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Introduction: Nurse-Administered Propofol Continuous Infusion Sedation (NAPCIS) is a new nonanesthesia propofol delivery method for gastrointestinal endoscopy. NAPCIS is adopted from the computer-assisted propofol sedation (CAPS) protocol. We evaluated the effectiveness, efficiency, and safety of NAPCIS in low-risk subjects., Methods: Between December 2016 and July 2017, patients who underwent esophagogastroduodenoscopy or colonoscopy with NAPCIS at our center were compared against 2 historical control groups of similar patients who had undergone procedures with CAPS or midazolam and fentanyl (MF) sedation., Results: The mean age of the NAPCIS cohort (N = 3,331) was 55.2 years (45.8% male) for 945 esophagogastroduodenoscopies and 57.8 years (48.7% male) for 2,386 colonoscopies. The procedural success rates with NAPCIS were high (99.1%-99.2%) and similar to those seen in 3,603 CAPS (98.8%-99.0%) and 3,809 MF (99.0%-99.3%) controls. NAPCIS recovery times were shorter than both CAPS and MF (24.8 vs 31.7 and 52.4 minutes, respectively; P < 0.001). On arrival at the recovery unit, 86.6% of NAPCIS subjects were recorded as "Awake" compared with 82.8% of CAPS and 40.8% of MF controls (P < 0.001). Validated clinician and patient satisfaction scores were generally higher for NAPCIS compared with CAPS and MF subjects. For NAPCIS, there were only 4 cases of oxygen desaturation requiring transient mask ventilation and no serious sedation-related complications. These low complication rates were similar to those seen with CAPS (8 cases of mask ventilation) and MF (3 cases)., Discussion: NAPCIS seems to be a safe, effective, and efficient means of providing moderate sedation for upper endoscopy and colonoscopy in low-risk patients.

Systems contradictions present challenges that need to be effectively managed, e.g. due to conflicting rules and advice, goal conflicts, and mismatches between demand and capacity. We apply FRAM (Functional Resonance Analysis Method) to intravenous infusion practices in an intensive care unit (ICU) to explore how tensions and contradictions are managed by people. A multi-disciplinary team including individuals from nursing, medical, pharmacy, safety, IT and human factors backgrounds contributed to this analysis. A FRAM model investigation resulting in seven functional areas are described. A tabular analysis highlights significant areas of performance variability, e.g. administering medication before a prescription, prioritising drugs, different degrees of double checking and using sites showing early signs of infection for intravenous access. Our FRAM analysis has been non-normative: performance variability is not necessarily wanted or unwanted, it is merely necessary where system contradictions cannot be easily resolved and so adaptive capacity is required to cope., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To develop a new type infusion set and apply it to the clinic, as well as explore its effectiveness in the prevention from needle stick injuries., Methods: A total of 200 inpatients who were in need of intravenous infusion with a disposable infusion needle were included and randomly divided into two groups: intervention group and control group. Disposable infusion needles with a separation-free safety tube were used in the intervention group, whereas conventional ones were used in the control group. Then, effects of the two types of infusion sets were observed and compared., Results: As for the operation time for infusion, it was (82.19 ± 1.80) seconds in the intervention group and (83.02 ± 1.83) seconds in the control group, with the difference statistically significant ( P < 0.05). Besides, the exposure time of the needles after infusion in the intervention group was (3.36 ± 0.17) seconds while (18.85 ± 1.18) seconds in the control group; the difference between which was statistically significant ( P < 0.05). In terms of the time for needle disposal, (18.60 ± 0.84) seconds was required in the intervention group, while for the control group, it took (18.85 ± 1.18) seconds, and the difference between two groups was of statistical significance as well ( P < 0.05). Nevertheless, there was no statistically significant difference in the accidental slip rate of the needles as that turned out 0% in both groups ( P > 0.05). It was worth noting that the block rate of the disposed needles in the intervention group was 100%., Conclusion: The separation-free safety tube on the disposable infusion needle could instantly block the sharp needle after infusion, which reduces the needle exposure time and lowers the risk of needle stick injuries. In the meantime, the safety tube is convenient to use, and its application can shorten the time for infusion and needle disposal, consequently improving the working efficiency of nurses. As the new type safety tube has above advantages and would not raise the risk of needle slippage, it is worthy of clinical promotion., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Weifen Lu et al.)

