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Antúnez-Blancat A, Gago-Valiente FJ, García-Iglesias JJ, Merino-Navarro D. The Role of Nursing in the Management of Chemotherapy Extravasation: A Systematic Review Regarding Public Health. Healthcare (Basel) 2024; 12:1456. [PMID: 39057599 PMCID: PMC11276807 DOI: 10.3390/healthcare12141456] [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: 07/04/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
The scientific literature was reviewed with the aim of analysing the state of the art on the role of nursing in the management of chemotherapy extravasation, recognising the possible risk factors and identifying effective training programmes for nurses. WOS, Scopus, and PubMed databases were used to perform the searches. Papers that met the inclusion criteria and that had been published in the last 9 years were selected. The Effective Public Health Practice Project (EPHPP) instrument was applied to the selected studies. In addition, this research was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: 512480). Out of the 23 initially selected articles, a total of 9 articles were eventually included, since they met the eligibility criteria that were established after a more exhaustive analysis, which included reading their abstracts and full texts. The results show that the management of chemotherapy extravasation is closely related to factors that largely depend on the nursing staff. Among the most relevant findings are factors including the identification of the nursing role in the management of extravasation due to chemotherapy; risk factors; and effective training programmes for nursing. Nurses play a crucial role throughout the entire process of treatment, prevention, and health education in chemotherapy treatment. Training programmes for nurses are fundamental, as they increase their professional competence and improve the safety of the patient. Adequate knowledge of chemotherapy treatment and the risk factors of extravasation are basic elements for the prevention of this type of injury, as well as for the improvement of the quality of life of patients under this kind of intravenous therapy.
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Affiliation(s)
- Antonio Antúnez-Blancat
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
| | - Francisco-Javier Gago-Valiente
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
- Centro de Investigación en Pensamiento Contemporáneo e Innovación para el Desarrollo Social (COIDESO), University of Huelva, 21007 Huelva, Spain
| | - Juan-Jesús García-Iglesias
- Preventive Medicine and Public Health Area, Department of Sociology, Social Work and Public Health, Faculty of Work Science, University of Huelva, 21007 Huelva, Spain;
| | - Dolores Merino-Navarro
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
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Yaqoob M, Masih S, Rasheed A, Shah Y, Uddin N, Siddiqui F, Rehan M, Khan RA, Ahmed F, Rehan M, Qasim R. Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S30-SIV. [PMID: 39023027 DOI: 10.12968/bjon.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. METHODS A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. RESULTS Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. CONCLUSION This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.
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Affiliation(s)
- Muhammad Yaqoob
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan; Program Director for Post-Graduate Nursing Programs, Dow Institute of Nursing & Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarfraz Masih
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Abdur Rasheed
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Yousaf Shah
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Nadeem Uddin
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Faraz Siddiqui
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Rehan
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Fahad Ahmed
- Indus College of Nursing and Midwifery, The Indus Hospital, Karachi, Pakistan
| | | | - Rubina Qasim
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
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Høvik LH, Gjeilo KH, Ray-Barruel G, Lydersen S, Børseth AW, Gustad LT. Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study. J Clin Nurs 2024; 33:2593-2608. [PMID: 38716868 DOI: 10.1111/jocn.17179] [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: 07/25/2023] [Revised: 03/03/2024] [Accepted: 04/10/2024] [Indexed: 06/14/2024]
Abstract
AIM To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. DESIGN Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. METHOD Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. RESULTS The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. CONCLUSION This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. IMPACT The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. REPORTING METHOD The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). PATIENT OR PUBLIC CONTRIBUTION A patient representative has been involved in planning this study.
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Affiliation(s)
- Lise Husby Høvik
- Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anita Wang Børseth
- Regional Centre for Infection Prevention and Control, Central Norway Regional Health Authority, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Mid-Norway Research Sepsis Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Torné‐Ruiz A, Sanromà‐Ortiz M, Corral‐Nuñez A, Medel D, Roca J, García‐Expósito J. Management from a multidisciplinary perspective of phlebitis related to peripheral venous catheter insertion: An international Delphi study. Nurs Open 2024; 11:e2229. [PMID: 38957104 PMCID: PMC11220340 DOI: 10.1002/nop2.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
AIM To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines. BACKGROUND PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous. DESIGN Delphi method. METHODS Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them. RESULTS Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work). CONCLUSION The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities. RELEVANCE TO CLINICAL PRACTICE Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice. REPORTING METHOD Delphi studies (CREDES). PATIENT OR PUBLIC CONTRIBUTION Experts contribution.
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Affiliation(s)
- Alba Torné‐Ruiz
- Department of Nursing and PhysiotherapyUniversity of LleidaLleidaSpain
- Xarxa Assistencial Universitària de ManresaBarcelonaSpain
| | | | | | - Daniel Medel
- Department of Nursing and PhysiotherapyUniversity of LleidaLleidaSpain
| | - Judith Roca
- Department of Nursing and PhysiotherapyUniversity of LleidaLleidaSpain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI)LleidaSpain
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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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Meto E, Cabout E, Rosay H, Espinasse F, Lot AS, Hajjam ME, Gnamien Clermont S, Launois R. Cost comparison of four venous catheters: Short peripheral catheter, Long peripheral line, Midline, and PICC for peripheral infusion. J Vasc Access 2024:11297298241258257. [PMID: 38855974 DOI: 10.1177/11297298241258257] [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: 06/11/2024] Open
Abstract
INTRODUCTION The use of midline catheters for patients requiring a peripheral IV infusion is sometimes limited by their cost. Although decision trees allow them to be positioned in relation to short peripheral cannulas (SPC), Midlines, and PICCs, their economic impact has not yet been evaluated. A study was conducted to estimate and compare the actual costs of using the three types of catheters for durations of 7, 14, and 21 days. METHODS A budget impact analysis compared midlines or mini-midlines/long peripheral cannulas (LPCs) with SPCs and PICCs for typical medical indications excluding indications requiring central line (infusion of irritant or vesicant drugs): treatment of peritonitis over 7 days, cystic fibrosis infection over 14 days, and meningitis over 21 days. A micro-costing study identified resources used during catheter care procedures (consumables, medical/nursing care, examinations, mechanical complications). The cost of remote systemic complications was estimated from the French national cost study. Literature review compared data based on published complication frequencies. RESULTS Midline is more economic than the SPC (saving of 39€ over 7 days and 174€ over 14 days), and than the PICC (saving of 102€ over 14 days and 95€ over 21 days). DISCUSSION Despite a much higher acquisition cost of the Midline than a SPC, the cost of using a Midline is lower. Although this approach cannot be the only argument for choosing a medical device, it can contribute to it in a tense economic context. The micro-costing has been performed in a center placing PICCline using fluoroscopy for catheter tip positioning. The implantation of a PICC with ECG technique does not require an interventional radiology facility and involves significantly lower logistical and personnel costs. This factor is a limitation in this study. However, even with the use of EGC, the cost difference is in favor of Midline.
