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Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022:S2588-994X(22)00067-7. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
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A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition. JOURNAL OF INFUSION NURSING 2022; 45:270-278. [PMID: 36112875 DOI: 10.1097/nan.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Vascular access specialists are responsible for assessing the patient in their unique situation and determining the correct vascular access device to complete the therapeutic goal without complication or failure. This retrospective cohort study compared the failure rates of a variety of polyurethane (PU) midline catheters and a midline catheter constructed of an emerging hydrophilic biomaterial (HBM). A total of 205 patients received a midline catheter and were situationally randomized by the facility where they received it. Patients who had received a midline catheter between March 2021 and May 2021 were assessed for catheter-related failures leading to increased staff time, delays in treatment, or replacement with a new vascular access device to complete the therapy. There were 101 patients in the PU cohort and 104 patients in the HBM cohort. Comparing overall failure rates between the groups revealed a 23.8% failure rate in the PU control group and only a 3.8% failure rate in the HBM group. This suggests that a midline catheter constructed of HBM biomaterial is associated with significantly lower rates of failure, thereby improving patient experience and health care economics.
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Yasuda H, Rickard CM, Marsh N, Yamamoto R, Kotani Y, Kishihara Y, Kondo N, Sekine K, Shime N, Morikane K, Abe T. Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units. Ann Intensive Care 2022; 12:33. [PMID: 35394571 PMCID: PMC8994002 DOI: 10.1186/s13613-022-01009-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01009-5.
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Affiliation(s)
- Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. .,Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan.
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia.,Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia.,Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Natsuki Kondo
- Department of Intensive Care Medicine, Chiba Emergency Medical Center, Chiba-shi, Japan
| | - Kosuke Sekine
- Department of Medical Engineer, Kameda Medical Center, Chiba, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - Takayuki Abe
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.,School of Data Science, Yokohama City University, Kanagawa, Japan
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Evison H, Carrington M, Keijzers G, Marsh NM, Sweeny AL, Byrnes J, Rickard CM, Carr PJ, Ranse J. Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study. BMJ Open 2022; 12:e054927. [PMID: 35273050 PMCID: PMC8915296 DOI: 10.1136/bmjopen-2021-054927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Rates of unused ('idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. DESIGN A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. SETTING Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. PARTICIPANTS Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. RESULTS From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. CONCLUSION The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.
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Affiliation(s)
- Hugo Evison
- Gold Coast Region, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
| | - Mercedes Carrington
- Department of Emergency Medicine, Robina Hospital, Robina, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Amy Lynn Sweeny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Joshua Byrnes
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Centre Research Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery/School of Pharmacy and Medical Science, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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Evison H, Sweeny A, Ranse J, Carrington M, Marsh N, Byrnes J, Rickard CM, Carr PJ, Keijzers G. Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices. Scand J Trauma Resusc Emerg Med 2021; 29:126. [PMID: 34454555 PMCID: PMC8403444 DOI: 10.1186/s13049-021-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. METHODS This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February-18 March 2017 and 5 January-4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. RESULTS A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7-3.3). CONCLUSION One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.
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Affiliation(s)
- Hugo Evison
- Queensland Ambulance Service, GPO Box 1425, Brisbane, QLD, 4000, Australia.
