Search

OBJECTIVE To determine whether student involvement in intravenous catheter (IVC) placement increases the risk for complications and to report the rate and types of complications associated with IVCs in adult horses in a university teaching hospital. ANIMALS 455 IVCs placed in 394 horses. METHODS Data relevant to IVC placement and removal were retrieved from an electronic medical record search including records of adult horses from January 1 to December 31, 2022. Data retrieved from records included the role of the individual who prepared the site and placed the IVC, site of IVC placement, and type of IVC. The reason for removal of the IVC and presence or absence of detectable changes within the vein at the time of removal were documented in addition to clinical data, allowing for classification of each case. Data were reviewed retrospectively, and statistical analyses were performed using mixed-effects logistic regression models. Significance was set at P ≤ .05. RESULTS The overall rate of complications was 15.6%, and the most common type of complication was swelling of the vein. Students were involved in 87 of 455 IVC site preparations and placements, and there were no statistically significant differences in complication rates between IVC sites prepared or placed by veterinary students versus nonstudent personnel. CLINICAL RELEVANCE Veterinary personnel and clients may be hesitant to allow student involvement in IVC placement in horses, but these data suggest that student involvement does not increase the risk of IVC complications. [ABSTRACT FROM AUTHOR]

Substantial knowledge gaps exist concerning the varying durations of peripherally inserted central catheter (PICC) placements that lead to either central line-associated bloodstream infection (CLABSI) or catheter colonization. We aimed to compare PICCs dwell time between patients who developed CLABSIs due to multidrug-resistant microorganisms (MDROs) and patients with catheter colonization by MDROs. Data from 86 patients admitted consecutively to a tertiary-care hospital from 2017 to 2020 were retrospectively analyzed. The mean dwell time was 25.73 ± 16.19 days in the PICC-CLABSI group and 16.36 ± 10.28 days in the PICC-colonization group (p = 0.002). The mean dwell time was 17.38 ± 9.5 days in the PICC-MDRO group and 22.48 ± 15.64 days in the PICC-non-MDRO group (p = 0.005). Within the PICC-CLABSI group, the mean dwell time for CLABSIs caused by MDROs was 21.50 ± 12.31 days, compared to 27.73 ± 16.98 days for CLABSIs caused by non-MDROs (p = 0.417). Within the PICC-colonization group, the mean dwell time was 15.55 ± 7.73 days in PICCs colonized by MDROs and 16.92 ± 11.85 days in PICCs colonized by non-MDROs (p = 0.124). The findings of the present study suggest that CLABSIs caused by MDROs in PICCs are associated with a shorter mean catheter dwell time compared to those caused by non-MDROs, underscoring the importance of considering infections by MDROs when evaluating PICC dwell times. [ABSTRACT FROM AUTHOR]

Intravenous catheter placement is a routine procedure in exotic pet medicine, yet the selection of the optimal venous site for catheterization in rabbits (Oryctolagus cuniculus) remains controversial. Recommendations differ between countries and authors, and lack evidence-based data. This prospective study aimed to document and compare the prevalence and types of complications secondary to peripheral venous catheterization in domestic rabbits as related to the vein catheterized. Catheterization events (n = 151) were randomly attributed to three groups, named according to the venous site selected: cephalic (n = 39), lateral saphenous (n = 58) and marginal ear vein (n = 54). Rabbits that needed a catheter for fluid therapy, surgery, or imaging, were included in the study. Catheters were placed by three veterinarians following a standardized method. Data regarding the patient, the type of catheter, and the treatment were recorded. Complications were evaluated every day after the catheter placement, at removal and after 15 days. Minor complications that were observed included catheters which were bent at the elbow or removed by the rabbit, and twisted or chewed tubing. Ear necrosis and signs of phlebitis were considered major complications. Catheter placement failure was significantly higher in the "cephalic" group (odds ratio = 4, 95% Confidence Interval = [16.67,1.04], P = 0.048), without differences between the operators. For the marginal ear vein, there was also a significant association between the failure rate and the length of the rabbit's ear (Wilcoxon effect size = 0.42, 95% CI = [0.14,0.64], P = 0.003). No major complication was observed in any groups. Minor complications occurred without significant differences between the groups. The results suggest that intravenous catheters in rabbits do not carry significant complications irrespective of the chosen site, but cephalic vein placement carries the highest risk of failure. [ABSTRACT FROM AUTHOR]