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Affiliation(s)
- Elise Meto
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Elise Cabout
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Hervé Rosay
- Centre Léon Bérard, Centre de lutte contre le cancer, Lyon, France
| | | | | | | | | | - Robert Launois
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
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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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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [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: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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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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10
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Lvovschi VE, Carrouel F, Hermann K, Lapostolle F, Joly LM, Tavolacci MP. Severe pain management in the emergency department: patient pathway as a new factor associated with IV morphine prescription. Front Public Health 2024; 12:1352833. [PMID: 38454991 PMCID: PMC10918692 DOI: 10.3389/fpubh.2024.1352833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Background Across the world, 25-29% of the population suffer from pain. Pain is the most frequent reason for an emergency department (ED) visit. This symptom is involved in approximately 70% of all ED visits. The effective management of acute pain with adequate analgesia remains a challenge, especially for severe pain. Intravenous (IV) morphine protocols are currently indicated. These protocols are based on patient-reported scores, most often after an immediate evaluation of pain intensity at triage. However, they are not systematically prescribed. This aspect could be explained by the fact that physicians individualize opioid pain management for each patient and each care pathway to determine the best benefit-risk balance. Few data are available regarding bedside organizational factors involved in this phenomenon. Objective This study aimed to analyze the organizational factors associated with no IV morphine prescription in a standardized context of opioid management in a tertiary-care ED. Methods A 3-month prospective study with a case-control design was conducted in a French university hospital ED. This study focused on factors associated with protocol avoidance despite a visual analog scale (VAS) ≥60 or a numeric rating scale (NRS) ≥6 at triage. Pain components, physician characteristics, patient epidemiologic characteristics, and care pathways were considered. Qualitative variables (percentages) were compared using Fisher's exact test or the chi-squared tests. Student's t-test was used to compare continuous variables. The results were expressed as means with their standard deviation (SD). Factors associated with morphine avoidance were identified by logistic regression. Results A total of 204 patients were included in this study. A total of 46 cases (IV morphine) and 158 controls (IV morphine avoidance) were compared (3:1 ratio). Pain patterns and patient's epidemiologic characteristics were not associated with an IV morphine prescription. Regarding NRS intervals, the results suggest a practice disconnected from the patient's initial self-report. IV morphine avoidance was significantly associated with care pathways. A significant difference between the IV morphine group and the IV morphine avoidance group was observed for "self-referral" [adjusted odds ratio (aOR): 5.11, 95% CIs: 2.32-12.18, p < 0.0001] and patients' trajectories (Fisher's exact test; p < 0.0001), suggesting IV morphine avoidance in ambulatory pathways. In addition, "junior physician grade" was associated with IV morphine avoidance (aOR: 2.35, 95% CIs: 1.09-5.25, p = 0.03), but physician gender was not. Conclusion This bedside case-control study highlights that IV morphine avoidance in the ED could be associated with ambulatory pathways. It confirms the decreased choice of "NRS-only" IV morphine protocols for all patients, including non-trauma patterns. Modern pain education should propose new tools for pain evaluation that integrate the heterogeneity of ED pathways.
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Affiliation(s)
- Virginie E. Lvovschi
- Emergency Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratory “Research on Healthcare Performance” (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Florence Carrouel
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Karl Hermann
- Rouen University Hospital, CIC-CRB 1404, Rouen, France
| | - Frédéric Lapostolle
- SAMU 93, UF Research and Teaching quality, Avicenne Hospital-APHP, Bobigny, France
- INSERM U942, Sorbonne Paris Cité, Paris 13 University, Paris, France
| | - Luc-Marie Joly
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Marie-Pierre Tavolacci
- Rouen University Hospital, CIC-CRB 1404, Rouen, France
- Univ Rouen Normandie, UMR1073 ADEN, Rouen, France
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11
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Ertaş Akyüz G, Turan N. Association between peripheral intravenous catheters and clinical characteristics in the development of phlebitis. J Vasc Access 2024:11297298231226426. [PMID: 38336606 DOI: 10.1177/11297298231226426] [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: 02/12/2024] Open
Abstract
BACKGROUND Serious complications can develop from erroneous insertion of a peripheral intravenous catheter (PIVC). Successful PIVC insertion has a great place in the continuation of IV treatment without causing complications that may require the removal of the PIVC. METHODS The population for this prospective observational study included patients who had undergone PIVC insertion in the surgical, intensive care, and inpatient units of a large teaching and research hospital in Istanbul. Data were collected via a patient information form, a PIVC and treatment information form, the Visual Infusion Phlebitis (VIP) scale, and a PIVC nurse observation form. The SPSS 24 software package was used to analyze the data. RESULTS Of the 168 patients enrolled, 64.9% (n = 109) were male, and the mean age was 56.71 ± 17.97 years. The mean PIVC dwell time was 73.46 ± 21.57 h, and 32.7% (n = 55) of the catheters were removed due to discharge from hospital. Overall, 29.2% (n = 49) of the cases developed phlebitis, with half of the cases (51%, n = 25) developing grade 2 phlebitis and developed within 48 h in 38.8% of cases (n = 19). The mean PIVC dwell time was significantly lower in patients with phlebitis than in those with no phlebitis (p < 0.05). CONCLUSIONS It was determined that PIVC dwell time could be increased by routine surveillance to monitor for phlebitis regularly. It is recommended that education programs for nurses be developed to prevent PIVC-related complications.
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Affiliation(s)
- Gonca Ertaş Akyüz
- Graduate Education Institute, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nuray Turan
- Department of Fundamentals of Nursing, Faculty of Nursing, Istanbul University, Fatih, Istanbul, Turkey
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12
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Lissy Ben B, Yeshwanth Peela S, Gopi K, Nelson A, Thakkar S, Sri Sai Jeevana M. Assessment of the Peripheral Venous Cannulation in a Teaching Hospital: A Prospective Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S283-S285. [PMID: 38595624 PMCID: PMC11000971 DOI: 10.4103/jpbs.jpbs_493_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction In today's healthcare environment, peripheral venous cannulations are frequently performed procedures. Bloodstream infections could occur as a result of the intrusive operation. Peripheral venous cannulas should be inserted and managed according to specific rules. This study compared these standards to the peripheral venous cannulation procedure and results at a teaching hospital institution. Materials and Methods This study investigated the procedure and results of peripheral venous cannulation in a teaching center using a prospectively completed audit loop study. The "Royal College of Nursing's criteria for infusion therapy" is one such set of recommendations. After the first phase of the observations, the audit was conducted. Later, after 4 months based on the recommendations, the personnel received training on a variety of cannulation-related topics and the second set of observations for the cannulations was performed. Both observations were made and compared for significance that was considered at. 05 using the ANOVA. Results During the first phase of the research, 212 cannulations were made, and 314 were made for the second phase to be audited. In the reaudit compared with the initial audit, there was a statistically substantial surge in documentation, cannula cleansing, glove use, suitable site selection, and hand cleanliness, according to comparative exploration. Moreover, there was a statistically substantial decline in recannulations. Conclusion Even though peripheral intravenous cannulation is a straightforward process, if done incorrectly, it might have serious side effects. Such techniques' auditing reveals performance flaws. Reaudit results reveal a noticeable increase in performance and outcome following proper personnel retraining.
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Affiliation(s)
- Bella Lissy Ben
- Department of General and Laparoscopic Surgery, Sree Ayyappa Medical College and Research Foundation, Vadasserikkara, Pathanamthitta, Kerala, India
| | | | - Kodali Gopi
- Department of General Surgery, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh, India
| | - Anish Nelson
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral and Maxillofacial Surgery, Mangalore, Karnataka, India
| | - Smit Thakkar
- Shri M P Shah Government Medical College, Gujarat, India
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13
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Taşkın O, Günay İsmailoğlu E. Validity and reliability of the Turkish version of the Difficult Intravenous Access Scale for adult patients. J Res Nurs 2024; 29:21-29. [PMID: 38495332 PMCID: PMC10939018 DOI: 10.1177/17449871241226586] [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: 03/19/2024] Open
Abstract
Background Difficult intravenous access is a condition that decreases the first-attempt success rate of intravenous catheterisation. It is important to evaluate patients with difficult vascular access using a standardised scale. This study was carried out to establish the Turkish validity and reliability of the 'Adult Difficult Intravenous Access Scale'. Methods The methodological descriptive study was carried out in the Adult Emergency Department. The research sample consisted of 100 patients over 18 years of age, who were conscious, whose condition was not critical or who did not require resuscitation. 'Case Report Form' and 'Adult Difficult Intravenous Access Scale' were used. Results The mean age of the patients was 57.54 ± 19.44 years, and 55% (n = 55) were female and 77% (n = 77) had a chronic disease. The factor loads of the scale items are between 0.366 and 0.852. The Cronbach's alpha coefficient was found to be 0.708. Conclusions The Turkish version of the scale is a valid and reliable scale for determining the risk of difficult intravenous access. The practical use of this scale by healthcare professionals will enable earlier diagnosis of patients with difficult vascular access.