Objectives: In clinical practice, there are various methods that can be used for the rapid administration of fluid in infants and children. The current study prospectively evaluates gravity, pressure-assisted, and hand-pump methods for the rapid administration of fluid using an in vitro model., Methods: Thirty participants were asked to deliver 500 mL of fluid using 1 of 6 setups: (1) standard blood tubing with gravity administration, (2) standard blood tubing with pressure bag maintained at 300 mm Hg, (3) standard blood tubing with pressure bag inflated to 300 mm Hg and left to flow, (4) blood tubing with in-line bulb pump, (5) blood tubing with in-line bulb pump and pressure bag, and (6) standard blood tubing with 20-mL syringe attached to the stopcock for a push-and-pull technique using a 20-mL syringe., Results: The blood tubing with an in-line bulb pump to allow manual acceleration of the administration of fluid along with a pressure bag on the intravenous fluid bag achieved the fastest flow rate, requiring an average of 98 seconds to deliver 500 mL of fluid., Conclusions: When considering factors that affect fluid administration, Poiseuille's law dictates that the most important variable is the radius of the intravenous cannula, whereas the length of the cannula and the viscosity of the fluid administered are of secondary importance. With these limitations in mind, other factors may be used to speed fluid administration. Our study demonstrates the advantage of using blood tubing with the in-line bulb pump combined with a pressure bag.

Objectives: Assess interventions' impact on preventing IV infusion identification and disconnection mix-ups., Design: Experimental study with repeated measures design., Setting: High fidelity simulated adult ICU., Subjects: Forty critical care nurses., Interventions: Participants had to correctly identify infusions and disconnect an infusion in four different conditions: baseline (current practice); line labels/organizers; smart pump; and light-linking system., Measurements and Main Results: Participants identified infusions with significantly fewer errors when using line labels/organizers (0; 0%) than in the baseline (12; 7.7%) and smart pump conditions (10; 6.4%) (p < 0.01). The light-linking system did not significantly affect identification errors (5; 3.2%) compared with the other conditions. Participants were significantly faster identifying infusions when using line labels/organizers (0:31) than in the baseline (1:20), smart pump (1:29), and light-linking (1:22) conditions (p < 0.001). When disconnecting an infusion, there was no significant difference in errors between conditions, but participants were significantly slower when using the smart pump than all other conditions (p < 0.001)., Conclusions: The results suggest that line labels/organizers may increase infusion identification accuracy and efficiency.

Intravenous therapy in patients' homes is a relatively new procedure in the community nursing practice. This article looks at the practicalities of administering home IV therapy from the following aspects: hand hygiene; how to adjust IV therapy practices to the home environment; care of the IV access site including appropriate dressings; identifying and reacting to problems; maintaining a safe environment when performing IV therapy in a patient's home; anaphylaxis and how to identify and manage it; and the need for training to perform home IV therapy.

Background:: in 2015, NHS Wales introduced a national standardised approach to aseptic non-touch technique (ANTT). This approach aims to standardise practice and promote better clinical outcomes., Aim:: to provide insight into the challenges faced by clinical staff adopting ANTT during intravenous therapy., Methods:: focused ethnography across two paediatric wards in NHS Wales. Data collection included participant observation, audit questionnaires and semi-structured interviews. Data were analysed according to Wolcott's (1994) process and emerging themes were reflected upon against the theoretical framework of Kirkpatrick's (1994) model of training evaluation., Findings:: absence of feedback following training, individual preference, lack of opportunity to practise the ANTT technique, lack of clarity and standardisation and expectations of parents/medical staff are all challenges faced by registered nurses., Implications of the Study:: the findings may be used by NHS managers to support national initiatives within staff training and development programmes, and to improve infection prevention initiatives. Organisational culture is a modifier of healthcare worker behaviour and requires further attention locally and nationally. Quality assurance in the adoption of standardised best practice must take into account staff training and development needs, and workplace culture.

To prevent the incidence of risks imputable to human error during the process of preparing the infusion pump, clarity in teaching and learning are required. Because traditional classroom training is difficult and time-consuming, the aim of the present study was to challenge the implementation of an e-learning education program for syringe pump use. The impact of the e-learning program was evaluated with 100 nurses between March and June 2016. The e-learning program significantly increased general baseline knowledge in syringe pump use; however, aspects of the program confused participants. The feedback from 98 % of nurses on the e-learning program was that it was effective in helping them with this skill. However, only 54 % opted for the e-learning program versus traditional training. The present study showed nurses preferred a blended learning format. Based on our hospital incident and error reports, this study shows local training requires a specific approach strategy for syringe pump education.

