Search

Background and Purpose: It has been shown that nurse confidence predicts peripheral intravenous catheter (PIVC) insertion success. However, intravenous cannulation is a challenging skill for entry to practice students. To date, there is no well-validated measure of nursing student self-confidence in learning and performing PIVC insertion. To address this measurement gap, we created and validated the Nursing Student PIVC Insertion Self-Confidence Scale. Methods: This study employed a descriptive, cross-sectional design. Three cohorts of undergraduate entry-to-practice students at a Canadian university were recruited and assessed during their studies. Two hundred eighty-one students completed the scale at the first data collection point and 146 at the second point. The structure of the tool was analyzed by exploratory factor analysis to extract factors and confirmatory factor analysis (CFA) was employed for validation. Results: CFA revealed a three-factor scale (PIVC Cannulation Confidence, PIVC Preparation and Securement Confidence, and PIVC Learning Confidence). It has 15 items with satisfactory goodness of fit indices. Conclusions: The Nursing Student PIVC Insertion Self-Confidence Scale is a valid and reliable scale to measure nursing students' confidence in learning about and performing PIVC insertions., (© Copyright 2024 Springer Publishing Company, LLC.)

Objective: This quality improvement project aimed to reduce central line bacteremias (central line-associated bloodstream infections [CLABSIs]) in a neonatal ICU (NICU) to a CLABSI rate of zero using a clinical nurse specialist (CNS)-led neonatal peripherally inserted central catheter (PICC) team., Background: The NICU at the study site was experiencing more than twice the National Healthcare Safety Network average CLABSI rate at 2.2 per 1000 line-days with an estimated cost of $2 072 806 to the organization., Methods: In early 2009, the CNS guided the unit from on-demand PICC placement to a dedicated team of PICC certified nurses who assumed total care of PICC line insertion and maintenance. The project used a continual, rapid cycle quality improvement model to incorporate the current evidence-based practices., Results: The CNS-led PICC team has maintained a zero CLABSI rate for 9 years with only 1 CLABSI since June 2022., Conclusions: The adoption of a CNS-led PICC team was instrumental in achieving a zero CLABSI rate over a prolonged period., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Peripheral I.V. access failure is a source of patient discomfort and dissatisfaction with a significant financial impact on healthcare. This article reviews the benefits and the risks of peripheral I.V. catheter (PIVC) utilization, infusate characteristics and their impact on peripheral vasculature, PIVC site assessment and management, and PIVC research priorities. Part 1 of this series was published in Nursing's September 2024 issue., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Peripherally Inserted Central Catheter (PICC) is essential in neonatal care, especially for critically ill infants. Traditional training for neonatal PICC insertion faces challenges such as high costs and limited practice opportunities. Virtual simulation technology has emerged as a potential training tool, providing a realistic, risk-free learning environment., Objectives: The study aimed to assess the effectiveness of a virtual simulation teaching system in neonatal PICC care training, focusing on improving nursing students' knowledge， skills and interest in pediatric nursing., Design: A quasi-experimental design was used, with assessments conducted before and after the activity., Participants: The study involved 58 graduate nursing students from China Medical University, divided into experimental and control groups., Methods: The System Usability Scale (SUS) was utilized to assess teachers' experiences with the PICC virtual simulation software. Students' perceptions of the software and their interest in pediatric nursing were measured using Self-Administered Questionnaires. Furthermore, Theoretical and Operational Assessments were applied to determine the extent of students' knowledge and practical skills before and after experimentation., Results: Teachers and students have favorably evaluated the software system, with notable improvements in theoretical scores following testing. While the virtual simulation system does not enhance practical skills, it does increase student interest in pediatric nursing and employment., Conclusions: This neonatal virtual simulation software serves as a complement to, rather than a replacement for, traditional clinical training. Its integration into educational programs significantly enhances learning outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: to identify and compare the practice of Nursing professionals regarding the insertion of peripheral vascular access devices, according to professional category., Method: descriptive sectional study carried out between July 2021 and May 2022 with 2,584 Nursing professionals, using a questionnaire validated by three judges with expertise in intravenous therapy, containing variables related to catheterization and the vascular access device. Descriptive and inferential analysis was carried out., Results: most professionals do not prepare the patient or perform some essential care before attempting peripheral intravenous catheterization. Regarding the preferred catheterization site, hands, arm and forearm stand out. There is no control over the tourniquet time, and the patient is punctured more than three times. The most used device materials are polyurethane and Teflon ® , more than one criterion is adopted for device selection, and Micropore ® type adhesive tape was the covering most cited by Nursing professionals. The identification of catheterization was not adequate., Conclusion: Nursing technicians and assistants are the professionals who least comply with what is recommended in recognized guidelines. Nurses' practice also presents deviations from scientific evidence.