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Affiliation(s)
| | - Elif Günay İsmailoğlu
- Associate Professor, Nursing Department, Health Sciences Faculty, Izmir Bakircay University, İzmir, Turkey
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14
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Aksoy F, Bayram SB. The effect of warm moist compresses in peripheral intravenous catheter-related phlebitis. Eur J Oncol Nurs 2023; 67:102438. [PMID: 37913684 DOI: 10.1016/j.ejon.2023.102438] [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: 07/31/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Phlebitis is a common complication in palliative patients. There are limited nursing practices in phlebitis care. The study was conducted to determine the effect of warm moist compresses in patients with peripheral intravenous catheter-related phlebitis. METHODS 70 patients (35 control and 35 experimental) with phlebitis symptoms who were hospitalized in the palliative clinic of a training and research hospital were recruited for the study. The phlebitis site of the patients in the control and experimental groups were followed for three days. While the control group received routine nursing care, the experimental group received a warm moist compresses at 28 °C for 15 min three times a day for three days in addition to routine nursing care. RESULTS According to the results, there was a decrease in the initial and final phlebitis grades between the control and experimental groups, but the difference was not statistically significant (p = 0.957, p = 0.078). In the final evaluation of the phlebitis site, a statistically significant difference was observed in redness, edema width, and pain intensity between the control and experimental groups in favor of the experimental group (p˂0.001, p = 0.006, p˂0.001, respectively). CONCLUSIONS It was determined that applying warm water compresses three times a day in phlebitis care had a positive effect on healing.
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Affiliation(s)
- Fatma Aksoy
- Karadeniz Technical University, Institute of Health Sciences, Trabzon, Turkey.
| | - Sule Biyik Bayram
- Karadeniz Technical University, Faculty of Health Sciences, Department of Nursing, Trabzon, Turkey.
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15
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Privitera D, Bassi E, Airoldi C, Capsoni N, Innocenti G, Santomauro I, Molin AD. Effectiveness of short peripheral intravenous catheter educational programmes to improve clinical outcomes protocol for a systematic review. MethodsX 2023; 11:102352. [PMID: 37705570 PMCID: PMC10495618 DOI: 10.1016/j.mex.2023.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
The placement of a short peripheral intravenous catheter (sPIVC) is the most common invasive clinical procedure for patients requiring fluid infusion and multiple blood draws. Phlebitis and infiltration represent the most common catheter-related complications. Occlusions, dislocations, and infections are less frequent. Insufficient knowledge and skills may increase the risk of these complications. This review aims to evaluate the effectiveness of training programmes to reduce sPIVC failure amongst hospitalised patients. We will search PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Vascular Specialized Register through the Cochrane Register of Studies, and Google Scholar. We defined the search query using the PICO framework (Participants: health professionals; Intervention: training programme; Comparison: No training programme; Outcomes: all-cause catheter failure). We will include experimental studies evaluating an educational programme to reduce early sPIVC failure amongst hospitalised patients. Two reviewers will independently screen studies for inclusion, extract data, and perform the risk of bias assessment using the Cochrane Effective Practice and Organisation of Care Risk of Bias tool for randomised controlled trials. This review will highlight important perspectives for future studies on the effectiveness of educational programmes focused on reducing the rate of sPIVC complications.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gloria Innocenti
- Centro Documentazione Biomedica, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Isabella Santomauro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Health Professions’ Direction, Maggiore della Carità Hospital, Novara, Italy
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16
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Agno KC, Yang K, Byun SH, Oh S, Lee S, Kim H, Kim K, Cho S, Jeong WI, Jeong JW. A temperature-responsive intravenous needle that irreversibly softens on insertion. Nat Biomed Eng 2023:10.1038/s41551-023-01116-z. [PMID: 37903901 DOI: 10.1038/s41551-023-01116-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
The high stiffness of intravenous needles can cause tissue injury and increase the risk of transmission of blood-borne pathogens through accidental needlesticks. Here we describe the development and performance of an intravenous needle whose stiffness and shape depend on body temperature. The needle is sufficiently stiff for insertion into soft tissue yet becomes irreversibly flexible after insertion, adapting to the shape of the blood vessel and reducing the risk of needlestick injury on removal, as we show in vein phantoms and ex vivo porcine tissue. In mice, the needles had similar fluid-delivery performance and caused substantially less inflammation than commercial devices for intravenous access of similar size. We also show that an intravenous needle integrated with a thin-film temperature sensor can monitor core body temperature in mice and detect fluid leakage in porcine tissue ex vivo. Temperature-responsive intravenous needles may improve patient care.
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Affiliation(s)
- Karen-Christian Agno
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Keungmo Yang
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyuk Byun
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Subin Oh
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Simok Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Heesoo Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Kyurae Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Sungwoo Cho
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Won-Il Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
| | - Jae-Woong Jeong
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
- KAIST Institute for Health Science and Technology, Daejeon, Republic of Korea.
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17
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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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18
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Sendi P, Nelson SB, Soriano A, Spellberg B. Early switch from intravenous to oral anti-microbial therapy in infectious diseases. Clin Microbiol Infect 2023; 29:1117-1119. [PMID: 37353077 DOI: 10.1016/j.cmi.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Sandra B Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Brad Spellberg
- Hospital Administration, Los Angeles General Medical Center, Los Angeles, CA, USA
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19
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Hontoria-Alcoceba R, López-López C, Hontoria-Alcoceba V, Sánchez-Morgado AI. Implementation of Evidence-Based Practice in Peripheral Intravenous Catheter Care. J Nurs Care Qual 2023; 38:226-233. [PMID: 36727916 DOI: 10.1097/ncq.0000000000000688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inserting a peripheral intravenous (PIV) catheter is a common health care procedure; however, risks include phlebitis, extravasation, and accidental dislodgement. Using evidence-based practices (EBPs) can reduce these risks. PURPOSE The purpose of this study was to implement an evidence-based PIV catheter care bundle and a decision-making algorithm. METHODS A quasi-experimental study design was used. A care bundle and an evidence-based decision-making algorithm were implemented on a medical unit. Outcomes included length of PIV catheter dwell time, phlebitis and other complications, and health professionals' adherence to the interventions. RESULTS A total of 364 PIV catheters were assessed. PIV catheter dwell time decreased from 3.6 to 2.9 days ( P < .001), and phlebitis rates decreased from 14.8% to 4.9% ( P < .05). Health professionals' adherence increased from 84.3% to 91.8%. CONCLUSIONS Implementing EBPs can improve care provided to patients with PIV catheters.
