Best Practices in the Management of Central Vascular Access Devices: An Observational Study in Areas With a High Prevalence of Trained Nurses

Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis

BACKGROUND

Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation.

METHODOLOGY

A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded.

RESULTS

The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€.

CONCLUSIONS

Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.

Intravenous Line Labels For High-Alert Drugs Administered To Critically Ill Patients: A Simulated Experimental Assessment

AIMS AND OBJECTIVES

Evaluate the effect of IV line labels on nurses' identification of high-alert medications in a simulated scenario of multiple infusions for critically ill patients.

DESIGN

Randomised crossover simulation experimental study.

METHODS

A study was conducted on 29 nurses working in intensive care for over 6 months. They were given two critical scenarios in a simulated environment, one with labels and the other without labels, involving multiple intravenous infusions. The nurses had to identify the medications infused into the critical patients' intravenous lines and disconnect a specific line. The data were collected and analysed to evaluate the errors made by the nurses in identifying and disconnecting the medications and the time they spent carrying out the tasks. The Wilcoxon test was used to analyse the variation in outcome before and after the intervention.

RESULTS

Approximately one-third of the study participants incorrectly identified the intravenous lines in both scenarios. There was no significant difference in the average number of errors between the scenarios with and without labels. However, the time taken to perform the tasks in the scenario with labels was 1 min less than in the scenario without labels, suggesting a potential efficiency gain.

CONCLUSIONS

The labels on the intravenous lines allowed for quick drug identification and disconnection. The professionals performed similarly in correctly recognising the high-alert medication intravenous lines, in the scenarios with or without labels.

RELEVANCE TO CLINICAL PRACTICE

The label can be used as a technology to prevent misidentification of high-alert medications administered to critically ill patients through intravenous lines, thereby enhancing medication safety in healthcare institutions. No Public Contribution.

Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study

PURPOSE

Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care.

METHODS

A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted.

RESULTS

A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences.

CONCLUSION

This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.

Flushing in Intravenous Catheters: Observational Study of Nursing Practice in Intensive Care in Brazil

An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.

Setting the Stage: Innovation in Port Access Education for Pediatric Emergency Nurses

INTRODUCTION

Pediatric port access can be challenging in the emergency department; however, it must be performed promptly and safely. Port education for nurses traditionally includes procedural practice on adult-size, tabletop manikins, which lacks the situational and emotional aspects inherent in pediatrics. The purpose of this foundational study was to describe the knowledge and self-efficacy gain from a simulation curriculum that promotes effective situational dialogue and sterile port access technique, while incorporating a wearable port trainer to enhance simulation fidelity.

METHODS

An educational intervention impact study was conducted using a curriculum integrating a comprehensive didactic session with simulation. A unique element included a novel port trainer worn by a standardized patient, along with a second actor portraying a distressed parent at the bedside. Participants completed precourse and postcourse surveys on the day of simulation and a 3-month follow-up survey. Sessions were video recorded for review and content analysis.

RESULTS

Thirty-four pediatric emergency nurses participated in the program and demonstrated an overall increase in knowledge and self-efficacy with port access that was sustained at the 3-month follow-up. Data revealed positive feedback regarding the participants' simulation experience.

DISCUSSION

Effective port access education for nurses requires a comprehensive curriculum integrating procedural aspects and situational techniques to address the components of a true port access experience involving pediatric patients and families. Our curriculum successfully combined skill-based practice with situational management, and promoted nursing self-efficacy and competence with port access in the pediatric population.

What do we know about flushing for intravenous catheter maintenance in hospitalized adults?

ABSTRACT Objective: to evidence the use of flushing to prevent complications from intravenous therapy. Methods: an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis. Results: it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals. Conclusion: there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.