Background: It may be challenging for practitioners to secure vascular access in animals, especially in a state of shock. Aim: This study aimed to evaluate the clinical relevance of commercial 16‐gauge intravenous (IV) catheter stylet vs. 15‐gauge intraosseous (IO) vascular access in emergencies. Methods: Six healthy dogs were used in this study. After general anaesthesia, IO catheterisation was performed on both trochanteric fossae of the femurs using a commercial 16‐gauge IV catheter stylet and EZIO 15‐gauge IO needle. The pressures were measured by manual, gravity and mechanical infusion for 5 min each. Additionally, insertion time and success rate were recorded. Results: In hand infusion, mean pressure of a 16‐gauge IO (605.06 ± 49.13 mmHg) was statistically lower than that of a 15‐gauge EZIO IO catheterisation (718.84 ± 93.09 mmHg). In gravity infusion, there was no significant difference in pressure during injection between the 16‐gauge IV catheter (52.23 ± 14.48 mmHg) and 15‐gauge EZIO IO catheterisation (50.68 ± 11.89 mmHg). In mechanical infusion, mean pressure of the 15‐gauge EZIO IO catheterisation (128.25 ± 50.16 mmHg) was lower than that of the 16‐gauge IV catheter (152.56 ± 67.23 mmHg). The insertion times of a 16‐gauge IV catheter and 15‐gauge EZIO IO catheterisation were 16.79 ± 0.92 and 11.65 ± 1.70 s, respectively. The success rates of the insertion were similar between both groups. Conclusion: This study shows that IO catheterisation with a commercial IV catheter stylet can be an alternative method of IO catheterisation in an emergency, especially for rapid vascular access. [ABSTRACT FROM AUTHOR]

More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients. [ABSTRACT FROM AUTHOR]

Substantial knowledge gaps exist concerning the varying durations of peripherally inserted central catheter (PICC) placements that lead to either central line-associated bloodstream infection (CLABSI) or catheter colonization. We aimed to compare PICCs dwell time between patients who developed CLABSIs due to multidrug-resistant microorganisms (MDROs) and patients with catheter colonization by MDROs. Data from 86 patients admitted consecutively to a tertiary-care hospital from 2017 to 2020 were retrospectively analyzed. The mean dwell time was 25.73 ± 16.19 days in the PICC-CLABSI group and 16.36 ± 10.28 days in the PICC-colonization group (p = 0.002). The mean dwell time was 17.38 ± 9.5 days in the PICC-MDRO group and 22.48 ± 15.64 days in the PICC-non-MDRO group (p = 0.005). Within the PICC-CLABSI group, the mean dwell time for CLABSIs caused by MDROs was 21.50 ± 12.31 days, compared to 27.73 ± 16.98 days for CLABSIs caused by non-MDROs (p = 0.417). Within the PICC-colonization group, the mean dwell time was 15.55 ± 7.73 days in PICCs colonized by MDROs and 16.92 ± 11.85 days in PICCs colonized by non-MDROs (p = 0.124). The findings of the present study suggest that CLABSIs caused by MDROs in PICCs are associated with a shorter mean catheter dwell time compared to those caused by non-MDROs, underscoring the importance of considering infections by MDROs when evaluating PICC dwell times.