Aims: To describe the development process of a device from the conception of the idea to the first contact with the commercial environment, and to demonstrate its practical application through an interdisciplinary collaboration between nursing and engineering for the design of a protective device for peripheral venous catheters., Background: Nurses are key agents for identifying unresolved needs or problems related to nursing care. To address these needs, creative ideation processes are often triggered among nurses to seek technological answers to these challenges., Results: The ten steps to develop a device are presented: (1) detecting an unsatisfied clinical need; (2) searching for preexisting marketed products; (3) searching for patents; (4) maintaining confidentiality throughout the process; (5) obtaining institutional support; (6) forming a multidisciplinary team; (7) developing the idea; (8) applying for a patent; (9) building the prototype; (10) marketing the device. This methodology was applied to design a protective device for peripheral venous catheters in hospitalized patients., Conclusions: Nurses can play a key role in the promotion of healthcare innovation in their field to improve procedures, thanks to their direct contact with patients, and by providing their insight on devices that can enhance patient care. The successful interdisciplinary collaboration between nurses and engineers can provide a response to relevant clinical problems such as the manipulation or removal of peripheral venous catheters., Implications for Nursing And/or Health Policy: A hospital policy is required to encourage the participation of nurses in innovative actions. Furthermore, it is important to support nurse leaders who can play a pivotal role in incorporating creativity into work environments and empowering other nurses to innovatively address clinical issues., No Patient or Public Contribution: This article describes the process for developing a health device., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

According to this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Short peripheral intravenous catheters (short PIVCs) are commonly used in acute care, guided by evidence-based policy with interventions to limit premature failure. Research on how nurses use evidence and change processes to optimize outcomes is needed. The study objective was to use a theory-based implementation science approach to evaluate and improve short PIVC insertion and care processes and reduce removals for adverse outcomes in acute care. This mixed-methods study was conducted with inpatient nursing units (n = 23) at a large urban quaternary medical center. Units identified and implemented one PIVC care intervention that could lower catheter removals for adverse outcomes over 3 months. Data from multiple sources were convergently analyzed to evaluate process and outcomes postintervention. Although overall frequency of PIVC removals for adverse outcomes was unchanged, several units improved their outcomes using implementation strategies. The determinant framework provides a plausible explanation for the study results. While adverse outcome rates remained below published rates, some units had limited success improving outcomes with traditional change strategies. Implementation strategies and readily accessible data can offer nursing units a new approach to effectively deploy, monitor, and maintain interventions to achieve improved outcomes., Competing Interests: Conflict of Interest: The authors of this article have no conflicts of interest to disclose., (Copyright © 2024 Infusion Nurses Society.)

Introduction: Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation., Methods: This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique., Results: A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group., Discussion: Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully., (Copyright © 2024 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Objective: Teaching ultrasound (US) guidance for placement of peripheral intravenous (PIV) catheters requires significant time for synchronous didactic and hands-on training. The investigators assessed the feasibility of an asynchronous model for critical care nurses to learn the novel skill of US-guided PIV placement. Secondary outcomes included the percentage of successful attempts and number of sticks per attempt for anatomy versus US-guided approaches., Methods: The investigators built a self-contained training cart for learners to practice and record their performance. Training occurred asynchronously. The learners recorded data from PIV attempts. Participants completed pre- and post-training surveys. Data from this prospective observational cohort was analyzed for descriptive and comparative statistics, using Kirkpatrick's Model for evaluation of this educational intervention., Results: During a 6 month period, 21 nurses completed the asynchronous training, with eight recording their PIV placements. 81.0% of the training occurred outside of a Monday to Friday 9AM-5PM period. There were 64 attempts by anatomy approach and 84 with US-guidance. The anatomic approach was successful in 35.9% of attempts with a mean of 1.5 sticks (SD 1.0, Range 1-5). The US-guided approach had a statistically significant greater rate of success (77.4%; p  < 0.001) with a mean of 1.2 sticks (SD 1.2, range 1-2, p  < 0.01). Participants reported increased confidence in US-guided PIV placement and enjoyment with this method of learning., Conclusions: Asynchronous learning model with cart-based instruction and practice is a feasible means for nurses to learn US-guided PIV placement. Significant outcomes were seen across Kirkpatrick levels I-IV for educational outcome assessment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: Insertion of a peripheral intravenous catheter (PIVC) is one of the most common procedures carried out in hospitals worldwide, but failure rates are unacceptably high. This local quality improvement project aimed to assess improvements in first-stick success rate, dwell time and overall catheter success rate when implementing a longer-length peripheral intravenous catheter (LPIVC) under ultrasound guidance for patients with difficult venous access (DVA)., Methods: Data were collected from 386 DVA patients requiring a PIVC at one hospital. Number of catheter insertion attempts, catheter dwell time and reason for catheter removal were recorded for each patient. To implement the new DVA catheterisation pathway, registered nurses undertook a training programme comprising workshops and ultrasound-guided cannulation technique practice on phantoms. Costs and waste weights associated with LPIVC insertion, compared with midline insertion, were calculated., Results: First-stick success rate was 95.0% using the LPIVC under ultrasound guidance. Dwell time ranged from 1 to 80 days, with a large proportion of those dwelling <1 day being placed in day-case patients. Treatment success rate with the LPIVCs was 83.6%. Equipment costs for an LPIVC insertion were £89.22 lower than for a midline insertion, and the weight of waste generated per procedure was 1 kg lower for LPIVCs., Conclusions: First-stick success rate of LPIVCs, aided by improved purchase in the vein and visualisation with ultrasound guidance, was very high, superior to rates reported in other studies. The procedure provides a better patient experience as successful first attempts avoid unnecessary further insertion attempts. Other benefits are increased nursing time efficiency, a reduction in clinical waste and the lower cost of the equipment required., Competing Interests: Declaration of interest: B. Braun Medical UK provided time and support with the production and submission of the article, but was not involved in the conception or design of the study or the decision of which devices to use. No financial payment was received for any part of this study or manuscript

