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Patrianakos J, Longo BA, Williams SC. Successful practices to reduce central line-associated bloodstream infections post pandemic: A qualitative study. Am J Infect Control 2024; 52:1227-1234. [PMID: 39025303 DOI: 10.1016/j.ajic.2024.07.005] [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: 04/02/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Central Line-Associated Bloodstream Infections (CLABSIs) decreased in U.S. hospitals over the last decade, but CLABSI rates increased during the COVID-19 pandemic disrupting the downward trend. This study explored factors contributing to the reduction of CLABSI, identifying deviations in infection prevention and control protocol during the pandemic, actions taken to address the increase in CLABSI, and factors promoting sustained progress. METHODS This qualitative study used the National Healthcare Safety Network data. The Centers for Disease Control and Prevention identified hospitals with elevated CLABSI standardized infection ratios (SIR) >1 between Q1 2019 - Q4 2021 followed by four quarters of sustained reduction (CLABSI SIR <1). Joint Commission researchers conducted semi-structured phone interviews with infection preventionist professionals from six hospitals representing these performance patterns. RESULTS Interview themes suggested that staffing shortages (83%) and less vigilant central line practices (100%) contributed to increased CLABSI SIR during the pandemic. Organizations described evidence-based interventions, such as using chlorhexidine gluconate for skin preparation, along with other innovative strategies they used to establish reduced CLABSI rates. CONCLUSIONS Despite challenges faced during the COVID-19 pandemic, some health care organizations have excelled in their efforts to reduce and sustain low rates of CLABSI by implementing evidence-based practices, innovative solutions, and education.
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Affiliation(s)
| | - Beth A Longo
- Department of Research, The Joint Commission, Oakbrook Terrace, IL
| | - Scott C Williams
- Department of Research, The Joint Commission, Oakbrook Terrace, IL
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2
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Knapek K, Stein EP, Bernhardt M, Flanigan J, Lazar C, Reese SM. Using a standardized algorithm to decrease central venous catheter utilization. Am J Infect Control 2024; 52:1336-1338. [PMID: 38942081 DOI: 10.1016/j.ajic.2024.06.016] [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: 04/12/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
Central venous catheters (CVCs) have many benefits in patient care but are associated with increasing risks with catheter duration. A level II trauma-certified community hospital sought to decrease CVC duration utilizing a daily assessment algorithm in the critical care unit. After implementation, CVC days decreased from 490 CVC days per 1,000 patient days to 452 (odds ratio 0.86, P < .01) and catheter duration decreased from 7.71 days to 6.57 (P = .19).
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Affiliation(s)
- Kelley Knapek
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO.
| | - Emma P Stein
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Marybell Bernhardt
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - John Flanigan
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Catherine Lazar
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Sara M Reese
- Infection Prevention, Intermountain Health, Broomfield, CO
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3
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Al-Zubeidi D, Davis MB, Rahhal R. Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review. Nutr Clin Pract 2024; 39:1037-1053. [PMID: 39152093 DOI: 10.1002/ncp.11201] [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: 05/03/2024] [Revised: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 08/19/2024] Open
Abstract
Hospitalized patients may benefit from parenteral nutrition to address their compromised nutrition status attributed to limited oral/enteral intake and increased nutrient/energy requirement during acute illness. Parenteral nutrition, however, can be associated with many complications that can negatively impact patient outcomes. In this review, we focus on potential metabolic and catheter-related complications associated with parenteral nutrition use. We report on potential risk factors for such complications and highlight strategies for prevention and early recognition. To optimize outcomes, key findings include the creation and implementation of evidence-based protocols with proven efficacy. For each hospital unit delivering parenteral nutrition to patients, tracking compliance with established protocols and patient outcomes is crucial for ongoing improvement through identification of gaps, proper reeducation and training, and ongoing refinement of care protocols. Establishment of specialized inpatient nutrition support teams should be considered.
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Affiliation(s)
- Dina Al-Zubeidi
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Mary Beth Davis
- College of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Riad Rahhal
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
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4
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Nickel B. Optimizing peripheral I.V. access outcomes - Part 2. Nursing 2024; 54:19-29. [PMID: 39302746 DOI: 10.1097/nsg.0000000000000069] [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: 09/22/2024]
Abstract
ABSTRACT Peripheral I.V. access failure is a source of patient discomfort and dissatisfaction with a significant financial impact on healthcare. This article reviews the benefits and the risks of peripheral I.V. catheter (PIVC) utilization, infusate characteristics and their impact on peripheral vasculature, PIVC site assessment and management, and PIVC research priorities. Part 1 of this series was published in Nursing's September 2024 issue.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the chair of the 2024 Infusion Nurses Society Standards of Practice Committee
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5
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Troubil M, Capozzoli G, Mussa B, Hodne M, Hoerauf K, Alsbrooks K. Performance and safety of PowerPICC catheters and accessories: a prospective observational study. BMJ Open 2024; 14:e081288. [PMID: 39349374 PMCID: PMC11448161 DOI: 10.1136/bmjopen-2023-081288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the safety and performance of PowerPICC catheters in a real-world setting. DESIGN Prospective, observational, multicentre study. SETTING Nine European countries, involving 14 centres. PARTICIPANTS General patient population. INTERVENTION PowerPICC catheter inserted by the clinician as standard of care with routinely collected outcomes followed through device removal or 180 days postinsertion. PRIMARY AND SECONDARY OUTCOMES MEASURES Safety and performance outcomes were assessed for PowerPICC, PowerPICC SOLO 2 and PowerGroshong PICC. The primary safety endpoint was the incidence of symptomatic venous thrombosis (VT), and secondary safety endpoints included phlebitis, extravasation, vessel laceration, vessel perforation local infection, accidental dislodgment and catheter-related bloodstream infection (CRBSI). The primary performance endpoint was the percentage of patients whose PowerPICC device remained in place through the completion of therapy. The secondary performance endpoints included catheter patency, placement success in a single attempt and usability. RESULTS The enrolled patients (N=451) received either PowerPICC, PowerPICC SOLO 2 or PowerGroshong PICC catheters. Across all devices, 1.6% of patients developed symptomatic VT, and CRBSI occurred in 1.6% of patients. There were no cases of phlebitis or extravasation and only three cases of vein laceration or vein perforation. The catheters showed high success rates in completing therapy (81.8%), maintaining patency (93.9%) and achieving successful placement in a single attempt (90.4%). Clinicians overwhelmingly agreed that both the guidewire and stylet (93.3% and 94.4%, respectively) were easy or very easy to use. CONCLUSIONS This study demonstrates the safety and performance of PowerPICC catheters across diverse settings and patient cohorts in real-world hospital settings across Europe. The findings indicate that these catheters are safe and can be effectively used in the general patient setting and when inserted by a variety of clinicians. The low incidence of complications and high success rates further support the clinical utility of these catheters. TRIAL REGISTRATION NUMBER NCT04263649.
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Affiliation(s)
| | | | | | - Melinda Hodne
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Klaus Hoerauf
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
- Medical University of Vienna, Vienna, Austria
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6
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Oviedo-Torres MA, Yepes-Velasco AF, Moreno-Araque JL, Rodríguez-Lima DR, Mora-Salamanca AF. Experience of a vascular ultrasound-guided program: from the ICU to the hospital. Ultrasound J 2024; 16:43. [PMID: 39297921 DOI: 10.1186/s13089-024-00393-2] [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: 07/07/2024] [Accepted: 09/09/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND The use of peripherally inserted central venous catheters (PICCs) has increased worldwide in the last decade. However, PICCs are associated to catheter-related thrombosis (CRT) and central line-associated bloodstream infections (CLABSIs). We describe the characteristics of patients requiring a PICC, estimate the incidence rate, and identify potential risk factors of PICC-related complications. METHODS All adult patients requiring a PICC at our institution (Fundación Santa Fe de Bogotá, Bogota, Colombia) from September 2022 to May 2024 were included in the analysis. The database from active PICC monitoring collected demographic and PICC-related information. The incidence rate of CLABSI and CRT, and crude odds ratios (cORs) were estimated. RESULTS Overall, 1936 individuals were included in the study. The median age was 67 years (IQR: 50-78 years), and 51.5% were females. The median duration of PICC lines was 10 days (IQR: 4-17). Seventy-nine patients had catheter-related complications, mostly in the Intensive Care Unit (ICU). The CLABSI and CRT institutional incidence rates per 1000 catheter-days were 2.03 (2.96 in the ICU) and 0.58 (0.61 in the ICU), respectively. Prolonged catheter use (≥ 6 days), PICC insertion in the intensive care unit, and postoperative care after cardiac surgery were identified as potential risk factors for CLABSI, while a catheter insertion into the brachial vein was associated with CRT. CONCLUSION Daily PICC assessment, particularly in patients with prolonged catheter use, PICC insertion into the brachial vein, or in postoperative care after cardiac surgery may significantly reduce CLABSI and CRT cases. Implementing Vascular Access Teams, venous catheter care bundles, and institutional insertion protocols optimize clinical outcomes.
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Affiliation(s)
- Miguel Angel Oviedo-Torres
- Department of Critical Medicine and Intensive Care, Fundación Santa Fe de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia
| | - Andrés Felipe Yepes-Velasco
- Department of Critical Medicine and Intensive Care, Fundación Santa Fe de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia.
