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Latos M, Kosson D, Zawadka M. Poland's first vascular access team 3-year analysis: Insights and learnings. J Vasc Access 2025; 26:887-895. [PMID: 38708844 DOI: 10.1177/11297298241251502] [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: 05/07/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, Poland saw a surge in interest in midline catheters (MCs) and Long Peripheral Catheters (LPCs) for intravenous therapy. Before this, MCs were not extensively utilised in the country, and there was no formally established Polish vascular access team. MCs, which have been used for years in many countries, are now becoming increasingly common in Poland. This study aimed to analyse the use of MCs in a 3-year perspective of their introduction in daily clinical practice based on a nurse-led Vascular Access Team (VAT). METHODS The records of adult patients who received intravenous therapy with 727 MCs and 293 LPCs from January 2021 to December 2023 at the University Clinical Centre of the Medical University of Warsaw were analysed. RESULTS The main indication for cannulation was expected intravenous therapy over 5 days (81.66%, n = 833), of which 71.37% (n = 728) of patients in this group had concomitant difficult intravenous access (DIVA). Over 6 years, centrally inserted central catheters (CICCs) inserted due to DIVA were reduced from n = 108 in 2017 to n = 18 in 2023. The end of intravenous therapy was the reason for the removal of 64.6% of catheters (n = 659), including death and switch to CICCs as well. Complications leading to premature removal accounted for 31.2%, such as: occlusion (14.6%), patient self-removal (7.1%) and thrombosis (3.43%). CONCLUSIONS The introduction of MCs as a possible option for peripheral venous access reduces the use of CVCs. Developing MCs programmes should be based on investing in staff competencies, which increases success rates. The nurses and physicians should be trained in infusion care to achieve better results in the use of MCs and LPCs. Increasing the competence of nurses in Poland is necessary for the implementation of full-service and top-level functioning of VAT.
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MESH Headings
- Humans
- Poland/epidemiology
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Catheterization, Peripheral/nursing
- Catheterization, Peripheral/trends
- Male
- Female
- Middle Aged
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheterization, Central Venous/trends
- Catheterization, Central Venous/nursing
- Time Factors
- Aged
- COVID-19/epidemiology
- Patient Care Team/trends
- Patient Care Team/organization & administration
- Adult
- Retrospective Studies
- Central Venous Catheters
- Catheters, Indwelling
- Administration, Intravenous
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Affiliation(s)
- Maciej Latos
- Department of Anaesthesiology and Intensive Care Division of Teaching, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care Division of Teaching, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Zawadka
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Cichowlas G, Fornal I, Latos M, Kosson D. Midline catheter insertion as a strategic component of intravenous infusion: A single-centre retrospective analysis. J Vasc Access 2025:11297298251316956. [PMID: 39935393 DOI: 10.1177/11297298251316956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Intravenous infusion is a key aspect of therapy in hospitalised patients. Choosing the right vascular catheter is important to minimise damage to the patient's tissues, improve the quality of medical care and reduce costs associated with treatment complications. The purpose of this study was to review the effectiveness of midline catheters as a strategic component of intravenous infusions in a Polish hospital. MATERIAL AND METHODS The study material consists of medical records of patients with midline catheters at Czerniakowski Hospital in Warsaw over the period from 5th October 2021 to 19th May 2023. An analysis of 341 infusion observation charts was performed, excluding illegible and incomplete data. In this article, all of the catheters we used were inserted under ultrasound guidance. RESULTS The type of vein chosen has no significant effect on the catheter dwell time (p = 0.984). Catheter length correlates with catheter dwell time (r = 0.133; p = 0.016). Catheters with a length of 15 cm have the longest dwell time, while those with a length of 20 cm have the shortest. Completion of therapy or patient death was the most common reason for catheter removal (46.9%). Catheter size had an impact on catheter dwell time (p = 0.034). The text presents observations regarding the relationship between catheter diameter and total aspiration time, based on all days during which blood was aspirated through the catheter. The statistical test results (H = 118.268; p < 0.001) indicate a significant impact of catheter diameter size on total aspiration time. CONCLUSIONS Midline catheters are an effective solution for patients with difficult vascular access, increase the possibility of intravenous therapy. Moreover, they improve patient comfort and reduce the number of multiple cannulations. Developing vascular access teams can better control infusion management and care.