The insertion, use, and maintenance of peripheral and central intravenous lines are skills used by nurses in a variety of health care and hospital settings. However, patient vascular access is not without potential complications that can result in patient harm. The aim of this review is to identify and summarize nursing research standards of care, and best practices for safe management and prevention of catheter-associated bloodstream infections related to peripheral intravascular (PIV) and central intravenous (CVC) line placement. The authors focused on concepts of site selection, skin preparation and insertion, securement, and maintenance and removal criteria for PIV and CVC., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies., Methods: An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry to practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches., Results: Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic., Conclusions: The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.

Objectives: To evaluate if nurses can reliably perform ultrasound-guided peripheral intravenous catheter placement in children with a high success rate after an initial training period. A secondary aim was to analyze complication rates of ultrasound-guided peripheral intravenous catheters., Methods: A database recorded all ultrasound-guided peripheral intravenous catheter encounters in the emergency department from November 2013 to April 2019 including the emergency department nurse attempting placement, number of attempts, and whether it was successful. Patient electronic medical records were reviewed for the time of and reason for intravenous removal.The probabilities of first-attempt successful intravenous placement and complication at successive encounters after an initial training period were calculated. These probabilities were plotted versus encounter number to graph best-fit logarithmic regressions., Results: A total of 83 nurses completed a standardized training program in ultrasound-guided peripheral intravenous catheter placement including 10 supervised ultrasound-guided peripheral intravenous catheter placements. In total, 87% (3513/4053) of the ultrasound-guided peripheral intravenous catheter placed after the training program were successful on the first attempt. The probability of successfully placing an ultrasound-guided peripheral intravenous catheter increased as nurses had more experience placing ultrasound-guided peripheral intravenous catheters (R 2  = 0.18) and was 83% at 10 encounters.Twenty-five percent (904/3646) of ultrasound-guided peripheral intravenous catheters had complications, and there was no statistically significant relationship between the number of encounters per nurse and complication rates (R 2  < 0.001)., Conclusion: Nurses can reliably place ultrasound-guided peripheral intravenous catheters at a high success rate after an initial training period. First-attempt success rates were high and increased from 67% to 83% for the first 10 unsupervised encounters after training and remained high. The complication rate was low and did not change as nurses gained more experience.

Objective: To compare the dwell times of ultrasound-guided and non-ultrasound-guided short peripheral intravenous catheters in hospitalized children., Methods: This was a retrospective analysis of data from 256 ultrasound-guided and 287 traditional peripheral intravenous catheters placed in hospitalized children between 1 September2016 and 31 October 2016 at a free-standing children's hospital with a 10-member vascular access team. A two-sample independent t test and Kaplan-Meier estimator were used to assess differences in dwell times between the ultrasound-guided peripheral intravenous catheters and non-ultrasound-guided peripheral intravenous catheters. Child age, peripheral intravenous catheter location, and subjective difficulty of placement were also analyzed., Results: There was a significant difference in mean hours of dwell time for ultrasound-guided versus non-ultrasound-guided peripheral intravenous catheters (96.06 vs 59.39, p < 0.001). Mean increase in dwell time was 36.68 h (95% CI: [24.14-49.22]). Median dwell times (50% probability of survival) for ultrasound-guided and non-ultrasound-guided peripheral intravenous catheters were 118 h (95% CI: [95-137]) and 71 h (95% CI: [61-79]), respectively. None of the additional covariates were significant predictors of dwell time., Conclusion: Peripheral intravenous catheters placed using ultrasound-guided methods had a significantly longer dwell time than those placed using non-ultrasound-guided methods in a cohort of hospitalized pediatric patients. This is in line with the findings in the adult literature and may suggest a need to increase the use of ultrasound-guided method for peripheral intravenous catheter placement in pediatric practice.