Objective: to evaluate the conformity of care practices of the nursing team during the administration of drugs through central vascular catheter., Method: a descriptive, prospective, observational study conducted in an Intensive Care Unit. The non-probabilistic intentional sample consisted of 3402 observations of drug administrations in patients with central vascular catheters. The previously validated collection instrument was constructed based on the Guideline for Prevention of Intravascular catheter-related infections. Data was collected through direct observations of nursing practices performed by the nursing team. The analysis used analytical, descriptive and inferential statistics (Chi-square test and Fisher's exact test)., Results: a total of 3402 procedures of drug administrations were observed. Female nursing technicians performed the highest number of actions. In none of the procedures did the professional perform all necessary actions. 0.2% of drug administrations were preceded by hand hygiene and 1.3% by disinfection of the multidose vial, ampoule or injectors., Conclusion: the practice evaluated was classified as undesirable. Failure to achieve the desired conformity was probably due to the low adherence of professionals to the practice of hand hygiene and disinfection of materials, injectors and connectors.

Background: intravenous (IV) drugs are administered widely and under-dosing can result in therapy failure. The aim of this study was to quantify frequency, volume and dose of drug discarded within administration sets in the clinical setting., Methods: residual volume for 24 different administration sets was measured under controlled conditions in a laboratory. Clinical assessment of current practice regarding post-infusion flushing occurred in 6 departments of one teaching hospital in the UK over 7 days. Details of drug last infused, (concentration, diluent and volume) and type and brand of administration set were collected., Results: 74% of administration sets were not flushed. Non-flushing exceeded 90% and 61% for gravity and pump infusions respectively (p<0.001) in all areas excluding oncology. Oncology was the only area where flushing was standard practice for all infusions (p<0.001). Mean residual volume of the administration sets was 13.1 ml and 16.7 ml for gravity and pump sets respectively. Antibiotics were commonly infused and up to 21% of antibiotic dose was frequently discarded., Conclusions: the findings suggest disposal of substantial volumes of drugs occurs frequently in general hospital areas. Without clear national and local policies this unrecognised under-dosing will continue.

Peripheral infiltration is defined as the inadvertent delivery of nonvesicant fluid or medication into surrounding tissue that has the potential to harm the patient. Vesicant fluid that has leaked into the tissue space is called extravasation. At present, there is no agreement in the literature on the best practice for managing these injuries in pediatric patients. The purpose of this study was to identify occurrences of peripheral infiltration injuries and examine treatment modalities used to treat pediatric patients who suffered such an injury.

Nicola Brooks, Associate Dean, Faculty of Health and Life Sciences, De Montfort University, reflects on the potential problems that can occur with the administration of intravenous therapy.

When administering intermittent secondary intravenous infusions, commonly referred to as intravenous piggyback (IVPB) infusions, residual medication remains in the administration set and bag. No previous studies exist examining the optimal technique to infuse the residual medication. The aims of this study were to identify various IVPB ancillary techniques used to administer medication residing in the secondary administration set and bag following an infusion, evaluate the potential drug loss associated with each technique, and recommend a standard ancillary technique for administration of select small-volume IVPB infusions. Qualitative and quantitative tests were performed, leading to a recommendation for a standard ancillary technique for select small-volume IVPB infusions.

Background: needle-free connectors are widely used in clinical practice. The aim of this study was to identify any differences between microbial ingress into six different connectors (three neutral-displacement, one negative-displacement and two anti-reflux connectors)., Methods: each connector underwent a 7-day clinical simulation involving repeated microbial contamination of the connector's injection ports with Staphylococcus aureus followed by decontamination and then saline flushes through each connector. The simulation was designed to be a surrogate marker for the potential risk of contamination in clinical practice., Results: increasing numbers of S. aureus were detected in the flushes over the 7 days of sampling despite adherence to a rigorous decontamination programme. Significant differences in the number of S. aureus recovered from the saline flush of some types of connectors were also detected. Two different durations (5- and 15-second) of decontamination of the injection ports with 70% isopropyl alcohol (IPA) wipes were also investigated. There was no significant difference between the median number of S. aureus recovered in the saline flushes following a 5-second (165.5, 95% CI=93-260) or a 15-second decontamination regimen (75, 10-190)., Conclusions: The findings suggest that there may be differences in the risk of internal microbial contamination with different types of connectors and that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices.

