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Ullman AJ, Larsen E, Gibson V, Binnewies S, Ohira R, Marsh N, Mcbride C, Winterbourn K, Boyte F, Cunninghame J, Dufficy M, Plummer K, Roberts N, Takashima M, Cooke M, Byrnes J, Rickard CM, Kleidon TM. An mHealth application for chronic vascular access: A multi-method evaluation. J Clin Nurs 2024; 33:1762-1776. [PMID: 38413831 DOI: 10.1111/jocn.17034] [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] [Received: 02/28/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose. AIM In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long-term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport. DESIGN Multi-site, parallel, multi-method, prospective cohort study. METHODS A multi-site, multi-method study was carried out in 2020-2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months. RESULTS Overall, utility rates were acceptable, with 78.3% (N = 36) using the IV Passport over the follow-up period, with high rates of planned future use for those still active in the project (N = 21; 73%), especially in the child/family cohort (N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5-10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality. CONCLUSION Several recommendations were made to improve the end-user experience including 'how to' instructions; and scheduling functionality for routine care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The IV Passport can be safely and appropriately integrated into healthcare, to support consumers. IMPACT Patient-/parent-reported feedback suggests the Intravenous Passport is a useful tool for record-keeping, and positive communication between patients/parents, and clinicians. REPORTING METHOD Not applicable. PATIENT CONTRIBUTION Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Emily Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Ryoma Ohira
- School of Information and Communication Technology, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Craig Mcbride
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Karen Winterbourn
- Parenteral Nutrition Down Under, Randwick, New South Wales, Australia
| | - Francesca Boyte
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Karin Plummer
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Natasha Roberts
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Metro North Health Service, Herston, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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2
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Elliott J, Ng L, Meredith C, Mander G, Thompson M, Reynolds L. Interventions to manage occluded central venous access devices: An umbrella review. J Vasc Access 2024:11297298241246092. [PMID: 38655780 DOI: 10.1177/11297298241246092] [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: 04/26/2024] Open
Abstract
The main objective of this umbrella review is to synthesise available evidence from systematic reviews on the effectiveness of interventions for the management of occlusions in central venous access devices. CVADS have been extensively utilised among the critically ill since the 1950s however have also been linked to an increase in catheter complications. CVAD occlusion can occur in 14%-36% of patients within 1-2 years of catheter placement and is a longstanding complication. Umbrella methodology was applied to review five healthcare databases. Databases were searched for publications from 2009 and 2022 and electronic keywords searches were conducted. The authors searched for reviews that reported on any intervention to prevent, maintain or manage patency of the central venous access devices within an acute care setting. Of the 278 articles identified from the initial search a total of 11 articles were identified. This umbrella review concluded that education enhances patient outcomes and decreases occlusion rates. Further studies are required to explore occlusion reduction strategies in relation to flushing and locking.
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Affiliation(s)
- Jessica Elliott
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Linda Ng
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Carolyn Meredith
- Nursing & Midwifery Education and Training, Darling Downs Health, Toowoomba, QLD, Australia
| | - Gordon Mander
- Faculty of Health and Behavioural Sciences, Southern Queensland Rural Health (SQRH), The University of Queensland, Toowoomba, QLD, Australia
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Medical Imaging, Toowoomba Hospital, Darling Downs Health, Queensland Health, Toowoomba, QLD, Australia
| | - Murray Thompson
- Medical Workforce, Darling Downs Health, Toowoomba, QLD, Australia
| | - Lorraine Reynolds
- Department of Medical Imaging, Toowoomba Hospital, Darling Downs Health, Queensland Health, Toowoomba, QLD, Australia
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Clesham J, Reynolds H, Carr PJ. A scoping review of Clinical Studies, Hospital Group Reports and National Strategic Documents on vascular access devices in cancer patients. J Vasc Access 2023; 24:575-590. [PMID: 34473000 DOI: 10.1177/11297298211041443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The extent of vascular/venous access device (VAD) research output from the Island of Ireland is unknown. The identification of the papers available is important to create a future research agenda. OBJECTIVES The main objective of this study is to answer three questions: What is the number and descriptive quality of reported Vascular Access Device literature from the Island of Ireland? Is the reporting of Catheter Related Infection rates for cancer patients common in Irish Hospital Groups, National Cancer Reports and Publication Outputs? What are the implications for future research in this area? METHODS We used a scoping review and searched selected databases, grey literature and hospital regulatory bodies websites following the Joanna Briggs Institute Guidelines 2017. A data charting form was developed based on a template from the Joanna Briggs Institute and this was used to extract data from the included reports. RESULTS A total of 660 reports were screened. Sixty-one full text articles were reviewed from which 20 reports were included for data extraction. Of the reports included the following designs were used: nine retrospective study designs, four guidelines, two prospective study designs, two literature reviews and one of the following; survey, case study and cross sectional analysis designs. We did not identify any randomised controlled trials, systematic reviews, meta-analysis, meta-synthesis and scoping reviews. Five studies included catheter related infection rates. Gaps in the research include the collection of data sets and the need to establish a VAD registry; develop core outcomes for VADs; assessment and evaluation of VAD care bundles among cancer patients; and, the inclusion of public and patient involvement in future VAD research. CONCLUSION The reporting of VAD outcomes in published literature regarding cancer patients receiving treatment in Ireland is inconsistent and varied with no interventional studies addressing vascular access complications in cancer care.