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Jeimy Lorena Moreno-Araque
- Department of Critical Medicine and Intensive Care, Fundación Santa Fe de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia
| | | | - Andrés Felipe Mora-Salamanca
- Department of Critical Medicine and Intensive Care, Fundación Santa Fe de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia
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7
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Lai JY, Wu MJ, Gautama MSN, Huang TW. Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2024; 151:131-139. [PMID: 39032564 DOI: 10.1016/j.jhin.2024.07.003] [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: 05/11/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
Midline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. We conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus and ProQuest, up to April 2024. The primary outcomes analysed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. Of 831 initially identified articles, five trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared with PICCs (relative risk = 1.95, 95% confidence interval = 1.23-3.08, P=0.005, I2= 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. PICCs are associated with fewer total complications and longer dwell times compared with MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional RCTs, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.
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Affiliation(s)
- J-Y Lai
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - M-J Wu
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - M S N Gautama
- Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali, Indonesia
| | - T-W Huang
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Gorski LA, Ong J, Van Gerpen R, Nickel B, Kokotis K, Hadaway L. Development of an Evidence-Based List of Non-Antineoplastic Vesicants: 2024 Update. JOURNAL OF INFUSION NURSING 2024; 47:290-323. [PMID: 39250767 DOI: 10.1097/nan.0000000000000568] [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: 09/11/2024]
Abstract
Infiltration of a vesicant, called extravasation, can result in severe patient injuries. Recognition of vesicants and their relative risk of injury is essential to extravasation prevention, early recognition, and appropriate treatment. In this article, the Vesicant Task Force (VTF) updates the previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS list diverges from earlier vesicant lists, such as the 2017 VTF list, by adopting a risk stratification approach based upon documented patient outcomes, in contrast to the reliance on expert consensus or only surrogate risk indicators, such as pH and osmolarity. The methodology used to create the updated list is explained, and the criteria for high- and moderate-risk vesicants and cautionary vesicants are defined.
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Affiliation(s)
- Lisa A Gorski
- Author Affiliations: Ascension at Home, Brentwood, Tennessee (Gorski); Bryan Medical Center, Lincoln, Nebraska (Ong); Retired from Bryan Medical Center, Lincoln, Nebraska (Van Gerpen); Omaha, Nebraska (Nickel); Retired from BD Medical, Munster, Indiana (Kokotis); Lynn Hadaway Associates, Inc., Milner, Georgia (Hadaway)
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9
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Yu C, Gao C, Zhao D, Lin Y. End-stage renal disease in a critical patient with superior vena cava syndrome with central vein catheters inserted via the superficial femoral vein: A case study. Nurs Crit Care 2024; 29:850-854. [PMID: 38183350 DOI: 10.1111/nicc.13025] [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: 03/13/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024]
Abstract
Superior vena cava syndrome (SVCS) is caused by obstruction to the blood flow through this vein. Indwelling central venous devices, such as cardiac pacemakers and haemodialysis catheters have emerged as the most common benign aetiology of SVCS. SVCS is particularly severe in patients with end-stage renal disease who require continuous renal replacement therapy plus infusion therapy. The presence of SVCS results in a reduction of available venous access for affected patients. Therefore, venous access plays a crucial role in the management of these patients. The importance of dealing with vascular access (VA) in critical patients with these conditions cannot be overstated. This case describes an 81-year-old man with respiratory failure who had end-stage renal disease complicated with SVCS. Using ultrasound-guided puncture, we inserted a peripherally inserted central catheter (PICC) into the superficial femoral vein to meet his infusion requirements in intensive care. After successful placement, the catheter tip position was adjusted using imaging to position the tip relative to the haemodialysis catheter. Whenever patients with severe renal dysfunction are treated, central veins should be preserved. Safe PICC access is possible via the superficial femoral vein to protect the last central VA for rational use. This meets urgent needs for infusion and deserves promotion.
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Affiliation(s)
- Chao Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
- Department of General Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Chunhua Gao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
- Department of General Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Dandan Zhao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Yan Lin
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
- Department of General Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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10
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Nickel B. Vascular access device selection: Optimizing patient outcomes - Part 1. Nursing 2024; 54:25-37. [PMID: 39186158 DOI: 10.1097/nsg.0000000000000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT A systematic evaluation of vascular access device (VAD) selection incorporates patient, device, and infusate characteristics to ensure optimal device placement. This article explores VAD selection from the perspective of vessel health and preservation and describes VAD selection options and indications, VAD-related complications, and strategies to reduce those complications.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is a clinical nurse specialist and the 2024 Infusion Nurses Society Standards of Practice Committee chair
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11
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Sakai H, Hirosue M, Iwata M, Terasawa T. The effect of introducing a nurse-practitioner-led peripherally inserted central venous catheter placement program on the utilization of central venous access device: A retrospective study in Japan. J Vasc Access 2024; 25:1601-1609. [PMID: 37341211 DOI: 10.1177/11297298231173160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated. OBJECTIVES To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs. MATERIALS AND METHODS Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications. RESULTS Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; p < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; p < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; p < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; p = .90). CONCLUSIONS This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.
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Affiliation(s)
- Hirotaka Sakai
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Miyuki Hirosue
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Mitsunaga Iwata
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Teruhiko Terasawa
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Hadaway L, Gorski LA. Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review. JOURNAL OF INFUSION NURSING 2024; 47:324-346. [PMID: 39250768 DOI: 10.1097/nan.0000000000000566] [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: 09/11/2024]
Abstract
Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.
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Affiliation(s)
- Lynn Hadaway
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| | - Lisa A Gorski
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
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13
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Gibson SM, Sarlabous J, Adair L, Bahl A. Operation STICK Improves Vascular Access Outcomes in a Specialty Team: A Quasi-Experimental Study. J Nurs Care Qual 2024:00001786-990000000-00157. [PMID: 39151043 DOI: 10.1097/ncq.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Education and training may improve outcomes within an experienced vascular access team. PURPOSE The purpose of this study was to measure the impact of a standardized peripheral intravenous catheter insertion educational program (Operation STICK) on vascular access outcomes. METHODS A quasi-experimental study design was used. Adult inpatients with difficult intravenous access (DIVA) requiring ultrasound-guided insertion by a vascular access specialty team were eligible. Data were collected before and 7 months after the educational training program. RESULTS A total of 54 subjects were included (24 pre- and 30 post-implementation). Significant improvements were found for mean peripheral intravenous catheter dwell time (3.62 to 14.97 days, P < .001), completion of therapy (58.3% to 96.7%, P = .001), and first-stick success rate (79.2% to 100%, P = .013). Catheter-to-vein ratio significantly decreased (P = .007). CONCLUSIONS Standardized education/training in vascular access focusing on best practices yields favorable outcomes for DIVA patients within an established specialty team.
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Affiliation(s)
- Steven Matthew Gibson
- Author Affiliations: Vascular Access Specialty Nurse, Vascular Access Consulting, Henderson, Kentucky (Mr Gibson); Vascular Access Specialty Nurse, Baptist Hospital, Miami, Florida (Ms Sarlabous and Ms Adair); and Professor of Emergency Medicine, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan (Dr Bahl)
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Pinelli F, Pittiruti M, Annetta MG, Barbani F, Bertoglio S, Biasucci DG, Bolis D, Brescia F, Capozzoli G, D'Arrigo S, Deganello E, Elli S, Fabiani A, Fabiani F, Gidaro A, Giustivi D, Iacobone E, La Greca A, Longo F, Lucchini A, Marche B, Romagnoli S, Scoppettuolo G, Selmi V, Vailati D, Villa G, Pepe G. A GAVeCeLT consensus on the indication, insertion, and management of central venous access devices in the critically ill. J Vasc Access 2024:11297298241262932. [PMID: 39097780 DOI: 10.1177/11297298241262932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
Central venous access devices are essential for the management of critically ill patients, but they are potentially associated with many complications, which may occur during or after insertion. Many evidence-based documents-consensus and guidelines-suggest practical recommendations for reducing catheter-related complications, but they have some limitations. Some documents are not focused on critically ill patients; other documents address only some special strategies, such as the use of ultrasound; other documents are biased by obsolete concepts, inappropriate terminology, and lack of considerations for new technologies and new methods. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to offer an updated compendium of the main strategies-old and new-that should be adopted for minimizing catheter-related complications in the adult critically ill patient. The project has been planned as a consensus, rather than a guideline, since many issues in this field are relatively recent, and few high-quality randomized clinical studies are currently available, particularly in the area of indications and choice of the device. Panelists were chosen between the Italian vascular access experts who had published papers on peer-reviewed journals about this topic in the last few years. The consensus process was carried out according to the RAND/University of California at Los Angeles (UCLA) Appropriateness Methodology, a modification of the Delphi method, that is, a structured process for collecting knowledge from groups of experts through a series of questionnaires. The final document has been structured as statements which answer to four major sets of questions regarding central venous access in the critically ill: (1) before insertion (seven questions), (2) during insertion (eight questions), (3) after insertion (three questions), and (4) at removal (three questions).
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Francesco Barbani
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
| | - Denise Bolis
- Intensive Care Unit, Hospital "A.Manzoni," Lecco, Italy
| | - Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Capozzoli
- Department of Anesthesiology, Hospital of Bolzano, Lehr-Krankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Elisa Deganello
- Anaesthesia and Intensive Care, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Stefano Elli
- Vascular Access Team, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Adam Fabiani
- Cardiac Surgery Intensive Care Unit, Vascular Access Team, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences, University of Milan, "Luigi Sacco" Hospital, Milan, Italy
| | - Davide Giustivi
- Post-Anesthesia Care Unit and Vascular Access Team, Lodi, Italy
| | - Emanuele Iacobone
- Anesthesia and Intensive Care, Hospital of Macerata, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Alberto Lucchini
- Adult and Pediatric Intensive Care Unit, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Bruno Marche
- Department of Hematology, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Valentina Selmi
- Vascular Access Team, Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Davide Vailati
- Department of Anesthesia and Intensive Care, Melegnano Hospital, Milano, Italy
| | - Gianluca Villa
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Gilda Pepe
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
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Heath M, Bernstein SJ, Paje D, McLaughlin E, Horowitz JK, McKenzie A, Leyden T, Flanders SA, Chopra V. Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis. Jt Comm J Qual Patient Saf 2024; 50:591-600. [PMID: 38762387 DOI: 10.1016/j.jcjq.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use. METHODS The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line-associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates. RESULTS Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all p < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314-$3,003). CONCLUSION A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.
