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Marsh N, Larsen EN, O'Brien C, Groom P, Kleidon TM, Alexandrou E, Young E, McCarthy K, Rickard CM. Comparing the use of midline catheters versus peripherally inserted central catheters for patients requiring peripherally compatible therapies: A pilot randomised controlled trial (the compact trial). Infect Dis Health 2023; 28:259-264. [PMID: 37142538 DOI: 10.1016/j.idh.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Midline catheter (MC) use has increased in acute-care settings, particularly for patients with difficult venous access or requiring peripherally compatible intravenous therapy for up-to 14 days. Our aim was to assess feasibility and generate clinical data comparing MCs with Peripherally Inserted Central Catheters (PICCs). METHODS A two-arm parallel group pilot randomised controlled trial (RCT), comparing MCs with PICCs, was conducted in a large tertiary hospital in Queensland between September 2020 and January 2021. The primary outcome was study feasibility, measured against rates of eligibility (>75%), consent (>90%), attrition (<5%); protocol adherence (>90%) and missing data (<5%). The primary clinical outcome was all-cause device failure. RESULTS In total, 25 patients were recruited. The median patient age was 59-62 years; most patients were overweight/obese, with ≥2 co-morbidities. PRIMARY OUTCOMES The eligibility and protocol adherence criteria were not met; of 159 screened patients, only 25 (16%) were eligible, and three patients did not receive their allocated intervention post-randomisation (88% adherence). All-cause failure occurred in two patients allocated to MC (20%) and one PICC (8.3%). CONCLUSIONS Our study found that a fully powered RCT testing MCs compared with PICCs is not currently feasible in our setting. We recommend a robust process evaluation before the introduction of MCs into clinical practice.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Peter Groom
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Tricia M Kleidon
- School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Evan Alexandrou
- Liverpool Hospital, New South Wales, Australia; School of Nursing, University of Wollongong, New South Wales, Australia.
| | - Emily Young
- School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia.
| | - Kate McCarthy
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia.
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Ross EL, Petty K, Salinas A, Her C, Carpenter JF. Physical compatibility of medications with concentrated neonatal and pediatric parenteral nutrition: A simulated Y-site drug compatibility study. JPEN J Parenter Enteral Nutr 2023; 47:372-381. [PMID: 36582024 DOI: 10.1002/jpen.2469] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The physical intravenous Y-site compatibility of 15 different medications with highly concentrated neonatal and pediatric parenteral nutrition (PN) compounds is described, using existing and novel methods. METHODS PN formulations were developed based on common prescribing practices in a 400+-bed freestanding children's hospital. Medications at commonly used pediatric concentrations were mixed in a 1:1 ratio with both pediatric and neonatal PN formulations and incubated at room temperature for 4 h to simulate Y-site administration. Samples were then analyzed using the light obscuration (LO) technique, as recommended by United States Pharmacopeia (USP) chapter <788>, in addition to novel flow imaging (FI) microscopy and backgrounded membrane imaging (BMI). Physical compatibility was determined using USP <788> particle count limits for all techniques. RESULTS Most combinations were found to be compatible per USP <788> thresholds. Pediatric PN was incompatible by at least two methods with cisatracurium 2 mg/ml, sildenafil 0.8 mg/ml, furosemide 10 mg/ml, and ketamine 10 mg/ml. Neonatal PN was incompatible by at least two methods with cisatracurium 2 mg/ml and furosemide 10 mg/ml. Overall, results for 20 of the 30 combinations (66%) agreed across all three methods. FI and BMI results agreed for 22 of 30 combinations. LO agreed with FI in 25 of 30 combinations, and BMI and LO results agreed in 23 of 30 combinations. CONCLUSION Most combinations tested were found to be compatible across all methods. Novel methods of FI and BMI seem useful to further evaluate LO findings and improve accuracy of particle counts when assessing PN-medication combinations.
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Affiliation(s)
- Emma L Ross
- Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kirsten Petty
- Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Allison Salinas
- Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Cheng Her
- Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado, Aurora, Colorado, USA.,Department of Biology, Merrimack College, New Andover, Massachusetts, USA
| | - John F Carpenter
- Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado, Aurora, Colorado, USA
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Vijayananthan A, Bhurani D, Sapra H, Yasuda H, Kim JY, Hoerauf K, Mifflin N, Hong SK, Sheng WH, Terasaka Y. Asia-Pacific guidelines for standardization of appropriate selection, placement, and management of vascular access devices. J Vasc Access 2023:11297298221150664. [PMID: 36688479 DOI: 10.1177/11297298221150664] [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: 01/24/2023] Open
Abstract
Vascular access devices (VADs) are common and essential in the healthcare setting. However, several factors influence VAD selection and management. Wide variations in VAD practices and the degree of VAD awareness are noted across Asia-Pacific (APAC) countries. An international panel was convened that applied the ASA 2020 method to develop standard criteria for use of VADs in the APAC region. After a literature search, scenarios related to VAD use, care, and maintenance were developed according to the patient population, indication for insertion, and duration of use. These scenarios were rated on a scale of 1-5 (1 being strongly disagreed and 5 strongly agreed) by 11 expert members. A total of 48 clinical scenarios were developed: 23 in hospitalized patients, 3 in critical patients, 4 in cancer settings, 7 pertinent to VAD placement, and 11 for VAD maintenance. The multidisciplinary panel generated several recommendations for the use, care, and management of VADs across general hospitalized patients with or without difficult venous access, critically ill patients, patients with malignancy, patients with different stages of chronic kidney disease (CKD) with or without dialysis, and in other special populations through evidence-based standards. These recommendations may help in achieving uniformity in practice patterns and improving the quality of VAD care and quality of life of patients in APAC region.
