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Can M, Özalp Gerçeker G. The effect of the Veinlite PEDI2 and passive virtual reality distraction on peripheral catheter insertion-related emotional behavior, pain, fear, and anxiety of children: A randomized controlled trial. J Pediatr Nurs 2024; 78:e227-e235. [PMID: 39060169 DOI: 10.1016/j.pedn.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Virtual reality (VR) distraction can be used during peripheral intravenous catheter (PIC) insertion. The vein imaging devices are recommended for increasing PIC success. OBJECTIVES This study aimed to evaluate the effect of a Veinlite PEDI2 and passive VR distraction on the first attempt at PIC insertion success, duration of insertion, emotional behavior, pain, fear, and anxiety associated with PIC insertion in children aged 4-10 years in the pediatric emergency department. METHODS The study was conducted with a total of 160 children who were assigned to groups (control, vein imaging, VR, and vein imaging with VR) through stratified randomization. The duration and number of attempts for PIC insertion were recorded. The children's emotional state, fear, and anxiety were evaluated before and after the procedure. After the procedure, pain was evaluated using the Wong-Baker FACES and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis test. RESULTS The PIC success rate on the first attempt was 80-85% in the groups. A significant difference was found between the groups in terms of total emotional behavior scores (KW = 21.608, df = 3, p < 0.001). There were statistically significant differences among the groups in emotional behavior, pain, and anxiety scores after the procedure, while no difference was observed in fear scores (KW = 6.485, df = 3, p = 0.09). CONCLUSIONS VR distraction effectively reduced pain and anxiety, while the Veinlite PEDI2 did not affect the first attempt at PIC insertion or duration. APPLICATION TO PRACTICE VR and Veinlite PEDI2 can be used for PIC insertion-related pain and anxiety (ClinicalTrials.gov: NCT06243419).
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Affiliation(s)
- Müge Can
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir 35340, Turkey
| | - Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir 35340, Turkey.
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Dunstan L, Sweeny AL, Lam C, Goucher B, Watkins S, George S, Snelling PJ. Factors associated with difficult intravenous access in the paediatric emergency department: A prospective cohort study. Emerg Med Australas 2024. [PMID: 39099445 DOI: 10.1111/1742-6723.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors. METHODS This was a single-centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt. RESULTS A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty-two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise. CONCLUSIONS The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient-centred goals of reducing pain and improving success.
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Affiliation(s)
- Lucy Dunstan
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Amy L Sweeny
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Clayton Lam
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Bianca Goucher
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Peter J Snelling
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Sonography Innovation and Research (SONAR) Group, Gold Coast, Queensland, Australia
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Garg P, Passarello L, O’Hea C, Lai T, Reid N, Farrell B. Developing a community-based model of care for venipuncture in children and young adults with an intellectual disability: a retrospective study. BMJ Paediatr Open 2024; 8:e002644. [PMID: 39097330 PMCID: PMC11298747 DOI: 10.1136/bmjpo-2024-002644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/20/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Regular blood tests for monitoring metabolic side effects are often unable to be collected for people with an intellectual/developmental disability (ID/DD) and challenging behaviours (CBs) using usual pathways. We aimed to develop a model of care to facilitate venipuncture for children and young adults with ID/DD and CBs. METHODS A systematic tiered model of care was developed for venipuncture to suit the individual needs of children and young adults with ID/DD and CBs. A partnership was formed by the disability health team with a community pathology service provider. An observational retrospective study of the baseline demographic data, severity of disability and diagnosis, oral sedation requirement, and outcome data on the success/failure of venipuncture was done. RESULTS 14 children (mean (SD), 12.8 (3.1) years) had 17 attempted venipuncture with 'reasonable adjustments' such as preparation with social stories, distraction, low sensory strategies and oral sedation at school clinics. 14 (82%) attempts were successful. After the success of the pilot programme at school, venipuncture was replicated in settings such as home, day programmes, pathology centres and a respite facility. 16 people with ID/DD and CBs (mean (SD)17.3 (3.7) years), had 14 successful venipuncture performed out of 18 attempts (success rate, 77.7%). Overall, 11 attempts (31.4%) succeeded without requiring oral sedation using only reasonable adjustments. 16 attempts (45.7%) succeeded with conscious oral sedation along with reasonable adjustments. Of those 16, 10 required olanzapine (5 mg), 1 required olanzapine (10 mg), 1 required combination of risperidone (1 mg) and diazepam (5 mg), 1 required clonazepam (2.5 mg) and olanzapine (5 mg), 1 required combination of olanzapine (10 mg) and diazepam (10 mg), 1 required combination of olanzapine (10 mg) and diazepam (5 mg) while 1 required only diazepam (5 mg). One had to be switched to the tier-3 pathway. CONCLUSION A model of care was developed to ensure compassionate and non-stressful venipuncture for children and young adults with disabilities. We demonstrated that a significant proportion of carefully selected children and young adults with ID/DD and CBs, considered 'challenging for blood collection' can have venipuncture performed successfully in non-hospital settings using 'reasonable adjustments' and oral sedation.
