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Takahashi T, Murayama R, Abe-Doi M, Miyahara-Kaneko M, Kanno C, Nakamura M, Mizuno M, Komiyama C, Sanada H. Preventing peripheral intravenous catheter failure by reducing mechanical irritation. Sci Rep 2020; 10:1550. [PMID: 32005839 PMCID: PMC6994694 DOI: 10.1038/s41598-019-56873-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022] Open
Abstract
Peripheral intravenous catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic “pre-scan” for selecting a large-diameter vein before catheterization, a “post-scan” for confirming the catheter tip position after catheterization with ultrasonography, and the use of a flexible polyurethane catheter to reduce the mechanical irritation that contributes to the incidence of catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was catheter failure, which was defined as accidental and unplanned catheter removal. We used Kaplan-Meier survival curves to compare rates of time until catheter failure. We analysed 189 and 233 catheters in the intervention and control groups, respectively. In the control group, 68 catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for catheter failure was 0.60 (95% CI: 0.47–0.71). Care protocols, including assessment of vein diameter, vein depth, and catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce catheter failure incidence.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maki Miyahara-Kaneko
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chiho Kanno
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Nakamura
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Mizuno
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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2
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Lv L, Zhang J. The incidence and risk of infusion phlebitis with peripheral intravenous catheters: A meta-analysis. J Vasc Access 2019; 21:342-349. [PMID: 31547791 DOI: 10.1177/1129729819877323] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Phlebitis is a common complication associated with the use of peripheral intravenous catheters. The aim of this study was to estimate the incidence of phlebitis with peripheral intravenous catheter use and to identify risk factors for phlebitis development. Method: Literature survey was conducted in electronic databases (CINAHL, Embase, Google Scholar, Ovid, and PubMed), and studies were included if they used peripheral intravenous catheter for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain overall and subgroup phlebitis incidence rates and odds ratio between males and females in phlebitis incidence. Results: Thirty-five studies were included (20,697 catheters used for 15,791 patients; age 57.1 years (95% confidence interval: 55.0, 59.2); 53.9% males (95% confidence interval: 42.3, 65.5)). Incidence of phlebitis was 30.7 per 100 catheters (95% confidence interval: 27.2, 34.2). Incidence of severe phlebitis was 3.6% (95% confidence interval: 2.7%, 4.6%). Incidence of phlebitis was higher in non-intervened (30% (95% confidence interval: 27%, 33%)) than in intervened (21% (95% confidence interval: 15%, 27%)) groups, and with Teflon (33% (95% confidence interval: 25%, 41%)) than Vialon (27% (95% confidence interval: 21%, 32%)) cannula use. Odds of developing phlebitis was significantly higher in females (odds ratio = 1.42 (95% confidence interval: 1.05, 1.93); p = 0.02). Longer dwelling time, antibiotics infusion, female gender, forearm insertion, infectious disease, and Teflon catheter are important risk factors for phlebitis development identified by the included studies. Conclusion: Incidence of phlebitis with the use of peripheral intravenous catheters during infusion is 31%. Severe phlebitis develops in 4% of all patients. Risk of phlebitis development can be reduced by adapting appropriate interventions.
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Affiliation(s)
- Luyu Lv
- Venous Blood Collection Room, Changchun Children’s Hospital, Changchun, China
| | - Jiaqian Zhang
- Department of Cardiology, Sino-Japanese Friendship Hospital, Jilin University, Changchun, China
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Monogue ML, Almarzoky Abuhussain SS, Kuti JL, Nicolau DP. Physical compatibility of fosfomycin for injection with select i.v. drugs during simulated Y-site administration. Am J Health Syst Pharm 2019; 75:e36-e44. [PMID: 29273611 DOI: 10.2146/ajhp170123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The results of a study to determine the physical compatibility of ZTI-01 (fosfomycin for injection) in 0.9% sodium chloride or 5% dextrose during simulated Y-site administration with 37 i.v. antimicrobials and 58 nonantimicrobials are reported. METHODS Fosfomycin, an epoxide antibiotic with broad-spectrum activity against multidrug-resistant bacteria, is marketed in the United States only in an oral formulation with limited bioavailability, but an i.v. formulation is in development. Fosfomycin for injection and other evaluated drugs were reconstituted according to manufacturer recommendations and further diluted with 0.9% sodium chloride or 5% dextrose to the final desired concentrations. Y-site administration was simulated in glass culture tubes. Incompatibility was defined as changes in visual characteristics or a change in turbidity of >0.5 nephelometric turbidity units over the 120-minute observation period. RESULTS Of the 95 drugs tested, 16 were incompatible with fosfomycin in 0.9% sodium chloride, and 18 were incompatible with fosfomycin in 5% dextrose; incompatibility was observed with 10 of 37 antimicrobials, including the 3 commercially available amphotericin B products, anidulafungin, caspofungin, ceftaroline, ciprofloxacin, daptomycin, doxycycline, and isavuconazonium sulfate. CONCLUSION Fosfomycin for injection at a concentration of 30 mg/mL was physically compatible with 73 of 95 (77%) of the i.v. drugs tested at concentrations used clinically in both 0.9% sodium chloride injection and 5% dextrose injection. Twenty-two drugs were deemed incompatible in at least 1 of the 2 diluents.