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Affiliation(s)
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre Sector 5, West Delhi, New Delhi, DL, India
| | - Harsh Sapra
- The Medicity Hospital, Gurgaon, Haryana, India
| | - Hideto Yasuda
- Department of Emergency and Critical care Medicine, Jichi Medical University Saitama Medical Center, Kyoto, Japan
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Klaus Hoerauf
- VP Global Medical Affairs, Becton, Dickinson and Company, New York City Metropolitan Area, USA
| | - Nicholas Mifflin
- Clinical Nurse Consultant Central Venous Access & Parenteral Nutrition Liverpool Hospital, Liverpool, NSW, Australia, Adjunct Fellow School of Nursing & Midwifery Western Sydney University, Blacktown, NSW, Australia
| | - Suk Kyung Hong
- University of Ulsan College of Medicine: Songpa-gu, Seoul, Korea
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City
| | - Yusuke Terasaka
- Director of Emergency Department, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan
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Ross EL, Petty K, Salinas A, Bremmer J, Her C, Carpenter JF. Physical Compatibility of Y-site Pediatric Drug Administration: A Call for Question of US Pharmacopeia Standards. J Pediatr Pharmacol Ther 2023; 28:84-92. [PMID: 36777987 PMCID: PMC9901315 DOI: 10.5863/1551-6776-28.1.84] [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: 08/11/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the physical intravenous Y-site compatibility of 29 combinations of medications at commonly used pediatric concentrations using both existing and novel techniques. METHODS Medication combinations included were selected by a varied group of pediatric inpatient pharmacists, and then assessed by 3 independent reviewers for existing literature. For each combination, 2 different medications were mixed together in a 1:1 ratio and incubated at room temperature for 4 hours to simulate Y-site administration. Each sample was then analyzed using the US Pharmacopeia (USP) <788> recommended analytical technique of light obscuration (LO) in addition to novel flow imaging (FI) microscopy and backgrounded membrane imaging (BMI). Physical compatibility was determined using USP chapter <788> large volume particle count limits for all techniques. RESULTS A total of 29 different medication combinations were studied. Five combinations met criteria for compatibility by all 3 techniques. The remaining 24 combinations reached the threshold to be considered incompatible by at least 1 of the 3 techniques. Light obscuration, BMI, and FI identified 14%, 59%, and 76% of combinations as incompatible, respectively. All samples deemed incompatible by LO were also incompatible by at least 1 of the other 2 techniques. Flow imaging and BMI results agreed in 69% of samples tested. CONCLUSIONS Most combinations tested were found to be incompatible by at least 1 of the 3 instruments used. Light obscuration appears to have reduced accuracy for identifying particulate resulting in physical medication incompatibility when compared with the novel techniques of FI and BMI.
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Affiliation(s)
- Emma L. Ross
- Department of Pharmacy (ELR, KP, AS), Children's Hospital Colorado, Aurora, CO
| | - Kirsten Petty
- Department of Pharmacy (ELR, KP, AS), Children's Hospital Colorado, Aurora, CO
| | - Allison Salinas
- Department of Pharmacy (ELR, KP, AS), Children's Hospital Colorado, Aurora, CO
| | - Jarrett Bremmer
- Department of Pharmacy (JB), University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO
| | - Cheng Her
- Department of Basic Science (CH, JFC), University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO
| | - John F. Carpenter
- Department of Basic Science (CH, JFC), University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO
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Villalba-Nicolau M, Chover-Sierra E, Saus-Ortega C, Ballestar-Tarín ML, Chover-Sierra P, Martínez-Sabater A. Usefulness of Midline Catheters versus Peripheral Venous Catheters in an Inpatient Unit: A Pilot Randomized Clinical Trial. NURSING REPORTS 2022; 12:814-823. [PMID: 36412798 PMCID: PMC9680301 DOI: 10.3390/nursrep12040079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Canalization of vascular accesses is one of the most used techniques in hospitalization units. When talking about peripherally inserted catheters, we can differentiate between peripheral intravenous catheters (PIVC), midline catheters, and long peripheral catheters (LPC). Midline catheters are rarely used despite being recommended for intravenous therapies lasting more than six days. This research is a pilot study of a longitudinal clinical trial. It aims to compare the complications associated with intravenous therapy between the control group (CG) with a PIVC and the experimental group (EG) with a midline in an Internal Medicine Unit of a Spanish hospital for three months. In this study, 44 subjects participated, 25 in the CG and 19 in the EG. The duration of cannulation was longer in the experimental group (8.13 days vs. 3.22, p < 0.001), and the appearance of phlebitis was more significant in the control group (19 patients in CG and 25 patients in EG). Midlines have presented a longer duration of cannulation and fewer complications than the PIVC. This protocol was registered with ClinicalTrials.gov (NCT05512117).