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Affiliation(s)
- Rocío Hontoria-Alcoceba
- Internal Medicine Service (Mss R. Hontoria-Alcoceba and Sánchez-Morgado) and Emergency and Trauma Intensive Care Unit (Dr López-López), Hospital Universitario 12 de Octubre, Madrid, Spain; Researcher of Care Research Group (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (Dr López-López); Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain (Dr López-López); and Emergency Medical Service of Madrid SUMMA 112, Madrid, Spain (Ms V. Hontoria-Alcoceba)
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20
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Shimoni Z, Houdhoud N, Isaacs Y, Froom P. Observational study of peripheral intravenous catheter outcomes in an internal medicine department. Intern Med J 2023; 53:221-227. [PMID: 36346286 DOI: 10.1111/imj.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In elderly patients hospitalised in internal medicine departments, risk factors, preferable placement area and methods of securement of short peripheral venous catheters (SPVC) a unclear. AIM To determine the incidence and risk factors of adverse events using a transparent bordered dressing for securement in the dorsum of the hand or cubital fossa in consecutive patients hospitalised in an internal medicine department. METHODS In a prospective observational study of patients admitted to a regional hospital with a SPVC, the dependent variable was the need to replace the catheter because of an adverse event (phlebitis, accidental removal, infiltration/occlusion). The independent variables were age, gender, disorientation, placement area, intravenous antibiotic therapy and indwelling time. Risk factors were determined by Cox regression model analysis. RESULTS There were 709 catheters placed in 499 patients. Per catheter placed the mean age was 75 ± 17 years. Accidental removal, infiltration/obstruction and phlebitis occurred in 21.5, 16.2 and 15.0 events per 1000 days respectively. There was a significantly increased risk on Day 3 compared to Days 2 and 4. An older age, intravenous antibiotics and disorientation increased the hazard for accidental displacement, whereas phlebitis was associated only with intravenous antibiotics and occlusion/infiltration only with age. CONCLUSIONS The observed low rates of adverse events suggests that placement in the dorsum of the hand or cubital fossa secured by a transparent dressing is acceptable. It is important to consider the indwelling catheter time when studying adverse events, and elderly patients, disoriented patients and/or patients receiving intravenous antibiotics deserve special attention.
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Affiliation(s)
- Zvi Shimoni
- The Adelson School of Medicine, Ariel University, Ariel, Israel.,Medical Director, Laniado Hospital, Netanya, Israel.,Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
| | - Nihad Houdhoud
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
| | - Yehudit Isaacs
- Department of Emergency Medicine and Nursing, Laniado Hospital, Netanya, Israel
| | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv, Israel
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21
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Walker RM, Pires MPO, Ray-Barruel G, Cooke M, Mihala G, Azevedo SS, Peterlini MAS, Felipe MDAA, Álvarez CP, Quintanilla M, Corzo MC, Villareal GC, Cigarroa EN, Pedreira MLG, Rickard CM. Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study. Front Med (Lausanne) 2023; 9:1039232. [PMID: 36687407 PMCID: PMC9846050 DOI: 10.3389/fmed.2022.1039232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Peripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs. Methods In 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement. Results A total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8-72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant. Conclusion Given the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.
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Affiliation(s)
- Rachel M. Walker
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maria Paula Oliveira Pires
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,*Correspondence: Maria Paula Oliveira Pires,
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Silvia Schoenau Azevedo
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Cirlia Petrona Álvarez
- Infection Control Service, Asociación de Terapia de Infusión y Seguridad del Paciente (ATISPA), Buenos Aires, Argentina
| | | | | | - Gabriela Cortez Villareal
- National Institute of Cardiology Ignacio Chávez, Directorate of Quality and Health Education of the Ministry of Health of Mexico, Ciudad de México, Mexico
| | - Eliazib Nataren Cigarroa
- Dr. Jesús Gilberto Gómez Maza Hospital, Health Services of the State of Chiapas, Tuxtla Gutiérrez, Mexico
| | - Mavilde L. G. Pedreira
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil,National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| | - Claire M. Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences and School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia,Metro North Hospitals and Health Service, Herston Infectious Diseases Institute (HeIDI), Brisbane, QLD, Australia
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22
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Corley A, Ullman AJ, Marsh N, Genzel J, Larsen EN, Young E, Booker C, Harris PNA, Rickard CM. A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure. Heart Lung 2023; 57:45-53. [PMID: 36041346 DOI: 10.1016/j.hrtlng.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. OBJECTIVES To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. METHODS In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. EXCLUSIONS laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. PRIMARY OUTCOME feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). SECONDARY OUTCOMES PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. RESULTS Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4-2.7) and 2.1 (95% CI 0.9-5.1) for Bundles 1 and 2, respectively. CONCLUSIONS A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Australia.
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Jodie Genzel
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Emily Young
- Centre for Applied Economics, School of Medicine, Griffith University, Nathan, 4111, Australia.
| | - Catriona Booker
- Workforce Development & Education Unit, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Patrick N A Harris
- Pathology Queensland, Health Support Queensland, Herston, 4006, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
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23
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Ray-Barruel G, Alexander M. CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management. Am J Nurs 2023; 123:32-37. [PMID: 37718967 DOI: 10.1097/01.naj.0000905568.37179.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for IV medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.
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Affiliation(s)
- Gillian Ray-Barruel
- Gillian Ray-Barruel is a senior research fellow at the Herston Infectious Diseases Institute and the University of Queensland School of Nursing, Midwifery and Social Work in Brisbane, Queensland, Australia; an adjunct senior research fellow at the Griffith University School of Nursing and Midwifery; education director at the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of Infection, Disease and Health. Mary Alexander is chief executive officer of the Infusion Nurses Society in Norwood, MA. Contact author: Gillian Ray-Barruel, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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24
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Assessment of Intravenous Antibiotics to Peroral Antibiotics Conversion Practice and Its Associated Factor at University of Gondar Comprehensive Specialized Hospital: Prospective Observational Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:8395424. [PMID: 36277733 PMCID: PMC9581647 DOI: 10.1155/2022/8395424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Background Improper utilization of antibiotics harms the patient, the public, and the economy. The overuse of injections is one of the key factors in the irrational use of medicines. However, little is known about intravenous (IV) to peroral (PO) conversion practice in the Ethiopian healthcare setting, specifically in the Northwest part of Ethiopia. Objective To assess antibiotics IV to PO conversion practice and its associated factors at the internal medicine ward of the University of Gondar Comprehensive and Specialized Hospital (UOGCSH). Method A prospective observational study was conducted on 324 study participants who were admitted to the University of Gondar Specialized Hospital from October 3 to November 14, 2021. A systematic random sampling technique was employed to select the study participants. Stata version 14.2 was used for the analysis. Descriptive statistics result was presented using mean and standard deviation. Logistic regression analysis was done to determine the association between independent variables and dependent variables. The association between independent variables and dependent variables was tested at 95% CI and P value≤ 0.05 was considered statistical significance. Result A total of 324 study participants were included in the study, and the mean age of the patients was 41.4 ± 18.6. Of the 324 study participants, 63.3% were male. The most frequently prescribed antibiotics used for empiric treatment were ceftriaxone (45.4%), followed by metronidazole (33.2%), and cloxacillin (11.4%). A total of 34.5.57% of patients who took antibiotics were converted to PO antibiotics. The most frequently converted type of conversion practice was sequential (23.1%), followed by the switch type of conversion (7.4%). Tachypnea, unavailability of medication, higher temperature, hospital stay greater than 10.78-days, and the presence of comorbidity were predictors of IV medications not being converted to PO medications. Conclusion Intravenous to peroral conversion practice was infrequent. The most frequently applied conversion practice was sequential type conversion practice, followed by switch type of conversion practice. IV to PO conversion practice was significantly associated with tachypnea, unavailability of medication, higher temperature, hospital stay greater than 10.78-days, and comorbidity. Awareness of IV to PO conversion practice and short-term training for healthcare teams is vital for better antibiotic conversion practice.