Background: One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization., Aims: The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates., Methods: A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed., Results: One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P < 0.001) but no significant improvement in Criterion 2 (P > 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P < 0.05). An interesting finding was that the number of reported occurrences of phlebitis increased after implementing the PVC care bundle., Discussion: The increase in phlebitis rates could be attributed to the care bundle facilitating prompt and early identification of phlebitis. Despite the initial increase in occurrences 1 month post implementation, the general effectiveness of the care bundle in reducing occurrences of phlebitis was seen 6 months post implementation. The effectiveness of the care bundle to reduce phlebitis rates may be even more evident across a longer implementation period., Conclusion: The current study showed that the implementation of a standardized PVC care bundle can significantly enhance the assessment and identification process of phlebitis and can aid in reducing the incidence of phlebitis. The nurses' compliance in practicing the PVC care bundle was determined by the post and preimplementation audits, thus, the audit approach was beneficial in translating evidence into practice.

Purpose: Peripheral venous catheterization is challenging in small children. The local warming technique has been used to increase the peripheral vein cross-sectional area (CSA) and improve the success rate. However, there is limited evidence on the effect of local warming on venous CSA in children under sedation., Design: A pilot randomized controlled trial., Methods: Eligible children aged 1 to 4 years undergoing ambulatory surgery were enrolled. At the bedside in the ambulatory surgery center, they were routinely sedated with 1 mcg/kg of intranasal dexmedetomidine. Through a computer allocation program, children were randomized into either a control group or a local warming group. Cephalic vein and basilic vein at 1 cm proximal to cubital fossa were scanned with ultrasound to measure venous CSA. Children in the control group received no intervention; those in the local warming group had a prepared hot pack of ~40°C applied to the target area on the arm for 5 minutes. A second ultrasound measurement was undertaken in both groups., Findings: A total of 35 from 40 children were analyzed. Cephalic vein CSA and basilic vein CSA increased significantly vs the first measurement within the local warming group (P < .05 for both) but not in the control group (P > .05 for both). Cephalic vein CSA was significantly different between groups at the second measurement (P < .05) but not at the first measurement (P > .05). Basilic vein CSA was significantly different between groups neither at the first measurement nor at the second measurement (P > .05 for both). The application of local warming resulted in an average of 34% increase (from 4.1 to 5.5 mm 2 ) in cephalic vein CSA and an average of 21% increase (from 4.8 to 5.8 mm 2 ) in basilic vein CSA., Conclusions: The application of local warming induced mild venodilation in cephalic vein with an increase in CSA by 34% and had little venodilation effect on the basilic vein with an increase in CSA by only 21%., (Copyright © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.