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Affiliation(s)
- Marcela Villalba-Nicolau
- Consultorio de Motilleja, Centro de Salud de Madrigueras, Gerencia de Arencion integrada de Albacete, 02230 Albacete, Spain
| | - Elena Chover-Sierra
- Nursing Department, Facultat d'Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
| | - Carlos Saus-Ortega
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
- Nursing School La Fe, Adscript Center of Universidad de Valencia, 46026 Valencia, Spain
| | - Maria Luisa Ballestar-Tarín
- Nursing Department, Facultat d'Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
| | - Pilar Chover-Sierra
- Nursing Department, Facultat d'Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain
| | - Antonio Martínez-Sabater
- Nursing Department, Facultat d'Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
- Grupo Investigación en Cuidados (INCLIVA), Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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Bahl A, Johnson S, Mielke N, Chen NW. Risk Factors for Midline Catheter Failure: A Secondary Analysis of an Existing Trial. Ther Clin Risk Manag 2022; 18:999-1007. [PMID: 36238957 PMCID: PMC9553030 DOI: 10.2147/tcrm.s383502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective While midline catheters (MCs) are considered to be a reliable form of vascular access, up to 25% of the placements culminate in failure. We aimed to explore risk factors for MC failure. Methods We performed an analysis of existing randomized controlled trial data involving a comparison of two midline catheters. The study aimed to assess risk factors related to MC failure, including patient, procedure, catheter, and vein characteristics. Cox regression was used for univariable and multivariable analyses to evaluate the association between characteristics and MC failure. Results Among 191 patients that were included in this secondary analysis, more patients were female (114/191 [59.7%]) and average age was 60.2 (SD = 16.7) years. Clinical indications for MC placement included antibiotics (60.7%), difficult venous access (32.5%), or both (6.8%). In a univariable Cox regression analysis, the increase in pulse rate (HR 1.02; 95% CI, 1.00–1.04; P=0.02), temperature ≥38°C (HR 5.59; 95% CI, 1.96–15.94; P=0.001), oxygen saturation <93% (HR 2.91; 95% CI, 1.03–8.24; P=0.04), norepinephrine in dextrose infusion (HR 2.41; 95% CI, 1.17–4.97; P=0.02) and cephalic vein insertion (HR, 2.47; 95% CI, 1.09–5.57; P=0.03) were all associated with higher risk of MC failure. In a multivariable Cox model, difficult venous access (aHR 2.05; 95% CI, 1.04–4.05; P=0.04) and norepinephrine in dextrose (aHR 2.29; 95% CI, 1.09–4.82; P=0.03) was associated with catheter failure. Conclusion Elevated pulse rate, decreased oxygen saturation level, temperature ≥38°C, and norepinephrine use were each associated with an increased risk of MC failure. These factors should be considered when selecting the most appropriate vascular access device for individual patients. Additionally, the cephalic vein insertion has the highest risk for MC failure and other access points could be preferentially considered.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA,Correspondence: Amit Bahl, Department of Emergency Medicine, Beaumont Hospital, Royal Oak, 3601 13 Mile Road, Royal Oak, MI, 48073, USA, Email
| | - Steven Johnson
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nai-Wei Chen
- Research Institute, Beaumont Hospital, Royal Oak, MI, USA
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Jeon MH, Kim CS, Han KD, Kim MJ. Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique. Vasc Specialist Int 2022; 38:2. [PMID: 35307696 PMCID: PMC8938155 DOI: 10.5758/vsi.210062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/06/2022] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose The midline catheter (MC) is a peripheral venous access device with the catheter tip located in the axilla and available for mid-term intravenous (IV) therapy. This study evaluated the efficacy and clinical outcomes associated with the placement of MCs with an integrated wire-accelerated Seldinger technique for IV access. Materials and Methods A retrospective review was conducted at a single center in South Korea between March 2020 and July 2020. Consecutive patients in whom MC insertions were performed by vascular surgeons were enrolled. The outcomes included catheter indwelling time and incidence of catheter-related adverse events. Results Ninety-five patients (117 catheters) were included in the study. The total indwelling time was 1,964 days, with a median of 16.7 days (range, 0-76). The complication-free catheter rates at 5 and 28 days were 92.9% and 65.5%, respectively. Overall, 32 (27.4%) catheters were removed due to complications; however, major complications, such as symptomatic deep venous thrombosis and catheter-induced bloodstream infections, were confirmed in only 3 (2.6%) catheters. A common reason for premature catheter removal is inadvertent removal owing to patient inattention. A high body mass index and female sex were identified as risk factors for short indwelling times and complicated premature catheter removal. Conclusion MC insertion is a simple and operator-friendly procedure with a low rate of major complication. It enables mid-term IV treatment through a single procedure if there are no specific complications, thereby improving quality of life of patients during hospital stay.
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Affiliation(s)
- Mun Hee Jeon
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Cheol Seung Kim
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Kyu Dam Han
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Mi Jin Kim
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
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Farhat R, Minoff J, Burke S, Patolia S. Recommended Reading from Saint Louis University School of Medicine Fellows. Am J Respir Crit Care Med 2021; 204:1473-1475. [PMID: 34699334 DOI: 10.1164/rccm.202103-0685rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rania Farhat
- Saint Louis University, 7547, Saint Louis, Missouri, United States
| | - Jennifer Minoff
- Saint Louis University, 7547, Saint Louis, Missouri, United States
| | - Shannon Burke
- Saint Louis University, 7547, Saint Louis, Missouri, United States
| | - Setu Patolia
- Saint Louis University, 7547, Pulmonary and Critical Care, Saint Louis, Missouri, United States;
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Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
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10
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Bing S, Smotherman C, Rodriguez RG, Skarupa DJ, Ra JH, Crandall ML. PICC versus midlines: Comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications. Am J Surg 2021; 223:983-987. [PMID: 34600737 DOI: 10.1016/j.amjsurg.2021.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To decrease the complications related to central catheters there has been an increasing utilization of peripherally inserted central catheters (PICC) and ultrasound-guided long peripheral intravenous catheters (i.e. midlines). While the complications of PICC lines are well described there is less reported data on complications related to midline catheters. Our study aims are to compare the incidences of infectious and deep venous thrombosis (DVT) and sepsis related to PICCs and Midlines. METHODS We performed a single-center retrospective review at an academic hospital. Data were collected on patients admitted between 1/1/2014-5/31/2016. Patient demographics, hospital length of stay (LOS), and ventilator days were collected. Outcomes of interest were line-related infections and thromboembolic events after the placement of these catheters. Endpoints were compared between three groups (PICC group, midline group and PICC placement followed by midline placement group). Univariate and multivariable analyses were used to compare across the three groups. RESULTS The study included 3560 unique patients with 5058 catheters. There was an increase in use of midlines over the observed study period (245% increase from the end of 2015 to the middle of 2016). We found no significant differences in the rates of DVT among the three groups (PICC 4%, midline 3% and PICC-midline 4%; p = 0.12). There were no differences across the groups for sepsis (PICC 29%, midline 27%, and PICC-midline 32%; p = 0.14) or septic shock (PICC 7%, midline 8%, and PICC-midline 6%; p = 0.39). Adjusted means LOS were higher for patients with PICC lines compared to midlines, in both females and males. PICC group stayed longer, on average, on the ventilator compared to the midline group. No other significant differences were seen among groups. CONCLUSION Increased utilization of midline catheters were not associated with decreased risk of DVT or sepsis when compared to peripherally inserted central catheters.