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Affiliation(s)
- Pankaj Garg
- University of New South Wales, Sydney, New South Wales, Australia
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Larissa Passarello
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Catherine O’Hea
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Teresa Lai
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Natasha Reid
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Bridget Farrell
- Specialist Intellectual Disability Health Team, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
- University of Tasmania, Hobart, Tasmania, Australia
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D’Alessandro M, Ricci M, Bellini T, Chianucci B, Calevo MG, Piccotti E, Moscatelli A. Difficult Intravascular Access in Pediatric Emergency Department: The Ultrasound-Assisted Strategy (DIAPEDUS Study). J Intensive Care Med 2024; 39:217-221. [PMID: 37735884 PMCID: PMC10845837 DOI: 10.1177/08850666231199050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/24/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
Vein line positioning represents one of the first diagnostic and therapeutic steps in Pediatric Emergency Department (PED); however, the outcome of this maneuver is frequently not as expected, especially for difficult-to-access (DIVA) patients. The standard technique (visual-palpatory) has a low success rate; hence ultrasound (US) assistance has been suggested for DIVA patients, although controversial results have been obtained. Our study compared the success rate of an intravascular (IV) access procedure at the first attempt, with and without ultrasound assistance, in pediatric DIVA patients. Secondary objectives were the global success rate, the mean procedural time, the IV device's life span, and the complications rate. We conducted an observational, prospective, monocentric, no-profit cohort study enrolling 110 patients presenting to our ED, aged 0-21 years. All the patients were considered difficult-to-access patients according to the DIVA score (≥4) or history of previous difficult intravascular access. They were randomized into two homogeneous groups: 50 patients with the standard and 60 with the US-assisted technique. We obtained a significantly higher success rate at first attempt with the US-guided technique (90% vs 18%, p ≤ .00001). Moreover, the overall success rate was higher in the US group (95% vs 46%, p < .00001). The mean procedural time resulted significantly less in the US group (2.7 ± 2.2 min vs 10 ± 6.4 min, p < .0001), as well as the overall number of attempts to obtain a stable IV line (1.09 ± 0.34 attempts vs 2.38 ± 1.09 attempts, p < .0001). We experienced some post-procedural complications without differences in the two groups, although none were severe. Our study showed that bedside ultrasound assisting implantation of peripheral venous access in pediatric DIVA patients improves first-time success rate, overall success rate, procedural time, and patient comfort, reducing the number of attempts to obtain a stable IV line.