Introduction: Establishing and maintaining peripheral intravenous access in patients with no visible or palpable veins can be arduous. Intravenous catheters placed with ultrasound do not survive as long as traditionally placed catheters. This study was performed to determine the relationship between the catheter length placed into the lumen of the vein using ultrasound and catheter survival., Methods: This was a nonrandomized prospective observational study of admitted patients with difficult intravenous placement in 2017. Subjects had ultrasound-guided peripheral intravenous placement in the emergency department or intensive care unit. The main outcome was the time of catheter survival. Data were analyzed using descriptive statistics and Cox regression., Results: A total of 98 patients with an average age of 63 years were enrolled. The total number of cases examined was 97 (N = 97), of which 29 intravenous catheters were removed for catheter-related problems (events). The mean (SD) survival time for catheters placed using ultrasound was 3,445 minutes (2,414) or 2.39 days. Peripheral catheter survival was not significantly related to the in-vein length of the catheter (X 2  = 0.03, P = 0.86) nor was it significantly related to any of the covariates., Discussion: The survival time of ultrasound-guided intravenous access doubled in the present study from 1674 minutes in a previous 2013 study. The results may have been due to clinician expertise and experience with the peripheral ultrasound-guided method and the use of updated equipment., (Copyright © 2020 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Intravenous (IV) peripheral access is often a difficult procedure in the paediatric ED, causing pain and significant distress. Clinical prediction tools including reproducible variables have been developed to help clinicians identify children at risk of difficult IV access, likely to need additional resources/interventions to maximise success at first attempt. We aimed to externally validate the Difficult IntraVenous Access (DIVA) and DIVA3 scores developed for this purpose., Methods: Cross-sectional study of children undergoing IV cannulation by nurses in a tertiary-care paediatric ED. Data were collected at the time of the procedure in a clinical report form., Results: Of 440 children included (56.8% males; median age 4.7 years (IQR 1.5-9.5)), 23.4% had a difficult IV access (defined as requiring >1 attempt). Diagnostic accuracy measures for a DIVA cut-off ≥4 and their 95% CIs were sensitivity 24.3% (16.4% to 33.7%), specificity 92.6% (89.2% to 95.1%), positive and negative predictive value 50.0% (35.3% to 64.5%) and 80.0% (75.7% to 83.9%), respectively. The same measures for the DIVA3 were 22.3% (14.7% to 31.6%), 93.5% (90.3% to 95.9%), 51.1% (35.8% to 66.3%) and 79.8% (75.4% to 83.6%). The area under the receiver operating characteristic curve was 0.652 (95% CI 0.591 to 0.712) for the DIVA and 0.649 (95% CI 0.589 to 0.709) for the DIVA3 score. In patients with DIVA and DIVA3 <4, nurses' prediction of greater difficulty in IV placement and moderate/severe dehydration were common independent predictors of difficult IV at multivariate analysis. Only nurses' prediction of greater difficulty in IV placement were associated with higher odds of difficult cannulation for both DIVA/DIVA3 scores ≥4., Conclusion: We externally validated the DIVA and DIVA3 showing a similar accuracy compared with the DIVA derivation cohort and between DIVA and DIVA3. We identified factors that can help refine further the risk of difficult IV access and support decision making on the best strategy to maximise the chances of cannulation success on first attempt., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Difficulty in accessing peripheral veins in emergency departments increases patients' discomfort and impedes their diagnosis. The objective of this study was to develop and test the prognostic accuracy of an easily applied scale to measure difficult venous access to peripheral veins in emergency departments, called the Adult-Difficult Venous Catheterization scale., Methods: This prospective observational study was conducted in adults from the hospital catchment area attending the emergency department. Using the Delphi technique, 5 experts reached a consensus regarding a 3-item scale scored from 0 to 5. Concurrent validity and predictive validity were analyzed using a numeric rating scale and the number of access attempts, respectively. Internal consistency and interobserver reliability for 3 independent observers were analyzed using Cronbach alpha and Cohen kappa, respectively., Results: In 392 participants, the concurrent and predictive validity scores pointed to positive relationships with the numeric rating scale (r = 0.82; P < 0.001) and the number of access attempts (r = 0.5; P < 0.001), respectively. The odds ratio for 1 to 2 access attempts versus more than 2 access attempts in relation to the Adult-Difficult Venous Catheterization scale score was 2.76 (95% confidence interval 1.86, 4.08; P < 0.001). Sensitivity and specificity values for the Adult-Difficult Venous Catheterization scale were good, at 93.75% and 78.99%, respectively, as were internal consistency (Cronbach alpha 0.81) and interobserver reliability (Cohen kappa 0.75)., Discussion: The Adult-Difficult Venous Catheterization scale is a valid and reliable instrument for predicting difficult venous access in emergency departments., (Copyright © 2020 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Adherence to the best standards of nursing practice is the fundamental principle to improve patient outcome and prevent nursing procedure related-infections. A peripheral venous catheter (PVC) is the most common invasive procedure performed in nursing care. Its poor performance could expose patients to bloodstream-related infections. The present study aimed to assess post-basic nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters., Methods: A cross-sectional study design was conducted on May 01-03, 2019, using a convenient sample 239 among post-basic nursing students in Wollega University., Results: The study result showed that nursing students' had a low mean (4.1±1.52) of knowledge about PVC procedure management. Only 41% of the respondents have adhered to recommendations of CDC guidelines. Among the provided options of the items, none achieved 100% correct answers. The majority of nursing students (77%) responded that antiseptic handwashing is always performed before insertion of PVCs. Meanwhile, few students (5%) correctly answered that the infusion set is recommended to be removed after 96 hours when neither lipids nor blood products are administered. In multivariable regression analysis, nursing students who had received training (AOR = 2.9, 95% CI (1.6, 5.1)) and who were younger (AOR = 2.4, 95% CI (1.3, 4.3)) significantly associated with a higher score of knowledge., Conclusions: This study finding shows that an overall level of knowledge of post-basic nursing students is inadequate. Measurements such as an increase in the provision of adequate training by nurses educators based on evidence-based guidelines could improve the post-basic nursing students' knowledge., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Peripheral intravenous cannula is often a first line invasive intervention for patients in the emergency department. It is used to facilitate blood sampling, deliver essential fluids, blood products and medication. However, the insertion and use of the peripheral intravenous cannula is not without complication. This study surveyed the number of peripheral intravenous cannulas inserted in the emergency department and identify the level of and reason for use., Methods: A cross-sectional study was conducted in the emergency department of a large tertiary hospital in Queensland. Descriptive and inferential statistics were used to describe peripheral intravenous cannula use and to explore associations., Results: Of the 224 patients assessed, 159 (71%) had at least one peripheral intravenous cannula inserted in emergency department. Of the 159 peripheral intravenous cannulas inserted, 54 (34%) remained unused while the patient was in the emergency department. For patients classified as Australasian Triage Scale categories 3, 4 and 5, 40% of peripheral intravenous cannulas remained unused. Overall, poor documentation was observed with 29% of peripheral intravenous cannulas insertions not documented at all., Conclusion: This study identified a high proportion of unused peripheral intravenous cannulass in the emergency department and inadequate documentation. An intervention to promote best practice, raise awareness of the risks of peripheral intravenous cannulas use, possible alternatives therapies, and improve documentation is required., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Background: Peripheral intravenous (PIV) management requires knowledge, skill, and clinical judgment to ensure positive patient outcomes; yet, many nurses lack confidence in their PIV knowledge and skills. It is important that graduate nurses acquire PIV knowledge and skills in nursing school. This study aimed to explore PIV content coverage and clinical opportunities provided in U.S. and Canadian nursing curricula., Method: Using a descriptive, exploratory design, representatives of nursing schools completed a 12-item, web-based PIV curriculum survey., Results: Most schools covered PIV content in classroom, laboratory, and clinical settings; however, some indicated students were not allowed to initiate PIVs in clinical settings. Participants noted that PIV education was a shared responsibility with health systems., Conclusion: It is important that nursing students develop PIV competence; however, competing pressures for time in nursing curricula may limit PIV coverage. Nurse educators can benefit from PIV and infusion therapy specialty organization resources. [J Nurs Educ. 2020;59(9):493-500.]., (Copyright 2020, SLACK Incorporated.)