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Affiliation(s)
- Shaoxu Bing
- Department of Surgery, Resident, University of Florida College of Medicine Jacksonville, FL, USA
| | - Carmen Smotherman
- Biostatistician, Center for Data Solutions, University of Florida, College of Medicine Jacksonville, FL, USA
| | - Ryan Gustavo Rodriguez
- Department of Surgery, Resident, University of Florida College of Medicine Jacksonville, FL, USA
| | - David J Skarupa
- Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jin Hee Ra
- Department of Surgery, University of North Carolina, Chapel Hill, USA
| | - Marie L Crandall
- Department of Surgery, Division Chief, Acute Care Surgery, University of Florida College of Medicine, Jacksonville, FL, USA.
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11
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Tomás-López MA, Cristóbal-Domínguez E, Báez-Gurruchaga O, Landa-Portilla B, González-Blas L, Lurueña-Rodríguez S, Picón-Santamaría A, Armenteros-Yeguas V. Experience in the use of midclavicular catheters: An inception cohort study. J Clin Nurs 2021; 31:2296-2308. [PMID: 34553435 DOI: 10.1111/jocn.16047] [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: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal. BACKGROUND Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length. DESIGN Inception cohort study. METHODS We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed. RESULTS Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure. CONCLUSIONS Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal. RELEVANCE TO CLINICAL PRACTICE Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.
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Affiliation(s)
- María Aranzazu Tomás-López
- Oncology department nursing supervisor, Bioaraba, Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Estíbaliz Cristóbal-Domínguez
- Evidence based nursing supervisor. Bioaraba, Nursing and Health Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Oiane Báez-Gurruchaga
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Beatriz Landa-Portilla
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Laura González-Blas
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Selene Lurueña-Rodríguez
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Arantxa Picón-Santamaría
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Victoria Armenteros-Yeguas
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
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12
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Kleidon TM, Schults JA, Wainwright C, Mihala G, Gibson V, Saiyed M, Byrnes J, Cattanach P, Macfarlane F, Graham N, Shevill E, Ullman AJ. Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial. Paediatr Anaesth 2021; 31:985-995. [PMID: 34053159 DOI: 10.1111/pan.14229] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The optimal intravenous device for antibiotic administration for children with respiratory disease is uncertain. We assessed the feasibility of a randomized controlled trial comparing midline catheters with peripherally inserted central catheters. METHODS Prospective, two-arm, feasibility randomized controlled trial in an Australian tertiary, pediatric hospital. Random assignment of 110 children (<18 years) to receive (i) midline catheter and (ii) peripherally inserted central catheters. Primary outcome was feasibility (eligibility, recruitment, retention, protocol adherence, and acceptability), and the primary clinical outcome was general anesthesia requirement for intravenous catheter insertion. SECONDARY OUTCOMES insertion time, treatment delays, infusion efficiency, device failure, complications, and cost. RESULTS There was 80% recruitment, 100% retention, no missing data, and high patient/staff acceptability. Mean patient experience assessed on a 0-10 numeric rating scale was 8.0 peripherally inserted central catheters and 9.0 (midline catheters), respectively. Participant eligibility was not achieved (49% of screened patients) and moderate protocol-adherence across groups (89% peripherally inserted central catheters vs. 76% midline catheter). Insertion of midline catheter for pulmonary optimization reduced the requirement for general anesthesia compared to peripherally inserted central catheters (10% vs. 69%; odds ratio = 0.01, 95% confidence interval: 0.00-0.09). Midline catheters failed more frequently (18.1 vs. 5.5 peripherally inserted central catheters per 1000 catheter-days); however, this reduced over trial duration. Midline catheter insertion compared to peripherally inserted central catheters saved AUD$1451 per pulmonary optimization episode. CONCLUSIONS An efficacy trial is feasible with expanded eligibility criteria and intensive staff training when introducing a new device. Midline catheter for peripherally compatible infusions is acceptable to patients and staff, might negate the need for general anesthesia and results in significant cost savings.
