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Background: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision‐making during insertion and perceptions of women. Methods: This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non‐participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. Results: Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18‐gauge catheter was considered more painful than a 16‐gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18‐gauge catheters mostly in hand or wrist (66%). Decision‐making about site, catheter gauge, dressing and attempts varied. Thirty‐four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non‐dominant arm as key reasons for the location of PIVC. Conclusions: Regular use of a large‐gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience. [ABSTRACT FROM AUTHOR]

Aims: The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications. Design: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies. Data sources: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019. Review Methods: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models. Results: Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p =.022) than for those inserted in other departments and pain was significantly higher (p <.001) in countries with developing economies compared with developed economies. Conclusion: Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. Impact: Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aim Design Methods Results Conclusion Impact Reporting Method Patient or Public Contribution An evidence and consensus‐based instrument is needed to classify central venous access device‐associated skin impairments.The aim of this study was to design and evaluate the central venous access device‐associated skin impairment classification tool.A two‐phase modified Delphi study.This two‐phase study consisted of a literature review, followed by the development and validation of a classification instrument, by experts in the fields of central venous access devices and wound management (Phase 1). The instrument was tested (Phase 2) using 38 clinical photographs of a range of relevant skin impairments by the same expert panel. The expert panel consisted of registered nurses who were clinical researchers (n = 4) and clinical experts (n = 3) with an average of 24 years of nursing and research experience and 11 years of experience in wound management. Measures to assess preliminary content validity and inter‐rater reliability were used.The instrument consists of five overarching aetiological classifications, including contact dermatitis, mechanical injury, infection, pressure injury and complex clinical presentation, with 14 associated subcategory diagnoses (e.g., allergic dermatitis, skin tear and local infection), with definitions and signs and symptoms. High agreement was achieved for preliminary scale content validity and item content validity (I‐CVI = 1). Inter‐rater reliability of aetiologies was high. The overall inter‐rater reliability of individual definitions and signs and symptoms had excellent agreement.The development and preliminary validation of this classification tool provide a common language to guide the classification and assessment of central venous access device‐associated skin impairment.The comprehensive and validated classification tool will promote accurate identification of central venous access device‐associated skin impairment by establishing a common language for healthcare providers. The availability of this tool can reduce clinical uncertainty, instances of misdiagnosis and the potential for mismanagement. Consequently, it will play a pivotal role in guiding clinical decision‐making, ultimately enhancing the quality of treatment and improving patient outcomes.The Guidance on Conducting and Reporting Delphi Studies (CREDES) was adhered to.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Reporting Method Patient or Public Contribution To explore the implementation contexts and strategies that influence the uptake and selection of alternative peripherally inserted central catheter (PICC) materials and design.Qualitative evaluation of end user perspectives within a randomized control trial of different PICC materials and design.Semi‐structured interviews with key stakeholders were undertaken via an adapted, rapid‐analytic approach using the Consolidated Framework for Implementation Research. Outcomes were mapped against the Expert Recommendations for Implementing Change (ERIC) tool for strategies to guide innovation in PICC practice.Participants (n = 23) represented a combination of users and inserters/purchasers, from adult and paediatric settings. Dominant themes included intervention characteristics (intervention source), inner setting (structural characteristics) and individuals involved (self‐efficacy). Strategies emerging to support a change from ERIC mapping (n = 16) included promotion of intervention adaptability, inclusion of staff and consumer perspectives and sufficient funding. Implementation contexts such as inner setting and individuals involved equally impacted PICC success and implementation effectiveness and enabled a greater understanding of barriers and facilitators to intervention implementation in this trial.Trial evidence is important, but healthcare decision‐making requires consideration of local contexts especially resourcing. Implementation contexts for Australian healthcare settings include a practical, strategic toolkit for the implementation of alternative PICC materials and designs.This study adhered to COREQ guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]