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Affiliation(s)
- Marguerite L Monogue
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT
| | - Safa S Almarzoky Abuhussain
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.,Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT
| | - David P Nicolau
- Center for Anti-Infective Research and Development and Division of Infectious Diseases, Hartford Hospital, Hartford, CT
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Weiss D, Yaakobovitch H, Tal S, Nyska A, Rotman OM. Novel short peripheral catheter design for prevention of thrombophlebitis. J Thromb Haemost 2019; 17:39-51. [PMID: 30506866 DOI: 10.1111/jth.14350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 12/01/2022]
Abstract
Essentials Phlebitis is one of the most frequent complications related to short peripheral catheters (SPC). A new SPC design, aimed for minimizing mechanical phlebitis, was tested in vivo in swine. MRI analysis revealed 40% less inflammation with the new SPC design compared to commercial SPC. The results confirm that our SPC biomechanical design approach can minimize phlebitis rates. SUMMARY: Background Short peripheral catheters (SPCs) are the most common intravenous device in today's medical practice. Short peripheral catheter thrombophlebitis (SPCT) occurs in up to 80% of hospitalized patients. Symptoms appear on average 3 days after catheter insertion and can lead to extended hospitalization and increased related costs. Here we introduce a novel SPC, named very short peripheral catheter (VSPC), that was designed to minimize biomechanical irritation and improve blood flow. Objective The goal was to test the performance of the novel catheter in vivo for reduction of thrombophlebitis. Methods Very short peripheral catheter prototypes were inserted into swine ear veins (n = 12). Verification of the catheter conformation in situ and blood perfusion was performed using Echo-Doppler. The SPCT development rate was measured using magnetic resonance imaging (MRI), 4 and 12 days after catheter insertion, and analyzed by means of edema and inflammation intensities. Blind histopathology analysis was performed on the veins postmortem. Clinically available SPC was used as a reference. Results Operation of the VSPC devices did not require any special skills over those used for the clinically available SPC. Echo-Doppler imaging confirmed that in contrast to the traditional SPC, the VSPC avoided contact with the vein wall and allowed better blood perfusion. The MRI analysis revealed 2-fold inflammation and edema rates (~80%) in the veins cannulated with the commercial SPC, whereas rates of only ~40% were seen with the novel VSPC. A similar trend was noticed in the histopathology analysis. Conclusions The results indicate that the novel catheter design significantly reduced SPCT rates and demonstrated proof of concept for our biomechanical approach.
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Affiliation(s)
- D Weiss
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - H Yaakobovitch
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - S Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- MRI and Neuroradiology Section, Assaf Harofeh Medical Center, Tel Aviv, Israel
| | - A Nyska
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Consultant in Toxicologic Pathology, Timrat, Israel
| | - O M Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Meng L, Nguyen CM, Patel S, Mlynash M, Caulfield AF. Association between continuous peripheral i.v. infusion of 3% sodium chloride injection and phlebitis in adults. Am J Health Syst Pharm 2018; 75:284-291. [PMID: 29472509 DOI: 10.2146/ajhp161028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE One institution's experience with use of peripheral i.v. (PIV) catheters for prolonged infusions of 3% sodium chloride injection at rates up to 100 mL/hr is described. METHODS A prospective, observational, 13-month quality assurance project was conducted at an academic medical center to evaluate frequencies of patient and catheter phlebitis among adult inpatients who received both an infusion of 3% sodium chloride injection for a period of ≥4 hours through a dedicated PIV catheter and infusions of routine-care solutions (RCSs) through separate PIV catheters during the same hospital stay. RESULTS Sixty patients received PIV infusions through a total of 291 catheters during the study period. The majority of patients (78%) received infusions of 3% sodium chloride injection for intracranial hypertension, with 30% receiving such infusions in the intensive care unit. Phlebitis occurred in 28 patients (47%) during infusions of 3% sodium chloride and 26 patients (43%) during RCS infusions (p = 0.19). Catheter phlebitis occurred in 73 catheters (25%), with no significant difference in the frequencies of catheter phlebitis with infusion of 3% sodium chloride versus RCSs (30% [32 of 106 catheters]) versus 22% [41 of 185 catheters]), p = 0.16). CONCLUSION Patient and catheter phlebitis rates were not significantly different with infusions of 3% sodium chloride injection versus RCSs, suggesting that an osmolarity cutoff value of 900 mOsm/L for peripheral infusions of hypertonic saline solutions may not be warranted.