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Affiliation(s)
- Tricia M Kleidon
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Jessica A Schults
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Claire Wainwright
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Gabor Mihala
- Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Victoria Gibson
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Masnoon Saiyed
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Joshua Byrnes
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Paula Cattanach
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Fiona Macfarlane
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Nicolette Graham
- Department of Pharmacy, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Elizabeth Shevill
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Amanda J Ullman
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia.,Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
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13
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Penoyer D, Bennett M, Geddie PI, Nugent A, Volkerson T. Evaluation of processes, outcomes, and use of midline peripheral catheters for the purpose of blood collection. ACTA ACUST UNITED AC 2021; 30:S24-S32. [PMID: 33529105 DOI: 10.12968/bjon.2021.30.2.s24] [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] [Indexed: 11/11/2022]
Abstract
HIGHLIGHTS Results added knowledge on use of midline catheters (MCs) for blood sampling. Using MCs for blood withdrawal resulted in low rates of hemolysis (0.69%). Dwell time was longer in those who had blood drawn from their MC. Nurse practices for blood sampling from MCs varied and learned from other nurses. BACKGROUND Blood withdrawal from midline catheters (MCs) is done clinically, but no studies were found evaluating outcomes from this procedure, nor were clinical guidelines found. Drawing blood samples from short peripheral catheters is associated with higher hemolysis rates. METHODS A prospective, observational, mixed methods study was used to evaluate outcomes from using MCs for blood withdrawal. Focus group sessions were held to evaluate nurses' practices for this procedure. RESULTS Data were collected over 3 months on 397 MCs in 378 patients. Hemolysis rates when the MC was used for blood withdrawal was 0.69% in 1021 tests. More than half had blood specimens drawn through the MC, and the time known for the successful withdrawal was on average 64 ± 85 hours. Mean dwell time for all MCs was 108.5 ± 98 hours, and when MCs were used for blood withdrawal, mean dwell time was 127.19 ± 109.13 hours and for MCs not used for blood withdrawal, 88.34 ± 79.86 hours (P < 0.001). In 338 patients who received therapy through their MC (n = 338), 87% completed intended therapy: 88% with blood withdrawal and 81% without blood withdrawal. Qualitative analysis from focus groups demonstrated wide variation in practice for blood sampling from MCs, and most learned techniques from their preceptors, other nurses, or patients. CONCLUSIONS Findings indicated that blood withdrawal from one specific type of MC had low rates of hemolysis, increased dwell time, and completion of therapy. More studies are needed to determine best practices for blood sampling through various types of MCs and outcomes.
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Affiliation(s)
- Daleen Penoyer
- Center for Nursing Research, Orlando Health, Orlando, FL
| | - Melody Bennett
- Center for Nursing Research, Orlando Health, Orlando, FL
| | | | - Alyssa Nugent
- Vascular Access Team, Orlando Regional Medical Center of Orlando Health, Orlando, FL
| | - Tara Volkerson
- Vascular Access Team, Orlando Regional Medical Center of Orlando Health, Orlando, FL
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14
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15
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Zhang Z, Wells C, Brito A, Chan CC, Patel G, Evans W, Hensel N, Kohli-Seth R. Adapting a vascular access service (VAS) to meet the needs of the COVID-19 pandemic. Am J Infect Control 2021; 49:523-524. [PMID: 33600883 PMCID: PMC7884228 DOI: 10.1016/j.ajic.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/23/2022]
Abstract
The novel coronavirus 2019 (COVID-19) pandemic has placed an unprecedented strain on healthcare systems and frontline workers worldwide. The large influx of these high acuity patients has placed pressure on services to modify their operations to meet this increased need. We describe how the Vascular Access Service (VAS) at a New York City academic hospital adopted a team-based approach to efficiently meet increased demand for vascular access devices, while ensuring safety and conserving personal protective equipment.
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Affiliation(s)
- Ziya Zhang
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Celia Wells
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Amy Brito
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Christy C Chan
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Gopi Patel
- Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - William Evans
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Nicole Hensel
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY.
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16
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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17
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Prasanna N, Yamane D, Haridasa N, Davison D, Sparks A, Hawkins K. Safety and efficacy of vasopressor administration through midline catheters. J Crit Care 2020; 61:1-4. [PMID: 33049486 DOI: 10.1016/j.jcrc.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Vasopressors are commonly administered through Central Venous Catheters (CVCs) as it is considered unsafe to administer them via peripheral IVs, mainly due to the concern of local tissue injury. Unlike peripheral IVs, midline catheters provide a wider lumen with the catheter tip ending in a large peripheral vein. The use of vasopressors through midline catheters has not yet been evaluated. OBJECTIVE The primary objective of this study is to determine the safety and efficacy of long term administration of vasopressors through a midline catheter. DESIGN This is a retrospective study between 2016 and 2019 looking at the outcomes of midline catheters. SETTING 45 bed Tertiary level ICU in a 600-bed teaching hospital. PATIENTS A total of 248 patients received vasopressors via midline catheters. RESULTS The average midline dwell time was 14.7 ± 12.8 days and the average duration of continuous vasopressor infusion was 7.8 ± 9.3 days. Vasopressors used with their average dose (AD) were norepinephrine (n = 165, 16.8 CE ± 10.7 μg/min), epinephrine (n = 56, 9.1 CE ± 6.0 μg/min), vasopressin (n = 123, 0.05 CE ± 0.02 units/min), phenylephrine (n = 158, 91.4 CE ± 64.7 μg/min) and Angiotensin II (50 CE ± 27.6 ng/kg/min). Early Complication rate was 3.6% due to Bloodstream infection (n = 6), drug extravasation (n = 1), thrombophlebitis (n = 1) and arterial puncture (n = 1). Late Complication rate was 0.8% (n = 2) due to midline-associated DVTs. There were no complications related to ineffective drug delivery or limb endangerment. CONCLUSIONS Many medical centers are attempting to limit the use of central venous catheters (CVCs) to avoid central line-associated bloodstream infections (CLABSIs). This study demonstrates that midline catheters are a safe alternative to CVCs, for the safe and efficacious administration of vasopressors for prolonged periods of time.
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Affiliation(s)
- Nivedita Prasanna
- Department of Anesthesiology and Critical Care, George Washington University Hospital, Washington D.C., USA.
| | - David Yamane
- Department of Anesthesiology and Critical Care, George Washington University Hospital, Washington D.C., USA
| | - Naeha Haridasa
- Department of George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Danielle Davison
- Department of Anesthesiology and Critical Care, George Washington University Hospital, Washington D.C., USA
| | - Andrew Sparks
- Department of George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Katrina Hawkins
- Department of Anesthesiology and Critical Care, George Washington University Hospital, Washington D.C., USA
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18
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Jacobi J. Call for pharmacists to join vascular safety teams. Am J Health Syst Pharm 2020; 77:1347-1353. [DOI: 10.1093/ajhp/zxaa169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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A Cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis. JOURNAL OF INFUSION NURSING 2019; 42:203-208. [PMID: 31283663 DOI: 10.1097/nan.0000000000000330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.