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia
| | - Mercedes Carrington
- Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, Southport, QLD, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Level 2 Building 34 Royal Brisbane and Women's Hospital, Herston, QLD, 4209, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, N78 Sir Samuel Griffith Building, Level 2.11, 170 Kessels Road, Southport, QLD, 4111, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, Southport, QLD, 4111, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Level 2 Building 34 Royal Brisbane and Women's Hospital, Herston, QLD, 4209, Australia.,Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Herston, QLD, 4006, Australia.,School of Nursing Midwifery and Social Work, The University of Queensland Centre for Clinical Research, Herston, QLD, 4006, Australia
| | - Peter J Carr
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,School of Nursing and Midwifery, National University of Ireland Galway, 26 Upper Newcastle, Galway, H91 E3YV, Ireland
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.,Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia.,School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, Southport, QLD, 4222, Australia.,Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
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Jacob ER, Jacob AM, Davies HT, Stoneman LJ, Coventry L. Peripheral intravenous cannulas for blood drawing: Nurses' views through content analysis. Collegian 2021. [DOI: 10.1016/j.colegn.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Handayani RN, Efendi D. The impact of multiple insertions on peripheral intravenous access in low-birth-weight infants in perinatology. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 37184325 DOI: 10.4081/pmc.2021.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Low-Birth-Weight (LBW) infants have very small veins, and there is a risk of needing multiple insertions to establish peripheral intravenous access. This study aimed to examine the impacts of multiple insertions during peripheral intravenous access in LBW infants. This cross-sectional study involved 216 respondents. Data were analyzed with the Spearman correlation. The results showed a significant relationship (p<α) between multiple insertions to establish peripheral intravenous access to LBW infants with increased pain, heart rate, respiratory rate, duration of crying, delayed treatment, duration of insertion, and high cost of care (p<0.001; r=0.358-0.836). Meanwhile, multiple insertions might decrease oxygen saturation and body temperature (p<0.001; r=0.358). In this study, multiple insertions were correlated with several negative impacts on the physiological function and discomfort of LBW infants. The study also highlights the effect on time of treatment precision and cost effectiveness. Recommendation: It is necessary to develop preventive measures to reduce the impact of multiple insertions to establish peripheral intravenous access in LBW infants.
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Abstract
Short peripheral catheter (SPC) insertion is a common invasive procedure performed in hospitalized patients. Variations in this fundamental nursing skill exist among nurses, with significant impacts on budgets, patient satisfaction, and worker safety―key concerns for nurse leaders. A performance improvement project focused on vascular access management was undertaken, with the goal to improve SPC practice and associated outcomes. Assessment of current SPC policies, practices, products, and outcomes identified areas of potential improvement. A performance improvement program was undertaken, and its effects on clinical, safety, and economic outcomes were assessed at 5 hospitals in 1 health care system. Clinical, safety, and economic outcomes improved, as demonstrated by longer average catheter dwell times, increased first-insertion success, improved patient satisfaction, reduced blood exposure, and annual cost savings. A vascular access management program can support leaders in achieving consistent guideline adherent practice among nurses while reducing cost and increasing patient and nurse satisfaction.
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Higgins N, Iu P, Carr P, Ware R, Van Zundert A. Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices using light, sounds or tactile actions (or palpations). J Clin Nurs 2021; 30:1091-1098. [PMID: 33440051 DOI: 10.1111/jocn.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/06/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 80% of patients admitted to acute hospitals have at least one peripheral intravenous catheter inserted during their admission, for the administration of fluids and medicines, and/or diagnostic tests, so the failure rate is concerning. New technology may decrease these rates even when used by inexperienced inserters. The choice of insertion site for an intravenous catheter is a known predictor of catheter failure. Therefore, the objective for this study was to evaluate the utility of vessel locating devices for novice clinicians to select catheter insertion sites in the forearm. METHODS An inter-subject incomplete counterbalanced research design was employed with healthy volunteers. Novice clinicians used either a vessel locating device using light or sound waves or they used palpation to identify relatively superficial veins in the forearm. This was compared to site selection performed by an expert clinician using palpation method only. Measurements of differences were analysed from photos of chosen sites. Bland-Altman agreement analysis was used to plot novice expert agreement. The STROBE checklist was followed in reporting this study (Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices (Appendix S1)). RESULTS A total of 32 novice clinicians used three vessel locating devices and a palpation technique. Novice clinicians did not choose more veins for optimum catheter placement when assisted with vessel locating devices compared to palpation techniques. All methods had a similar mean difference between novice and expert measurements and a similar percentage difference in distance from the expert choice. Bland-Altman agreement analysis did not identify any advantage for the novice with vessel locating devices over palpation. CONCLUSION Vessel locating devices do not enhance the ability of novice clinicians any greater than palpation when selecting suitable forearm veins. If vessel locating device approaches are to be adopted in clinical practice to support better insertion outcomes then current PIVC teaching techniques should include structured vessel locating devices theory and practice. RELEVANCE TO CLINICAL PRACTICE Successful insertion of a peripheral intravenous catheter (PIVC) on the first attempt is a challenging procedure for nurses. Careful consideration of the selected site of insertion could modify this risk factor for catheter failure. The choice of PIVC insertion site by a novice clinician compared to an expert does not necessarily improve with the use of vein locating technology. While there is a range of technological devices available to assist with locating vessels, there needs to be more emphasis from educators on how to select an appropriate insertion site for intravenous therapy.