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Affiliation(s)
| | | | | | - Michael Mlynash
- Department of Neurology and Neurological Sciences, Stanford Health Care, Stanford, CA
| | - Anna Finley Caulfield
- Department of Neurology and Neurological Sciences, Stanford Health Care, Stanford, CA
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Göransson K, Förberg U, Johansson E, Unbeck M. Measurement of peripheral venous catheter-related phlebitis: a cross-sectional study. LANCET HAEMATOLOGY 2017; 4:e424-e430. [DOI: 10.1016/s2352-3026(17)30122-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
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Enes SMS, Opitz SP, Faro ARMDCD, Pedreira MDLG. Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon. Rev Esc Enferm USP 2017; 50:263-71. [PMID: 27384206 DOI: 10.1590/s0080-623420160000200012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. OBJETIVO Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.
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9
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Low-Angled Peripheral Intravenous Catheter Tip Placement Decreases Phlebitis. J Vasc Access 2016; 17:542-547. [DOI: 10.5301/jva.5000601] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis. Methods Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall. Results There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (p<0.001). The median angles of the catheter tip were 7.8° and 4.1°, respectively (p<0.001). Phlebitis occurred more frequently when the catheter-tip was placed at angle >5.8°. Discussion The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.
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Palese A, Ambrosi E, Fabris F, Guarnier A, Barelli P, Zambiasi P, Allegrini E, Bazoli L, Casson P, Marin M, Padovan M, Picogna M, Taddia P, Salmaso D, Chiari P, Marognolli O, Canzan F, Saiani L. Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study. J Hosp Infect 2016; 92:280-6. [DOI: 10.1016/j.jhin.2015.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022]
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Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A. Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.62008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Singh A, Kaur A, Singh M, Kaur S. CT Guided Removal of Iatrogenic Foreign Body: A Broken Intravenous Cannula. J Clin Diagn Res 2015; 9:PD28-9. [PMID: 26500957 DOI: 10.7860/jcdr/2015/14344.6549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/31/2015] [Indexed: 11/24/2022]
Abstract
Foreign bodies are encountered on day to day basis by a surgeon. Usually foreign bodies are lodged in narrow cavities of the body and the common age group is in children. They may range from foreign bodies in ear, nose, cricopharynx and even in rectum. Iatrogenic foreign bodies are not uncommon. Unknowingly, surgeons have been known to leave sponges, artery forceps in the abdomen which lead to hazardous sequelae. Intravascular foreign bodies occurrence has increased from a decade or so.
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Affiliation(s)
- Amanpreet Singh
- Assistant Professor, Department of Ear, Nose and Throat, M.M Medical College , Mullana, Ambala, India
| | - Anupama Kaur
- Asscociate Professor, Department of Physiology, M.M Medical College , Mullana, Ambala, India
| | - Majhail Singh
- Profeesor, Department of Surgery, M.M Medical College , Mullana, Ambala, India
| | - Surinder Kaur
- Professor, Department of Physiology, M.M Medical College , Mullana, Ambala, India
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Ray-Barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract 2014; 20:191-202. [PMID: 24401116 PMCID: PMC4237185 DOI: 10.1111/jep.12107] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility. METHOD We conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS Infusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested. CONCLUSION Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.