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20
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Bahl A, Karabon P, Chu D. Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option? Clin Appl Thromb Hemost 2019; 25:1076029619839150. [PMID: 30909723 PMCID: PMC6714901 DOI: 10.1177/1076029619839150] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs)
and peripherally inserted central catheters (PICCs). Limited existing data for MCs suggest
a favorable complication profile for MCs. To compare incidence of CR thrombosis between
MCs and PICCs and to evaluate the impact of quantity of lumens and catheter diameter on CR
thrombosis. This was a retrospective comparison spanning 13 months of MCs and PICCs for
symptomatic CR thrombosis at an 1100 bed tertiary care academic medical center. Adult
patients who had an MC or a PICC placed by the were included. Data were collected using
the electronic medical record. Statistical analysis was performed using SAS software. A
total of 2577 catheters were included in the analysis with 1094 MCs and 1483 PICCs. One
hundred thirty (11.88%) MCs developed CR thrombosis (deep vein thrombosis [DVT] or
superficial venous thrombophlebitis [SVT]) as compared to 112 (6.88%) PICCs (odds ratio
[OR]: 1.82; P < .0001). Midline catheters had a 53% greater odds of
developing CR DVT than PICCs (7.04% MCs and 4.72% PICCs; OR: 1.53; P =
.0126). For CR SVT, MCs have a 2.29-fold greater odds of developing CR SVT than PICCs
(4.84% MCs and 2.16% PICCs; OR: 2.29; P = .0002). For MCs and PICCs, the
incidence of CR thrombosis was 13.50% for double lumen/5F lines and was 6.92% for single
lumen/4F lines (OR: 2.10; P = <.0001). Symptomatic CR thrombosis is a
serious, life-threatening complication that occurs more frequently in MCs compared to
PICCs. Inserters should consider placement of single lumen catheters with the smallest
diameter to reduce this risk when a midline is used.
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Affiliation(s)
- Amit Bahl
- 1 William Beaumont Hospital, Royal Oak, MI, USA
| | - Patrick Karabon
- 2 Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - David Chu
- 2 Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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21
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AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:E4-E18. [PMID: 30758889 DOI: 10.1002/jum.14954] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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22
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Brugioni L, Barchetti M, Tazzioli G, Gelmini R, Girardis M, Bianchini M, Schepis F, Nicolini M, Pinelli G, Martella P, Barozzi M, Mori F, Scarabottini S, Righetti A, Ravazzini M, Bertellini E. A new device for ultrasound-guided peripheral venous access. J Vasc Access 2018; 20:325-328. [PMID: 30253683 DOI: 10.1177/1129729818801302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients with difficult peripheral venous access, alternative techniques require expertise and are invasive, expensive, and prone to serious adverse events. This brought us to designing a new venous catheter (JLB® Deltamed, Inc.) for the cannulation of medium and large bore veins; it is echogenic, and available in different lengths (60 / 70 / 80 mm) and Gauges (14 / 16 / 17 / 18). METHODS We led a multi-center observational convenience sampling study to evaluate safety and effectiveness of JLB. Data was collected from June 2015 to February 2018. Inclusion criteria were age ⩾ 18, difficulty in obtaining superficial venous access in the veins of the arm, need for rapid infusion, or patient's preference. RESULTS We enrolled 1000 patients, mean age 66.8 years. In total, 951 (95.1%) had the device placed in internal jugular vein, 28 in basilic or cephalic vein, 15 in femoral vein, 5 in axillary vein (infra-clavicular tract), and 1 in the external jugular vein. The procedure was performed by attending physicians or emergency medicine residents under US guidance. Mean procedure time (from disinfection to securing) was approximately 240 s. Mean attempts number was 1.21. Early complications (<24 h) occurred in four patients, consisting in two soft tissue hematoma, one phlebitis, and one atrial tachyarrhythmia. No major complications (such as pneumothorax) were reported. Mean indwelling time was 168 h (7 days); early occlusion/dislocation occurred in four cases. CONCLUSION According to preliminary data, the application of JLB appears to be safe, cost-effective, and rapid to place bedside.
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Affiliation(s)
- Lucio Brugioni
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | | | | | | | | | | | | | | | | | - Marco Barozzi
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Mori
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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Chenoweth KB, Guo JW, Chan B, Dowling D, Thibeau S. The Extended Dwell Peripheral Intravenous Catheter Is an Alternative Method of NICU Intravenous Access. Adv Neonatal Care 2018; 18:295-301. [PMID: 29847401 PMCID: PMC6085132 DOI: 10.1097/anc.0000000000000515] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Establishing vascular access is a common neonatal intensive care unit procedure. The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 8-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter. Extended dwell peripheral intravenous catheters have been widely used in adults but evidence in neonates is lacking. PURPOSE To explore indwell time, success rate, catheter-associated complications, and cost among EPIV catheters, PICCs, and PIV catheters in neonates. METHODS We retrospectively compare patient demographics, indwell time, success rate, and catheter-associated complications, and analyze the rate of hyaluronidase-treated intravenous (IV) fluid extravasation on neonates who had an EPIV catheter, a PICC, or a PIV catheter in a level III neonatal intensive care unit. We also estimate the insertion cost of these 3 vascular access devices on the basis of our hospital charges. RESULTS Extended dwell peripheral intravenous catheters were inserted in 432 neonates with an indwell time of 4.0 ± 2.3 (mean ± SD) days. Peripherally inserted central catheters were inserted in 202 neonates with an average indwell time of 7.3 ± 4.4 (mean ± SD) days, which was longer than EPIV catheters (P < .001). Peripherally inserted central catheters had a higher success rate of 83.6% than 71.7% of EPIV catheters, meaning succeeded in lasting through the completion of therapy (P = .001). Peripherally inserted central catheters were associated with 4 cases of life-threatening complications; none was seen in the EPIV catheter group. The incidence of hyaluronidase-treated IV fluid extravasation was less in EPIV catheter recipients (1.2%) than in the PIV catheter recipients (3.9%) (P = .004); none was in the PICC group. Cost savings were noted with using an EPIV catheter. IMPLICATIONS FOR PRACTICE Extended dwell peripheral intravenous catheter is a feasible option for neonatal vascular access. IMPLICATIONS FOR RESEARCH These data provide a baseline for future studies to explore the efficacy and effectiveness of EPIV catheter in the neonates.
