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Aims and objectives: To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device. Introduction: To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation. Design: An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus. Review method: A modified version of Cooper's five‐stage method and the PRISMA guidelines were used to perform the integrative review. Results: Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision‐making process, they should take the lead in the use of the proactive approach. Conclusion: Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high‐quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach. Relevance to clinical practice: The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material. [ABSTRACT FROM AUTHOR]

Aims and objectives To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. Background In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. Design A cross-sectional study was conducted. Methods 'Highly complex' patients ( n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. Results The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. Conclusions The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. Relevance to clinical practice The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access. [ABSTRACT FROM AUTHOR]

Central venous access devices (CVADs) are an essential part of patient therapy and provide a route for the delivery of intravenous medications, solutions, and blood sampling, as well as for hemodialysis. Complications such as CVAD occlusions can have a significant impact on the patient and health care system, causing suboptimal treatment, yet there is a lack of standard practices for CVAD occlusion management outside of hemodialysis. A national task force of Canadian clinicians was formed to review the published literature and develop a clinical guideline for the management of catheter occlusions - for CVADs not used specifically for hemodialysis. The recommendations are presented here. Clinical practice tools and templates that support the application of this guideline will be available to ensure safe and effective management of CVAD occlusions. [ABSTRACT FROM AUTHOR]

Infusion therapy has evolved dramatically over the past few decades. From being used only in emergencies and for critically-ill patients, intravenous (IV) therapy has become a specialized form of treatment used for almost 90% of hospitalized patients (Corrigan, 1995). Infusion therapy is the parenteral administration of fluids, medications, nutritional support, blood products and the transfusion of blood. Fluids are delivered through a vascular access device, which is inserted into a peripheral or central vein (Royal College of Nursing (RCN), 2003). The venous route is the most predictable and reliable way to administer fluids and drugs when oral administration is not longer achievable or appropriate. [ABSTRACT FROM AUTHOR]

Background Although it is common for central line catheters to develop a thrombotic occlusion, pediatric patients are at especially high risk of occlusion due to smaller vessels, smaller-gauge catheters, and slower rates of infusion. Mitigating catheter occlusions is costly, requiring tissue plasminogen activator, supplies, and nursing time. Our facility tested a novel neutral displacement needle-free valve designed to reduce occlusion. Methodology The organization determined a baseline occlusion rate for Hickman/Broviac catheters, in our 38-bed inpatient hematology/oncology department and our outpatient hematology/oncology clinic from August 2010 through October 2010. In 2011, a premarket test of the Neutron device (ICU Medical, San Clemente, CA) was conducted on the units. Based on the positive trial results, it was decided to implement the device housewide in December 2012. Results A comparison of baseline central line complete occlusion rates from August to October 2010 with Neutron trial data from July to October 2011. This pilot project demonstrated a 74.3% reduction (from a rate of 3.82 to a rate of 0.98) in all hematology/oncology department Hickman and Broviac complete catheter occlusions. Subsequently, comparing 5 months of housewide occlusion data from June through October 2012 to 2013, complete occlusions fell by 32.1% (from a rate of 1.56 to a rate of 1.06). Conclusions The use of the Neutron needle-free catheter patency device was associated with a reduction in complete occlusions. The corresponding reduction in treatment delays, nursing time spent managing occluded catheters, and fewer needlesticks to patients likely translates to financial benefit for the organization and improved patient and family satisfaction. [ABSTRACT FROM AUTHOR]