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Affiliation(s)
- Gillian Ray-Barruel
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Denise F Polit
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Jenny E Murfield
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith UniversityBrisbane, Queensland, Australia
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Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini D, Capasso L, Di Baldassarre A, Eltaji Elfarouki G. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi‐centre prospective study. J Adv Nurs 2014; 70:2539-49. [DOI: 10.1111/jan.12403] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
- ASL 02 Abruzzo Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Valentina Simonetti
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Dania Comparcini
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences University of Chieti‐Pescara Italy
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Cicolini G, Simonetti V, Comparcini D, Labeau S, Blot S, Pelusi G, Di Giovanni P. Nurses' knowledge of evidence-based guidelines on the prevention of peripheral venous catheter-related infections: a multicentre survey. J Clin Nurs 2013; 23:2578-88. [DOI: 10.1111/jocn.12474] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Science of Aging; “G. d'Annunzio” University of Chieti; Chieti Italy
| | - Valentina Simonetti
- Department of Medicine and Science of Aging; “G. d'Annunzio” University of Chieti; Chieti Italy
| | - Dania Comparcini
- Department of Medicine and Science of Aging; “G. d'Annunzio” University of Chieti; Chieti Italy
| | - Sonia Labeau
- Faculty of Education, Health and Social Work; University College Ghent; Ghent Belgium
| | - Stijn Blot
- Department of Internal Medicine; Ghent University; Ghent Belgium
| | | | - Pamela Di Giovanni
- Department of Pharmacy; “G. d'Annunzio” University of Chieti; Chieti Italy
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Dorniak-Wall T, Rudaks L, Solanki NS, Greenwood J. Safe and correct use of peripheral intravenous devices. ANZ J Surg 2012; 83:764-8. [PMID: 23035825 DOI: 10.1111/j.1445-2197.2012.06281.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND A peripheral intravenous device (PIVD) provides venous access for the administration of medications, blood products and fluids. They can be associated with a risk of infection and other complications, which have prompted the development of evidence-based guidelines for their use at the Royal Adelaide Hospital (RAH). A previous audit performed at the RAH found unsatisfactory compliance with these guidelines across a group of wards. The Burns Unit performed poorly compared with other wards, but the reasons for this were not explored. METHODS A repeat audit was performed for all PIVDs in the Burns Unit over a 3-week period and compliance with the PIVD safety guidelines was assessed. Factors influencing compliance were investigated and the evidence behind the guidelines was reviewed. RESULTS Overall compliance with the seven safety criteria was 71%. Poorest compliance was for documentation of insertion date, which has implications for scheduling PIVD replacement. CONCLUSION The guidelines are largely evidence-based; however, not all of them are feasible for all patients within a hospital. The Burns Unit had an overall compliance rate of 71%. Auditing of individual wards is not effective in assessing those wards' compliance with the guidelines as many PIVDs are inserted in other locations in the hospital. For compliance to improve, other areas of the hospital where PIVDs are inserted need to be targeted.
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Affiliation(s)
- Taisa Dorniak-Wall
- Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Furtado LCDR. Incidence and predisposing factors of phlebitis in a surgery department. ACTA ACUST UNITED AC 2011; 20:S16-8, S20, S22 passim. [DOI: 10.12968/bjon.2011.20.sup7.s16] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luís Carlos do Rego Furtado
- Central Operating Theatre, Hospital do Divino Espírito Santo de Ponta Delgada EPE, São Miguel Island, Portugal
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Reis AMM, Cassiani SHDB. Adverse drug events in an intensive care unit of a university hospital. Eur J Clin Pharmacol 2011; 67:625-32. [DOI: 10.1007/s00228-010-0987-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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Hasselberg D, Ivarsson B, Andersson R, Tingstedt B. The handling of peripheral venous catheters - from non-compliance to evidence-based needs. J Clin Nurs 2010; 19:3358-63. [DOI: 10.1111/j.1365-2702.2010.03410.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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De Marinis MG, Piredda M, Pascarella MC, Vincenzi B, Spiga F, Tartaglini D, Alvaro R, Matarese M. 'If it is not recorded, it has not been done!'? consistency between nursing records and observed nursing care in an Italian hospital. J Clin Nurs 2010; 19:1544-52. [PMID: 20438599 DOI: 10.1111/j.1365-2702.2009.03012.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study is to evaluate the consistency between the care given to patients and that documented, by comparing care observations with nursing records and describing which interventions were reported and which were omitted. BACKGROUND Assumptions have been made about the relationship between documentation and care actually delivered, but there is insufficient evidence on the relationship between the actual care given and its recording. DESIGN Observational study of the care given, completed by interviews and retrospective survey of records. METHODS Structured observation during day shifts in the first six days of admission of pre and postsurgical care provided to 21 consecutive patients undergoing major abdominal surgery and audit of their nursing records. Each observation was completed by short interviews to nurses to ensure observations validity. RESULTS Only 40% of nursing activities observed were included in the nursing records (37% of the assessments and 45% of the interventions). This indicated that nurses carry out more activities than they report. Consistency between performed and recorded care decreased significantly during the days when a higher number of activities were performed. Consistency between recording and observation of assessment activities was 38% for physical needs and 0% for educational needs. Consistency was higher for the assessments of physical signs/symptoms and risk factors for complications compared to the assessment of basic needs and pain. Consistency was 47% for technical interventions and 3% for educational activities. CONCLUSIONS Nursing records were not found to be an adequate tool for quality care evaluation, because they did not include all the caring activities that the nurses had carried out. RELEVANCE TO CLINICAL PRACTICE This study supports the need to identify documentation systems that are easy to complete. Moreover, nursing education should pay more attention to the competences in the field of holistic care and patient education.
