was found that the average pain score of the peripheral intravenous catheter insertion using ShotBlocker® was statistically significantly lower than the peripheral intravenous catheter insertion using the standard method, and the comfort score averages were statistically higher. When the correlation between the pain and comfort score averages of individuals undergoing peripheral intravenous catheter insertions was investigated, a statistically significant and strong negative relationship (p = 0.001) was discovered. CONCLUSIONS As a result, the use of ShotBlocker® during the short PIV insertion procedure is an effective method to reduce the pain caused by the peripheral intravenous catheter. It was determined that the comfort level of the individuals increased as the pain due to peripheral intravenous catheter insertion decreased.
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Affiliation(s)
- Tuba Karabey
- Nursing Department, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Şerife Karagözoğlu
- Nursing Department, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey
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Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [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: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
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Grantham KL, Forbes AB, Hooper R, Kasza J. The staircase cluster randomised trial design: A pragmatic alternative to the stepped wedge. Stat Methods Med Res 2024; 33:24-41. [PMID: 38031417 PMCID: PMC10863363 DOI: 10.1177/09622802231202364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This article introduces the 'staircase' design, derived from the zigzag pattern of steps along the diagonal of a stepped wedge design schematic where clusters switch from control to intervention conditions. Unlike a complete stepped wedge design where all participating clusters must collect and provide data for the entire trial duration, clusters in a staircase design are only required to be involved and collect data for a limited number of pre- and post-switch periods. This could alleviate some of the burden on participating clusters, encouraging involvement in the trial and reducing the likelihood of attrition. Staircase designs are already being implemented, although in the absence of a dedicated methodology, approaches to sample size and power calculations have been inconsistent. We provide expressions for the variance of the treatment effect estimator when a linear mixed model for an outcome is assumed for the analysis of staircase designs in order to enable appropriate sample size and power calculations. These include explicit variance expressions for basic staircase designs with one pre- and one post-switch measurement period. We show how the variance of the treatment effect estimator is related to key design parameters and demonstrate power calculations for examples based on a real trial.
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Affiliation(s)
- Kelsey L Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Hooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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8
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Costa SPD, Silveira RED, Monteiro DAT, Contim D, Toffano SEM. Quality of care in peripheral venous catheterization: A scoping review. Rev Bras Enferm 2023; 76:e20220578. [PMID: 38055472 DOI: 10.1590/0034-7167-2022-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To map the current status of parameters and tools to assess quality of care related to peripheral venous catheter use in adults. METHODS Scoping review, conducted in 2022 in the MEDLINE, LILACS, CINAHL and SCOPUS databases and with a publication time limit from 2013 to 2022. RESULTS The sample consisted of 15 articles, summarized in the following categories: Indication, documentation and registration, coverage assessment, connection, stabilization and signs and symptoms inherent to the catheter. The use of a complete instrument, with the domains observed in this review, may have a positive impact on a more effective and safe clinical practice. CONCLUSIONS The present review mapped the evidence about the insertion and maintenance of peripheral venous catheters that can be improved with training of good practices and the quality of the team, regarding the use of tools, materials and instruments for the evaluation of care.
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Affiliation(s)
| | | | | | - Divanice Contim
- Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
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9
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Kihwili L, Silago V, Francis EN, Idahya VA, Saguda ZC, Mapunjo S, Mushi MF, Mshana SE. A Point Prevalence Survey of Antimicrobial Use at Geita Regional Referral Hospital in North-Western Tanzania. PHARMACY 2023; 11:159. [PMID: 37888504 PMCID: PMC10609811 DOI: 10.3390/pharmacy11050159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
We conducted a point prevalence survey (PPS) to determine the prevalence of antibiotic use at Geita Regional Referral Hospital (GRRH) located along the shores of Lake Victoria in north-western Tanzania. This has led to the identification of gaps for improvement. This PPS study was conducted on 9-10 March 2023. Patient-related information, including sociodemographic and clinical data, was collected from medical records. STATA software version 15.0 was used to perform descriptive data analysis. About 94.8% (55/58) patients were on antibiotics with a mean (±SD) prescription of 2 (±0.5) antibiotic agents ranging from 1 to 4 different agents. The commonest indications of the antibiotic prescription were medical prophylaxis 47.3% (26/55) followed by empiric treatment 41.8% (23/55). In total, 110 prescriptions were made, of which metronidazole (25.5%; n = 28), ceftriaxone (23.6%; n = 26), and ampicillin-cloxacillin (23.6%; n = 26) were frequently observed. Only 67.3% (n = 74) of prescriptions complied with Tanzania Standard Treatment Guidelines. Moreover, according to the WHO-AWaRe classification, 50.9%, 23.6%, and 25.5% were under the Access category, Watch category, and Not Recommended category, respectively. The prevalence of antibiotic use among patients admitted to GRRH was high, whereby medical prophylaxis and empiric treatment were the commonest indications for antibiotic prescription. To support rational therapy and antimicrobial stewardship initiatives, we recommend that laboratories in regional hospitals be equipped to conduct sustained routine culture and antimicrobial susceptibility testing.