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Dominikus H, Veronika W, Mair Maximilian J, Martina S, Pavla K, Christoph K, Christian K, Christian L, Rupert B, Christoph M. Complication Rates of Peripherally Inserted Central Catheters in Oncologic Versus Non-Oncologic Patients. Semin Oncol Nurs 2024; 40:151681. [PMID: 38945733 DOI: 10.1016/j.soncn.2024.151681] [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: 02/07/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Peripherally inserted central catheters are commonly used in cancer patients and provide vascular access for the administration of chemotherapy, antibiotics, or parenteral nutrition. Besides many advantages, they represent a source of possible complications such as catheter related blood stream infection, catheter occlusion, or thrombosis. In this study, the catheter-related complication rate between oncologic and non-oncologic patients was compared. METHODS This retrospective cohort-study included 411 patients who underwent their first catheter placement at the Vienna General Hospital-Medical University of Vienna from January 2013 to June 2018. Patient demographics and catheter-related parameters were collected and statistically analyzed using a competing risk model. RESULTS Mean catheter dwell time was 27.75 days. The overall complication rate was 7.54% (2.72 per 1000 catheter days). Underlying malignant disease (hazard ratio: 0.351, 95% confidence interval [CI]: 0.133-0.929, P = .035) and chemotherapy administration (hazard ratio: 2.837, 95% CI: 1.088-7.394, P = .033) were significantly associated with the occurrence of any kind of complication. Catheter related blood stream infection was observed among 11 (2.68%) patients and again significantly associated with chemotherapy administration (hazard ratio: 4.545, 95% CI: 1.178-17.539; P = .028). Thrombosis was found in 7 (1.70%) patients and occlusion in 13 (3.16%) cases. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE Choice of venous access is an interdisciplinary decision with emphasis on patient participation. In oncologic patients, our data suggests that the benefits of peripherally inserted central catheters regarding costs, invasiveness, and accessibility might be outweighed by the higher rate of complications associated with the device. This becomes even more important in a community care setting, where standardized handling procedures and patient education play a pivotal role in device safety.
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Affiliation(s)
- Huber Dominikus
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Weiler Veronika
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J Mair Maximilian
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Spalt Martina
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Krotka Pavla
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Krall Christoph
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Kinstner Christian
- Division of Cardiovascular and Interventional Radiology, Department of Radiology and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Loewe Christian
- Division of Cardiovascular and Interventional Radiology, Department of Radiology and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bartsch Rupert
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Minichsdorfer Christoph
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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August D, Walker RM, Gibson V, Marsh N, Kleidon TM, Delaforce A, Mihalopoulous C, Ullman A, Keogh S. Implementation contexts and strategies for alternative peripherally inserted central catheter material and design selection: A qualitative exploration using CFIR/ERIC approach. J Adv Nurs 2024. [PMID: 39046170 DOI: 10.1111/jan.16342] [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: 12/04/2023] [Revised: 06/27/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
AIM To explore the implementation contexts and strategies that influence the uptake and selection of alternative peripherally inserted central catheter (PICC) materials and design. DESIGN Qualitative evaluation of end user perspectives within a randomized control trial of different PICC materials and design. METHODS Semi-structured interviews with key stakeholders were undertaken via an adapted, rapid-analytic approach using the Consolidated Framework for Implementation Research. Outcomes were mapped against the Expert Recommendations for Implementing Change (ERIC) tool for strategies to guide innovation in PICC practice. RESULTS Participants (n = 23) represented a combination of users and inserters/purchasers, from adult and paediatric settings. Dominant themes included intervention characteristics (intervention source), inner setting (structural characteristics) and individuals involved (self-efficacy). Strategies emerging to support a change from ERIC mapping (n = 16) included promotion of intervention adaptability, inclusion of staff and consumer perspectives and sufficient funding. Implementation contexts such as inner setting and individuals involved equally impacted PICC success and implementation effectiveness and enabled a greater understanding of barriers and facilitators to intervention implementation in this trial. CONCLUSION Trial evidence is important, but healthcare decision-making requires consideration of local contexts especially resourcing. Implementation contexts for Australian healthcare settings include a practical, strategic toolkit for the implementation of alternative PICC materials and designs. REPORTING METHOD This study adhered to COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Deanne August
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Alana Delaforce
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Queensland, Australia
| | - Claire Mihalopoulous
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Stefano E, Dario D, Silvia C, Gloria C, Mariavittoria G, Francesco M, Jessica P, Mario R, Alberto L, Giuseppe F, Matteo P, Marco G. Impact of distance of the catheter tip from cavo-atrial junction on bubble test (delay) time: A prospective study. J Vasc Access 2024; 25:1187-1193. [PMID: 36765463 DOI: 10.1177/11297298231153517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Correct tip positioning is a critical aspect in central vascular access devices insertion. The verification of positioning at the cavo-atrial junction is usually performed by intracavitary electrocardiography. Recently, echocardiographic techniques were proposed, including the direct visualization of the catheter or the visualization of a saline/air bolus (i.e. "bubble test"). As for the latter, a push-to-bubbles delay time below 2 s was proposed to indicate a correct positioning of the catheter tip. The aim of this study was to measure the variations of the push-to-bubbles time at increasing distance from the cavo-atrial junction, to verify if a cut-off of 1-2 s correspond to a well-positioned catheter. METHODS We performed a prospective study including patients with clinical indication of positioning a peripherally inserted central catheter. The catheter tip was positioned at the cavo-atrial junction (P0) via intracavitary electrocardiography, and the push-to-bubbles delay time was measured. The catheter was then retracted 5 cm (P1) and 10 cm (P2), and the test was repeated at this positioning. Push-to-bubbles time measurements were performed off-line by analyzing an audio/video recording which included the echography screen and the voice signal of the operator. RESULTS Forty-nine patients were included. The average push-to-bubble time when the catheter tip was in the reference position was 0.41 ± 0.21 s. Retraction of the PICC catheter of 5 and 10 cm determined a significant increase of the push-to-bubbles time: mean time difference was +0.34 (95% IC 0.25-0.43, p < 0.001) s between P0 and P1 (5 cm distance), and +0.77 (95% IC 0.62-0.92, p < 0.001) s between P0 and P2 (10 cm distance). When the catheter was at the reference position (i.e. cavo-atrial junction) only 2.1% of bubbles delay times were above 1 s. CONCLUSION The push-to-bubbles time is very low when the catheter tip is at the cavo-atrial junction. This delay increases progressively with increasing distance from the target. Push-to-bubbles delay time above 1 s might indicate a catheter not close to the cavo-atrial junction.
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Affiliation(s)
- Elli Stefano
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - D'amata Dario
- A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | | | | | | | | | - Pozzoli Jessica
- IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Russo Mario
- ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Lucchini Alberto
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Foti Giuseppe
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Pozzi Matteo
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Giani Marco
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
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Gravdahl E, Haugen DF, Fredheim OM. Use of peripherally inserted central venous catheters and midline catheters for palliative care in patients with cancer: a systematic review. Support Care Cancer 2024; 32:464. [PMID: 38926160 PMCID: PMC11208250 DOI: 10.1007/s00520-024-08664-3] [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: 12/20/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) and midline catheters (MCs) may offer convenient intravenous access, but evidence to support their place in palliative care is limited. This review aimed to assess catheter indications, utilization, complications, dwell time, and patient experiences in cancer patients receiving palliative care. METHODS A systematic search for studies on catheter utilization for supportive or symptom treatment was conducted in Medline, Embase, CINAHL, Web of Science, Cochrane, and CENTRAL databases. Studies with a study population or a subgroup of palliative care cancer patients were included. Study quality was assessed using the Effective Public Health Practice Quality assessment tool. RESULTS Of 7631 unique titles, 17 articles were examined in detail, all published between 2002 and 2022. Median catheter dwell time varied from 15 to 194 days, the longest when utilized for home parenteral nutrition. For pain and symptom management, the typical duration was 2-4 weeks, often until the patient's death. Complication rates were minimal, with thrombosis, infections, and occlusion ranging from 0 to 2.46 incidents per 1000 catheter days. In studies from palliative care services, patients reported minimal distress during procedures and high user satisfaction. Quality of life assessments post-procedure improved, possibly influenced by concurrent specialist palliative care provision. All studies were assessed to be of moderate or weak quality. CONCLUSION PICC and MC are safe and valuable tools in palliative care cancer patients who would benefit from intravenous access for symptom management. Further studies are needed to clarify indications for PICC or MC in palliative care.