Clinical skills learning is commonplace for all health professionals, with many training programmes incorporating multiple modes of facilitation, aligned to clinical standards and evidence-based research. There is often variance, however, in the facilitation of training programmes across healthcare settings and disciplines, highlighting differing levels of knowledge and clinical competence and illustrating a need for standardisation of training. Evidence illustrates many different approaches to learning from the traditional 'see one, do one, teach one', to academic facilitation by clinical skills tutors, to in-house expert facilitation. There has been a significant change in the medical education paradigm towards a more structured work-based competency assessed approach to learning. This paper explores the theoretical aspects of clinical skills learning and leadership theory in healthcare practice, placing emphasis on interprofessional and collaborative working and learning partnerships.

Limited availability of compounded antibiotics used for continuous infusion outpatient parenteral antibiotic therapy (OPAT) can delay or interrupt an OPAT course. To solve this problem, OPAT nurses at a hospital in Australia have been compounding elastomeric pumps for immediate use. The incidence of sepsis in 5014 patients before and after the introduction of nurse compounding was compared. There were no cases of laboratory-confirmed bloodstream infection among the nurse-compounded group compared with 2 cases (0.045/1000 catheter days) among the control group without nurse compounding (P = .16). No compounding medication errors occurred in more than 180 patient years of follow-up among the nurse compounding group. Nurse compounding can be a safe and convenient alternative when immediate access to preloaded elastomeric pumps is required.

An intravenous perfusion is a procedure which comprises infection and medication risks. To manage these risks, caregivers must respect, in addition to the usual hygiene rules, a series of best practices, ensuring the proper use and management of the medical devices and administered drugs., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.

Intravenous (IV) infusions are an essential part of hospital patient care, but occlusions in peripheral cannulae are common. One of the most dangerous consequences of occlusion (blockage) is extravasation-the non-intentional leakage of infused vesicant fluid into the tissue surrounding the vein-as it can lead to long-term, or even permanent, tissue damage. Adults and children are affected, with preterm neonates being particularly vulnerable. In-line pressure monitoring (ILPM) can help identify occlusions early and help prevent complications such as extravasation and infiltration. Occlusions cause a rise in pressure in the IV line, so IV pumps fitted with ILPM are able to detect this rise in pressure early and sound an alarm, allowing the user to take corrective measures before the patient suffers any serious chemical damage. ILPM also helps prevent or minimise other consequences of in-line occlusions such as suboptimal medicine dosing, patient distress, and economic costs to NHS trusts.

Outpatient parenteral antibiotic therapy (OPAT) is a growing area of practice that has numerous benefits for both patients and the healthcare system. In order for OPAT services to be successful, strategies need to be in place to maximise efficiency while providing safe, high-quality care. The use of elastomeric pumps to deliver intravenous (IV) antibiotics can have many benefits for OPAT services; they are cost-effective, easy to use and allow the patient to be fully ambulant. However, plans need to be put in place to make sure their use is safe and effective. This article discusses the use of elastomeric pumps by a UK-based OPAT team and the governance processes the team put in place to optimise patient safety when using elastomeric pumps to deliver IV antibiotics. Furthermore, with experience of using elastomeric pumps for more than 4 years the OPAT team was asked to evaluate an elastomeric pump new to the UK market: the Accufuser pump (Vygon (UK) Limited). By collecting data on its use it was found to be safe and easy to use. The team felt that the Accufuser pump ran to time in 96% of completed evaluations and considered it to be clinically acceptable in all responses.