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Affiliation(s)
- Lutugera Kihwili
- Department of Pharmaceutical Sciences, School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
| | | | - Vicent A. Idahya
- Geita Regional Referral Hospital, Geita P.O. Box 40, Tanzania; (V.A.I.); (Z.C.S.)
| | - Zabron C. Saguda
- Geita Regional Referral Hospital, Geita P.O. Box 40, Tanzania; (V.A.I.); (Z.C.S.)
| | - Siana Mapunjo
- National Multi-Sectoral Coordinating Committee, Ministry of Health, Dodoma P.O. Box 573, Tanzania;
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
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Ribeiro GDSR, Campos JF, Camerini FG, Parreira PMSD, da Silva RC. Flushing in Intravenous Catheters: Observational Study of Nursing Practice in Intensive Care in Brazil. JOURNAL OF INFUSION NURSING 2023; 46:272-280. [PMID: 37611285 DOI: 10.1097/nan.0000000000000516] [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: 08/25/2023]
Abstract
An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.
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Affiliation(s)
- Gabriella da Silva Rangel Ribeiro
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Juliana Faria Campos
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Flávia Giron Camerini
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Pedro Miguel Santos Dinis Parreira
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Rafael Celestino da Silva
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
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Marsh N, Larsen EN, O'Brien C, Ware RS, Kleidon TM, Groom P, Hewer B, Alexandrou E, Flynn J, Woollett K, Rickard CM. Safety and efficacy of midline catheters versus peripheral intravenous catheters: A pilot randomized controlled trial. Int J Nurs Pract 2022; 29:e13110. [PMID: 36303515 DOI: 10.1111/ijn.13110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite pervasive need for peripheral intravenous catheters, insertion is often difficult, and approximately two thirds fail prematurely. Midline catheters are an alternative long peripheral catheter, inserted in the upper arm, ideal for patients with difficult access. AIM The aim of this study is to test feasibility of the protocol and compare the efficacy and safety of midline catheters to peripheral intravenous catheters. DESIGN A parallel-group, pilot randomized controlled trial of adult medical/surgical hospitalized patients, from a single Australian referral hospital. METHODS Participants with difficult vascular access (≤2 palpable veins) and/or anticipated ≥5 days of peripherally compatible intravenous therapy were recruited between May 2019 and March 2020. Participants were randomized to (1) peripheral intravenous catheter or (2) midline catheter. Primary feasibility outcome measured eligibility, recruitment, protocol adherence, retention and attrition. Primary clinical outcomes measured device insertion failure and post-insertion failure. RESULTS In total, n = 143 participants (71 peripheral intravenous catheters and 72 midline catheters) were recruited; n = 139 were analysed. Most feasibility criteria were met. Peripheral intravenous catheters had shorter functional dwell time, with higher incidence of post-insertion failure compared to midline catheters. CONCLUSION Midline catheters appear to be superior for patients with difficult vascular access or receiving prolonged intravenous therapy; a large, multi-centre trial to confirm findings is feasible.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
- School of Nursing Queensland University of Technology Kelvin Grove Queensland Australia
| | - Emily N. Larsen
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Robert S. Ware
- School of Medicine and Menzies Health Institute Queensland Griffith University Brisbane Australia
| | - Tricia M. Kleidon
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
- Queensland Children's Hospital South Brisbane Queensland Australia
| | - Peter Groom
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Barbara Hewer
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Evan Alexandrou
- Liverpool Hospital, Department of Intensive Care Liverpool New South Wales Australia
- School of Nursing and Midwifery Western Sydney University New South Wales Australia
| | - Julie Flynn
- School of Nursing and Midwifery University of Southern Queensland Ipswich Queensland Australia
| | - Kaylene Woollett
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Claire M. Rickard
- Nursing and Midwifery Research Centre, Surgical and Perioperative Services; Herston Infectious Diseases Institute Royal Brisbane and Women's Hospital Herston Queensland Australia
- School of Nursing, Midwifery and Social Work The University of Queensland, UQCCR Herston Herston Queensland Australia
- School of Nursing and Midwifery Griffith University Brisbane Queensland Australia
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Evidence-Informed Development of a Bundle for Peripheral Intravenous Catheterization in Portugal: A Delphi Consensus Study. NURSING REPORTS (PAVIA, ITALY) 2022; 12:498-509. [PMID: 35894037 PMCID: PMC9326523 DOI: 10.3390/nursrep12030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/25/2022]
Abstract
Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses’ clinical decision-making in this scope. Methods: Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward’s nurses. Results: After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter’s functionality and performance at each shift. Conclusion: The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.