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Affiliation(s)
- Eva Gravdahl
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Olav Magnus Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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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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Adelakun AR, De Vera MA, McGrail K, Turgeon RD, Barry AR, Andrade JG, MacGillivray J, Deyell MW, Kwan L, Chua D, Lum E, Smith R, Loewen P. Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study. Adv Ther 2024; 41:2352-2366. [PMID: 38658484 DOI: 10.1007/s12325-024-02859-0] [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: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Patients with atrial fibrillation (AF) often switch between oral anticoagulants (OACs). It can be hard to know why a patient has switched outside of a clinical setting. Medication attribute comparisons can suggest benefits. Consensus on terms and definitions is required for inferring OAC switch benefits. The objectives of the study were to generate consensus on a taxonomy of the potential benefits of OAC switching in patients with AF and apply the taxonomy to real-world data. METHODS Nine expert clinicians (seven clinical pharmacists, two cardiologists) with at least 3 years of clinical and research experience in AF participated in a Delphi process. The experts rated and commented on a proposed taxonomy on the potential benefits of OAC switching. After each Delphi round, ratings were analyzed with the RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness method. Median ratings, disagreement index, and comments were used to modify the taxonomy. The resulting taxonomy from the Delphi process was applied to a cohort of patients with AF who switched OACs in a population-based administrative health dataset from 1996 to 2019 in British Columbia, Canada. RESULTS The taxonomy was finalized in two Delphi rounds, reaching consensus on five switch benefit categories: safety, effectiveness, convenience, economic considerations, and drug interactions. Safety benefit (a switch that could lower the risk of adverse drug events) had three subcategories: major bleeding, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding. Effectiveness benefit had four subcategories: stroke and systemic embolism (SSE), ischemic stroke, myocardial infarction (MI), and all-cause mortality. Real-world OAC switches revealed that more OAC switches had convenience (72.6%) and drug interaction (63.0%) benefits compared to effectiveness (SSE 22.0%, ischemic stroke 11.1%, MI 3.1%, all-cause mortality 10.1%), safety (major bleeding 24.3%, GI bleeding 10.6%, ICH 48.5%), and economic benefits (12.1%). CONCLUSIONS The Delphi-based taxonomy identified five criteria for the beneficial effects of OAC switching, aiding in characterizing real-world OAC switching.
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Affiliation(s)
- Adenike R Adelakun
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Kim McGrail
- UBC School of Population and Public Health, Vancouver, Canada
- UBC Centre for Health Services and Policy Research, Vancouver, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- Jim Pattison Outpatient Care and Surgery Centre, Surrey, Canada
| | - Jason G Andrade
- Vancouver General Hospital, Vancouver, Canada
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | | | - Marc W Deyell
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
- St. Paul's Hospital, Vancouver, Canada
| | - Leanne Kwan
- Royal Columbian Hospital, New Westminster, Canada
| | | | - Elaine Lum
- Vancouver General Hospital, Vancouver, Canada
| | | | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada.
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.
- Centre for Cardiovascular Innovation, Vancouver, Canada.
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22
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Felipe MDAA, Peterlini MAS, Ullman A, Pedreira MDLG. Michigan appropriateness guide for intravenous catheters in pediatrics - miniMAGIC-Brasil: translation into Brazilian portuguese. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023159. [PMID: 38747843 PMCID: PMC11095236 DOI: 10.1590/1984-0462/2024/42/2023159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/25/2023] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. METHODS Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master's and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, "not equivalent"; 2, "inequivalent"; 3, "cannot assess"; 4, "quite equivalent"; 5, "totally equivalent". The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. RESULTS The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. CONCLUSIONS The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.
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Takahashi T, Morita K, Uda K, Matsui H, Yasunaga H, Nakagami G. Complications after peripherally inserted central catheter versus central venous catheter implantation in intensive care unit: propensity score analysis using a nationwide database. Expert Rev Med Devices 2024; 21:447-453. [PMID: 38661659 DOI: 10.1080/17434440.2024.2346191] [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: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND It remains unclear whether peripherally inserted central catheters (PICCs) are superior to central venous catheters (CVCs); therefore, we compared post-implantation complications between CVC and PICC groups. RESEARCH DESIGN AND METHODS Patients who received CVCs or PICCs between April 2010 and March 2018 were identified from the Diagnosis Procedure Combination database, a national inpatient database in Japan. The outcomes of interest included catheter infection, pulmonary embolism, deep vein thrombosis, and phlebitis. Propensity score overlap weighting was used to balance patient backgrounds. Outcomes were compared using logistic regression analyses. RESULTS We identified 164,185 eligible patients, including 161,605 (98.4%) and 2,580 (1.6%) in the CVC and PICC groups, respectively. The PICC group was more likely to have overall complications (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.32-2.19), pulmonary embolism (OR, 2.32; 95% CI, 1.38-3.89), deep vein thrombosis (OR, 1.86; 95% CI, 1.16-2.99), and phlebitis (OR, 1.72; 95% CI, 1.27-2.32) than the CVC group. There was no significant intergroup difference in catheter infection (OR, 1.09; 95% CI, 0.39-3.04). CONCLUSIONS Patients with PICCs had a significantly greater incidence of complications than did those with CVCs. Further research is necessary to explore the factors contributing to these complications.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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de Souza Fantin S, Scherer Dos Santos M, Ferro EB, Hirakata VN, Ferreira de Azeredo da Silva A, Rabelo-Silva ER. Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis. Value Health Reg Issues 2024; 41:123-130. [PMID: 38401289 DOI: 10.1016/j.vhri.2023.12.006] [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: 10/07/2022] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs). METHODS Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar). RESULTS A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL. CONCLUSIONS PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.
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Affiliation(s)
- Simone de Souza Fantin
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Vascular Access Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Scherer Dos Santos
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduarda Bordini Ferro
- Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vania Naomi Hirakata
- Biostatistics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Eneida Rejane Rabelo-Silva
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Vascular Access Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Pisney L, Camplese L, Greene MT, Saint S, Fowler KE, Chopra V. Practices to prevent central line-associated bloodstream infection: A 2021 survey of infection preventionists in US hospitals. Infect Control Hosp Epidemiol 2024:1-5. [PMID: 38654493 DOI: 10.1017/ice.2024.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To determine prevalence of technical and behavioral interventions aimed at preventing central line-associated bloodstream infection (CLABSI) following the COVID19 pandemic. DESIGN Cross-sectional survey. SETTING US acute care hospitals. PARTICIPANTS Infection preventionists at participating hospitals. METHODS Surveys were sent to infection preventionists from a national random sample of 881 US acute care hospitals. Questions covered use of technical interventions to prevent CLABSI (eg, alcohol-containing chlorhexidine gluconate [CHG] for skin antisepsis, use of coated catheters), socio-adaptive interventions (eg, feedback of CLABSI rates, use of appropriateness criteria), and leadership support for CLABSI prevention. RESULTS Survey response rate was 47% (415/881). Technical interventions such as maximal sterile barriers (99%) or CHG-impregnated dressings (92%) were highly prevalent, but routine use of CHG bathing was less common (68% indicated regular use in intensive care unit [ICU] vs 18% in non-ICU settings). Although 97% of respondents indicated use of systems to monitor CLABSI, feedback to providers on CLABSI events was reported by 89%. Only 53% of respondents indicated regular use of tools to determine appropriateness of central venous catheters (CVC). Three-quarters of respondents indicated their hospital assessed CVC necessity daily, but only 23% reported strategies to reduce routine blood cultures. CLABSI prevention was extremely important to hospital leadership at 82% of responding hospitals. CONCLUSIONS Most US hospitals continue to use evidence-based methods to prevent CLABSI as recommended by leading organizations. Opportunities to focus on socio-adaptive interventions such as feedback of infection rates, use of appropriateness criteria for CVC placement, and improving the "culture of pan-culturing" remain.
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Affiliation(s)
- Larissa Pisney
- The Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
- University of Colorado Health System, Aurora, CO, USA
| | - Lisa Camplese
- University of Colorado Health System, Aurora, CO, USA
| | - M Todd Greene
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sanjay Saint
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E Fowler
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
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Catho G, Fortchantre L, Teixeira D, Galas-Haddad M, Boroli F, Chraïti MN, Abbas M, Harbarth S, Buetti N. Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm. Antimicrob Resist Infect Control 2024; 13:38. [PMID: 38600526 PMCID: PMC11007875 DOI: 10.1186/s13756-024-01395-4] [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: 11/26/2023] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Most surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU). METHODS We developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital's data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period. RESULTS From January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50-70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06-0.41) and 3.86/1000 catheter days (95% CI: 3.17-4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7-96.9), 100% (95% CI 99.5-100), 100% (95% CI 56.5-100), and 99.9% (95% CI 99.2-100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm. CONCLUSIONS A fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems.
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Affiliation(s)
- Gaud Catho
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
- Infectious Diseases Division, Central Institute, Valais Hospital, Sion, Switzerland.