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Affiliation(s)
- Matteo D’Alessandro
- Pediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Margherita Ricci
- Pediatric and Neonatology Unit, San Paolo Hospital (Savona), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tommaso Bellini
- Pediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Benedetta Chianucci
- Pediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Directorate IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Özalp Gerçeker G, Yıldırım BG, Önal A, Ören H, Olgun HN, Bektaş M. The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study. Eur J Oncol Nurs 2023; 67:102430. [PMID: 37879193 DOI: 10.1016/j.ejon.2023.102430] [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: 07/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications. METHOD This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed. RESULTS The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication. CONCLUSIONS The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population. CLINICALTRIALS GOV IDENTIFIER NCT05769452.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Büşra Güliz Yıldırım
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Ayşe Önal
- Dokuz Eylul University Child Hospital, Izmir, Turkey; Dokuz Eylul University, Institute of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hatice Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
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Alberto EC, Mastrianni A, Sullivan TM, McCarthy KH, Milestone ZP, Chung L, Cha N, Mapelli E, Sippel GJ, Marsic I, O'Connell KJ, Sarcevic A, Burd RS. Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation. J Surg Res 2023; 283:241-248. [PMID: 36423472 PMCID: PMC9990681 DOI: 10.1016/j.jss.2022.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Intravenous access is required for resuscitation of injured patients but may be delayed in children because of challenges associated with peripheral intravenous (PIV) catheter placement. Early identification of factors predisposing patients to difficult PIV placement can assist in deciding strategies for timely intravenous access. METHODS We conducted a retrospective, video-based review of injured children and adolescents treated between April 2018 and May 2019. Patient demographic, physiological, injury, and resuscitation characteristics were obtained from the patient record, including age, race, weight, injury type, Injury Severity Score, initial systolic blood pressure, initial Glasgow Coma Score, intubation status, activation level, and presence of prearrival notification. Video review was used to determine the time to PIV placement, the number of attempts required, the purpose for additional access, and the reason for abandonment of PIV placement. Multivariable regressions were used to determine factors associated with successful placement. RESULTS During the study period, 154 consented patients underwent attempts at PIV placement in the trauma bay. Placement was successful in 139 (90.3%) patients. Older patients (OR [odds ratio]: 0.9, 95% confidence interval [CI]: 0.9, 0.9) and patients who required the highest level activation response (OR: 0.0, 95% CI: 0.0, 0.3) were less likely to have an attempt at PIV placement abandoned. Children with nonblunt injuries (OR: 11.6, 95% CI: 1.3, 119.2) and pre-existing access (OR: 39.6, 95% CI: 7.0, 350.6) were more likely to have an attempt at PIV placement abandoned. Among patients with successful PIV placement, the time required for establishing PIV access was faster as age increased (-0.5 s, 95% CI: -1.1, -0.0). CONCLUSIONS Younger age was associated with abandonment of PIV attempts and, when successful, increased time to placement. Strategies to improve successful PIV placement and alternate routes of access should be considered early to prevent treatment delays in younger children.
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Affiliation(s)
- Emily C Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Angela Mastrianni
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Travis M Sullivan
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Kathleen H McCarthy
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Zachary P Milestone
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Lauren Chung
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Nicholas Cha
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Emily Mapelli
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Genevieve J Sippel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Ivan Marsic
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey
| | - Karen J O'Connell
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia.
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Yıldırım BG, Gerçeker GÖ. The Effect of Virtual Reality and Buzzy on First Insertion Success, Procedure-Related Fear, Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial. J Emerg Nurs 2023; 49:62-74. [PMID: 36376127 DOI: 10.1016/j.jen.2022.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Distraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success. METHODS A randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal-Wallis test. RESULTS There were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure. DISCUSSION Virtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.