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.

Vascular access team (VAT) nurses receive many consults to place short peripheral catheters (SPCs), a portion of which do not require skilled insertion by a VAT member. VAT nurses at a health care organization in the Midwestern United States developed a program to train direct care nurses as unit-based vascular access champions to increase and improve SPC placement, care, and maintenance. Twenty-one nurses from 6 units were selected to train as vascular access champions; knowledge and confidence around SPC placement were assessed before, immediately after, and 6 months after the training. The training sessions resulted in increased knowledge of SPC insertion, as well as care and maintenance by vascular access champions and other direct care nurses on the units. The percentage of unwarranted VAT referrals for SPC placement decreased on the participating hospital units.

Purpose: To understand nursing perceptions of hospital requirements for routine resiting of short peripheral catheters (SPCs)., Methods: This exploratory research project at the authors' medium-sized regional referral and trauma center utilized an online survey to assess the perceived efficacy and patient disruption related to SPC resiting among acute care nurses., Results: Out of 203 eligible nurses, 81 participated. The survey results support the perception that SPC insertions and resiting can be time-consuming and disruptive to the flow of care. The strongest correlation occurred between patients who had requested no SPC resiting and the reported disruption from SPC resiting., Conclusion: Based on the survey results, a formal recommendation was made within the hospital system to amend the existing policy and remove the requirement for SPC resiting after 96 hours in favor of the nurses' best clinical judgment.

Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.

Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.

Background: A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to the clinical practice guideline (CPG) of clinically indicated replacement., Methods: Guided by Lean principles, a clinical nurse leader (CNL) led a quality improvement small test of change on a 38-bed medical unit. The impact of the CPG was evaluated using quality, safety, and workflow measures., Results: Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Nurses attributed the improvements in workflow (P = .01) and the quality of patient care (94%) to the updated PIVC guideline., Conclusions: Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, improved efficiency, and is being implemented hospital-wide. This project highlights and advances the CNL role in transforming healthcare.

This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.

Purpose: To describe worldwide characteristics, performance and risk factors of peripheral intravenous catheters (PIVCs), in pediatrics., Design: A secondary, subgroup analysis of pediatric (<18 years) data was undertaken, using a global, cross-sectional study of PIVCs. Practice characteristics included: demographic, diagnostic, utility, management, performance and resources. Multivariate regression identified complication risks factors., Results: Data from 4206 children in 278 hospitals across 47 countries. Most PIVCs (outside of Australia, New Zealand) were inserted by nurses (71%; n = 2950), with dedicated teams only common in North America (23.2%; n = 85). Large gauges (≤18G) were mostly used in South America, Europe and Africa. Regions predominantly placed 24G (49%; n = 2060) except in Australia and New Zealand, who more commonly placed 22G (38.7%; n = 192). The most common placement was the hand (51%; n = 2143), however North America, Australia and New Zealand frequently utilised the antecubital fossa (24.5%, n = 90; 21.4%; n = 106). Polyurethane dressings were most used (67.1%; 2822), and many were not clean, dry and intact (17.1%; n = 715). Over 8% of PIVCs were idle, with the highest rates in North America (21.2%; n = 78). PIVC local complication risk factors included: >2 years age (odds ratio [OR] > 1.58; 1.2-2.1); ambulance/emergency insertion (OR 1.65; 1.2-2.3); upper arm/antecubital placement (OR 1.44; 1.1-2.0); poor dressing integrity (OR 5.4; 4.2-6.9); and 24-72 h dwell (OR > 1.9; 1.3-2.6)., Conclusions: There is global inconsistency in pediatric PIVC practice, which may be causing harm., Clinical Implications: Improvements in pediatric PIVC placement, dressings, and gauge selection are needed., Competing Interests: Declaration of competing interest Griffith University has received investigator-initiated grants and unrestricted donations from vascular access product manufacturers (3M, Adhezion, Angiodynamics, Becton Dickinson [BD]-Bard, BBraun, Centurion Medical Products-Medline), to support research led by AJU, unrelated to the current project. Griffith University has received investigator initiated research grants from vascular access product manufacturers (Adhezion, Angiodynamics, Becton Dickinson, Centurion Medical Products), to support research led by TK, unrelated to the current project. MT has no financial disclosures. Griffith University has received on GRB's behalf unrestricted investigator-initiated research grants (3M, Becton Dickinson, Smiths Medical) and consultancy payments (3M, Becton Dickinson, Medline, ResQDevices). Western Sydney and Griffith University has received on EA's behald unrestricted investigator-initiated research grants (from 3M, Becton Dickinson, BBraun, Cook Medical and Flo Medical). Griffith University has received investigator-initiated grants, or consultancy payments on behalf of CMR from vascular access product manufacturers (3M, Adhezion, Angiodynamics, BD-Bard, Baxter; BBraun, Centurion Medical Products, Medtronic, Smiths Medical unrelated to the current project., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients., Background: Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure., Design: Prospective, observational study. We have complied with the STROBE checklist of items., Methods: This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables., Results: A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events., Conclusions: The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr., Relevance to Clinical Practice: The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr., (© 2019 John Wiley & Sons Ltd.)