Abstract Background It may be challenging for practitioners to secure vascular access in animals, especially in a state of shock. Aim This study aimed to evaluate the clinical relevance of commercial 16‐gauge intravenous (IV) catheter stylet vs. 15‐gauge intraosseous (IO) vascular access in emergencies. Methods Six healthy dogs were used in this study. After general anaesthesia, IO catheterisation was performed on both trochanteric fossae of the femurs using a commercial 16‐gauge IV catheter stylet and EZIO 15‐gauge IO needle. The pressures were measured by manual, gravity and mechanical infusion for 5 min each. Additionally, insertion time and success rate were recorded. Results In hand infusion, mean pressure of a 16‐gauge IO (605.06 ± 49.13 mmHg) was statistically lower than that of a 15‐gauge EZIO IO catheterisation (718.84 ± 93.09 mmHg). In gravity infusion, there was no significant difference in pressure during injection between the 16‐gauge IV catheter (52.23 ± 14.48 mmHg) and 15‐gauge EZIO IO catheterisation (50.68 ± 11.89 mmHg). In mechanical infusion, mean pressure of the 15‐gauge EZIO IO catheterisation (128.25 ± 50.16 mmHg) was lower than that of the 16‐gauge IV catheter (152.56 ± 67.23 mmHg). The insertion times of a 16‐gauge IV catheter and 15‐gauge EZIO IO catheterisation were 16.79 ± 0.92 and 11.65 ± 1.70 s, respectively. The success rates of the insertion were similar between both groups. Conclusion This study shows that IO catheterisation with a commercial IV catheter stylet can be an alternative method of IO catheterisation in an emergency, especially for rapid vascular access.

Peripheral intravenous catheter applications are an important part of nursing interventions. A 52-year-old male patient applied to the emergency department with complaints of pain and stiffness in the left wrist and vascular access cannula on the back of the left hand. After the tests were performed in the emergency department, a Cardiovascular Surgery consultation was requested and it was decided that there was a need for surgical intervention regarding the vein that had a complaint. The cardiovascular surgery department performed a superficial venous exploration with a 1.5 cm incision on the dorsal side at the level of carpel bones on the left hand under local anesthesia. The thrombus was removed from the vein via an incision made on the superficial vein. The incisional vein was repaired primarily. This case was presented to emphasize the importance of follow-up during peripheral intravenous catheterization applications in hospitals and to draw attention to the cost of the problems and complications that threaten patient safety. [ABSTRACT FROM AUTHOR]

Background: Catheter-related bloodstream infection (CRBSI) is quite evident in hemodialysis (HD) patients. The pattern of the isolates from the catheter tip as well as blood culture and their sensitivity against antibiotics varies and set a huge challenge for the physician for its management. Aims and Objectives: The present study was undertaken to isolate and identify, causative organism in CRBSI from the HD patient and to determine the antibiotic susceptibility profile of each isolate and determines the current trend. Materials and Methods: A total (n=101) patients admitted for HD in the nephrology unit of a tertiary care hospital with preexisting comorbidities such as diabetes and hypertension (HT) were recruited according to inclusion/exclusion criteria after obtaining written consent. Blood samples from peripheral blood vessel of suspected CRBSI patients were collected as well as the catheter tip was cut and collected in sterile test tube and transported to microbiology laboratory for isolation, identification, and antibiotic susceptibility test. Results: The HD catheter tip culture was found positive in 54 (53.46%) samples out of the total 101 samples. The distribution of catheter tip culture positive patients and their association with diabetes mellitus was highest at age group > 60 years with a p < 0.0001. The association between catheter tip culture positive and HT was also found significant with P

• Linear association between costs of infection control items and anesthesia units? • Prospective observational of 38 anesthetics, recording infection control supplies used. • Associated anesthesia units (base + time) with supply costs, linear association. • Examples show how to use to forecast annual anesthesia infection control supply costs. Some costs for anesthesia supplies to reduce intraoperative infections depend on the procedure and duration of the case. For regular anesthesia supplies and medications, costs are linearly related to American Society of Anesthesiologists' Relative Value Guide units, known for nearly all cases in the United States of America. We hypothesized linear association between costs of infection control items and anesthesia units. A prospective observational study of 38 surgical cases was performed. Usage of anesthesia infection control supplies was recorded: alcohol hand dispensers, microfiber cloths for machine disinfection, and disinfecting and cleaning caps for syringe tips, Luer connectors, and stopcocks. Cost per case was calculated using 2022 US dollar payments for those items. Using least squares linear regression to associate the anesthesia units (base + time) with supply costs, in addition to intercept and linear slope, none of 5 potential extra non-linear terms were significant (all P ≥.46). Further assessment showed lack of fit to a quadratic model. Pearson linear correlation coefficient between cost and units was 0.88. An example was created showing how to forecast annual infection control supply costs for anesthesia based on the linear model. For purposes of predicting intraoperative anesthesia supplies to reduce bacterial transmission in the anesthesia workspace, a valid approach is to assume a linear association with the total anesthesia units, a predictor generally known for all anesthetics. [ABSTRACT FROM AUTHOR]