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Zingg W, Pittet D. Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 2010; 34 Suppl 4:S38-42. [PMID: 19931816 DOI: 10.1016/s0924-8579(09)70565-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Peripheral venous catheters (PVC) are the most frequently used invasive devices in hospitals. Up to 70% of patients require a peripheral venous line during their hospital stay, and conservative estimates suggest that PVC days account for 15-20% of total patient days in acute care hospitals. Most published studies focus on thrombophlebitis and address the issue of scheduled catheter change, but there is still no consensus on the optimal time point for PVC change, or whether catheter replacement is required at all. Although PVC-associated catheter-related bloodstream infections (PVC-BSI) are far more serious than thrombophlebitis, few studies address this issue, and a large multicentre trial is lacking. Some studies on thrombophlebitis mention that no, or only a few, PVC-BSIs were identified, but such results must be interpreted with caution. Current data available on PVC-BSI suggest incidence density rates of 0.2-0.7 episodes per 1000 device days, which appear low when compared with other catheters. However, some studies report absolute PVC-BSI numbers in the range of central line-associated infections. It remains unclear whether PVC-BSI should be considered a serious healthcare problem or simply a very rare event. More research is needed both to capture the dimension of the problem and to provide efficient control measures.
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Affiliation(s)
- Walter Zingg
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
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Cicolini G, Bonghi AP, Di Labio L, Di Mascio R. Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study. J Adv Nurs 2009; 65:1268-73. [DOI: 10.1111/j.1365-2648.2009.04980.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johansson ME, Pilhammar E, Khalaf A, Willman A. Registered Nurses' Adherence to Clinical Guidelines Regarding Peripheral Venous Catheters: A Structured Observational Study. Worldviews Evid Based Nurs 2008; 5:148-59. [DOI: 10.1111/j.1741-6787.2008.00105.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Uslusoy E, Mete S. Predisposing factors to phlebitis in patients with peripheral intravenous catheters: A descriptive study. ACTA ACUST UNITED AC 2008; 20:172-80. [DOI: 10.1111/j.1745-7599.2008.00305.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozyazicioğlu N, Arikan D. The effect of nurse training on the improvement of intravenous applications. NURSE EDUCATION TODAY 2008; 28:179-85. [PMID: 17445954 DOI: 10.1016/j.nedt.2007.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 12/20/2006] [Accepted: 03/02/2007] [Indexed: 05/15/2023]
Abstract
This research was performed to determine the effect of training on intravenous applications. The research was conducted between March 2004 and December 2004 as a single group pre-test, post-test, quasi- experimental design. The study population was composed of 45 volunteer nurses working in pediatric clinics of three hospitals at Erzurum city, in eastern Turkey. There was no sampling: the research was started with 45 nurses and completed with 40 nurses. Results of the research indicate that after the nurse training there has been a noticeable improvement in the following practices: intravenous peripheral catheter application skills, handwashing, glove wearing, antiseptic use, collaboration with the child, choice of cannula appropriate for the treatment, adequate securement with tape, record keeping of cannula placement time, informing the parents of the reason for cannula placement and the duration of treatment, informing the parents that it will not affect the mobility of the child and that the nurse can be notified in case of pain or discomfort following the procedure. These results may be useful in determining the weaknesses in the nurses' performance and planning their training accordingly.
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Affiliation(s)
- Nurcan Ozyazicioğlu
- Department of Child Health Nursing, College of Nursing, Uludağ University, 16059 Bursa, Turkey
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Lavery I, Smith E. Peripheral vascular access devices: risk prevention and management. ACTA ACUST UNITED AC 2007; 16:1378, 1380, 1382-3. [DOI: 10.12968/bjon.2007.16.22.27767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irene Lavery
- Practice Development (CPPD) Practitioner, Practice Development
| | - Emma Smith
- Clinical Skills, CPPD Office, c/o Outpatients Building, Western General Hospital, Edinburgh
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Abstract
The Royal College Of Nursing (RCN) have evidence-based guidelines with regard to optimal time for changing peripheral intravenous cannulae (PIC) and documentation post-insertion (patient and nursing notes). This clinical audit assesses the compliance with respect to the RCN and Eastbourne District General Hospital guidelines of documenting the date post-insertion of PIC, optimal time for changing cannulae and rates of superficial phlebitis on the surgical wards. All PIC, their dressings, sites and intravenous infusions were examined on all inpatients on the surgical wards on three random days. Staff awareness with regard to RCN and local guidelines for optimal time to change peripheral venous cannulae and documentation post-insertion was assessed. The majority of staff nurses correctly stated that the optimal time for changing an uncomplicated PIC was 72 hours, despite this 13.8% had a cannulae which had been inserted for more than 72 hours. Our study has found that despite medical and nursing staff being aware of RCN and local guidelines, there is still poor compliance with regards to documentation, optimal time for changing and thus increased levels of superficial phlebitis post insertion of PIC.