Establishing reliable peripheral intravenous access is one of the most common procedures performed daily by nurses across clinical settings in the hospital. The insertion of peripheral intravenous access devices is usually guided by palpation, direct visualization, landmark technique, or by trial and error. The invasive nature of the procedure accompanied by the associated risks requires successful cannulation on the initial attempt. In an effort to decrease the number of peripheral venous access attempts in patients with difficult venous access, a course was developed to educate a cohort of registered nurses on the basic principles and use of ultrasound. After successful completion of the course, each registered nurse was required to perform a minimum of 10 proctored successful ultrasound venous peripheral intravenous catheter insertions. The first attempt success rate for the proctored ultrasound venous peripheral intravenous catheter attempts was 83%, which was higher than that reported in the literature (20%-50%). Overall, the program effectively demonstrated a decrease in the number of attempts required to insert a peripheral venous catheter in patients with difficult venous access., (Copyright © 2019 Society for Vascular Nursing. All rights reserved.)

Background Peripheral vein cannulation is one of the most common invasive practical nursing skills performed by registered nurses. However, many registered nurses lack competence in this practical skill. Learning peripheral vein cannulation associated with successful placement and maintenance is not well understood. Framework Ryle's ways of knowing, "knowing that" and "knowing how", can be used during peripheral vein cannulation learning to guide development and competence in this practical skill. Aim The aim of the article was to provide an overview of Ryle's ways of knowing and to make recommendations for best practices for nurse teachers and nurses teaching students peripheral vein cannulation. Conclusion Ryle's ways of knowing can assist nursing students in their learning and development of peripheral vein cannulation.

Background: Cancer patients are considered the most at risk of the consequences of catheter occlusion. Therefore, nursing interventions that can effectively reduce the occlusion of peripherally inserted central catheter (PICC) lines must be identified to ensure a smooth treatment., Objective: This study aimed to evaluate nursing interventions to minimize PICC line occlusion and make recommended measures for preventing or decreasing occlusion and abnormal extubation., Methods: Studies about PICC occlusion that were published up to January 2017 were searched and screened in PubMed, Web of Science, Science Direct (Elsevier), EMBASE, Cochrane Library, and Chinese databases CNKI and Wanfang. Two independent reviewers screened the literature in accordance with the inclusion and exclusion criteria, assessed the quality of the included studies, and extracted the data. Further meta-analysis was performed using RevMan 5.3., Results: Thirteen trials were included. Meta-analysis revealed that education for nurses (relative risk, 0.31; 95% confidence interval, 0.19-0.51; P < .00001) was significantly associated with PICC occlusion, whereas PICC type (relative risk, 0.60; 95% confidence interval, 0.32-1.15; P = .12) was not significantly associated with PICC occlusion. The solution to washing pipes and the PICC insertion techniques were descriptively analyzed to reach statistical significance., Conclusion: This study determined the correlation of PICC occlusion with the nurses' knowledge and skills, PICC types, flushing liquid and methods, and insertion techniques., Implications for Practice: The findings of this study can serve as a guide for clinical work and for developing targeted measures to reduce occlusion.

Aims and Objectives: To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence., Background: Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence., Design: The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses., Methods: The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed., Results: Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research., Conclusions: An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research., Relevance to Clinical Practice: Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care., (© 2019 John Wiley & Sons Ltd.)

Nursing practice and institutional policies regarding short peripheral catheter (SPC) flushing vary. These variations result in a lack of understanding about the factors that influence nurses' SPC flushing practices and leave their effect on outcomes unexplored-information that could potentially enhance nurses' clinical education, institutional policy efforts, and patient care. Using a mixed-methods design, this study examined SPC flushing practices and outcomes among a cohort of medical-surgical nurses and explored their rationale for flushing. Trends were noted in the timing of flushes, and the factors that influenced nurses' SPC flushing practices included patient acuity, experience, and workload.