The hemolysis rate in the emergency department (ED) is higher compared to that in other departments. We propose a new blood sampling technique without repeated venipuncture to reduce hemolysis and compare the hemolysis rate between blood collected by this method and that collected with an intravenous (IV) catheter. This prospective study included a nonconsecutive sample of patients visiting the ED (aged ≥ 18 years) of a tertiary urban university hospital. The intravenous catheterization was performed by three pre-trained nurses. The new blood collection technique involved sample collection without removing the catheter needle, performed immediately before the conventional method (through an IV catheter), without additional venipuncture. Two blood samples were collected from each patient using both the new and conventional methods, and the hemolysis index was evaluated. We compared the hemolysis rate between the two methods. From the 260 patients enrolled in this study, 147 (56.5%) were male, and the mean age was 58.3 years. The hemolysis rate of the new blood collection method was 1.9% (5/260), which was significantly lower than that of the conventional method (7.3%; 19/260) (p = 0.001). The new blood collection method can reduce the hemolysis rate as compared to the conventional blood collection method. [ABSTRACT FROM AUTHOR]

Abstract Background In perioperative care or intensive care units, the expansion lines of endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) may be accidentally cut off during medical procedures. We designed a simple method for repairing damaged ETT and LMA expansion lines. Methods In this in vitro study, ETT (n = 20) or LMA (n = 20) models were each categorized into experimental (n = 10) and control (n = 10) groups. In the experimental groups, the expansion lines were cut in the middle, and a 22G intravenous catheter was inserted into the broken end of each expansion line. The time taken to repair the expansion lines was recorded in both experimental groups. The repaired expansion lines in both groups were tested for visible underwater air leakage with cuffs under high pressure (120 cm H2O). After 15 h, the cuff pressure and tensile strength of the expansion lines were measured. Results The overall time required to repair the expansion line was 27.8 ± 1.5 s in the ETT group and 20.4 ± 1.1 s in the LMA group. When the cuff pressure was increased to 120 cmH2O, no air leakage was observed in the experimental LMA and ETT groups. The mean difference in the cuff pressures of the control and experimental groups was insignificant for both, ETT (9.50 ± 1.29 vs. 9.50 ± 1.08 cmH2O, 95% CI = − 1.11 to 1.11 cmH2O, P = 1.00) and LMA (34.1 ± 1.10 cmH2O vs. 34.5 ± 0.97 cmH2O, 95% CI = − 0.57 to 1.37 cmH2O, P = 0.40) groups, The tensile strength and the force required to pull apart the expansion lines in the experimental groups were lower than those in the control groups for ETTs (3.32 ± 0.37 N vs. 35.03 ± 4.47 N, 95% CI = − 34.69 to − 28.72 N, P