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Larsen EN, Marsh N, Mihala G, King M, Zunk M, Ullman AJ, Keogh S, Kleidon TM, Rickard CM. Intravenous antimicrobial administration through peripheral venous catheters - establishing risk profiles from an analysis of 5252 devices. Int J Antimicrob Agents 2022; 59:106552. [PMID: 35183678 DOI: 10.1016/j.ijantimicag.2022.106552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase the PVC failure rate, risk profiles for many are unclear. OBJECTIVE To synthesize data from prospective PVC studies conducted between 2013 and 2019 to determine associations between common antimicrobials and PVC failure. METHODS A secondary analysis was undertaken of seven randomized controlled trials and two prospective cohort studies from three quaternary hospitals (two adult and one paediatric) in Australia between 2013 and 2019. The primary outcome was PVC failure due to vessel injury (occlusion, infiltration or extravasation) or irritation (pain or phlebitis). Associations between antimicrobial use and PVC failure were explored using multi-variable Cox regression. RESULTS In total, 5252 PVCs (4478 patients) were analysed; vessel injury and irritations occurred in 19% and 11% of all PVCs, respectively. Vessel injury was significantly associated with cefepime hydrochloride [hazard ratio (HR) 2.50; 95% confidence interval (CI) 1.44-4.34], ceftazidime pentahydrate (HR 1.91, 95% CI 1.11-3.31), flucloxacillin sodium (HR 1.84, 95% CI 1.45-2.33), lincomycin hydrochloride (HR 1.67, 95% CI 1.10-2.52) and vancomycin hydrochloride (HR 1.73, 95% CI 1.25-2.40). Irritation was significantly associated with flucloxacillin sodium (HR 2.58, 95% CI 1.96-3.40). CONCLUSIONS This study identified several antimicrobials associated with increased PVC failure, including some that were already known to be associated and some that had not been identified previously. Research is needed urgently to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure.
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Affiliation(s)
- Emily N Larsen
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Michelle King
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew Zunk
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
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Indarwati F, Munday J, Keogh S. Nurse knowledge and confidence on peripheral intravenous catheter insertion and maintenance in pediatric patients: A multicentre cross-sectional study. J Pediatr Nurs 2022; 62:10-16. [PMID: 34798582 DOI: 10.1016/j.pedn.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients. DESIGN AND METHODS An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score. RESULTS A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p < 0.05). CONCLUSION Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance. PRACTICE IMPLICATIONS The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.
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Affiliation(s)
- Ferika Indarwati
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
| | - Judy Munday
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Queensland University of Technology (QUT), Faculty of Health, School of Nursing, Centre for Healthcare Transformation, Brisbane, Queensland, Australia; Alliance of Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia.
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15
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Ribeiro GDSR, Campos JF, Silva RCD. What do we know about flushing for intravenous catheter maintenance in hospitalized adults? Rev Bras Enferm 2022; 75:e20210418. [DOI: 10.1590/0034-7167-2021-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evidence the use of flushing to prevent complications from intravenous therapy. Methods: an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis. Results: it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals. Conclusion: there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.
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Huang LS, Huang Y, Hu J. Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses' knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study. BMC Nurs 2021; 20:236. [PMID: 34814906 PMCID: PMC8609804 DOI: 10.1186/s12912-021-00758-1] [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: 05/17/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses' knowledge, attitude, and practice (KAP) concerning PIVC fixation. METHODS An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses' KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. RESULTS The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses' knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). CONCLUSION PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses' KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients.
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Affiliation(s)
- Li-Sha Huang
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yan Huang
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Deceases of Woman and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Juan Hu
- Department of Emergency Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
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Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z, Zhang F, Lyu Y, Lin F. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. J Clin Nurs 2021; 31:2959-2970. [PMID: 34779070 DOI: 10.1111/jocn.16129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. BACKGROUND Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. DESIGN A multisite randomised controlled trial. METHODS The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. RESULTS The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients' first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. CONCLUSIONS In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. RELEVANCE TO CLINICAL PRACTICE In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.
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Affiliation(s)
- Jing Li
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Peking University School of Nursing, Beijing, China
| | - Peiying Zhang
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, China.,Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | | | - Yang Lyu
- Beijing Chao-Yang Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia.,School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
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18
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Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
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19
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Peripheral intravenous catheter failure-is it us or is it them? LANCET HAEMATOLOGY 2021; 8:e615-e617. [PMID: 34450094 DOI: 10.1016/s2352-3026(21)00234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
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Blanco-Mavillard I, de Pedro-Gómez JE, Rodríguez-Calero MÁ, Bennasar-Veny M, Parra-García G, Fernández-Fernández I, Bujalance-Hoyos J, Moya-Suárez AB, Cobo-Sánchez JL, Ferrer-Cruz F, Castro-Sánchez E. Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial. LANCET HAEMATOLOGY 2021; 8:e637-e647. [PMID: 34450101 DOI: 10.1016/s2352-3026(21)00206-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING The College of Nurses of the Balearic Islands. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital de Manacor, Manacor, Spain; Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain.
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain; Health Care Office, Balearic Islands Health Service, Palma, Spain
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | - Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain; Biomedical Research Institute of Málaga, Málaga, Spain
| | | | | | - Enrique Castro-Sánchez
- City, University of London, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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