| | - Loïc Fortchantre
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Teixeira
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Murielle Galas-Haddad
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Filippo Boroli
- Intensive Care Unit Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Noëlle Chraïti
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolò Buetti
- Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- INSERM, IAME, Université Paris-Cité, Paris, 75006, France
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Liu S, Xiang Y, Gu Y, Chen N, Fu P, Wei Y, Zhao P, Li Y, Du C, Mu W, Xia Z, Chen Y. Patient preferences and willingness to pay for central venous access devices in breast cancer: A multicenter discrete choice experiment. Int J Nurs Stud 2024; 152:104695. [PMID: 38301304 DOI: 10.1016/j.ijnurstu.2024.104695] [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: 09/11/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Despite being a significant management decision in clinical or nursing practice, there is limited understanding of the preferences regarding risks, benefits, costs, and other attributes of patients with breast cancer when selecting peripherally inserted central catheters or totally implanted ports. The objective of this study is to investigate the preferences of patients with breast cancer who require chemotherapy when selecting an optimal central venous access device. METHODS Data on patients' preferences for central venous access devices were collected using a face-to-face discrete choice experiment from the oncology departments of three public hospitals in China representing the eastern (Zhejiang province), central (Henan province), and western (Sichuan province) regions. The study used six attributes to describe the preferences of breast cancer patients for central venous access devices, including out-of-pocket cost, limitations in activities of daily living, catheter maintenance frequency, risk of catheter-related thrombosis, risk of catheter-related infection, and size of incision. Data were analyzed using a conditional logit model and mixed logit model. The marginal willingness to pay (mWTP) was calculated by assessing the ratio of the preference for other attributes to the preference for out-of-pocket cost. RESULTS A total of 573 respondents completed the survey. The discrete choice experiment results showed that respondents strongly preferred a central venous access device with a catheter maintenance frequency of one time a month (vs four times a month, β = 1.188, p < 0.001), the lower risk of catheter-related thrombosis (2 % vs 10 %, β = 1.068; p < 0.001) and lower risk of catheter-related infection (2 % vs 8 % risk: β = 0.824; p < 0.001). Respondents were willing to pay CNY ¥11,968.1 (US$1776.5) for a central venous access device with a catheter maintenance frequency of one time a month rather than four times a month, ¥10,753.6 (US$1596.2) for a central venous access device with 2 % thrombosis risk over one with 10 %, and ¥8302.0 (US$1232.3) for a central venous access device with 2 % infection risk over one with 8 %. Respondents with longer travel time to the hospital, younger than 50 years old, and with urban employee basic medical insurance were willing to pay more for an improvement in the attributes. CONCLUSIONS These findings suggest that patients with breast cancer were mainly concerned with the out-of-pocket cost, catheter maintenance frequency, risk of catheter-related thrombosis and risk of catheter-related infection when choosing a central venous access device for the delivery of chemotherapy. In clinical or nursing practice, when making central venous access device recommendation for young patients and those who live far from hospitals, totally implanted ports may be a preferable choice.
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Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
| | - Yuliang Xiang
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Na Chen
- Department of Nursing, Chengdu Medical College, Chengdu 610500, China; Department of Anesthesiology, The Second Affiliated Hospital of Air Force Military Medical University, Shaanxi 710038, China
| | - Peifen Fu
- Department of Breast Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Yanan Wei
- Department of Breast Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pei Zhao
- Department of Breast Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yinfeng Li
- Department of Nursing, Sichuan Cancer Hospital, Chengdu 610042, China
| | - Chengyong Du
- Department of Breast Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Wenxuan Mu
- Department of Nursing, Chengdu Medical College, Chengdu 610500, China
| | - Zhiyuan Xia
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China.
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China.
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Mena Lora AJ, Lindsey B, Echeverria S, Ali M, Krill C, Takhsh E, Bleasdale SC. Impact of a midline catheter prioritization initiative on device utilization and central line-associated bloodstream infections at an urban safety-net community hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e27. [PMID: 38415093 PMCID: PMC10897721 DOI: 10.1017/ash.2024.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
Overuse of peripherally inserted central catheters (PICCs) can lead to idle central line (CL) days and increased risk for CL-associated bloodstream infections (CLABSIs). We established a midline prioritization initiative at a safety-net community hospital. This initiative led to possible CLABSI avoidance and a decline in PICC use.
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Affiliation(s)
- Alfredo J Mena Lora
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Brenna Lindsey
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Mirza Ali
- Saint Anthony Hospital, Chicago, IL, USA
| | | | | | - Susan C Bleasdale
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Chopra V. Finding the Middle Ground for Intravenous Therapy. JAMA Netw Open 2024; 7:e2355724. [PMID: 38349658 DOI: 10.1001/jamanetworkopen.2023.55724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Vineet Chopra
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
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Thomsen SL, Boa R, Vinter-Jensen L, Rasmussen BS. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2355716. [PMID: 38349655 PMCID: PMC10865154 DOI: 10.1001/jamanetworkopen.2023.55716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated. Objective To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days. Design, Setting, and Participants This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized. Intervention Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group. Main Outcomes and Measures The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed. Results A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days. Conclusions and Relevance In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level. Trial Registration ClinicalTrials.gov Identifier: NCT04140916.
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Affiliation(s)
- Simon L. Thomsen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Boa
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Vinter-Jensen
- Department of Gastroenterology, Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [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: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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Winkler MA, Spencer TR, Siddiqi N, Wallace JE, Gallien JZ, Elbalasi H, Issa M, Yu Q, Raissi D. Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study. J Vasc Access 2024; 25:225-231. [PMID: 34628991 DOI: 10.1177/11297298211049648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations. METHODS This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records. RESULTS A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups-cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%. CONCLUSION Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.
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Affiliation(s)
- Michael A Winkler
- Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Nasir Siddiqi
- Department of Radiology, Baylor College of Medicine, Baylor University, Houston, TX, USA
| | - Jessica E Wallace
- Department of Radiology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - John Z Gallien
- Department of Emergency, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Hossam Elbalasi
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohamed Issa
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Qian Yu
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Driss Raissi
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
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Calleja JL, Delgado Sánchez O, Fuentes Pradera MÁ, Llop E, López Zárraga F, Lozano ML, Parra R, Turnes J. Recommendations for the future management of thrombocytopenia in patients with liver cirrhosis: A modified RAND/UCLA appropriateness method. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:32-50. [PMID: 37028757 DOI: 10.1016/j.gastrohep.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE The lack of consensus and specific guidelines, and the introduction of new treatments in thrombocytopenia management in liver cirrhosis patients, required a series of recommendations by experts to improve knowledge on this disease. This study's aim was to improve the knowledge around thrombocytopenia in liver cirrhosis patients, in order to contribute to the generation of future evidence to improve the management of this disease. PATIENTS AND METHODS A modified version of the RAND/UCLA appropriateness method was used. The scientific committee, a multidisciplinary team of 7 experts in managing thrombocytopenia in liver cirrhosis patients, identified the expert panel, and participated in elaborating the questionnaire. Thirty experts from different Spanish institutions were invited to answer a 48-item questionnaire covering 6 areas on a nine-point Likert scale. Two rounds were voted. The consensus was obtained if >77.7% of panelists reached agreement or disagreement. RESULTS A total of 48 statements were developed by the scientific committee and then voted by the experts, resulting in 28 defined as appropriate and completely necessary, relating to evidence generation (10), care circuit, (8), hemorrhagic risk assessment, decision-making and diagnostic tests (14), professionals' role and multidisciplinary coordination (9) and patient education (7). CONCLUSIONS This is the first consensus in Spain on the management of thrombocytopenia in liver cirrhosis patients. Experts indicated several recommendations to be carried out in different areas that could help physicians make better decisions in their clinical practice.
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Affiliation(s)
- José Luis Calleja
- Department of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, IDIPHISA, CIBERehd, Madrid, Spain.
| | | | | | - Elba Llop
- Department of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, IDIPHISA, CIBERehd, Madrid, Spain
| | - Fernando López Zárraga
- Vascular and Interventional Radiology Unit, Álava University Hospital, Vitoria-Gasteiz, Spain
| | - María Luisa Lozano
- Department of Hematology, Morales Meseguer General University Hospital, Murcia, Spain; Biomedical Research Institute of Murcia (IMIB-Pascual Parrilla), CIBERER, Murcia, Spain
| | - Rafael Parra
- Blood and Tissue Bank, Vall d'Hebrón Hospital, Barcelona, Spain
| | - Juan Turnes
- Department of Gastroenterology and Hepatology, Pontevedra University Hospital Complex, IIS Galicia Sur, Pontevedra, Spain; Health Research Institute (IIS) Galicia Sur, Pontevedra, Spain
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Trautman K, Kobayashi T, McPherson C, Brust K. Defaulting peripherally inserted central catheter (PICC) orders to single lumen: A quality improvement initiative at a Midwestern academic center 2022-2023. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e242. [PMID: 38156217 PMCID: PMC10753506 DOI: 10.1017/ash.2023.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
Defaulting the order for peripherally inserted central catheters (PICCs) placement to single lumen increased proportion of single-lumen insertions over total insertions from 42/126 (33%) to 57/104 (51)%. Single-lumen PICCs had a nonsignificant lower rate of central line-associated bloodstream infection compared to double-lumen PICCs.
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Affiliation(s)
- Kathryn Trautman
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Takaaki Kobayashi
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Chad McPherson
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Karen Brust
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Jang E, Son SM, Moon KY, Lee S, Han HS, Park SC, Kim JY, Yun SS. Analysis of tip malposition and correction of peripherally inserted central catheters under ultrasound-guidance: 5-year outcomes from a single center. J Vasc Access 2023:11297298231209564. [PMID: 38053249 DOI: 10.1177/11297298231209564] [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: 12/07/2023] Open
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) has become a common procedure. Although ultrasound (US)-guidance has improved success rates, a small percentage of malposition is inevitable. The purpose of our study is to evaluate malposition rates of US-guided bedside PICC catheter insertion, and the clinical factors associated with malposition. METHODS This is a retrospective cohort study evaluating 5981 patients who had undergone ultrasound-guided bedside PICC placement from January 2017 to December 2021 at a single tertiary center. Final tip location was confirmed on chest radiograph. RESULTS Patients were categorized into optimal, suboptimal, and malposition groups according to final tip location. 4866 cases (81.7%) showed optimal tip position, 790 (13.3%) were suboptimal, and 299 (5.0%) were malpositioned. Logistic regression analysis identified six variables associated with tip malposition; height (odds ratio (OR) 1.044; 95% confidence interval (CI), 1.028-1.061; p < 0.001), body mass index (BMI) (OR 1.051; 95% CI, 1.017-1.087; p = 0.003), prior failure at accessing peripheral intravenous (IV) access (OR 1.718; 95% CI, 1.215-2.428; p = 0.002), side of the arm (OR 3.467; 95% CI, 2.457-4.891; p < 0.001), length of the catheter (OR 0.763; 95% CI, 0.734-0.794; p < 0.001), and number of previous central catheter insertions (OR 1.069; 95% CI, 1.004-1.140; p = 0.038). Malpositioned catheters were corrected by either bedside repositioning, bedside reinsertion, fluoroscopic reinsertion, switching to jugular catheters or catheter removal. No patient related factors were significantly associated with malposition or success of reposition. CONCLUSION US-guidance can help reduce catheter malposition during bedside PICC insertion. Patients with risk factors such as multiple previous central vein insertions, failed peripheral line insertions, left arm insertion, or high BMI should undergo thorough sonographic evaluation of the arm vessels to prevent malposition.