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Affiliation(s)
- Niall Higgins
- Queensland University of Technology, Kelvin Grove, Qld, Australia.,Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Peter Iu
- Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Peter Carr
- National University of Ireland, Galway, Ireland.,Griffith University, Nathan, Qld, Australia
| | | | - André Van Zundert
- Queensland University of Technology, Kelvin Grove, Qld, Australia.,Royal Brisbane and Women's Hospital, Herston, Qld, Australia.,The University of Queensland, Herston, Qld, Australia
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Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207552. [PMID: 33080802 PMCID: PMC7589933 DOI: 10.3390/ijerph17207552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: In Portugal, no accurate and reliable predictive instruments are known that could assist healthcare professionals in recognizing patients with difficult venous access. Thus, this study aimed to translate and validate the Modified A-DIVA scale to European Portuguese. (2) Methods: A methodological and cross-sectional study was conducted in two phases: translation of the Modified A-DIVA scale to European Portuguese following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 100 patients who required peripheral intravenous catheterization in a Portuguese hospital. (3) Results: The European version of the Modified A-DIVA scale (A-DM scale) showed excellent inter-rater accordance scores, k = 0.593 (95% CI, 0.847 to 0.970), p < 0.0005. The A-DM scale's criterion and construct validity was assessed through predictive, convergent, and correlational analysis with variables identified in the literature as associated with difficult peripheral intravenous access, with moderate to large magnitudes and statistical significance. (4) Conclusions: The A-DM scale is a reliable and valid instrument that can support healthcare professionals and researchers in the early identification of patients at risk of difficult peripheral intravenous access. Future validation studies are needed to test the A-DM scale's applicability across clinical settings and in different patient cohorts.
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Rodriguez-Calero MA, de Pedro-Gomez JE, Molero-Ballester LJ, Fernandez-Fernandez I, Matamalas-Massanet C, Moreno-Mejias L, Blanco-Mavillard I, Moya-Suarez AB, Personat-Labrador C, Morales-Asencio JM. Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study. J Clin Med 2020; 9:E799. [PMID: 32183475 PMCID: PMC7141318 DOI: 10.3390/jcm9030799] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician's experience in this context. METHODS Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients' clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified. RESULTS The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event. CONCLUSION The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.
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Affiliation(s)
- Miguel Angel Rodriguez-Calero
- Nurse Director Office, Health System of the Balearic Islands (Ib-Salut), Carrer de la Reina Esclaramunda, 9. Piso 3, 07003 Palma Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Joan Ernest de Pedro-Gomez
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Luis Javier Molero-Ballester
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ismael Fernandez-Fernandez
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Catalina Matamalas-Massanet
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Luis Moreno-Mejias
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ana Belén Moya-Suarez
- Costa del Sol Hospital, Endoscopy & digestive medicine unit. Autovia A-7, Km. 187, 29603 Marbella, Spain;
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
| | - Celia Personat-Labrador
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
| | - José Miguel Morales-Asencio
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
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Araujo T, Rodriguez LP, Patel SA. Does my patient need a peripheral intravenous catheter? Br J Hosp Med (Lond) 2020; 81:1-3. [PMID: 32003618 DOI: 10.12968/hmed.2019.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tiago Araujo
- Division of Post-Graduate Education, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Luis Parra Rodriguez
- Division of Post-Graduate Education, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Sanjay A Patel
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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