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Öntürk ZK, İsabetli S, Bahadır M, Doğru E. The effect of "pediatric peripheral intravenous access (PPIVA) pathway" on the success of vascular access in children. J Pediatr Nurs 2022; 69:e32-e38. [PMID: 36494235 DOI: 10.1016/j.pedn.2022.11.029] [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] [Received: 07/07/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Determine the affects of the developed "Pediatric Peripheral Intravenous Access (PPIVA) Pathway" on the success of the vascular access in children. DESIGN AND METHODS A quantitative approach was used using a quasi-experimental single-group post-test design involved pediatric patients. The patients who were first attempted for peripheral vascular access were subjected to the procedure in accordance with the "PPIVA Pathway". The data was collected via a form on which we recorded down the patients' characteristics alongside their procedural data, as well as the Difficult Intravenous Access (DIVA) Score. For statistical analysis, the R vers. 2.15.3 program was utilized. RESULTS The patients who applied to the pediatric observation clinic had a mean age of 8.14 ± 5.01 years. The DIVA total mean score of the patients was 1.73 ± 1.79. 89.1% (n = 163) of pediatric peripheral intravenous procedures were successfully completed on the first access. The logistic regression analysis model was found to be statistically significant to identify the factors that affect pediatric peripheral intravenous success on the first attempt (χ2 = 24.701; p < 0.001). A one-point increase in the DIVA score was found to reduce the likelihood of success on the first attempt by 56.1% [OR (95% CI) = 0.439 (0.280, 0.686), p < 0.001]. CONCLUSIONS Using an algorithm to perform a peripheral intravenous intervention in children increases the likelihood of success on the first attempt. PRACTICE IMPLICATIONS Using PPIVA Pathway shall improve the provision of atraumatic care for children, as the success rate of pediatric peripheral intravenous access on the first attempt is high.
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Affiliation(s)
- Zehra Kan Öntürk
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Health Sciences, Department of Nursing, Acıbadem Mehmet Ali Aydınlar Üniversitesi Kerem Aydınlar Kampüsü, Kayışdağı Cad. No:32 Ataşehir, İstanbul, Turkey.
| | - Serpil İsabetli
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Merve Bahadır
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
| | - Ebru Doğru
- Acıbadem Health Group, Maslak Hospital, Nursing Services, Acıbadem Maslak Hastanesi, Darüşşafaka Büyükdere Caddesi No:40, 34457 Sarıyer, İstanbul, Türkiye.
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Effect of Fist Clenching on Vein Visibility and Palpability: An Observational Descriptive Study. JOURNAL OF INFUSION NURSING 2022; 45:252-257. [PMID: 36112872 DOI: 10.1097/nan.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
No information exists on the minimum number of times that fist clenching should be performed to increase vein visibility and palpability. In this study, the researchers aimed to determine the average number and duration of fist clenching to increase vein visibility and palpability before peripheral intravenous catheter insertion. This observational study included 207 healthy individuals. Participants meeting the inclusion criteria were asked to perform fist clenching. The number and duration of fist clenches performed to increase dorsal metacarpal vein and cephalic vein grade were determined. The participants carried out fist clenching 7.57 ± 4.26 times for the first increase and 22.16 ± 7.93 times for the second increase in dorsal metacarpal vein grade. Fist clenching was carried out 10.05 ± 7.30 times for the first increase and 21.30 ± 7.86 times for the second increase in cephalic vein visibility. A statistically significant, weak, but positive relationship was observed between the duration of fist clenching and the change in dorsal metacarpal vein grade and anxiety level ( r = 0.194, P < .005). However, the relationship was negative between room temperature and the duration of fist clenching in dorsal metacarpal vein grade ( r = -0.207, P = .003). This inexpensive and simple technique should be performed in specified numbers before catheter insertion.
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10
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Mitchell EO, Jones P, Snelling PJ. Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review. Pediatrics 2022; 149:186816. [PMID: 35445257 DOI: 10.1542/peds.2021-055523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Establishing peripheral intravenous catheter (PIVC) access in infants and children is a common procedure but can be technically difficult. The primary objective was to determine the effect ultrasound had on first attempt PIVC insertion success rates in the pediatric population. Secondary objectives included overall success rates and subgroups analyses. METHODS A systematic review of articles using Medline, Embase, CENTRAL, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Randomized trials evaluating ultrasound-guided PIVC insertion against the landmark approach in pediatric patients who reported at least 1 outcome of success rate (first attempt or overall) were included. Methodological quality of the literature was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis using a random-effects model was performed. RESULTS Nine studies with 1350 patients, from a total of 1033 studies, were included for analysis. Ultrasound showed a statistically significant improvement in PIVC insertion success on first attempt in 5 of 8 studies, with an overall success rate of 78% in the ultrasound group and 66% in the control group. The secondary outcome of overall success was improved by ultrasound in studies that allowed ≥3 attempts (pooled OR 3.57, 95% CI 2.05 to 6.21, P < .001, I2 = 0.0%). CONCLUSIONS This systematic review suggested that ultrasound improves pediatric PIVC first pass and overall success rates. Subgroup analysis showed improvement in PIVC success rates for patients with difficult intravenous access and a single operator, dynamic, short-axis ultrasound technique.