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25
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Libbis E, Sweeny AL, Holmes T, Aggarwal N, Snelling PJ, Slaughter E, Poncia H, Watkins SC. Forearmed is forewarned: A prospective intervention observational time-series study of patient empowerment for ultrasound-guided peripheral intravenous access. Emerg Med Australas 2022; 34:779-785. [PMID: 35578995 PMCID: PMC9790456 DOI: 10.1111/1742-6723.13981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/28/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ultrasound (US) is a valuable adjunct to improve the success rates of difficult peripheral intravenous cannula (PIVC) insertions but is usually clinician initiated. The present study assessed for any change in clinician practice resulting from interventions aimed at empowering patients to advocate for early use of US if they self-identified as having difficult PIVC access. METHODS This was a prospective observational time-series study using a rapid quality improvement (RQI) framework. Three ED waiting room intervention strategies (printed media, video and wristband) were tested over three 2-week periods at a large teaching hospital. The impact of each intervention was assessed at eight time points during each intervention and compared to a pre-intervention baseline period using trend and time-series analysis. RESULTS A total of 1611 PIVC insertions were surveyed over 42 time points. The proportion of US-guided PIVC insertions was highest during Intervention 3 (wristbands; 5.5%) but all proportions remained below baseline (6.5%). Trend analysis identified an increasing frequency of US use during Intervention 1 (printed media, P = 0.01). However, no statistically significant trends were observed within the periods. CONCLUSIONS This is the first prospective study to assess the effect of various interventions to empower patients to self-identify as having difficult PIVC access and advocate for the use of US-guidance. The present study was indeterminate: no intervention tested in the present study noticeably influenced clinical practice, potentially attributable to the study design and confounding factors. This innovative study serves as a pilot for future research into patient empowerment, which is currently lacking in the literature.
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Affiliation(s)
- Eng Libbis
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Amy L Sweeny
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Travis Holmes
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Nisha Aggarwal
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Peter J Snelling
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Eugene Slaughter
- Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,School of NursingMidwifery and Social Work, The University of QueenslandBrisbaneQueenslandAustralia
| | - Hugo Poncia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia,Emergency DepartmentThe Tweed HospitalTweed HeadsNew South WalesAustralia
| | - Stuart C Watkins
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
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Abu-Much A, Darawshi R, Dawud H, Kasem H, Abu Ammar A. Preparation and characterization of flexible furosemide-loaded biodegradable microneedles for intradermal drug delivery. Biomater Sci 2022; 10:6486-6499. [PMID: 36178014 DOI: 10.1039/d2bm01143c] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transdermal drug delivery systems are a useful and minimally invasive alternative to other drug administration routes. Biodegradable polymeric microneedles (MNs) are widely used in controlled-release drug delivery due to their tunable properties and ease of patient self-administration. Polylactic-co-glycolic acid (PLGA) is often used for sustained drug release owing to special intrinsic properties including biocompatibility and biodegradability, which offer excellent applicability in preparing MNs. Congestive heart failure (CHF) is characterized by fluid overload during acute exacerbation, necessitating frequent patient hospitalization for continuous intravenous (i.v.) diuretic therapy. In the present study, we incorporated furosemide (FUR) as a model drug into flexible PLGA MN skin patches for potential intradermal delivery to overcome the limitations associated with i.v. diuresis. The MNs were fabricated by a casting-mold technique and consisted of two main parts, PLGA needle tips loaded with varying concentrations of FUR and a flexible backing layer comprising sodium alginate and glycerol. MN formulations were characterized by SEM and exhibited a uniform pyramidal shape. The measured surface pH of all samples suggested that no skin irritation is expected upon application. High encapsulation efficiency was obtained for FUR-MN formulations in which a decrease was noted as the FUR/PLGA ratio decreased. Drug loading content ranged from 19.1 ± 1% to 28.9 ± 1.4%. Successful insertion of MNs into a Parafilm® skin simulant model suggested that MNs will easily penetrate the skin's outermost layer, the stratum corneum, and will permit intradermal delivery of FUR. The MNs were further characterized by analytical methods. Finally, the MNs exhibited an initial burst release followed by a sustained release of FUR. Self-administered FUR-MNs can open new avenues to overcome i.v. drip limitations and increase patient compliance.
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Affiliation(s)
- Arsalan Abu-Much
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Raya Darawshi
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, 26 Yaakov Shreibom Street, Ramat Beit Hakerem, Jerusalem 9103501, Israel.
| | - Hala Dawud
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, 26 Yaakov Shreibom Street, Ramat Beit Hakerem, Jerusalem 9103501, Israel.
| | - Haytam Kasem
- Department of Mechanical Engineering, Azrieli College of Engineering Jerusalem, Jerusalem, Israel
| | - Aiman Abu Ammar
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, 26 Yaakov Shreibom Street, Ramat Beit Hakerem, Jerusalem 9103501, Israel.
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Noel F, Hoang P, Truchot J, Bard AS, Yordanov Y, Thiebaud PC. An educational intervention to reduce unjustified peripheral intravenous infusions in the emergency department. Intern Emerg Med 2022; 17:1225-1227. [PMID: 34800237 PMCID: PMC8605468 DOI: 10.1007/s11739-021-02896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Florent Noel
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Phan Hoang
- Emergency Department, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
- Ilumens, Université de Paris, Paris, France
| | - Anne-Sophie Bard
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Pierre-Clément Thiebaud
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
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28
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Karaoğlan N, Sarı HY, Devrim İ. Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S23. [PMID: 35439080 DOI: 10.12968/bjon.2022.31.8.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. METHOD The study was conducted in the largest children's hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. RESULTS The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P<0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P<0.001). CONCLUSION Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.
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Affiliation(s)
- Nalan Karaoğlan
- Nurse, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Hatice Yıldırım Sarı
- Professor, Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - İlker Devrim
- Professor, Division of Pediatric Infectious Disease, Dr Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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29
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Yasuda H, Rickard CM, Marsh N, Yamamoto R, Kotani Y, Kishihara Y, Kondo N, Sekine K, Shime N, Morikane K, Abe T. Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units. Ann Intensive Care 2022; 12:33. [PMID: 35394571 PMCID: PMC8994002 DOI: 10.1186/s13613-022-01009-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01009-5.
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Affiliation(s)
- Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. .,Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan.
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia.,Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia.,Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Natsuki Kondo
- Department of Intensive Care Medicine, Chiba Emergency Medical Center, Chiba-shi, Japan
| | - Kosuke Sekine
- Department of Medical Engineer, Kameda Medical Center, Chiba, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - Takayuki Abe
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.,School of Data Science, Yokohama City University, Kanagawa, Japan
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30
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Thibaut A, Olga FB, Fanyu H, Jeremy G, Jean G, Sophia B, Isabelle R, Céline PE, Michel D, Philippe B. Binding communication to improve peripheral venous catheter monitoring. J Eval Clin Pract 2022; 28:186-193. [PMID: 34346126 DOI: 10.1111/jep.13602] [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: 04/01/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Optimizing the monitoring of peripheral venous catheters is essential. We developed a nursing record system at bedside (Patient Smart Reader) to track peripheral venous catheter acts. AIMS The aim of the present study was to improve peripheral venous catheter monitoring. To improve the quality of monitoring, we aimed to increase the usage of the nursing record system at the bedside. METHODS We developed a 'commitment intervention' course based on a binding communication paradigm. The corresponding effect on monitoring was analysed using a p-chart and time series analysis. FINDINGS Nurses observed a significant improvement in compliance with catheter monitoring over time (shifts after shifts), ranging from 27.6% (CI = [25.3; 30.0]) compliance before the commitment intervention to 47.4% (CI = [45.0; 49.9]) compliance after training. The commitment intervention increased the chances of carrying out monitoring through the tool for acts related to peripheral venous catheters by a factor of 2.42 (odds ratio) (CI = [1.88; 3.11]). CONCLUSION Binding communication provides an effective method for changing nurses' behaviours in terms of safe care. The determinants of engagement (individual vs collective) can be indicators for defining future communication and training strategies in care centers for all health care workers.