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Affiliation(s)
- Eunju Jang
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Soo Mi Son
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Ki-Yoon Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Seunghoon Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Hong Seok Han
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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Lee HN, Lee S, Park SJ, Cho Y, Chung HH. Development and validation of an updated PICC length prediction formula based on anteroposterior chest radiographs for the ultrasound-guided bedside placement. PLoS One 2023; 18:e0294598. [PMID: 37988401 PMCID: PMC10662780 DOI: 10.1371/journal.pone.0294598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
Bedside peripherally inserted central catheter (PICC) placement is sometimes required when the patient's intrahospital transport is restricted, and the ideal catheter length prediction is needed. This study aimed to develop an updated formula that predicts the optimal length of a PICC based on anteroposterior chest radiographs (AP-CXRs). This retrospective study collected PICC procedure data as the training and validation sets in three hospitals, including cubital crease-puncture point distance (CP), the actual PICC length (aCL), and the approach side. Horizontal and vertical measurement variables were set on the AP-CXRs. Two dependent variables were ipsilateral upper arm length (AL) and ideal truncal catheter length (iTCL). Simple and multiple regression analyses were used for formula development, and it was applied to the test set to evaluate the length prediction performance. The study included 309 patients in the training and validation sets and 91 intensive care patients in the test set. The final derived formula was: (AL + iTCL = CP + estimated PICC length, cm) = 19.831 - 0.062 × (contralateral clavicle length, cm) + 0.255 × (2nd ribs horizontal distance, cm) + 0.720 × (humero-vertebral distance, cm) + 0.761 × (thoraco-carinal distance, cm) + 1.024 × (the vertical distance of two vertebral body units, cm). (If approaching from the left, add 2.843cm, and if female, subtract 0.821cm.) In the test set, there was no case of length prediction failure. Moreover, the catheter tip position was evaluated as optimal in 82 cases (90.1%). This study's results suggest an updated formula to predict the ideal PICC length using only AP-CXRs for bedside placement.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
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Paje D, Heath M, Heung M, Horowitz JK, Bernstein SJ, Flanders SA, Chopra V. Midline catheters in patients with advanced chronic kidney disease. J Hosp Med 2023; 18:969-977. [PMID: 37771294 DOI: 10.1002/jhm.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Midline catheters (midlines) are increasingly used in patients with advanced chronic kidney disease (CKD). OBJECTIVE This study describes current practice and acute complications associated with midlines in CKD patients. DESIGNS, SETTING, AND PARTICIPANTS Trained abstractors at 66 hospitals from the Michigan Hospital Medicine Safety (HMS) Consortium collected data on a sample of patients who received a midline during hospitalization. Patients were classified as having advanced CKD if their estimated glomerular filtration rate was <45 mL/min/1.73 m2 . MAIN OUTCOME AND MEASURES Midline recipients with advanced CKD were compared to those without advanced CKD by patient, provider, and device characteristics, and by the occurrence of acute complications including major (e.g., upper extremity deep vein thrombosis [UE-DVT] and catheter-related bloodstream infection [CRBSI]) or minor (e.g., catheter occlusion, catheter dislodgement, infiltration, superficial thrombophlebitis, and leaking at insertion site) events. Multivariable mixed effects logistic regression was used to evaluate the association between catheter-related complications and stage of CKD. RESULTS Of 21,415 midline recipients, 5272 (24.6%) had advanced CKD, while 16,143 (75.4%) did not. Most midlines were single lumen (90.5%) and remained in place for a median of 6 days. A major or minor midline complication occurred in 804 (15.3%) patients with and 2239 (14.4%) patients without advanced CKD (adjusted odds ratios = 1.04; 95% confidence interval: 0.94-1.14). Among patients with advanced CKD, CRBSI occurred in 13 patients (0.2%) and UE-DVT occurred in 65 patients (1.2%). The proportion of advanced CKD among midline recipients and the frequency of midline-related complications varied across hospitals (interquartile range [IQR] = 19.2% to 29.8% [median = 25.0%] and IQR = 11.0%-18.9% [median = 15.4%], respectively).
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Affiliation(s)
- David Paje
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Megan Heath
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Michael Heung
- Department of Internal Medicine, Division of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer K Horowitz
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Steven J Bernstein
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Scott A Flanders
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Locatello LG, Saitta T, Maggiore G, Signorini P, Pinelli F, Adembri C. A 5-year experience with midline catheters in the management of major head and neck surgery patients. J Vasc Access 2023; 24:1412-1420. [PMID: 35441553 DOI: 10.1177/11297298221091141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. METHODS Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. RESULTS A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications. CONCLUSIONS MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.
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Affiliation(s)
| | - Thomas Saitta
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Patrizia Signorini
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Fulvio Pinelli
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
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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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Kleidon TM, Gibson V, Cattanach P, Schults J, Royle RH, Ware RS, Marsh N, Pitt C, Dean A, Byrnes J, Rickard CM, Ullman AJ. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:1132-1140. [PMID: 37695594 PMCID: PMC10495929 DOI: 10.1001/jamapediatrics.2023.3526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Importance Peripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs. Objective To compare device failure of MCs with PIVCs. Design, Setting, and Participants This was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer. Interventions Patients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, >5 years). One catheter was studied per patient. Main Outcomes and Measures The primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs. Results Of the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P <.001). MCs were associated with fewer insertion attempts (mean difference [MD], -0.3; 95% CI, -0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P <.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS -$151.67 [US -$101.13] per person; 95% credible interval, AUS -$171.45 to -$131.90 [US -$114.20 to -$87.95]). Conclusions and Relevance Findings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure. Trial Registration Australia New Zealand Clinical Trials Registry, ACTRN12620000724976.
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Affiliation(s)
- Tricia M. Kleidon
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Victoria Gibson
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ruth H. Royle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Colleen Pitt
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Anna Dean
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Claire M. Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amanda J. Ullman
- Department of Anaesthesia and Pain, Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Armstrong SH, Gangu S, West AN, Spentzas T. Peripheral vascular access as exclusive access mode in pediatric intensive care unit. Front Pediatr 2023; 11:1259395. [PMID: 37876526 PMCID: PMC10591082 DOI: 10.3389/fped.2023.1259395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction The type of vascular access (central or peripheral) in pediatric critical care depends on several factors, including the duration of treatment, the properties of the medication (osmolarity or vesicant), and the need for central pressure monitoring. The utilization of peripheral intravascular catheters (PIVCs) has shown a notable increase in the number of patients being treated. Extended dwell or midline catheters are another peripheral access option in addition to PIVCs. However, there are currently no established guidelines on their placement. Objectives The aim of this study is to estimate the duration of dwell time for PIVCs, analyze the specific parameters affecting it, and develop recommendations for switching to extended dwell and midline catheter placement as an alternative to peripheral access. Methods The study enrolled patients aged 0-18 years admitted to the pediatric intensive care unit (PICU) for over 24 h and managed with peripheral access only over 2 years (2019-2021). Measurements and main results A total of 484 patients met the specified criteria. Patients who had peripheral access exhibited a lower PRISM score and a shorter length of stay in the PICU, with mean values of 18 (SD: 8.5) and 9.5 (SD: 6.4) days, respectively, compared with patients who had central access with mean values of 8.9 (SD: 5.9) and 5.7 (SD: 3.6) days, respectively. The PIVC dwell time was found to be 50.1 h (SD: 65.3) and required an average of 1.6 insertion attempts. Patients with three or more insertions exhibited an increased odds ratio of 5.2 (95% CI: 3.1-8.5) for receiving an extended dwell or midline insertion. Increased dwell time was associated with female gender, 59.5 h (P < 0.001), first attempt insertion, 53.5 h (P < 0.001), use of 24 Ga bore, 56.3 h (P = 0.04), left-sided insertions, 54.9 (P = 0.07), less agitation, 54.8 h (P = 0.02), and less edema, 61.6 (P < 0.001). Decreased dwell time was associated with the use of vancomycin infusion at 24.2 h (P < 0.001) and blood transfusions at 29.3 h (P < 0.001). Conclusions Extended catheters last longer than PIVCs in PICU patients. Extended catheter placement requires consideration of the length of treatment, as well as the overall body edema, the level of the patient's restlessness, and the need for vancomycin infusion or blood transfusions, as these factors reduce PIVC dwell time and expose the patients to painful insertions. For such cases, an extended dwell catheter may be a better option, even if the projected treatment time is less than 6 days.