Background: In perioperative care or intensive care units, the expansion lines of endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) may be accidentally cut off during medical procedures. We designed a simple method for repairing damaged ETT and LMA expansion lines. Methods: In this in vitro study, ETT (n = 20) or LMA (n = 20) models were each categorized into experimental (n = 10) and control (n = 10) groups. In the experimental groups, the expansion lines were cut in the middle, and a 22G intravenous catheter was inserted into the broken end of each expansion line. The time taken to repair the expansion lines was recorded in both experimental groups. The repaired expansion lines in both groups were tested for visible underwater air leakage with cuffs under high pressure (120 cm H2O). After 15 h, the cuff pressure and tensile strength of the expansion lines were measured. Results: The overall time required to repair the expansion line was 27.8 ± 1.5 s in the ETT group and 20.4 ± 1.1 s in the LMA group. When the cuff pressure was increased to 120 cmH2O, no air leakage was observed in the experimental LMA and ETT groups. The mean difference in the cuff pressures of the control and experimental groups was insignificant for both, ETT (9.50 ± 1.29 vs. 9.50 ± 1.08 cmH2O, 95% CI = − 1.11 to 1.11 cmH2O, P = 1.00) and LMA (34.1 ± 1.10 cmH2O vs. 34.5 ± 0.97 cmH2O, 95% CI = − 0.57 to 1.37 cmH2O, P = 0.40) groups, The tensile strength and the force required to pull apart the expansion lines in the experimental groups were lower than those in the control groups for ETTs (3.32 ± 0.37 N vs. 35.03 ± 4.47 N, 95% CI = − 34.69 to − 28.72 N, P < 0.0001) and LMAs (36.55 ± 2.20 N vs. 26.18 ± 1.67 N, 95% CI = − 12.21 to − 8.53 N, P < 0.0001). Conclusion: An intravenous catheter can be directly inserted into the damaged ETT or LMA expansion lines; it is a simple, rapid, and effective repair method. [ABSTRACT FROM AUTHOR]

Background: Catheter-related bloodstream infection (CRBSI) is quite evident in hemodialysis (HD) patients. The pattern of the isolates from the catheter tip as well as blood culture and their sensitivity against antibiotics varies and set a huge challenge for the physician for its management. Aims and Objectives: The present study was undertaken to isolate and identify, causative organism in CRBSI from the HD patient and to determine the antibiotic susceptibility profile of each isolate and determines the current trend. Materials and Methods: A total (n=101) patients admitted for HD in the nephrology unit of a tertiary care hospital with preexisting comorbidities such as diabetes and hypertension (HT) were recruited according to inclusion/exclusion criteria after obtaining written consent. Blood samples from peripheral blood vessel of suspected CRBSI patients were collected as well as the catheter tip was cut and collected in sterile test tube and transported to microbiology laboratory for isolation, identification, and antibiotic susceptibility test. Results: The HD catheter tip culture was found positive in 54 (53.46%) samples out of the total 101 samples. The distribution of catheter tip culture positive patients and their association with diabetes mellitus was highest at age group > 60 years with a p < 0.0001. The association between catheter tip culture positive and HT was also found significant with P<0.0001. After analysis of culture reports of HD catheter tip and peripheral blood, culture-positive reports were found in 15 (14.85%) patients as CRBSI. The distribution of CRBSI predominantly found in the age group of 41–50 years (33%) which was significant with P=0.004. The causative organisms for CRBSI were Gram negative under this study and multidrug resistant too. The only drug polymyxin B was 100% sensitive to Gram-negative organism whereas vancomycin and linezolid were 100% sensitive to Gram-positive organisms. Conclusion: Patients with kidney disease receiving HD with a central venous catheter experience high rates of bloodstream and catheter tip infection commonly in those suffering from diabetes, HT, and dyslipidemia. The causative organisms for CRBSI were mainly Gram negative with a concern over existence of multidrug resistance strain. [ABSTRACT FROM AUTHOR]

To compare 5% lidocaine ointment applied for 10 minutes before intravenous (IV) catheterization to a eutectic mixture of local anesthetics (2.5% lidocaine and 2.5% prilocaine; EMLA) cream applied for 10 or 60 minutes prior and a water-based placebo for 60 minutes for successful marginal ear IV catheterization in rabbits. Randomized, blinded, complete crossover, controlled trial. A total of 10 intact male, New Zealand White rabbits aged 4 months. After application of one of the treatments on the marginal ear vein, an operator unaware of the treatment attempted IV catheter placement. Successful IV catheterization was considered as a catheter inserted at the first attempt, safely secured, with appropriate patency. Generalized linear mixed models were developed to identify relevant predictors of successful catheter placement. Ears that had EMLA cream applied 60 minutes before the catheterization attempt had more than 10 times the odds of successful catheter placement [odds ratio (OR)=10.75; 95% confidence interval (CI), 1.92–60.16; p < 0.008] compared with placebo. Both the application of EMLA cream or lidocaine ointment 10 minutes before the catheterization attempt resulted in approximately three times the odds of successful catheter placement compared with placebo, but were not statistically significant. Application of EMLA cream on the marginal ear vein 60 minutes before catheterization increases the chance of successful IV catheter placement in conscious rabbits. [ABSTRACT FROM AUTHOR]