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Affiliation(s)
- Albertini Thibaut
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Mediterranean Institute for Information and Communication Science, Aix Marseille Univ, Marseille, France
| | - Florea Bodean Olga
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France
| | - Huang Fanyu
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France
| | - Gonin Jeremy
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,AP-HM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistics & ICT, Aix Marseille Univ, Marseille, France
| | - Gaudart Jean
- AP-HM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistics & ICT, Aix Marseille Univ, Marseille, France
| | - Boudjema Sophia
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France
| | - Richer Isabelle
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France
| | - Pascual-Espuny Céline
- Mediterranean Institute for Information and Communication Science, Aix Marseille Univ, Marseille, France
| | - Durampart Michel
- Mediterranean Institute for Information and Communication Science, Aix Marseille Univ, Marseille, France
| | - Brouqui Philippe
- AP-HM, IRD, IHU-Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France
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31
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Corley A, Marsh N, Ullman AJ, Rickard CM. Peripheral intravenous catheter securement: An integrative review of contemporary literature around medical adhesive tapes and supplementary securement products. J Clin Nurs 2022; 32:1841-1857. [PMID: 35118759 DOI: 10.1111/jocn.16237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
AIM To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure. DESIGN Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement. DATA SOURCES The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000-21 September 2020. REVIEW METHODS Studies enrolling hospitalised participants >16 years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists. RESULTS Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence. CONCLUSION Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications; multiproduct dressing and securement bundles were prevalent; and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
| | - Amanda J Ullman
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery & AVATAR Group, Menzies Health Queensland, Griffith University, Nathan, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, Australia
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32
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Schettini F, Ferrario L, Foglia E, Garagiola E, Parodi L, Cavagnaro P, Garra L, Valeri A, Cirone M, Rapetti R. The implementation of a standardized optimal procedure for peripheral venous catheters' management: Results from a multi-dimensional assessment. PLoS One 2022; 17:e0263227. [PMID: 35085363 PMCID: PMC8794079 DOI: 10.1371/journal.pone.0263227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Peripheral Venous Catheter (PVC) is a widely used device in the hospital setting and is often associated with significant adverse events that may impair treatment administration and patient health. The aim of the present study is to define the incremental benefits related to the implementation and the standardized and simultaneous use of three disposable devices for skin antisepsis, infusion, and cleaning, assuming the hospital's point of view, from an effectiveness, efficiency, and organizational perspective. For the achievement of the above objective, real-life data were collected by means of an observational prospective study, involving two hospitals in the Liguria Region (Northern Italy). Consecutive cases were enrolled and placed into two different scenarios: 1) use of all the three disposable devices, thus representing the scenario related to the implementation of a standardized optimal procedure (Scenario 1); 2) use of only one or two disposable devices, representing the scenario related to not being in a standardized optimal procedure (Scenario 2). For the definition of effectiveness indicators, the reason for PVC removal and the PVC-related adverse events occurrence were collected for each patient enrolled. In addition, an activity-based costing analysis grounded on a process-mapping technique was conducted to define the overall economic absorption sustained by hospitals when taking in charge patients requiring a PVC. Among the 380 patients enrolled in the study, 18% were treated with the standardized optimal procedure (Scenario 1). The two Scenarios differed in terms of number of patients for whom the PCV was removed due to the end of therapy (86.8% versus 39.40%, p-value = 0.000), with a consequent decrease in the adverse events occurrence rate. The economic evaluation demonstrated the sustainability and feasibility of implementing the standardized optimal procedure specifically related to the need for lower economic resources for the hospital management of adverse events occurred (€19.60 versus €21.71, p-value = 0.0019). An organizational advantage also emerged concerning an overall lower time to execute all the PVC-related activities (4.39 versus 5.72 minutes, p-value = 0.00). Results demonstrate the feasibility in the adoption of the standardized optimal procedure for PVC management, with significant advantages not only from a clinical point of view, but also from an organizational and economic perspective, thus being able to increase the overall operational efficiency of the hospitals.
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Affiliation(s)
- Fabrizio Schettini
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Elisabetta Garagiola
- Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
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33
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Leipheimer J, Balter M, Chen A, Yarmush M. Design and Evaluation of a Handheld Robotic Device for Peripheral Catheterization. J Med Device 2022; 16:021015. [DOI: 10.1115/1.4053688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Medical robots provide enhanced dexterity, vision, and safety for a broad range of procedures. In this paper, we present a hand-held, robotic device capable of performing peripheral catheter insertions with high accuracy and repeatability. The device utilizes a combination of ultrasound imaging, miniaturized robotics, and machine learning to safely and efficiently introduce a catheter sheath into a peripheral blood vessel. Here, we present the mechanical design and experimental validation of the device, known as VeniBot. Additionally, we present results on our ultrasound deep learning algorithm for vessel segmentation, and performance on tissue-mimicking phantom models that simulate difficult peripheral catheter placement. Overall, the device achieved first-attempt success rates of 97 ± 4% for vessel punctures and 89 ± 7% for sheath cannulations on the tissue mimicking models (n=240). The results from these studies demonstrate the viability of a hand-held device for performing semi-automated peripheral catheterization. In the future, the use of this device has the potential to improve clinical workflow and reduce patient discomfort by assuring a safe and efficient procedure.
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34
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Ng M, Mark LKF, Fatimah L. Management of difficult intravenous access: a qualitative review. World J Emerg Med 2022; 13:467-478. [PMID: 36636560 PMCID: PMC9807392 DOI: 10.5847/wjem.j.1920-8642.2022.104] [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: 03/18/2022] [Accepted: 06/02/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. METHODS We conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESULTS We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. CONCLUSION DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.
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Affiliation(s)
- Mingwei Ng
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Leong Kwok Fai Mark
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Lateef Fatimah
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
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35
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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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36
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Berger S, Winchester K, Principe RB, Culverwell E. Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital. J Clin Nurs 2021; 31:2324-2330. [PMID: 34535927 DOI: 10.1111/jocn.16051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). BACKGROUND Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. DESIGN Observational point prevalence study. METHODS Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. RESULTS There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. CONCLUSIONS Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. RELEVANCE TO CLINICAL PRACTICE Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.
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Affiliation(s)
- Sarah Berger
- Infection Prevention and Control Service, Canterbury District Health Board, Christchurch, New Zealand.,Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Kerry Winchester
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Rommel B Principe
- Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Elizabeth Culverwell
- Department of Nursing, Canterbury District Health Board, Christchurch, New Zealand
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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: 14] [Impact Index Per Article: 4.7] [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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Abstract
TOPIC This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter-related bloodstream infections is likely as high as and may surpass the number of central venous catheter-related bloodstream infections, with significant associated morbidity and mortality. PURPOSE OF PAPER Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. CONTENT COVERED This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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Reducing the incidence of phlebitis in medical adult inpatients with peripheral venous catheter care bundle: a best practice implementation project. JBI Evid Implement 2021; 19:68-83. [PMID: 33570335 DOI: 10.1097/xeb.0000000000000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization. AIMS The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates. METHODS A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed. RESULTS One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P < 0.001) but no significant improvement in Criterion 2 (P > 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P < 0.05). An interesting finding was that the number of reported occurrences of phlebitis increased after implementing the PVC care bundle. DISCUSSION The increase in phlebitis rates could be attributed to the care bundle facilitating prompt and early identification of phlebitis. Despite the initial increase in occurrences 1 month post implementation, the general effectiveness of the care bundle in reducing occurrences of phlebitis was seen 6 months post implementation. The effectiveness of the care bundle to reduce phlebitis rates may be even more evident across a longer implementation period. CONCLUSION The current study showed that the implementation of a standardized PVC care bundle can significantly enhance the assessment and identification process of phlebitis and can aid in reducing the incidence of phlebitis. The nurses' compliance in practicing the PVC care bundle was determined by the post and preimplementation audits, thus, the audit approach was beneficial in translating evidence into practice.