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Affiliation(s)
- Grzegorz Cichowlas
- Department of Anesthesiology and Intensive Care, Czerniakowski Hospital Ltd., Warsaw, Poland
- Department of Anesthesiology and Intensive Care Education, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Fornal
- Department of Basic Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Latos
- Department of Anesthesiology and Intensive Care Education, Medical University of Warsaw, Warsaw, Poland
- University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kosson
- Department of Anesthesiology and Intensive Care Education, Medical University of Warsaw, Warsaw, Poland
- University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
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3
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Wang L, Zhen M, Liao L, Li H, Yan H, Wiley JA, Lu Q, Chen X, Yv J, Ding B. Effects of dietary habits and catheterization type on breast cancer-related lymphedema: a retrospective cohort study. BMC Cancer 2024; 24:1264. [PMID: 39394086 PMCID: PMC11468185 DOI: 10.1186/s12885-024-13025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Understanding the factors that contribute to variability in breast cancer-related lymphedema (BCRL) is an important first step in developing targeted interventions to improve quality of life in breast cancer patients. Although previous research studies have has identified many risk factors for BCRL, dietary habits and catheterization type have rarely been studied until the present. AIM This study aims to explore the effects of nursing factors such as dietary habits and catheterization type on breast cancer-related lymphedema (BCRL). METHODS This retrospective cohort study included 1,476 breast cancer patients who underwent surgery between January 1, 2012, and September 1, 2020. Lymphedema was assessed with a validated self-report questionnaire. All research data were obtained from medical records and a follow-up database. Multivariate Cox regression was conducted to explore the effects of dietary habits and catheterization type on BCRL. RESULTS The results showed an increased risk for BCRL among breast cancer patients who followed a high-fat diet prehospitalization (HR = 2.47; 95% CI = 1.55-3.94; P < 0.001), indwelling totally implantable venous access ports (TIVAPs) compared with indwelling needles (HR = 0.56; 95% CI = 0.35-0.90;P = 0.017) or indwelling peripherally inserted central catheters (PICCs) (HR = 0.69; 95% CI = 0.45-1.05; P = 0.086). CONCLUSION High-fat diet pre-hospitalization was an independent risk factor for lymphedema. The TIVAPs did not exert a protective effect on lymphedema compared with the PICC and indwelling needle. This study finding offers new insights to develop targeted interventions to decrease the incidence of lymphedema.
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Affiliation(s)
- Ling Wang
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Meixin Zhen
- Xiangya Nursing School, Central South University, Changsha, China
| | - Lulu Liao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Li
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China.
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China.
| | - Huang Yan
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - James A Wiley
- Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, USA
| | - Qing Lu
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xuemei Chen
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Jun Yv
- Nursing Department, The Third Xiangya Hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
| | - Boni Ding
- Department of Thyroid Breast Surgery, The Third Xiangya hospital, Central South University, 138 Tong Zi Po Road, Changsha, Hunan, 410013, China
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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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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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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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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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8
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Fabiani A, Aversana N, Santoro M, Sanson G. Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection. Thromb Res 2024; 236:117-126. [PMID: 38422981 DOI: 10.1016/j.thromres.2024.02.022] [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: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. METHODS Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. RESULTS Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. CONCLUSIONS A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes.