Objective: This study analyzed outcomes associated with nurse-performed ultrasound (US)-guided intravenous (IV) placement compared to standard of care (SOC) palpation IV technique on poor vascular access patients., Methods: This was a randomized, prospective single-site study. Phase 1 involved education/training of a cohort of nurses to perform US-guided IVs. This consisted of a didactic module and hands-on requirement of 10 proctored functional IVs on live subjects. Phase 2 involved patient enrollment. emergency department patients meeting strict criteria of poor access were randomized to US-guided or SOC palpation arm. A functional IV placed by a study nurse was considered successful. Unsuccessful placement implied the study nurse failed, and a rescue IV was attempted. Time to IV placement was the total time required to obtain a functional IV and, if needed, a rescue IV., Results: A total of 124 subjects were enrolled; 63 were randomized to the US-guided arm, and 61 were randomized into the SOC arm; 2 patients were excluded, leaving 59 patients. Success rate was 76% for the US-guided arm and 56% for the SOC arm (P=.02). Compared to the SOC arm, the odds ratio for success for the US-guided arm was 2.52 (95% confidence interval, 1.09-5.92). The mean time to IV placement for the US-guided arm was 15.8 and 20.7 minutes for the SOC arm (P=.75)., Conclusion: In difficult access patients, nurses were more successful in obtaining IV access using US guidance than palpation SOC technique. Lengthier placement times were observed more frequently when the SOC IV technique was used., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Characteristics of medication errors involving the intravenous (IV) route of administration were analyzed in reports from 1995 to 2013. This was accomplished through a voluntary medication error reporting program. A retrospective case study design analyzed reports by practitioners or consumers on IV-associated medication errors (N = 975) affecting patients. Patterns in error accounts reflected cultural changes in health care organizations. Equipment, labeling, incorrect route of administration, types of errors, patient outcomes, and causal agents represented major codes. Results point to health care provider and consumer knowledge, the need for ongoing education of nursing staff, and interdisciplinary strategies for preventing IV-associated medication errors.

Orienting to a new job can be overwhelming, especially if the nurse is required to develop or refine new skills, such as intravenous (IV) therapy or blood administration. At the National Institutes of Health Clinical Center Nursing Department, a group of nurse educators redesigned their IV/Blood Workshop to prepare nurses with skills needed when caring for patients on protocol in a research intensive environment. Innovative teaching strategies and a hybrid instructional approach were used along with a preworkshop activity, skills lab practice, and follow-up skill validation at the unit level to provide a comprehensive curriculum while decreasing resource utilization.

Intravenous infiltrates pose tremendous risk for the hospitalized pediatric patient. Infiltrate events increase hospital-acquired harm, the number of painful procedures, use of supplies, length of stay, and nursing time; it threatens relationships essential in patient- and family-centered care. The goal of this quality improvement project was to achieve a 10% decrease in the baseline infiltrate rate on two inpatient units and in the overall infiltrate rate across all of the pediatric units. A Lean Six Sigma methodology was used to guide project activities. Improvement strategies focused on evidence-based education, intravenous (IV) catheter securement, and family engagement. A comparative purposive sample was used to evaluate the pre- and post-implementation period to determine if desired project success measures were achieved. Data analysis revealed positive results across all units, with the number of events (n = 51 pre; n = 19 post) and the infiltration rates (13.5 pre; 7.1 post) decreasing over a three-month period. A decrease was also noted in the overall percent of IVs that infiltrated in the first 24 hours (45% pre; 42% post). A statistically significant increase (t = 15.16; p < 0.001) was noted in nurses' education pre- and post-assessment survey scores. The family engagement strategy revealed overall parental responses to be 88% positive. By decreasing infiltrates, quality of care improved, resulting in the delivery of safe, effective, and patient-centered IV therapy.

Nurses endure daily low-level exposure to cytotoxic drugs, which can lead to significant absorption with potential harmful consequences. New sterile medical devices called cytotoxic safe infusion systems (CSISs), intended by their manufacturers to improve safety and quality of cytotoxic drug infusions, have been made commercially available. CSISs from 3 manufacturers were tested in 2 cancer units and compared with standard infusion sets. The aim of this study is to evaluate the devices regarding occupational exposure, quality of the infusion, and economic aspects.

In patients with diminished kidney function, the pharmacokinetics of many medications are altered. Alterations in absorption, distribution, and metabolism are observed in addition to altered elimination through the kidney. Classes of intravenous medications in which dose modifications are frequently required for patients with diminished kidney function include antibiotics, some anticoagulants, and chemotherapy agents. Failure to follow renal dose adjustment recommendations can lead to an increased risk of toxicity. Equations frequently used to estimate kidney function for the purpose of making renal dose adjustments include the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.