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Affiliation(s)
- Kimberlee B. Chenoweth
- Primary Children's Neonatal Nurse Practitioner Group, Intermountain Healthcare, Salt Lake City, Utah (Dr Chenoweth); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Guo); and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Chan)
| | - Jia-Wen Guo
- Primary Children's Neonatal Nurse Practitioner Group, Intermountain Healthcare, Salt Lake City, Utah (Dr Chenoweth); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Guo); and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Chan)
| | - Belinda Chan
- Primary Children's Neonatal Nurse Practitioner Group, Intermountain Healthcare, Salt Lake City, Utah (Dr Chenoweth); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Guo); and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Chan)
| | - Donna Dowling
- Primary Children's Neonatal Nurse Practitioner Group, Intermountain Healthcare, Salt Lake City, Utah (Dr Chenoweth); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Guo); and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Chan)
| | - Shelley Thibeau
- Primary Children's Neonatal Nurse Practitioner Group, Intermountain Healthcare, Salt Lake City, Utah (Dr Chenoweth); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Guo); and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah (Dr Chan)
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Comparison of complications in midlines versus central venous catheters: Are midlines safer than central venous lines? Am J Infect Control 2018. [PMID: 29525366 DOI: 10.1016/j.ajic.2018.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND With the rising use of midline catheters (MCs), validation of their safety is essential. Our study aimed to evaluate the incidence of bloodstream infections (BSIs) and other complications related to the use of MCs and central venous catheters (CVCs). METHODS A retrospective cohort study was performed at a tertiary care hospital in Detroit, Michigan, from March-September 2016. Adult patients with either MC or CVC were included. Outcomes assessed were catheter-related BSI (CRBSI), mechanical complications, hospital length of stay, readmission within 90 days of discharge (RA), and mortality. Statistical analysis was performed using SAS software. RESULTS A total of 411 patients with MC and 282 patients with CVC were analyzed. More CRBSIs were seen in patients with CVC (10/282) than MC (1/411) (3.5% vs 0.2%, respectively; P = .0008). More mechanical complications were seen in patients with MC (2.6%) than CVC (0.3%; P = .03). Patients with CVC had a higher crude mortality (17.3% vs 5.3%; P < .0001), RA (58% vs 35%; P ≤ .0001), line-related RA (2.8% vs 0.2%; P = .0041), and transfer to intensive care unit after line placement (9% vs 5%; P = .01). CVC was a significant exposure for a composite of mortality, CRBSI, mechanical issues, thrombosis, and readmission because of a line-related complication (odds ratio, 3.2; 95% confidence interval, 1.8-5.8). CONCLUSIONS Our findings show use of MC is safer than CVC, but larger studies are needed to confirm our findings.
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Evaluating the Evidence for Midline Catheter Use in the Newborn Intensive Care Unit. JOURNAL OF INFUSION NURSING 2017; 38:420-9. [PMID: 26536329 DOI: 10.1097/nan.0000000000000134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
When deciding which vascular access devices (VADs) are appropriate for patients in newborn intensive care units (NICUs), clinical providers may have difficulty reaching consensus because of a lack of evidence-based recommendations. The aim of this literature review is to evaluate current research and practice pertaining to midline catheter (MC) use in NICU patients. Discussion of the literature review includes information pertaining to the historical perspective of MC use, devices currently in use, common sites for placement, average dwell times, associated costs, and acceptable fluids and medications for infusion through MCs. Conclusive findings suggest that MCs are not an appropriate VAD for NICU patients because of insufficient high-level evidence demonstrating safety and efficacy. Randomized controlled trials are needed to evaluate current MC practice in the NICU and the rates of infection and extravasation associated with their use.
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Abstract
Older adults are a special patient population who require attention to a variety of issues and considerations related to infusion therapy. The need to alter practice approaches includes vascular access techniques and the administration of intravenous medications, fluids, and blood components. In addition, older adults will manifest very different signs and symptoms related to development of an infection in the body. This article reviews the normal physical changes that occur in their major body systems and discusses recommendations to accomplish successful venous access and correct administration of infusates.
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Moureau N, Chopra V. Indications for Peripheral, Midline, and Central Catheters: Summary of the Michigan Appropriateness Guide for Intravenous Catheters Recommendations. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.java.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access; those requiring multiple attempts; and those who are obese, have diabetes, or have other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In clinical settings, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate use for VADs. This article summarizes the work and recommendations of the panel that created the Michigan Appropriateness Guide for Intravenous Catheters.