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Affiliation(s)
- Adam Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata - Via Montpellier 1, Rome, Italy; Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Nicola Aversana
- School of Nursing, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, 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: 4] [Impact Index Per Article: 2.0] [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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10
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García-Zambrano L, Morales-Gómez D, Dennis-Halley MJ, Román-Ortega CF, Cabrera-Rivera PA, Parra M. Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia. SAGE Open Med 2023; 11:20503121231201349. [PMID: 37808511 PMCID: PMC10557411 DOI: 10.1177/20503121231201349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Peripherally inserted central catheters (PICCs) are an effective tool as a medical device in patients who require them. However, it is a procedure that has been associated with multiple complications and possible negative outcomes for the health of the patients. This paper seeks to describe the main complications derived from the insertion and maintenance of peripherally inserted central venous catheters (PICCs), based on the experience of a vascular accesses group in a cardiovascular center in Colombia. Methods A retrospective cross-sectional analytical study of the adult population undergoing PICC insertion at the Fundación Cardioinfantil-Instituto de Cardiología, during the period between 2019 and 2020 by the vascular access program, was performed. Results The frequency of any registered complication was 15.9% for 2019 and 11.2% for 2020. Bleeding at the procedure site occurred in 15.3% during 2019 and 7.0% in 2020, making it the most frequent complication during the procedure. All the variables of complications associated with infection (bacteremia, phlebitis, and catheter-related infection) showed a decrease in 2020 compared to the previous year. The central line-associated bloodstream infection registered for the year 2019 was 1.94 bacteremia's/1000 catheters-day compared to 0.29 bacteremia's/1000 catheters-day. Conclusions There has been a 4.7% reduction in the frequency of any registered complication after the implementation of the vascular access groups. Global and specific complications decreased significantly from 2019 to 2020. Notably, bacteremia, a common post-procedure complication, showed a substantial decrease in frequency compared to national and worldwide literature. It is also been described that complications associated with infection showed a decrease in 2020 compared to 2019. Whether or not all these findings are directly or somewhat related to the results stemming from the vascular access groups still needs further investigation.
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Affiliation(s)
- Laura García-Zambrano
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Daniel Morales-Gómez
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
| | | | - Carlos F Román-Ortega
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
- Vascular Access Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
| | - Paulo A. Cabrera-Rivera
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
| | - Marcela Parra
- Vascular Access Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
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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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12
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Vrotniakaite-Bajerciene K, Tritschler T, Jalowiec KA, Broughton H, Schmidli F, Schneider JS, Haynes A, Rovo A, Hovinga JAK, Aujesky D, Angelillo-Scherrer A. Adherence to thrombophilia testing guidelines and its influence on anticoagulation therapy: A single-center cross-sectional study. Thromb Res 2023; 223:87-94. [PMID: 36724651 DOI: 10.1016/j.thromres.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The collected evidence on thrombophilia guidelines is scarce and data about their impact on clinical decisions are unknown. We aimed to investigate the adherence to thrombophilia testing guidelines, its therapeutic impact in patients with guideline-adherent and non-adherent testing and identify the patients' clinical characteristics mostly associated with treatment decisions. MATERIALS AND METHODS We conducted a single-center cross-sectional study of patients referred for thrombophilia testing at the outpatient clinic of a tertiary hospital between 01/2010-10/2020. We systematically evaluated the adherence of thrombophilia testing to internal guidelines and the influence of test results on anticoagulation therapy. Using multivariable logistic regression, we evaluated the association between clinical characteristics and influence of thrombophilia tests on anticoagulation therapy in the entire cohort and by indication for referral. RESULTS Of 3686 included patients, mostly referred for venous thromboembolism (2407, 65 %) or arterial thrombosis (591, 16 %), 3550 patients (96 %) underwent thrombophilia testing. Indication for testing was according to guidelines in 1208 patients (33 %). Test results influenced treatment decisions in 56 of 1102 work-ups (5.1 %) that were adherent to guidelines, and in 237 of 2448 (9.7 %) non-adherent work-ups (absolute difference, 4.3 %; 95 % confidence interval, 2.9-6.3 %). Age < 50 years, female sex, absence of risk factors and co-morbidities, weakly provoked venous thromboembolism and referral indication other than venous thromboembolism were associated with influence on anticoagulation therapy. CONCLUSIONS Adherence to guidelines for thrombophilia testing was poor and did not have an impact on treatment decisions. Refinement of selection criteria is needed to increase the therapeutic impact of thrombophilia testing.