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Affiliation(s)
- Evan O Mitchell
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Departments of Pediatrics
| | - Philip Jones
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter J Snelling
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Sonography Innovation and Research (Sonar) Group, Queensland, Australia.,Child Health Research Centre, University of Queensland, Queensland, Australia
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Positioning of Vascular Access in Pediatric Patients: An Observational Study Focusing on Adherence to Current Guidelines. J Clin Med 2021; 10:jcm10122590. [PMID: 34208254 PMCID: PMC8230876 DOI: 10.3390/jcm10122590] [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: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Venous access devices (VADs) play an important role in different clinical contexts. In pediatric subjects, VAD placement is more complicated than in adults due to children’s poor cooperativity and reduced vascular access. Adherence to guidelines for the placement of VADs could prevent the occurrence of complications, but data in the literature are general and not exhaustive, especially with regard to the pediatric population. The objective of this study was to assess adherence to guidelines for the placement of VADs in a pediatric setting. A retrospective observational study was conducted in the general ward of a pediatric hospital in the northern region of Italy. Data related to consecutive admissions in the period from 1 January to 31 December 2019 were collected according to the availability of clinical documentation. A cohort of 251 subjects was considered, yielding a total of 367 VADs. Device permanence in situ and the effective administration of intravenous therapy were associated with an increased risk of complications, while adherence to guidelines was an important protective factor. Adherence to guidelines for the placement of VADs is an independent and positive predictive factor for the prevention of complications due to the presence of a vascular device.
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Eren H, Turkmen AS, Aslan A. Effect of topical application of black pepper essential oil on peripheral intravenous catheter insertion: A randomized controlled study. Explore (NY) 2021; 18:457-462. [PMID: 34154965 DOI: 10.1016/j.explore.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The literature describes many techniques to increase vein visibility and palpability that facilitate peripheral intravenous catheter insertion. However, there is only one study examining the effect of topical essential black pepper oil on veins. We aimed to determine the effects of topical application of black pepper essential oil on peripheral intravenous catheter insertion success. METHODS This randomized controlled trial was carried out on 60 patients randomly assigned to either the experimental group (n=30) or the control group (n=30) reporting to the endoscopy unit of the clinic between May 2019 and October 2019. The study results were evaluated using an information form, a catheter insertion form, and a visual analog scale (VAS). In the experimental group, black pepper essential oil was used to increase vein degree before the procedure, while in the control group, no extra interventions were applied. The time taken in determining an appropriate vein, time taken for successful catheter insertion, and the patient's and nurse's satisfaction after the process were recorded. RESULTS Significant improvements in vein degree were detected after the experimental group's oil application (p1<0.001). The period of appropriate vein selection and successful catheter insertion showed a statistically significant decrease in the experimental group (p<0.05). The satisfaction levels of patients and nurses in the control group were significantly lower than those of the patients from the experimental group (p<0.05). CONCLUSION Topical black pepper oil application can increase the vein degree and the success of the procedure.
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Affiliation(s)
- Handan Eren
- Yalova University, Faculty of Health Sciences, Department of Nursing, Yalova, Turkey.