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Affiliation(s)
- Sonya Hayes Armstrong
- Pediatric Intensive Care Unit, Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Shantaveer Gangu
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Alina Nico West
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Thomas Spentzas
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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Gravdahl E, Steine S, Augestad KM, Fredheim OM. Use and safety of peripherally inserted central catheters and midline catheters in palliative care cancer patients: a retrospective review. Support Care Cancer 2023; 31:580. [PMID: 37725150 PMCID: PMC10509059 DOI: 10.1007/s00520-023-08045-2] [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: 05/04/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Some cancer patients in palliative care require intravenous administration of symptom relieving drugs. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) provide easy and accessible intravenous access. However, limited evidence supports the use of these devices in palliative care. The aim was to assess the use, safety, and efficacy of PICC and MC in this patient population. METHODS A retrospective study of all palliative care cancer patients who received PICC or MC at the Department of Palliative Medicine at Akershus University Hospital between 2020 and 2022. RESULTS A total of 374 patients were included; 239 patients received a PICC and 135 an MC with a total catheterization duration of 11,698 days. The catheters remained in place until death in 91% of patients, with a median catheter dwell time of 21 days for PICCs and 2 days for MCs. The complication rate was 3.3 per 1000 catheter days, with minor bleeding and accidental dislocation as the most common. The catheters were utilized primarily for opioids and other symptom directed treatments, and 89% of patients received a patient or nurse-controlled analgesia pump. Patients with PICC or MC discharged to home or nursing homes spent 81% of their time out of hospital. CONCLUSION PICC and MC provide safe parenteral access for palliative care cancer patients where intravenous symptom treatment is indicated. Their use can facilitate intravenous symptom treatment beyond the confines of a hospital and supplement the traditional practice relying on subcutaneous administration.
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Affiliation(s)
- Eva Gravdahl
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Siri Steine
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | - Knut Magne Augestad
- Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Department of Gastrointestinal Surgery, Akershus University Hospital, Oslo, Norway
- Department of Surgery, Helgelandssykehuset, Prestmarkveien 1, 8800, Sandnessjøen, Norway
| | - Olav Magnus Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
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Buetti N, Ruckly S, Souweine B, Mimoz O, Timsit JF. Risk of infections in intravascular catheters in situ for more than 10 days: a post hoc analysis of randomized controlled trials. Clin Microbiol Infect 2023; 29:1200.e1-1200.e5. [PMID: 37245658 DOI: 10.1016/j.cmi.2023.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES We aimed to describe the infectious risk during the dwell time for different catheter types. Furthermore, we wanted to identify risk factors for infections from catheters in place for >10 days. METHODS We performed a post hoc analysis using prospectively collected data from four randomized controlled trials. First, we evaluated the infectious risk after 10 days of analysing the significance of the interaction between dwell time and catheter type in a Cox model. Second, we investigated risk factors for infection in catheters in place for >10 days using multivariable marginal Cox models. RESULTS We included 15 036 intravascular catheters from 24 intensive care units. Infections occurred in 46 (0.7%) of 6298 arterial catheters (ACs), 62 (1.0%) of 6036 central venous catheters (CVCs) and 47 (1.7%) of 2702 short-term dialysis catheters (DCs). The interaction between dwell time beyond 10 days and catheter type was significant for CVCs (p 0.008) and DCs (p < 0.001), thus indicating an increased risk of infection after 10 days. The interaction was not significant for ACs (p 0.98). Therefore, we selected 1405 CVCs and 454 DCs in place for >10 days for further analyses. In the multivariable marginal Cox model, we observed an increased hazard ratio (HR) for infection for femoral CVC (HR, 6.33; 95% CI, 1.99-20.09), jugular CVC (HR, 2.82; 95% CI, 1.13-7.07), femoral DC (HR, 4.53; 95% CI, 1.54-13.33) and jugular DC (HR, 4.50; 95% CI, 1.42-14.21) compared with subclavian insertions. DISCUSSION We showed that the risk of catheter infection for CVCs and DCs increased 10 days after insertion, thus suggesting routine replacement for nonsubclavian catheters in situ for >10 days.
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Affiliation(s)
- Niccolò Buetti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland.
| | | | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
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Silva EVC, Ochiai ME, Vieira KRN, Pereira Barretto AC. The use of peripherally inserted central catheter reduced the incidence of phlebitis in heart failure patients: A randomized trial. J Vasc Access 2023; 24:942-947. [PMID: 34812074 DOI: 10.1177/11297298211059650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During decompensated heart failure, the use of intravenous inotropes can be necessary. With peripheral venous access, prolonged inotrope infusion can cause phlebitis. However, traditional central venous catheters have possible complications. Peripherally inserted central catheters (PICCs) may be an alternative to traditional catheters. AIM Our objective was to compare the incidence of phlebitis between patients with PICC and those with peripheral venous access catheter indwelling. METHODS In a randomized clinical trial, the patients were randomized to PICC and control groups, with 40 patients in each group. The inclusion criteria were hospitalized patients with advanced heart failure, ejection fraction of <0.45, and platelet count of >50,000/mm3 and current use of continuous intravenous infusion of dobutamine. The patients were randomly assigned to receive a PICC or keep their peripheral venous access. The primary end point was the occurrence of phlebitis. RESULTS The PICC and control groups included 40 patients each. The median age was 61.5 years; ejection fraction, 0.24; and dobutamine dose, 7.73 µg/(kg min). Phlebitis occurred in 1 patient (2.5%) in the PICC group and in 38 patients (95.0%) in the control group, with an odds ratio of 0.10% (95% confidence interval: 0.01%-1.60%, p < 0.001). CONCLUSION In conclusion, in severe heart failure patients who received intravenous dobutamine, PICC use reduced the incidence of phlebitis when compared to patients with peripheral venous access. Therefore, the PICC use should considered over peripheral venous access for prolonged intravenous therapy in heart failure patients.
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Alaiev D, Krouss M, Israilov S, Musser L, Talledo J, Mestari N, Uppal A, Madaline T, Cohen G, Bravo N, Cervantes M, Contractor D, Manchego PA, Chandra K, Zaurova M, Tsega S, Cho HJ. Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety net system. Infect Control Hosp Epidemiol 2023; 44:1381-1385. [PMID: 36960818 DOI: 10.1017/ice.2022.306] [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: 03/25/2023]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in inpatient settings. Compared to multilumen PICCs, single-lumen PICCs carry a lower rate of complications, including central-line-associated bloodstream infection and thrombosis. Despite this, multilumen PICCs are still overused. METHODS This quality improvement initiative was implemented across 11 hospitals at New York City Health + Hospitals safety net system. The electronic health record (EHR) interventional radiology or vascular access team consultation orders were modified to allow for lumen choice, with default selection to a single-lumen PICC. RESULTS Average single-lumen PICC utilization increased by 25.5%, from 44.4% to 69.9% (P < .001). CLABSI rates had a nonsignificant reduction by 26.7% from 2.44 to 1.79 infections per month (P = .255). Among provider types in the postintervention period, single-lumen PICC utilization ranged from 67.7% for advanced practice providers to 82.4%-94.6% for physicians. Among provider specialties, utilization ranged from 31.8% for neurology to 97.7% for orthopedics. Additionally, there was large variation in pre- and postintervention differences in utilization by hospital. CONCLUSIONS We successfully increased single-lumen PICC utilization across all 11 safety net hospitals. This expands on previous work on improving single-lumen PICC use and use of default nudges in large, resource-limited settings. Further study is needed to examine variation among provider types, specialties, and hospitals.
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Affiliation(s)
- Daniel Alaiev
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
| | - Mona Krouss
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sigal Israilov
- Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lara Musser
- Department of Emergency Medicine, NYC Health + Hospitals/Jacobi, The Bronx, New York
| | - Joseph Talledo
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
| | - Nessreen Mestari
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
| | - Amit Uppal
- Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York
| | - Theresa Madaline
- Department of Quality and Safety, NYC Health + Hospitals/Coney Island, Brooklyn, New York
| | - Gabriel Cohen
- Department of Population Health, NYC Health + Hospitals, New York, New York
| | - Nathaniel Bravo
- Department of Infection Control and Prevention, NYC Health + Hospitals/Queens, Queens, New York
| | - Marialeah Cervantes
- Department of Infection Control and Prevention, NYC Health + Hospitals/Queens, Queens, New York
| | - Daniel Contractor
- Department of Radiology, NYC Health + Hospitals/Queens, Queens, New York
| | - Peter Alacron Manchego
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
- Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York
| | - Komal Chandra
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
| | - Milana Zaurova
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
- Department of Emergency Medicine, Icahn School of Medicine, New York, New York
| | - Surafel Tsega
- Department of Quality and Safety, New York City Health + Hospitals, New York, New York
| | - Hyung J Cho
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts
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Gifford AH, Hinton AC, Jia S, Nasr SZ, Mermis JD, Lahiri T, Zemanick ET, Teneback CC, Flume PA, DiMango EA, Sadeghi H, Polineni D, Dezube RH, West NE, Dasenbrook EC, Lucas FL, Zuckerman JB. Complications and Practice Variation in the Use of Peripherally Inserted Central Venous Catheters in People With Cystic Fibrosis: The Prospective Study of Peripherally Inserted Venous Catheters in People With Cystic Fibrosis Study. Chest 2023; 164:614-624. [PMID: 37019356 PMCID: PMC10504599 DOI: 10.1016/j.chest.2023.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are used commonly to administer antibiotics to people with cystic fibrosis (CF), but their use can be complicated by venous thrombosis and catheter occlusion. RESEARCH QUESTION Which participant-, catheter-, and catheter management-level attributes are associated with increased risk of complications of PICCs among people with CF? STUDY DESIGN AND METHODS This was a prospective observational study of adults and children with CF who received PICCs at 10 CF care centers in the United States. The primary end point was defined as occlusion of the catheter resulting in unplanned removal, symptomatic venous thrombosis in the extremity containing the catheter, or both. Three categories of composite secondary outcomes were identified: difficult line placement, local soft tissue or skin reactions, and catheter malfunction. Data specific to the participant, catheter placement, and catheter management were collected in a centralized database. Risk factors for primary and secondary outcomes were analyzed by multivariate logistic regression. RESULTS Between June 2018 and July 2021, 157 adults and 103 children older than 6 years with CF had 375 PICCs placed. Patients underwent 4,828 catheter-days of observation. Of the 375 PICCs, 334 (89%) were ≤ 4.5 F, 342 (91%) were single lumen, and 366 (98%) were placed using ultrasound guidance. The primary outcome occurred in 15 PICCs for an event rate of 3.11 per 1,000 catheter-days. No cases of catheter-related bloodstream infection occurred. Other secondary outcomes developed in 147 of 375 catheters (39%). Despite evidence of practice variation, no risk factors for the primary outcome and few risk factors for secondary outcomes were identified. INTERPRETATION This study affirmed the safety of contemporary approaches to inserting and using PICCs in people with CF. Given the low rate of complications in this study, observations may reflect a widespread shift to selecting smaller-diameter PICCs and using ultrasound to guide their placement.