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Lulie M, Tadesse A, Tsegaye T, Yesuf T, Silamsaw M. Incidence of peripheral intravenous catheter phlebitis and its associated factors among patients admitted to University of Gondar hospital, Northwest Ethiopia: a prospective, observational study. Thromb J 2021; 19:48. [PMID: 34256784 PMCID: PMC8276507 DOI: 10.1186/s12959-021-00301-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlebitis, inflammation of tunica intima of venous wall, occurred in 13-56% of hospitalized patients. It is characterized by pain, erythema, swelling, palpable venous cord, and pussy discharge at catheter site. Cannula-related blood stream infection (CRBSI) is recognized complication of phlebitis. Adverse outcomes of phlebitis embrace patient discomfort, longer hospital stay and higher health care cost. This study aimed to determine the incidence and associated factors of peripheral vein phlebitis among hospitalized patients. METHODS A hospital-based prospective, observational study was conducted between April 1 and August 31, 2020 at University of Gondar hospital, Northwest Ethiopia. A consecutive sampling method was used to recruit 384 patients. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients' records. Presence and severity of phlebitis was identified by Jackson's Visual Infusion Phlebitis (VIP) Scoring System. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with occurrence of phlebitis. P-value < 0.05 was used to declare significant association. RESULT A total of 384 study subjects were included in the study. The mean age of study subjects was 46 years, with a range of 19 to 96 years. The incidence of phlebitis was 70% among study subjects. Mid-stage (grade 3) and advanced-stage (grade 4) phlebitis were noticed in 136/268 (51%) and 89/268 (33%) respectively. Odds of developing phlebitis were twofold higher in patients with catheter-in situ > 96 h (AOR = 2.261, 95% CI 1.087-4.702, P-value = 0.029) as compared to those with catheter dwell time < 72 h. Female patients were 70% (AOR = 0.293, 95% CI 0.031-0.626, P-value = 0.002) lower than male patients with risk of developing phlebitis. Patients who use infusates were 53% (AOR = 0.472, 95% CI 0.280-0.796, P-value = 0.005) less likely to develop phlebitis as compared to those who didn't use infusates. CONCLUSION The cannula must be reviewed on daily basis, and it should be removed if it stayed later than 96 h.
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Affiliation(s)
- Mulugeta Lulie
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Yesuf
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Clua M, Deroche A, Cudennec T, Pepin M. [Not Available]. SOINS. GERONTOLOGIE 2021; 26:47-48. [PMID: 34304812 DOI: 10.1016/j.sger.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Morane Clua
- Service de médecine gériatrique, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Aurélie Deroche
- Service de soins de suite et de réanimation Gériatrie, AP-HP, université Paris-Descartes, site Corentin-Celton, 4 parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - Tristan Cudennec
- Service de médecine gériatrique, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Marion Pepin
- Service de médecine gériatrique, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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42
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Ho OTW, Ng WCA, Ow ZGW, Ho YJ, Lim WH, Yong JN, Wang RS, Wong KL, Ng CH, Muthiah MD, Teo CML. Bisphosphonate therapy after liver transplant improves bone mineral density and reduces fracture rates: an updated systematic review and meta-analysis. Transpl Int 2021; 34:1386-1396. [PMID: 33884669 DOI: 10.1111/tri.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022]
Abstract
To investigate the efficacy of bisphosphonates and compare oral and IV formulations on bone mineral density (BMD) and fracture incidence in post-orthotopic liver transplant (OLT) patients. Electronic databases were searched, and six RCTs and three cohort studies were included out of 711 articles. Main outcomes included post-OLT BMD changes, fracture incidence, and treatment adverse reactions. Pairwise meta-analysis was conducted for binary and continuous outcomes, while pooled fracture incidence utilized single-arm meta-analysis. Post-OLT fracture incidence was reported in nine studies (n = 591). Total fracture incidence was 6.6% (CI: 3.4-12.4%) in bisphosphonate group and 19.1% (CI: 14.3-25.1%) in calcium and vitamin D group. Total fractures were significantly lower in patients on bisphosphonate, compared to calcium and vitamin D (n = 591; OR = 0.037; CI: 0.18-0.77; P = 0.008). Overall fractures were significantly lower in the oral group (n = 263; OR = 0.26; CI: 0.08-0.85; P = 0.02) but not in the IV group (n = 328; OR = 0.45; CI: 0.16-1.26; P = 0.129). Both oral and IV bisphosphonates are effective in reducing fracture incidence post-OLT compared to calcium and vitamin D. Oral formulations may also have an advantage over IV in reducing bone loss and fracture incidence post-OLT.
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Affiliation(s)
- Owen Tsung Wen Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Winston Cheng Ann Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yeung Jek Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Renaeta Shiqi Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keng Lin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Orthopedics Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Claire Min-Li Teo
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
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Analgesic Pump Tubing Securement to Prevent Dislodgement of Peripheral Vein Indwelling Catheter. J Perianesth Nurs 2021; 36:480-486.e1. [PMID: 34183256 DOI: 10.1016/j.jopan.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aims to compare the incidence of complications when using a new approach to secure an indwelling peripheral venous catheter (PVC), involving tying of the tube with a surgical knot at two places and several layers of elastic adhesive bandage, with a standard approach using sterile, transparent, and protective film. METHODS This study enrolled 311 consecutive adults undergoing thoracoscopic lobectomy under general anesthesia at Taizhou Hospital of Zhejiang Province between October 2017 and May 2018. Patients were randomized to experimental and control groups and were followed for up to 72 hours. The primary endpoint was dislodgement of the PVC. Secondary endpoints were blood in the catheter; analgesia pump obstruction alarm; time taken and cost of PVC replacement; replacement of securing materials and analgesia pump line; and time and cost of replacing them. All adverse events were recorded. FINDINGS Final analysis included 248 patients (experimental group: n = 126; control group: n = 122). PVC dislodgement was less frequent in the experimental group than in the control group. In the control group, 78.7% of patients required replacement of securing materials (costing 37 cents each time) and 13.1% required PVC replacement (costing 3.6 dollars each time), necessitating additional nursing time. No patients in the experimental group required replacement of the PVC or securing materials. Blisters were less common in the experimental group than in the control group (0% vs 9.84%, P < .001). No patients had limb edema. CONCLUSIONS This new method of securing an analgesia pump line can reduce traction on the indwelling PVC, lowering the dislodgement rate.
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Hosseini SJ, Eidy F, Kianmehr M, Firouzian AA, Hajiabadi F, Marhamati M, Firooz M. Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial. J Caring Sci 2021; 10:84-88. [PMID: 34222117 PMCID: PMC8242293 DOI: 10.34172/jcs.2021.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency. Methods: In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1). Results: The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups. Conclusion: There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.
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Affiliation(s)
| | - Fereshteh Eidy
- Department of Biostatistics, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Majid Kianmehr
- Department of Basic Sciences, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | | | - Fatemeh Hajiabadi
- Department of Medical Surgical, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Marhamati
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Mahbobeh Firooz
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
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Dogu Kokcu O, Cevik C. The Predictive Strength of Students' Self-Efficacy, Problem Solving Skills to Perform Catheter Care. J Korean Acad Nurs 2021; 50:411-418. [PMID: 32632074 DOI: 10.4040/jkan.20002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to determine the predictive strength of students' self-efficacy, problem-solving skills, and other characteristics in performing intravenous practices and monitor phlebitis and infiltration. METHODS This cross-sectional study was carried out with 736 third and fourth-year students studying at the Health Sciences Faculties of Balikesir and Sakarya universities. The data were collected using the Self-Efficacy Scale, Problem-Solving Inventory and Catheter Care and Infiltration Monitoring Questionnaire. RESULTS The participants' mean Catheter Care and Infiltration Monitoring Questionnaire score significantly and positively correlated with their mean Self-Efficacy Scale score on a moderate level (r=.25; p <.001) but significantly and negatively correlated with their mean Problem-Solving Inventory score on a moderate level (r=-.21; p <.001). In other words, because a low Problem-Solving Inventory score indicates that the person's problem-solving skill is high, the Care and Infiltration Monitoring Questionnaire score increased as the problem-solving skill increased. While the Self-Efficacy Scale predicted the year of study and catheter care and infiltration monitoring variables positively, the Problem-Solving Inventory predicted the satisfaction with the profession variable negatively. CONCLUSION Self-efficacy, problem-solving, liking the profession, and year of study predict success in catheter care and infiltration monitoring. For this reason, guidance may be provided in the development of a comprehensive education system toward increasing students' problem-solving skills, self-efficacy, and professional knowledge and skills.