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MESH Headings
- Attitude of Health Personnel
- Bandages
- Benchmarking
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/nursing
- Clinical Competence/standards
- Documentation/standards
- England
- Equipment Design
- Evidence-Based Medicine
- Guideline Adherence/standards
- Health Knowledge, Attitudes, Practice
- Hospitals, District
- Hospitals, General
- Humans
- Infection Control/standards
- Infusions, Intravenous/adverse effects
- Infusions, Intravenous/nursing
- Nursing Audit
- Nursing Evaluation Research
- Nursing Records
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/psychology
- Phlebitis/epidemiology
- Phlebitis/etiology
- Phlebitis/prevention & control
- Practice Guidelines as Topic
- Skin Care/nursing
- Skin Care/standards
- Time Factors
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Affiliation(s)
- Juyaly Biswas
- General Medicine, Dewsbury and District General Hospital
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30
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Idvall E, Gunningberg L. Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: a systematic review. J Adv Nurs 2007; 55:715-22. [PMID: 16925620 DOI: 10.1111/j.1365-2648.2006.03962.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper reports a review of the scientific evidence for elective replacement of peripheral intravenous catheters in adults in the absence of any clinical complications, with the aim being to reduce the incidence and severity of thrombophlebitis. BACKGROUND The incidence of thrombophlebitis associated with peripheral intravenous catheters has been reported to range from 5.3% to 77.5%. Many factors that increase the risk for thrombophlebitis have been reported, of which time in situ is one. In Sweden, the recommended guideline is elective replacement of peripheral intravenous catheters every 12-24 hours. METHOD A systematic literature review was carried out in 2005 using the Cochrane Library, OvidMedline and CINAHL databases and hand searching of reference lists and with keywords catheterization, peripheral, thrombophlebitis and parenteral nutrition. The review included randomized controlled trials of elective replacement of peripheral intravenous catheters in adults. Three reviewers assessed the data found according to predetermined criteria. FINDING Three randomized control trials met the inclusion criteria and were retrieved for critical appraisal. The samples in two of the trials included patients requiring total parenteral nutrition. Patients in the third trial were receiving crystalloid and drugs. Time intervals for elective replacement varied. Study quality and relevance were rated as 'medium' in two of the trials and as 'low' in the third trial. CONCLUSION Limited scientific evidence suggests that elective replacement of peripheral intravenous catheters reduces the incidence and severity of thrombophlebitis.
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Affiliation(s)
- Ewa Idvall
- Research Section, Kalmar County Council, Kalmar, Sweden.
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31
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Ahlqvist M, Bogren A, Hagman S, Nazar I, Nilsson K, Nordin K, Valfridsson BS, Söderlund M, Nordström G. Handling of peripheral intravenous cannulae: effects of evidence-based clinical guidelines. J Clin Nurs 2006; 15:1354-61. [PMID: 17038095 DOI: 10.1111/j.1365-2702.2006.01403.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. BACKGROUND Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. DESIGN A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. METHOD A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. RESULTS A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). CONCLUSION We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. RELEVANCE TO CLINICAL PRACTICE Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.
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Affiliation(s)
- Margary Ahlqvist
- Division of Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.
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32
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Barlow G, Palniappan S, Mukherjee R, Jones M, Nathwani D. Unnecessary peripheral intravenous catheterisation on an acute medical admissions unit: a preliminary study. Eur J Intern Med 2002; 13:380. [PMID: 12225783 DOI: 10.1016/s0953-6205(02)00126-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND: The ability to secure peripheral intravenous access is regarded as a basic medical skill that is often required for the management of patients admitted to acute medical admission wards. The decision to insert a peripheral intravenous catheter (PIC) is usually taken by relatively inexperienced members of the acute medical team and is primarily based on 'traditional' or 'routine' practice, rather than on an assessment of need. Furthermore, there appears to be little recognition of the potentially serious adverse events associated with PIC insertion. METHOD: We conducted a prospective study to evaluate unnecessary PIC insertion in a United Kingdom teaching hospital's acute medical admissions unit. RESULTS: Of the 338 patients included in the study, 272 (80.5%) received a PIC. Of these, 179 patients (66%) received a PIC that had been used by the post-on-call ward round. Of the 93 patients (34%) with an unused PIC, 30 patients (11%) had been catheterised inappropriately by the study criteria. CONCLUSIONS: Despite our use of conservative criteria for PIC insertion, a notable level of inappropriate peripheral intravenous catheterisation was identified. A hypothetical cost-minimisation analysis is presented and a care pathway for best practice proposed.