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Affiliation(s)
| | | | - Peter J Carr
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
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Badparva B, Ghanbari A, Karkhah S, Osuji J, Kazemnejad Leyli E, Jafaraghaee F. Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers. Nurs Crit Care 2022; 28:419-426. [PMID: 35118750 DOI: 10.1111/nicc.12757] [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: 03/27/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. AIMS AND OBJECTIVES The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice. DESIGN A cross-sectional study. METHODS Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. RESULTS A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. CONCLUSIONS Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. RELEVANCE TO CLINICAL PRACTICE The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.
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Affiliation(s)
- Bita Badparva
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari
- Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.,Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Joseph Osuji
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
| | - Ehsan Kazemnejad Leyli
- Department of Bio-statistics, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Jafaraghaee
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Kelly LJ, Snowden A. 'Pinholes in my arms': the vicious cycle of vascular access. ACTA ACUST UNITED AC 2021; 30:S4-S13. [PMID: 34288751 DOI: 10.12968/bjon.2021.30.14.s4] [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: 11/11/2022]
Abstract
BACKGROUND Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). AIMS To explore how patients make sense of living with a CVAD. METHODS This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. FINDINGS Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. CONCLUSION Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.
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Affiliation(s)
| | - Austyn Snowden
- Chair in Mental Health, School of Health and Social Care, Edinburgh Napier University
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Burt W, Spowart L. Assessing the impact of a new central venous access device training progam for nurses: A quasi-experimental evaluation study. J Infect Prev 2021; 22:166-172. [PMID: 34295378 PMCID: PMC8274137 DOI: 10.1177/1757177420982041] [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: 06/17/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central venous access devices (CVAD) are widely used for both long- and short-term purposes within healthcare and are suitable for both hospital and community management. Training is essential in the prevention of complications such as infection. OBJECTIVES To assess the impact of a new standardised education programme on clinical practice and patient care. The new education programme was introduced to all registered nurses working in one care group within an acute healthcare Trust with the aim of improving knowledge and skills and reduce CVAD-related complications. METHODS This retrospective quasi-experimental evaluation study analyses the impact of the programme on direct patient care. Secondary data sources such as infection incidence rates and CVAD clinical audits were used to identify and measure the relationship between staff confidence, infection incidence and care audit results. Data spanning a two-year period were used to capture an accurate representation of the patient group. RESULTS Improvements in audited care elements and a reduction of infection incidences were evident during and after implementation of the education programme. This was reflective of the self-reported increased confidence and knowledge and skill acquisition from staff who attended the programme. DISCUSSION Recommendations have been made including a review of the education content to target all key elements and promotion of an end goal with regular feedback to staff reinforcing the importance. The challenge of using secondary data sources also highlighted the need for quality improvements in the current care audit process.
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Affiliation(s)
| | - Lucy Spowart
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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Tian L, Li W, Su Y, Gao H, Yang Q, Lin P, Wang L, Zeng J, Li Y. Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis. Thromb Haemost 2020; 121:625-640. [PMID: 33186995 DOI: 10.1055/s-0040-1720976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children. METHODS A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis. RESULTS In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57-5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99-3.46), hematologic disease (OR = 1.45, 95% CI: 1.06-1.99), and cancer (OR = 1.58, 95% CI: 1.01-2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21-2.39), hemodialysis (OR = 2.17, 95% CI: 1.34-3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31-1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06-14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32-0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15-2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41-5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14-0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01-5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99-6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15-6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07-2.54) were associated with an increased CRT risk. CONCLUSION The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.
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Affiliation(s)
- Lingyun Tian
- Xiangya Nursing School, Central South University, Changsha, China.,School of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Wan Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yanan Su
- Xiangya Nursing School, Central South University, Changsha, China
| | - Huimin Gao
- Xiangya Nursing School, Central South University, Changsha, China
| | - Qiuhong Yang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Pan Lin
- Xiangya Nursing School, Central South University, Changsha, China
| | - Liqian Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jiaqi Zeng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yinglan Li
- Xiangya Nursing School, Central South University, Changsha, China.,School of Nursing, Xinjiang Medical University, Urumqi, China
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