Copyright of Karya Journal of Health Science is the property of Karya Journal of Health Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to investigate whether an intravenous (IV) strategy based on new-generation midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. Methods: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. Results: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p

Most patients in hospital will have some form of intravenous (IV) catheter in situ at some time to facilitate the administration of IV therapy. Accidental dislodgement, although widespread, is often unrecognised as a contributor to IV catheter failure. Dislodgement usually contributes to the delay in the administration of treatment, time-consuming IV restarts and a potential need for more invasive procedures. Dislodgement has serious implications, with costs to both patient and healthcare costs. Historically, prevention of IV catheter dislodgement has focused on the use of the correct securement methods and technique; however, these fail in many occasions, for example, where patients are confused or during bed transfers. In the recent years, new breakaway connector systems, such as ReLink, have been designed, which allow the tubing to become disconnected when undue pressure or pull is placed on it. This is done by a safety release valve that breaks apart, sealing off both ends of the tubing in an aseptic manner, while shutting off medication flow and preserving IV catheter integrity. Awareness raising and education focusing on accidental IV catheter dislodgement and the different ways to reduce its incidence in clinical practice would improve patient safety and potentially have significant healthcare savings. [ABSTRACT FROM AUTHOR]

Background: In the hospitalization wards where phlebitis has an incidence and accounts for the most serious complications of environmental fluid therapy. Objectives: This study aimed to determine the effect of structured nursing education programs in prevention of admitted patients’ phlebitis. Methods: In this quasi-experimental study in which the post-test design with control and intervention group was used, 400 patients were randomly divided into two groups of 200. Data were collected by questionnaire including demographic questions and Jackson’s Visual Infusion Phlebitis (VIP) scale was used to evaluate the complications of peripheral vascular catheter (phlebitis). The findings were analyzed by SPSS 25 software. Results: The mean score of phlebitis incidence in the hospital wards, whose nurses that had undergone such trainings, was significantly decreased (p

Abstract Background Intravenous catheters are common and essential devices within medical practice. Their placement can be difficult, leading to application of several technologies to improve success. Functionally expanding catheters were once an exciting technology, derailed clinically by hypersensitivity reactions. The exact cause of reactions, attributed to Aquavene catheter materials, remains unknown. Aims To reinvestigate functionally expanding intravenous catheters. Materials and Methods The history of the functionally expanding intravenous catheter is presented here along with its utility in current medical practice, potential for further investigation, and possible redesign of these once promising devices. Results This review demonstrates clinical utility and a lack of definitive cause for failure of the previous functionally expanding intravenous catheter design. As Aquavene materials themselves are commonly considered the cause of hypersensitivity reactions which removed expanding intravenous catheters from the market, this review found several possible substitutes for this material for use in any redesign. Discussion and Conclusion The functionally expanding intravenous catheter failed due to hypersensitivity reactions in patients. Alternative materials exist for a possible redesign on this once promising clinical product.

Copyright of Vascular Access is the property of Canadian Vascular Access Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is one of the commonest complications that develop after intravenous catheter application. Aims: This study aims to investigate the incidence of phlebitis and to evaluate factors contributing to the development of phlebitis. Settings and Design: This was a prospective observational study conducted on patients admitted at 4 Air Force Hospital Kalaikunda. Methods: Study conducted on 150 patients who were admitted to the medical and surgical division of the hospital during the period from July 2018 to April 2019. The factors studied were age, gender, site of insertion, place of insertion, cannula size, IV medications, and blood products used. Phlebitis was graded using Visual Infusion Phlebitis Score. Statistical Analysis Used: The incidence of phlebitis was expressed in percentage and odds ratio was calculated to estimate the effects of suspected risk factors. Results: Incidence of phlebitis was found to be 31.4% from our study. The increased incidence rate of phlebitis was seen in the female gender, age less than 60 years, insertion in the lower limb, large catheter size, catheters inserted in emergency situations, and IV drugs administration. Conclusion: Phlebitis is an important on-going problem in present-day clinical practice. Avoiding of preventable risk factors, proper nursing care, and daily inspection of catheters needed for prevention of phlebitis.