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Affiliation(s)
- Nancy Moureau
- Griffith University, Brisbane, Australia
- PICC Excellence, Inc, Greenville, SC
- Greenville Memorial Hospital, Greenville, SC
| | - Vineet Chopra
- School of Medicine, University of Michigan, Ann Arbor, MI
- Ann Arbor VA Medical Center, Ann Arbor, MI
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28
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Adams DZ, Little A, Vinsant C, Khandelwal S. The Midline Catheter: A Clinical Review. J Emerg Med 2016; 51:252-8. [DOI: 10.1016/j.jemermed.2016.05.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
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Moureau N, Chopra V. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. ACTA ACUST UNITED AC 2016; 25:S15-24. [DOI: 10.12968/bjon.2016.25.8.s15] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nancy Moureau
- Registered Nurse, Adjunct Associate Professor, Griffith University, Brisbane, Australia; Chief Executive Officer, PICC Excellence, Inc and Vascular Access Specialist, Greenville Memorial Hospital, Greenville, South Carolina
| | - Vineet Chopra
- Doctor of Medicine, Assistant Professor of Medicine and Research Scientist, School of Medicine, University of Michigan, and Ann Arbor VA Medical Center, Ann Arbor, Michigan
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Barton A. Complex vascular access requires making the best use of technology. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S20. [PMID: 26496870 DOI: 10.12968/bjon.2015.24.sup19.s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Barton
- Advanced Nurse Practitioner Vascular Access & IV Lead, Frimley Health NHS Foundation Trust
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Abstract
Abstract
Introduction: Establishing an effective midline program involves more than simply learning an insertion technique for a new product. Midline catheters provide a reliable vascular access option for those patients with difficult venous access who would otherwise require multiple venipunctures or the use of higher-risk central lines to maintain access. An effective midline program establishes a protocol for device selection and includes standing orders to facilitate speed to placement.
Methods: Our retrospective descriptive review evaluated the successful integration of midline programs into existing vascular access bedside insertion programs in 2 acute care hospitals. The investigator reviewed a convenience sample of hospital patients. Participants in the study included vascular access team managers and team members from the sample sites.
Results: The results of this 2-hospital study demonstrate successful integration of a midline program into a bedside insertion program with 0 midline-related infections since initiation. Documentation of overall central line-associated bloodstream infection rates for hospital 1 changed from 1.7/1000 catheter-days to 0.2/1000 catheter-days, reflecting a 78% reduction in infections and a projected cost avoidance of $531,570 annually. Both hospitals demonstrated reduced rates of infection following implementation of a midline program.
Conclusions: Midlines have a history of lower risk for both infection and thrombosis compared with central venous devices. Although more research is needed on the more recently developed midline catheters, available evidence suggests that midlines provide a safe and reliable form of vascular access, reducing costs and the risk of infection associated with central venous catheters, especially those placed solely for patients with difficult venous access.
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Zerla PA, Canelli A, Caravella G, Gilardini A, De Luca G, Parini R, Gianoli M. Open- vs Closed-Tip Valved Peripherally Inserted Central Catheters and Midlines: Findings from a Vascular Access Database. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.java.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal.
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Affiliation(s)
| | | | | | | | - Giuseppe De Luca
- Struttura Complessa Struttura Infermieristica Tecnica Riabilitativa Aziendale, A.O. Melegnano, Milan, Italy
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Affiliation(s)
- Kate Owen
- Senior District Nurse, Community IV Team Leader and Queen's Nurse, Dudley Group NHS Foundation Trust, Dudley
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Affiliation(s)
- Cheryl Dumont
- At Winchester Medical Center in Winchester, Va., Cheryl Dumont is director of nursing research and the vascular access team, and Ozlem Getz and Sheri Miller are members of the vascular access team. Dr. Dumont is also a member of the Nursing2014 editorial board and coordinates both the I.V. Rounds and Research Corner departments
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Warrington WG, Penoyer DA, Kamps TA, Van Hoeck EH. Outcomes of Using a Modified Seldinger Technique for Long Term Intravenous Therapy in Hospitalized Patients with Difficult Venous Access. ACTA ACUST UNITED AC 2012. [DOI: 10.2309/java.17-1-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background and Significance: Many hospitalized patients require an intravenous (IV) catheter to maintain vascular access or for administration of fluids and medications. The best approach to attaining peripheral intravenous (PIV) access for long term therapy is unknown, particularly in patients with a history of difficult IV placement.
Purpose: To measure clinical outcomes using a Modified Seldinger Technique (MST) with ultrasound (US) guidance to achieve and maintain PIV for long term IV therapy.
Methods: Subjects were patients with a history of difficult peripheral intravenous catheter placement and need for IV therapy longer than 72 hours. Modified Seldinger Technique was used with US guidance to place all PIVs in the deep veins of the upper extremities.
Results: A convenience sample of 157 subjects was enrolled in the study. Mean dwell time for catheter duration was seven days. First attempt placement success was 95%, 88.5% of patients had completion of IV therapy, and a low overall complication rate (9.57/1000 catheter days).
Conclusion: Using MST for access for long term PIV therapy was associated with low complications and effective in our study population. Using MST requires specialized knowledge and skills, including the use of US and specialized insertion techniques. In patients who require extended PIV therapy with a history of difficult IV placement, this type of insertion technique may have benefit.
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Affiliation(s)
| | | | - Teresa A. Kamps
- Clinical Support Manager, Access Scientific, Inc., San Diego, CA
| | - Ella H. Van Hoeck
- Registered Nurse, PICC Department, Orlando Regional Medical Center, a part of Orlando Health, Orlando, FL
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Alexandrou E, Murgo M, Calabria E, Spencer TR, Carpen H, Brennan K, Frost SA, Davidson PM, Hillman KM. Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services. Int J Nurs Stud 2012; 49:162-8. [DOI: 10.1016/j.ijnurstu.2011.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/17/2011] [Accepted: 08/31/2011] [Indexed: 11/30/2022]
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