| | - Ayse Sonay Turkmen
- Karamanoglu Mehmetbey University, Faculty of Health Sciences, Department of Nursing, Karaman, Turkey
| | - Ahmet Aslan
- Karamanoglu Mehmetbey University, School of Medicine, Department of General Surgery, Karaman, Turkey
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Keskin G, Akin M, Senayli Y, Saydam S, Kurt DT. Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient? J Vasc Access 2021; 23:240-245. [PMID: 33438490 DOI: 10.1177/1129729820987947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The primary objective of the present study was to determine the rate and the independent predictors of the difficult peripheral intravascular access (PIVA) in the operating room (OR). The secondary objective was to validate the ability of the difficult intravenous access (DIVA) scoring system in the detection of difficult PIVA in the operating room. METHODS In this prospective observational study, patients between 0 and 18 years old who were operated in the pediatric hospital were evaluated. Peripheral intravenous cannulation performed during inhalation induction in 1008 patients were recorded. The following data were collected: demographic characteristics, the presence of a chronic disease, the DIVA score, operating room temperature, the area of PIVA application, the duration of PIVA and the number of PIVA attempts. The independent determinants of the difficult PIVA were determined with multivariate logistic regression. RESULTS A total of 1008 patients (82% boys) with a median age of 4 (range 0.04-17 years) were included in the study. The median number of PIVA attempts was 1 whereas the median duration for successful PIVA was 15 s (range 4-2100). PIVA was successful at the first attempt in 75.3% of patients. Among patients who required more than two PIVA attempts, the most common adjunctive method was to seek help from another operator (80.8%). In the multivariable logistic regression model, only the presence of chronic disease, being underweight, and DIVA score ⩾4 (OR 6.355, CI 4.57-9.486) remained to be the significant determinants of difficult PIVA. CONCLUSION The success rate of anesthesiologist-performed PIVA at the first attempt in the OR was 75.3%. Having a chronic disease, a DIVA score ⩾4 and being underweight appeared as the independent predictors for difficult PIVA.
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Affiliation(s)
- Gulsen Keskin
- Department of Anesthesia, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mine Akin
- Department of Anesthesia, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yesim Senayli
- Department of Anesthesia, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sibel Saydam
- Department of Anesthesia, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Devrim Tanil Kurt
- Department of Anesthesia, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Nicholl A, Evelegh K, Deering KE, Russell K, Lawrence D, Lyons-Wall P, O’Sullivan TA. Using a Respectful Approach to Child-centred Healthcare (ReACH) in a paediatric clinical trial: A feasibility study. PLoS One 2020; 15:e0241764. [PMID: 33166989 PMCID: PMC7652280 DOI: 10.1371/journal.pone.0241764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 10/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a growing momentum in paediatric ethics to develop respectful research and healthcare protocols. We developed, tested and refined our 'Respectful Approach to Child-centred Healthcare' (ReACH), to underpin respectful participant interactions in a clinical trial. OBJECTIVE To determine whether a ReACH-based approach is acceptable to children and parents, and effective in obtaining compliance with common healthcare assessments in a clinical trial of healthy 4-6-year-old children. METHODS ReACH-based child assessments were evaluated at two baseline clinics and one post-intervention, using mixed methods. Children (n = 49; 46.9% female; mean age = 5.24±0.88 years at baseline) and their parents provided independent evaluation, via customised 5-point Likert scales and qualitative feedback. A dedicated child researcher evaluated adherence to the study ReACH principles. RESULTS Children achieved compliance rates of 95% for body composition (BodPod) assessments; 89% for blood pressure measurements, and 92% (baseline) and 87% (post-intervention) for blood draws. Adherence to ReACH principles during clinic visits was positively associated with child compliance, significantly for baseline BodPod (p = 0.002) and blood test (p = 0.009) clinics. Satisfaction with BodPod protocols was positively associated with compliance, for children at baseline (p = 0.029) and for parents post-intervention (p <0.001). Parents rated the study itself very highly, with 91.7% satisfied at baseline and 100% post-intervention. Qualitative feedback reflected an enjoyable study experience for both parents and children. CONCLUSIONS Adherence to our emerging ReACH approach was associated with high child compliance rates for common healthcare assessments, although no causality can be inferred at this preliminary stage of development. Participants expressed satisfaction with all aspects of the study. Our use of child-centred methods throughout a research intervention appears feasible and acceptable to children and their parents.
