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Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are. A systematic integrative review was undertaken using Whittemore and Knafl's five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways. This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients. [ABSTRACT FROM AUTHOR]

Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28% (n = 82), at an incidence rate of 62.5 per 1000 catheter days (95% confidence interval [CI] 49.775.9). Failure was most frequent in PIVCs (37%; n = 68), peripheral arterial catheters (33%; n = 2), and peripherally inserted central catheters (20%; n = 6). Infiltration and extravasation were the most frequent cause of PIVC failure (12%; n = 35). A birth weight less than 1500 g was associated with a significant decrease in PIVC failure (hazard ratio 0.58; 95% CI 0.34-0.99). [ABSTRACT FROM AUTHOR]

Background: Hospitalised patients receiving intravenous antimicrobial therapy require a reliable device through which this is delivered. Short peripheral intravenous catheters (PIVCs) are the default device for antimicrobial therapy but up to half fail before therapy completion, leading to suboptimal drug dosing, patient distress from repeated insertions, and increased healthcare costs. This study will investigate the use of long PIVCs to determine if they are more reliable at delivering antimicrobial therapy. Methods: A two-arm, parallel randomised controlled trial of hospitalised adults requiring at least 3 days of peripherally compatible intravenous antimicrobials. Participants will be randomised to a short (<4 cm) or long (4.5-6.4 cm) PIVC. After interim analysis (n=70) for feasibility and safety, 192 participants will be recruited. Primary outcome is disruption to antimicrobial administration from all-cause PIVC failure. Secondary outcomes include: number of devices to complete therapy, patient-reported pain and satisfaction, and a cost analysis. Ethical and regulatory approvals have been received. [ABSTRACT FROM AUTHOR]

Background: Despite pervasive need for peripheral intravenous catheters, insertion is often difficult, and approximately two thirds fail prematurely. Midline catheters are an alternative long peripheral catheter, inserted in the upper arm, ideal for patients with difficult access. Aim: The aim of this study is to test feasibility of the protocol and compare the efficacy and safety of midline catheters to peripheral intravenous catheters. Design: A parallel‐group, pilot randomized controlled trial of adult medical/surgical hospitalized patients, from a single Australian referral hospital. Methods: Participants with difficult vascular access (≤2 palpable veins) and/or anticipated ≥5 days of peripherally compatible intravenous therapy were recruited between May 2019 and March 2020. Participants were randomized to (1) peripheral intravenous catheter or (2) midline catheter. Primary feasibility outcome measured eligibility, recruitment, protocol adherence, retention and attrition. Primary clinical outcomes measured device insertion failure and post‐insertion failure. Results: In total, n = 143 participants (71 peripheral intravenous catheters and 72 midline catheters) were recruited; n = 139 were analysed. Most feasibility criteria were met. Peripheral intravenous catheters had shorter functional dwell time, with higher incidence of post‐insertion failure compared to midline catheters. Conclusion: Midline catheters appear to be superior for patients with difficult vascular access or receiving prolonged intravenous therapy; a large, multi‐centre trial to confirm findings is feasible. Summary statement: What is already known about this topic? Peripheral intravenous catheters have endemically high incidence of complications.Midline catheters have been proposed as an alternative peripheral intravenous device, following recent advancements in catheter material and design.Few studies have compared safety and efficacy of contemporary midline catheters with peripheral intravenous catheters. What this paper adds: Midline catheters had a longer functional dwell time and lower incidence of post insertion‐failure, compared to peripheral intravenous catheters.Midline catheters appear safe; however, inserter skill appears to have critical influence on insertion success. The implications of this paper: This study established the feasibility and importance of a large, multicentre, randomized controlled trial to confirm findings.Future research should also focus on financial impacts, including cost‐efficiency.Policy makers should consider training specialist inserters to place midline catheters. [ABSTRACT FROM AUTHOR]

Objective: To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US). Methods: Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies. Results: In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) 'Escalation' is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward–'measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use. Conclusion(s): DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

• Approximately 50% of all peripheral venous catheters (PVCs) are used to administer intravenous antibiotics. • Subsequently, 11% and 19% of PVCs lead to irritation and vessel injury, respectively. • Flucloxacillin, lincomycin and vancomycin were confirmed to increase the risk of PVC failure. • This study newly identified cefepime and ceftazidime as significant risk factors for PVC failure. • Methods to improve antibiotic delivery are necessary to improve patient care. Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase the PVC failure rate, risk profiles for many are unclear. To synthesize data from prospective PVC studies conducted between 2013 and 2019 to determine associations between common antimicrobials and PVC failure. A secondary analysis was undertaken of seven randomized controlled trials and two prospective cohort studies from three quaternary hospitals (two adult and one paediatric) in Australia between 2013 and 2019. The primary outcome was PVC failure due to vessel injury (occlusion, infiltration or extravasation) or irritation (pain or phlebitis). Associations between antimicrobial use and PVC failure were explored using multi-variable Cox regression. In total, 5252 PVCs (4478 patients) were analysed; vessel injury and irritations occurred in 19% and 11% of all PVCs, respectively. Vessel injury was significantly associated with cefepime hydrochloride [hazard ratio (HR) 2.50; 95% confidence interval (CI) 1.44–4.34], ceftazidime pentahydrate (HR 1.91, 95% CI 1.11–3.31), flucloxacillin sodium (HR 1.84, 95% CI 1.45–2.33), lincomycin hydrochloride (HR 1.67, 95% CI 1.10–2.52) and vancomycin hydrochloride (HR 1.73, 95% CI 1.25–2.40). Irritation was significantly associated with flucloxacillin sodium (HR 2.58, 95% CI 1.96–3.40). This study identified several antimicrobials associated with increased PVC failure, including some that were already known to be associated and some that had not been identified previously. Research is needed urgently to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure. [ABSTRACT FROM AUTHOR]

Approximately 25% of hospitalised adults require an indwelling urinary catheter (IDC) during their hospital stay. IDCs expose patients to risks of infectious and non-infectious complications.To identify IDC prevalence, assess adherence to clinical practice guidelines and patient-reported involvement in IDC care for adult hospital inpatients.This point prevalence study was conducted in 22 wards in a single quaternary hospital. Data was collected by clinical and research nurses working in pairs on a single day. Study outcomes were reported descriptively as frequencies and percentages.Of 502 patients included, 77 (15.3%) had an IDC (median duration 99.6 h). The median age of patients with an IDC was 64 years (interquartile range 22–88 years), 54 (70%) were male and one-quarter (n = 19; 25%) of IDCs were inserted at another hospital. More than half (n = 44; 57%) of the 77 IDCs had no documented removal plan. Three patients were unavailable for review for observed clinical practices, and it was found 43% (n = 32/74) lacked a securement device. Of 77 people with IDCs, there were 44 patient responses, and 27 (61.4%) patients did not know the reason for their catheter.Areas for improvement included securement device use, timely removal plans and patient education for the reason for the device. Regular point prevalence studies to assess use and adherence to clinical practical guidelines can improve safety outcomes for patients requiring IDCs. [ABSTRACT FROM AUTHOR]