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Affiliation(s)
- G Barlow
- Infection Unit (East Block), Ninewells Hospital and Medical School, Tayside University Hospitals NHS Trust, DD1 9SY, Dundee, UK
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33
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Griffiths VR, Philpot P. Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intensive Crit Care Nurs 2002; 18:37-47. [PMID: 12008876 DOI: 10.1054/iccn.2002.1615] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over an eight-month period, 177 patients were admitted to a study to determine whether there was any significant difference between the peripherally inserted central catheter (PICC) in relation to the central venous catheter (CVC) and the peripheral venous access device in respect of the length of stay, incidence of phlebitis and the need for removal for suspected sepsis and infection. The results demonstrated no significant difference in terms of gender, age, or severity of illness. The PICC line had a significally higher length of stay and less incidence of phlebitis. In conclusion, PICC placement does have a place in the critical care setting. It should not be expected to replace existing methods of vascular access but used to provide a safe and effective alternative.
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Garitano Tellería B, Barberena Iriarte C, Alonso Vallejo M, Gistau Torres C. Revisión sistemática: efectividad de los cuidados en el mantenimiento de catéteres de inserción periférica. ENFERMERIA CLINICA 2002. [DOI: 10.1016/s1130-8621(02)73747-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Pereira RC, Zanetti ML. [Complications resulting from intravenous treatment in surgical patients]. Rev Lat Am Enfermagem 2000; 8:21-7. [PMID: 12040622 DOI: 10.1590/s0104-11692000000500004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nursing plays an important role in prevention and reduction of complications related to venous access. This study had the purpose to find complications derived from intravenous therapy. Major data were: 77.3% of the venous accesses were performed by auxiliary nursing; 68% of the procedures were performed without gloves; 60% of the accesses were not satisfactorily performed by nurses; 47% of the cannulae were "in situ" between 24 and 72 hours; among the complications, 20% were related to infiltration, 5.4% to infiltration and hematoma and 5.3% to obstruction. Data suggest the need to improve the education of the nursing team about intravenous therapy.
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Affiliation(s)
- R C Pereira
- Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo
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36
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Shreve WS, Knotts FB. Quality improvement with prehospital-placed intravenous catheters in trauma patients. J Emerg Nurs 1999; 25:285-9. [PMID: 10424956 DOI: 10.1016/s0099-1767(99)70054-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- W S Shreve
- St. Vincent Mercy Medical Center, Toledo, OH, USA
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37
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Abstract
This review analyses 97 research reports dealing with peri-operative care which included patients. The literature review was done as the basis of a development project to measure the quality of intra-operative nursing care from the patient's perspective. The pre-operative phase provides information about the teaching, anxiety and stress of patients. Few sources dealt with the intra-operative phase; there were a small amount of reports concerning concrete nursing activities (e.g. surgical position and warming the patient). The most information was available on the post-operative phase, such as recovery, adaptation and the treatment of pain. Peri-operative research is mainly concerned with the quality of nursing care, control of life and ambulatory surgery. The main defects of analysed studies can be characterized as follows: small samples and a single hospital, lack of definition of terms, theoretical ambiguity, short follow-up times, anaesthetic or other drugs used during the care not mentioned in the report (especially in studies on pain and quality). Previously developed research tools had usually been well tested, but there was great variety in the testing of investigator-constructed tools. There were also discrepancies in the evaluation of validity and reliability. Future research should especially deal with treatment of pain and anxiety, information and guidance given to patients, and the costs of surgical care; there is also a need for studies dealing with intra-operative care from the patient's perspective. Although information is already available on the above mentioned topics, more detailed and comprehensive facts are still needed.
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Affiliation(s)
- T Leinonen
- Department of Surgery, Turku University Hospital, Finland
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38
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Campbell L. I.v.-related phlebitis, complications and length of hospital stay: 2. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1998; 7:1364-6, 1368-70, 1372-3. [PMID: 10076215 DOI: 10.12968/bjon.1998.7.22.5533] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Review of the literature on the various types of phlebitis, risk factors, clinical indicators, severity grading scales, and associated complications of phlebitis, in the first article in this series (Vol 7(21): 1304-12), indicated that an awareness of such factors could reduce the incidence of intravenous (i.v.)-related phlebitis. This article presents a quantitative study, of longitudinal design, conducted to determine the incidence and severity of i.v.-related phlebitis in 90 patients from a large teaching hospital over a 2-month period. The study concluded that although there were multiple risk factors for the development of phlebitis, routine IV site observation and the use of phlebitis severity measurement scales could reduce the incidence and severity of phlebitis. Complications arising from phlebitis can have long-term effects on patient care, satisfaction, and length of hospital stay. If not controlled, these risk factors can increase the personal and financial costs to patients, encourage litigation, and ultimately increase the overall costs to the hospital.