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Affiliation(s)
- Analise Nicholl
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Evelegh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kane Evan Deering
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Russell
- Peaceful Parents, Confident Kids, Toowoomba, Queensland, Australia
| | - David Lawrence
- Faculty of Arts, Business, Law and Education, Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Philippa Lyons-Wall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Therese Anne O’Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
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Robertson E, Treadgold C, Parker B, Quinn L. Positive distraction for children during burn wound care in Australia - An evaluation of the 'Captains on Call' pilot. J Pediatr Nurs 2020; 54:10-17. [PMID: 32570190 DOI: 10.1016/j.pedn.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Burn wound care procedures can cause severe pain to the child, and distress for both the child and caregivers. We evaluated a new Starlight Children's Foundation program, 'Captains on Call', which aims to provide positive distraction during burn wound care procedures to reduce the child's anxiety and pain. This paper presents a preliminary evaluation, using a qualitative design, of Captains on Call at the Women's and Children's Hospital, Australia. METHODS We conducted interviews with caregivers (n = 18), patients (n = 6), nurses (n = 5) and Captain Starlights (n = 3). Interviews focused on program impact and recommendations for how to improve the program. RESULTS We identified seven themes: (1) positive distraction from pain and boredom, (2) benefit of additional support, (3) creating positive memories of the hospital, (4) catering for unique needs of each patient and family, (5) general appreciation, (6) importance of regular visits, and (7) a desire to expand the program. All caregivers, nurses and patients reported that they were likely to recommend the program to others. CONCLUSION This study provides early evidence to support the benefit of the Captains on Call program to families and health professionals, as well as the feasibility in providing this integrated care.
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Affiliation(s)
- Eden Robertson
- Starlight Children's Foundation, Australia; School of Women's and Children's Health, UNSW Sydney, Australia.
| | - Claire Treadgold
- Starlight Children's Foundation, Australia; School of Women's and Children's Health, UNSW Sydney, Australia.
| | | | - Linda Quinn
- Burns Service, Women's and Children's Hospital, Australia
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Lee SU, Jung JY, Ham EM, Wang SW, Park JW, Hwang S, Kim DK, Kwak YH. Factors associated with difficult intravenous access in the pediatric emergency department. J Vasc Access 2019; 21:180-185. [DOI: 10.1177/1129729819865709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Successful intravenous catheter placement plays a vital role in the pediatric emergency department. We assessed pediatric emergency department–related factors associated with difficult intravenous catheter placement. Method: We retrospectively reviewed the electronic medical records of patients younger than 18 years who had an intravenous catheter placement attempt during their pediatric emergency department stay. Difficult intravenous access was defined as intravenous catheter placement requiring more than one attempt. The demographic-, clinical- and procedure-related factors were collected, and a logistic regression analysis was used to evaluate the factors associated with difficult intravenous access. Result: In total, 925 patients were enrolled, and 77 (8.32%) cases had difficult intravenous access. The median age of the patients was 3.0 (interquartile range = 1–9) years, and 496 (53.6%) patients were male. After adjustment, we found that age (odds ratio = 0.91, 95% confidence interval = (0.85–0.98), p = 0.01); a history of prematurity (odds ratio = 2.31, 95% confidence interval (1.08–4.98), p = 0.03); the intravenous catheter insertion site (foot versus hand odds ratio = 5.65, 95% confidence interval = (2.97–10.75); p < 0.001); and the experience of the provider (<6 months versus ⩾12 months odds ratio = 4.59, 95% confidence interval = (1.92–11.01), p = 0.01) were associated with difficult intravenous access. However, the acuity of disease, crowdedness at the pediatric emergency department, sex, vein visibility, vein palpability, intravenous catheter size, patients’ experience with intravenous access, and time of day were not significantly correlated with difficult intravenous access. Conclusion: The success rate of intravenous catheter placement at the pediatric emergency department could be improved by experienced providers. The acuity of disease and crowdedness at the pediatric emergency department were not significantly associated factors.
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Affiliation(s)
- Se Uk Lee
- Department of Emergency Medicine, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul Medical Center, Seoul, South Korea
| | - Sang Won Wang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
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