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Affiliation(s)
- Alex H Gifford
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Pulmonology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Shijing Jia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Samya Z Nasr
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Joel D Mermis
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Kansas Health System, Kansas City, KS
| | - Thomas Lahiri
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont Children's Hospital, Division of Pulmonary Disease & Critical Care Medicine, Department of Medicine, the University of Vermont Medical Center, Burlington, VT
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Charlotte C Teneback
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont Children's Hospital, Division of Pulmonary Disease & Critical Care Medicine, Department of Medicine, the University of Vermont Medical Center, Burlington, VT
| | - Patrick A Flume
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Emily A DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Hossein Sadeghi
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Deepika Polineni
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO
| | - Rebecca H Dezube
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | - Natalie E West
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | | | - F Lee Lucas
- Maine Medical Center Research Institute, Scarborough, ME
| | - Jonathan B Zuckerman
- Maine Medical Center Research Institute, Scarborough, ME; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Maine Medical Center, Portland, ME.
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Özsaban A, Bayram A. A content validity, reliability and quality analysis of peripheral intravenous catheterization videos on YouTube™. J Vasc Access 2023:11297298231186374. [PMID: 37586014 DOI: 10.1177/11297298231186374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND YouTube™ has become a potential way to integrate technology into nursing curriculum and acquire skills. However, it is important to review the accuracy of the information contained in YouTube™. This study was conducted to evaluate the content validity, reliability and quality of YouTube™ videos on peripheral intravenous catheterization. METHODS In this descriptive study, videos were searched using the keyword 'Peripheral Venous Catheter'. The content validity, reliability and quality of the videos were evaluated using the 'Peripheral Intravenous Catheterization Insertion Skill Form', 'DISCERN Questionnaire', 'Global Quality Scale', respectively. These videos were categorized by their theme, upload source, technical features and analysed statistically. RESULTS Of the 48 videos, 38 (79.2%) classified as an useful video, 24 (50%) were uploaded by medical educational platforms and 28 (58.3%) had an average technical feature. There was a statistically significant difference between the reliability, quality, content validity scores by the video theme (p < 0.05). The content validity, reliability and quality score of useful videos were higher than misleading videos. In addition, pairwise comparisons indicated that there was a statistically significant difference between the content validity, reliability and quality scores of Peripheral Intravenous Catheterization demonstrated on a person or a mannequin were higher than those applied with ultrasonography (p < 0.05). CONCLUSIONS As a result of the reviewing of the videos, it was determined that these videos provided useful content. Despite this positive result, some videos provide risky information for patient safety due to issues such as ignoring the asepsis principles and not including proper Peripheral Intravenous Catheterization steps. It may be recommended to consider the Peripheral Intravenous Catheterization steps and patient safety principles in international guidelines in the preparation of videos showing the Peripheral Intravenous Catheterization insertion.
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Affiliation(s)
- Aysel Özsaban
- Department of Fundamentals of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Türkiye
| | - Aysun Bayram
- Department of Fundamentals of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Türkiye
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48
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Lee MO, Lee SK, Song YG. Midline catheters in the operating room. Niger J Clin Pract 2023; 26:1097-1100. [PMID: 37635602 DOI: 10.4103/njcp.njcp_843_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Backgrounds Among various vascular access devices, midline catheters (MCs) are commonly used in emergency departments, but rarely in operating rooms. Aims To evaluate the feasibility and safety of MCs in the operating room. Materials and Methods This was a retrospective study. The medical records of patients who underwent MC placement in the operating room from October 2020 to July 2022 were reviewed. The rates of successful catheter insertion as well as major and minor complications were assessed. Results Successful catheter insertions were achieved in 149 of 161 patients (92.5%). The median dwell time of midlines was eight days (IQR: 6-10 days). A major or minor complication occurred in 6.7% of the midlines. The rates of major complications of occlusion, upper extremity deep vein thrombosis (DVT), and catheter-related bloodstream infection were 1.3%, 0.7%, and 0%, respectively. Conclusions Placement of MCs in the operating room was feasible and safe. Also, the procedure provides an acceptable alternative for replacing central line catheters and peripherally inserted central catheters.
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Affiliation(s)
- M O Lee
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
| | - S K Lee
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
| | - Y G Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
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Derouin Y, Le Thuaut A, Dauvergne J, Cinotti R, Cartron E. Complications and risk factors on midline catheters' follow-up about non-ICU patients: study protocol for a multicentre observational study (the midDATA study). BMJ Open 2023; 13:e067796. [PMID: 37463802 PMCID: PMC10357646 DOI: 10.1136/bmjopen-2022-067796] [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] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The midline catheter (MC) is an increasingly popular device used commonly for patients with difficult venous access or those who require infusion for more than 6 days. Little is known about complications such as infection, thrombosis or occlusion for inpatient and home care patient. This protocol presents the follow-up of non-intensive care unit patients with an MC. The aim is to identify complications and search for risk factors associated with these complications. METHOD AND ANALYSIS A prospective observational design is used for the follow-up of 2000 patients from 13 centres in France. Each practitioner (inserting clinician, anaesthetist nurse, hospital nurse and home nurse) will fill out a logbook to report each care made (eg, number of saline flushes, dress maintenance) on the MC and if any complications occurred. The incidence of complications (ie, infections, thrombosis or occlusions) will be expressed by the total number of events per 1000 catheter days. The period of recruitment began in December 2019 for a duration of 2 years. An extension of the inclusion period of 1 year was obtained. ETHICS AND DISSEMINATION This study received the approval of the Committee for the Protection of Persons of Nord Ouest IV (No EudraCT/ID-RCB : 2019-A02406-51). It was registered at clinical trials (NCT04131088). It is planned to communicate results at conferences and in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04131088.
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Affiliation(s)
- Yvan Derouin
- Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Unité d'accès vasculaires (UnAV), Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, INSERM UMR 1246 Methods in Patients-Centered Outcomes and Health Research, Nantes, France
| | - Aurélie Le Thuaut
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jérome Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Pole hospitalo-universitaire 2 Institut du thorax et du systeme nerveux, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Raphaël Cinotti
- Nantes Université, Université de Tours, CHU Nantes, INSERM UMR 1246 Methods in Patients-Centered Outcomes and Health Research, Nantes, France
- Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuelle Cartron
- Département universitaire des sciences infirmières de l'Université de Paris Cité, Université de Paris, Paris, France
- ECEVE - UMR-S 1123, Université de Paris Faculté de Santé, Paris, France
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Cardoso PC, Rabelo-Silva ER, Martins Bock P, Chopra V, Saffi MAL. Biomarkers Associated with Thrombosis in Patients with Peripherally Inserted Central Catheter: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4480. [PMID: 37445515 DOI: 10.3390/jcm12134480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The measurement and identification of plasma biomarkers can support the estimation of risk and diagnosis of deep vein thrombosis (DVT) associated with the use of a peripherally inserted central catheter (PICC). OBJECTIVES This systematic review and meta-analysis aimed to identify the association between the levels of potential biomarkers that reflect the activation of the blood system, long-term vascular complications, inflammatory system, and the occurrence of PICC-related DVT. METHODS Seven electronic databases (Embase, Web of Science, Medline, Scopus, Cinahl, Cochrane Central Register of Controlled Trials, and ERIC) were searched to identify literature published until December 2022. Studies were required to report: (I) adult and pediatric patients, outpatient or admitted to clinical, surgical, or ICU with PICC; (II) patients with PICC-related DVT and patients without PICC-related DVT as a comparator; and (III) at least one biomarker available. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Study precision was evaluated by using a funnel plot for platelets level. We provided a narrative synthesis and meta-analysis of the findings on the biomarkers' outcomes of the studies. We pooled the results using random effects meta-analysis. The meta-analysis was conducted using Review Manager software v5.4. This systematic review is registered in PROSPERO (CRD42018108871). RESULTS Of the 3564 studies identified (after duplication removal), 28 were included. PICC-related DVT was associated with higher D-dimers (0.37 μg/mL, 95% CI 0.02, 0.72; p = 0.04, I2 = 92%; p for heterogeneity < 0.00001) and with higher platelets (8.76 × 109/L, 95% CI 1.62, 15.91; p = 0.02, I2 = 41%; p for heterogeneity = 0.06). CONCLUSIONS High levels of D-dimer and platelet were associated with DVT in patients with PICC. However, biomarkers such as APTT, fibrinogen, FDP, glucose, hemoglobin, glycated hemoglobin, INR, prothrombin time, prothrombin fragment 1.2, the thrombin-antithrombin complex, and WBC were not related to the development of DVT associated with PICC.
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Affiliation(s)
- Patrícia Cristina Cardoso
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90620-110, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Patricia Martins Bock
- Nursing Department, Faculdades Integradas de Taquara (FACCAT), Taquara 95612-150, RS, Brazil
| | - Vineet Chopra
- Department of Medicine, University of Colorado, Denver, CO 80045, USA
| | - Marco Aurélio Lumertz Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
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