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Affiliation(s)
- Ozlem Dogu Kokcu
- Department of Fundamentals of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Celalettin Cevik
- Department of Public Health Nursing, Faculty of Health Sciences, Balikesir University Cagıs Campus, Balikesir, Turkey.
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Senkal M, Bonavina L, Reith B, Caruso R, Matern U, Duran M. Perioperative peripheral parenteral nutrition to support major gastrointestinal surgery: Expert opinion on treating the right patients at the right time. Clin Nutr ESPEN 2021; 43:16-24. [PMID: 34024508 DOI: 10.1016/j.clnesp.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS Patients undergoing major gastrointestinal surgery may be in particular need of nutritional therapy due to potential pre-existing disease-related malnutrition and the impact of surgical procedures. Peripheral parenteral nutrition (PPN), delivered via a peripheral catheter, is aligned with the Enhanced Recovery After Surgery (ERAS) concept of minimally invasive interventions where possible. However, uncertainties regarding perioperative PPN for patients undergoing major gastrointestinal surgery arise, in part, due to lack of clinical guidelines. This paper aims to provide practical guidance on perioperative PPN, within the framework of ERAS. METHODS A panel of surgeons and nurses convened to identify knowledge gaps and share their best practice experience regarding PPN provision for patients undergoing major gastrointestinal surgery. Clinical needs were identified and addressed based on the panel's experience and a narrative review. RESULTS Key topics addressed include how PPN can support ERAS nutritional recommendations, identifying gastrointestinal surgery patient subgroups who are likely to benefit from PPN, perioperative timepoints when PPN may be required, and optimizing the delivery of PPN. An algorithm to support the identification and management of patients' perioperative nutritional needs was developed. CONCLUSIONS This paper aims to assist healthcare providers by addressing best practice questions related to the use of PPN during the critical perioperative period within the ERAS concept. This may facilitate timely nutritional intervention to help improve postoperative clinical outcomes and quality of life for patients undergoing major gastrointestinal surgery.
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Affiliation(s)
| | - Luigi Bonavina
- University of Milan Medical School, Milan, Italy; IRCCS Policlinico San Donato, Division of General and Foregut Surgery, San Donato Milanese, Milan, Italy.
| | - Bernd Reith
- Agaplesion Diakonie Clinic, Kassel, Germany.
| | - Rosario Caruso
- IRCCS Policlinico San Donato, Health Professions Research and Development Unit, San Donato Milanese, Milan, Italy.
| | | | - Manuel Duran
- King Juan Carlos University Hospital, Faculty of Health Sciences, King Juan Carlos University, Madrid, Spain.
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Impact of Physician Inspection in the Detection of Phlebitis and Factors Contributing to it in Admitted Children of a Tertiary Care Hospital: A Prospective Study. Indian J Pediatr 2021; 88:358-362. [PMID: 33051788 DOI: 10.1007/s12098-020-03520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether additional dedicated observations by a doctor would increase the pickup rate of phlebitis and related complications due to intravenous cannulation. Also, to identify the common demographic and clinical factors predisposing to phlebitis in children. METHODS This prospective study was conducted from January 2019 through December 2019. A total of 184 children with 341 cannulations were enrolled. The authors added dedicated inspection of cannula by the physician during rounds in attempt to increase the detection of phlebitis. The difference in detection rates of thrombophlebitis by physician and routine observation along with the demographic and clinical variables contributing to thrombophlebitis in hospitalized children were studied. RESULTS Total incidence of thrombophlebitis was 35/341 (10.3%), which included 2 extravasations. Nineteen events (55%) were picked up by routine nursing observations and an additional 16 (45%) by the physician. Among the factors contributing to phlebitis, maternal education status <12th standard (41.7% vs. 15.1% P = 0.018), cannula located on forearm (p value 0.008), bigger cannula size (18% vs. 8.6% P = 0.008), non-splinted cannula (14.4% vs. 7.7% P = 0.046) intravenous fluid containing potassium (15.4% vs. 2.9%, P = 0.001) and concentrated infusions in particular aminophylline and magnesium sulphate (26.3% vs. 9.3%, P = 0.018) were found to be significantly associated with the development of phlebitis. CONCLUSIONS Physician inspection during rounds can improve phlebitis detection and will also increase the sensitivity of nursing observation.
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An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC). Infect Control Hosp Epidemiol 2021; 42:1098-1104. [PMID: 33441207 DOI: 10.1017/ice.2020.1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data on short-term peripheral intravenous catheter-related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied. METHODS International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used. RESULTS In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635-2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975-1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%. CONCLUSIONS Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
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Roberts R, Borley A, Hanna L, Dolan G, Ganesh S, Williams EM. Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study. Clin Oncol (R Coll Radiol) 2020; 33:230-240. [PMID: 33308947 DOI: 10.1016/j.clon.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 11/15/2022]
Abstract
AIMS Anthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20-30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms. MATERIALS AND METHODS A prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments. RESULTS After three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001). CONCLUSION It is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.
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Affiliation(s)
- R Roberts
- Velindre Cancer Centre, Whitchurch, Cardiff, UK.
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - L Hanna
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - G Dolan
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - S Ganesh
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access 2020; 23:57-66. [PMID: 33302797 DOI: 10.1177/1129729820978124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PVCs) are widely used vascular access devices for infusion therapy; however, they are associated with relatively high failure rates. This study aimed to identify the incidence, risk factors and medical costs of PVC-induced complications in adult hospitalised adult patients in China. METHODS An observational, prospective study on 1069 patients lasting 5 months was conducted at a tertiary teaching hospital. RESULTS Infiltration ranked first among PVC complications with an incidence of 17.8%, followed by occlusion (10.8%) and phlebitis (10.5%). Most complications in phlebitis (88.4%) and infiltration (93.7%) were Grade 1. Catheters left in for over 96 h did not show a higher incidence of complications. Patients from the surgical department were more susceptible to infiltration, phlebitis and occlusion. The 26 gauge (Ga) catheters decreased the risk of phlebitis and occlusion, whereas 24Ga catheters increased infiltration rates. Infusing irritant drugs increased phlebitis and infiltration rates. The presence of comorbidities and non-use of needleless connectors were associated with occlusion. Compared with forearm insertion, the risk of occlusion nearly doubled with the dorsum of the hand insertion and the risk of infiltration tripled with antecubital fossa insertion. Medical treatment costs for PVC complications ranged from 0.3 to 140.0 CNY. CONCLUSIONS Infiltration is the most common PVC-related adverse event. Clinically-indicated instead of routine replacement of catheters is safe. More efforts are warranted to improve nurses' adherence to recent guidelines in terms of insertion site selection and needleless connector utilisation to reduce medical costs associated with catheter replacement.
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Affiliation(s)
- Congcong Liu
- Ward III, Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lin Chen
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Dong Kong
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Fangfang Lyu
- Department of Cardiac Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Linlin Luan
- Ward II, Department of Anesthesia Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
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