Aims and Objectives: To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients., Background: In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important., Design: This is a prospective, observational, descriptive study., Methods: Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (See Supporting Information Appendix S1)., Results: A total of 472 patients were included in the final analyses. According to the logistic regression analysis, independent factors which affected first-attempt failure were found to be: choosing a nonupper extremity site for PIVC (OR: 4.72, 95% CI: 1.35-16.45, p-value: 0.015), history of difficult intravenous access (OR: 3.02, 95% CI: 1.72-5.29, p-value: <0.001), nurse having less than 2 years of professional experience (OR: 3.45, 95% CI: 2.00-5.97, p-value: <0.001), nonpalpable veins observed after the application of tourniquet (OR: 2.21, 95% CI: 1.10-4.41, p-value: 0.025), a moderate degree of difficulty anticipated by the nurse prior to the procedure (OR: 4.32, 95% CI: 2.31-8.08, p-value: <0.001) and a high degree of difficulty anticipated by the nurse prior to the procedure (OR: 8.41, 95% CI: 4.10-17.24, p-value: <0.001)., Conclusion: Factors affecting first-attempt success rates in peripheral intravenous catheter placement in older emergency department patients may be listed as follows: the anticipated difficulty of the procedure rated by the nurse, previous history of a difficult intravenous cannulation, choosing a nonupper extremity site for cannulation, the level of experience of the nurse and the palpability of the vein., Relevance to Clinical Practice: Healthcare providers should consider alternative methods in the presence of factors affecting first-attempt success in older emergency department patients., (© 2019 John Wiley & Sons Ltd.)

Implanted ports are an important vascular access device for patients with malignancies requiring long-term chemotherapy. Peripherally placed ports are increasing in use as they are a safe, cost-effective alternative to chest-placed ports. Most peripheral ports can be placed bedside by specialist nurses in designated clinical areas rather than costly operating rooms or interventional radiology suites. Peripheral ports are considered less invasive compared with chest port placement because of reduced procedural risk. To enhance the success rate of peripheral port placement and minimize risks, we provide vascular access specialists with a systematic approach along with some technical advice tips and tricks to help avoid mechanical complications such as repeated puncture of the vein, excessive bleeding, thrombosis or skin dehiscence, as well as latent complications such as catheter migration and catheter-related blood stream infection., (Copyright © 2019 Society for Vascular Nursing. Published by Elsevier Inc. All rights reserved.)

Introduction: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement., Methods: We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts., Results: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%., Discussion: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

Background: peripheral intravenous cannulation is the most prevalent invasive procedure performed on patients admitted to hospital. The procedure is not always easy to undertake and can lead to problems for the patient and nurse. Alongside various procedures, local warming is one technique that could be used to increase the diameter of superficial veins. This prospective non-randomised trial aimed to determine the effect of local warming on vein diameter in the antecubital area in adults aged 20-40 years., Method: the subjects included 55 volunteers who were in good health. The cephalic vein diameter of the right arm cubital area was measured for each participant using ultrasound guidance. The arm was warmed for 10 minutes using a heating device maintained at 42ºC. A second ultrasound scan was then undertaken immediately afterwards and cephalic vein diameter measured., Results: local warming increased the cephalic vein diameter in the cubital area by 0.43±0.4 mm. There was no significant relationship between change in cephalic vein diameter and participants' gender, age or body mass index., Conclusion: the results indicate that the application of heat is an effective technique for venodilation and could be considered in emergencies or in cases when other veins are difficult to access.

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., (© 2018 John Wiley & Sons Ltd.)

Introduction:: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions., Methods:: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0-12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success., Results:: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%-80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients., Discussion:: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients' clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.

Objectives: To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses., Background: Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations., Design: A descriptive cross-sectional survey design was used., Results: A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent., Conclusions: Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post-educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations., Relevance to Clinical Practice: Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation., (© 2018 John Wiley & Sons Ltd.)

Patients wait an average of 23 hours for a peripherally inserted central catheter (PICC) in our hospital. Long waits lead to delays in discharge and medication administration. For quality improvement, development of a Certified Registered Nurse Anesthetist (CRNA) PICC line backup service was proposed. This project collected benchmarking data about the current PICC line service over 3 months. The Intravenous (IV) Nursing Unit and the Interventional Radiology Division teams insert an average of 8.1 PICC lines daily, but the demand for PICC lines is 12 insertions per day; thus, the current, combined PICC service meets 66% of its demand. The CRNAs insert IV catheters daily and are eligible to insert PICC lines. A PICC training pro-gram was developed to train a CRNA in a standardized curriculum with simulation using a partial-task trainer. Using an N-of-1 method, the CRNA inserted 10 PICCs over 3 weeks under the guidance of an IV team PICC nurse. The CRNA reached a level of competence in PICC insertion after 10 attempts, with a 70% success rate, in intervals equivalent to those of IV PICC RNs. A CRNA can be trained in a short timeframe as a resource to decrease waiting for patients needing PICC lines., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)