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Affiliation(s)
- Kristina Vrotniakaite-Bajerciene
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland.
| | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Katarzyna Aleksandra Jalowiec
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Helen Broughton
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Fabienne Schmidli
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Jenny Sarah Schneider
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johanna Anna Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department for BioMedical Research, University of Bern, Switzerland
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13
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Buetti N, Marschall J, Catho G, Timsit JF, Mermel L. Which trial do we need? Infectious and non-infectious complications of peripherally inserted central venous catheters and midline catheters. Clin Microbiol Infect 2023; 29:568-569. [PMID: 36682453 DOI: 10.1016/j.cmi.2023.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; INSERM, IAME, Université Paris-Cité, Paris, France.
| | - Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | | | - Leonard Mermel
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Division of Infectious Diseases, Rhode Island Hospital, Providence, RI, USA; Department of Epidemiology and Infection Prevention, Lifespan Hospital System, Providence, RI, USA
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Urtecho M, Torres Roldan VD, Nayfeh T, Espinoza Suarez NR, Ranganath N, Sampathkumar P, Chopra V, Safdar N, Prokop LJ, O’Horo JC. Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad024. [PMID: 36751645 PMCID: PMC9898877 DOI: 10.1093/ofid/ofad024] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
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Affiliation(s)
- Meritxell Urtecho
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
| | - Victor D Torres Roldan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasia Safdar
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Larry J Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
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Rabelo-Silva ER, Lourenço SA, Maestri RN, Candido da Luz C, Carlos Pupin V, Bauer Cechinel R, Bordini Ferro E, Aurélio Lumertz Saffi M, do Campo Silva TC, Martins de Andrade L, Sales Gomes LF, Alves da Gama L, Marques de Araújo M, Santo FRFDE, López Pedraza L, Hirakata VN, Santana Soares V, Sousa Montenegro W, Rocha Costa de Freitas G, Souza de Jesus T, Chopra V. Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters. BMJ Qual Saf 2022; 31:652-661. [PMID: 35086961 PMCID: PMC9411873 DOI: 10.1136/bmjqs-2021-013869] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023]
Abstract
Background Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. Methods We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. Results Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). Conclusions Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed.
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Affiliation(s)
| | | | | | | | | | | | - Eduarda Bordini Ferro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Aurélio Lumertz Saffi
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | - Leticia López Pedraza
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vânia Naomi Hirakata
- Hospital de Clínicas de Porto Alegre - Vascular Access Program, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Vineet Chopra
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
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Nickel B. Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care? Crit Care Nurse 2021; 41:e1-e21. [PMID: 34851379 DOI: 10.4037/ccn2021818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. OBJECTIVE To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. RESULTS Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. DISCUSSION Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. CONCLUSIONS Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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18
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Lu H, Yang Q, Tian F, Lyu Y, He H, Xin X, Zheng X. A Meta-Analysis of a Cohort Study on the Association between Sleep Duration and Type 2 Diabetes Mellitus. J Diabetes Res 2021; 2021:8861038. [PMID: 33834077 PMCID: PMC8012145 DOI: 10.1155/2021/8861038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To study the association between sleep duration and the incidence of type 2 diabetes mellitus (T2DM) and to provide a theoretical basis for the prevention of T2DM through a meta-analysis. METHODS PubMed, Web of Science, Scopus, Embase, Cochrane Library, ProQuest, CNKI, Wanfang, VIP, and SINOMED were searched from their inception until May 2020. All cohort studies on the relationship between sleep duration and T2DM in adults were included. According to the inclusion and exclusion criteria, two authors independently assessed the literature and extracted the data. Metaregression and publication bias were evaluated, and sensitivity and meta-analyses were conducted with RevMan 5.3. RESULTS A total of 17 studies were collected, involving 737002 adults. The incidence of T2DM was 4.73% in short sleep duration (SSD) (t ≤ 6 h), 4.39% in normal sleep duration (NSD) (6 h < t < 9 h), and 4.99% in long sleep duration (LSD) (t ≥ 9 h). The meta-analysis demonstrated that SSD increased the risk of T2DM compared with NSD (RR = 1.22, 95% CI: 1.15-1.29, P < 0.001), LSD increased the risk of T2DM compared with NSD (RR = 1.26, 95% CI: 1.15-1.39, P < 0.001), and the risk of T2DM has no significant difference between SSD and LSD (RR = 0.97, 95% CI: 0.89-1.05, P = 0.41). The sensitivity of each study was robust and the publication bias was weak. CONCLUSION SSD or LSD can increase the risk of T2DM.
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Affiliation(s)
- Huapeng Lu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Qinling Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Fang Tian
- School of Nursing, Yan'an University, Yan'an, Shaanxi 710061, China
| | - Yi Lyu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Hairong He
- Department of Clinical Research Center, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xia Xin
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xuemei Zheng
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
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