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Campbell L. I.v.-related phlebitis, complications and length of hospital stay: 1. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1998; 7:1304-6, 1308-12. [PMID: 10076204 DOI: 10.12968/bjon.1998.7.21.5551] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article, the first of two-parts, addresses the growing problem of intravenous-related phlebitis in hospitalized patients, and the resultant personal and financial costs to both patient and hospital. Literature on the various types of phlebitis, the factors that increase the patient's risk of developing phlebitis, clinical indicators and severity grading scales, and the complications of phlebitis are examined. Awareness of such factors is considered instrumental in minimizing the incidence of intravenous-related phlebitis. The second article in this series will present a study of 90 patients from a large teaching hospital, which was conducted to determine the incidence and severity of intravenous-related phlebitis, risk factors, associated complications, and the related length of hospital stay. The implications of the results for current and future nursing care of patients receiving i.v. therapy will be discussed, and recommendations for safe practice will be made.
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40
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Abstract
The purpose of the study was to describe nurses' routines in connection with the planning, care and handling, and documentation of a peripheral intravenous cannula (PIV) and also to examine factors that control how nurses act. Nurses and physicians in three English hospitals were interviewed. The results showed a difference between nurses' and physicians' opinions about PIV routines, except in few cases. The PIV was inserted by the physicians while the nurses took care of and documented its care and handling. In many cases the insertion of the PIV was also documented by the nurses. Although small PIVs and short insertion time had previously been recommended, many physicians preferred large cannulae and an insertion time of between 3 and 7 days. All nurses and six physicians had the opinion that the cannula should be changed more often, but this did not happen. Some physicians maintained that the nurses' care and handling varied. On the other hand some criticism had been expressed by the nurses about unclear directives from the physicians. English participants were aware that unsatisfactory routines existed and that the policy had not always been followed.
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Affiliation(s)
- A Lundgren
- Department of Medicine and Care, Faculty of Health Science, Linköping University, Sweden
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41
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Lundgren A, Ek AC. Factors influencing nurses' handling and control of peripheral intravenous lines--an interview study. Int J Nurs Stud 1996; 33:131-42. [PMID: 8675374 DOI: 10.1016/0020-7489(95)00051-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of the study was to describe how nurses (n = 37) planned, took care of, and documented peripheral intravenous (vein) cannulae (PIV) and what controls their way of action. Knowledge, experience, and routine were said to govern the care and handling of PIV. The nurses' intention was that a PIV should be inserted for 1-3 days, but all of them were aware of PIV being inserted considerably longer, the reasons being forgetfulness, carelessness, mistake, no one to take responsibility, bad routines and stress. Patients who had received drugs or solutions daily were given less information and furthermore the same PIV-entry was used for drugs, solutions and blood. Only one nurse documented the insertion and the removal of a PIV. The nurses' personal comments were that the area was neglected and there were great variations in the care and handling of PIV. Their task is to systematically identify the patients' needs and risk factors, and to analyse, diagnose, plan, implement and evaluate the care given. Using a standardised guide could be a way to reduce the frequency of complications in the daily care of PIV.
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Affiliation(s)
- A Lundgren
- College of the Health Professions, Department of Caring Sciences, Kalmar University College of Health Sciences (Kalmar Iäns Värdhögskola) Västervik, Sweden
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Abstract
Proponents of intravenous filters claim that they remove bacterial contaminants, particulate matter, air emboli and reduce the incidence of phlebitis. From unstructured observation by the author at a large general hospital not using filters it was concluded that the incidence of complications was no greater than at a hospital having a policy for using these filters. Despite the introduction of a filter that claims to retain endotoxin for up to 96 h, filters are still misused, over used or unused in different departments of the same hospital. This paper examines the literature that supports and criticizes the advantages and disadvantages of using such filters. The research is reviewed to ascertain whether the widespread use of filters is justified and whether they effectively reduce or prevent the complications of intravenous therapy. The paper reviews the causes and incidence of complications of intravenous therapy and alternative methods used for reducing these complications. The evidence shows conflicting results and argues that complications are inevitable despite the use of filters or careful medical action. The manufacturer's claims are supported by a plethora of literature but discrepancies are evident and the author remains unconvinced of their widespread use in today's fragile economic climate when the cost of treating the adverse effects of intravenous therapy is considered.
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Nicoll LH, Ambler KE. CDC Guidelines for Peripheral Intravenous Therapy (1982) Revisited: An Integrative Review of the Literature. Worldviews Evid Based Nurs 1995. [DOI: 10.1111/j.1524-475x.1995.00001.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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