Les dispositifs de perfusion intraveineuse sont multiples et indispensables à la pratique quotidienne. Ils sont également responsables d'une morbi-mortalité importante. Cathéter veineux périphérique simple ou inséré par écho-guidage, midline, PICCline, cathéter veineux central tunnellisé ou non, cathéter à chambre implantable sont actuellement à notre disposition. Ainsi, le choix du cathéter, la durée et les indications d'utilisation, la prévention et le traitement des complications varient en fonction des situations. L'objectif de cette mise au point est de proposer au clinicien un état des lieux des connaissances et règles de bonne pratique sur l'utilisation des cathéters. Intravenous catheters are multiple and essential for daily practice. They are also responsible for high morbidity and mortality. Simple or echo-guided peripheral venous catheters, midlines, PICCline, tunneled or non-tunneled central venous catheters, and implantable venous access device are currently at our disposal. Thus, catheter selection, duration and indications for use, and prevention and treatment of complications vary according to the situation. The objective of this update is to provide the clinician with an overview of knowledge and rules of good practice on the use of catheters. [ABSTRACT FROM AUTHOR]

• Midline catheters can be inserted with ultrasound guidance at the bedside. • A midline catheter-based strategy reduced the need for central venous catheters. • The complication-free catheter survival time was 15 days in the midline group. • A midline catheter-based strategy reduced personnel time expenditure. This study was performed to investigate whether an intravenous (IV) strategy based on new-generation midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0–60 days) in the midline group and 4 days (range 0–84 days) in the conventional group (p = 0.002). In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs. [ABSTRACT FROM AUTHOR]

The subjects of the study consisted of 164 sick newborn infants (97 boys and 67 girls) who had no signs or symptoms of infections. The intravenous fluid drip (at scalp vein or saphenous vein) was put on soon after taking blood culture. Removal of venous catheters was indicated when the patients condition. No longer needed their use or there was sign of local infection. This study showed that the lower the birth weight or the gestational age, the higher the incidence of infection. The most prominent nosocomial infection in this study was phlebitis (16.5%) followed by infiltration (14.6%), and bacteremia (7 ,9%). The predominant microorganism was E. coli (59.7%). The overall incidence of nosocomial infection was 44.5% and the mortality was 24.7%.

Background: Peripheral intravenous catheters connected to an infusion pump are necessary for the delivery of fluids, nutrition, and medications to hospitalized neonates but are not without complications. These adverse events contribute to hospital-acquired patient harm. An artificial intelligence theory called fuzzy logic may allow the use of appropriate variables to predict infusion failure.Purpose: This innovative study aimed to develop an intravenous infusion nanotechnology monitoring system that would alert the nurse to impending peripheral intravenous infusion failure.Methods: An intravenous infusion nanotechnology monitoring system, using predictor variables of pressure, pH, and oxygen saturation used in a fuzzy logic alarm algorithm was developed to alert the nurse to impending peripheral intravenous infusion failure.Findings: The developed intravenous infusion nanotechnology monitoring system is composed of a peripheral intravenous catheter with nanotechnology multimodal sensor, an intravenous pump, a fuzzy logic algorithm, and alarm. For example, using this system, an elevated in-line pressure, a low pH, and a low venous oxygen level would generate an alarm for possible impending infusion failure.Implications For Practice: With further development, this technology may help nurses predict and prevent adverse outcomes from intravenous infusions. This work shows how nurses can be content experts and innovators of technology that they use to make clinical decisions.Implications For Research: After regulatory approval, a randomized controlled trial may be performed to investigate whether interventions at the time of an alarm would result in fewer adverse outcomes and improve safety. [ABSTRACT FROM AUTHOR]

Phlebitis is one of the most common complications of peripheral intravenous catheter (PIVC) that can lead to many complications, including higher medical costs and longer hospital stays. To identify the incidence of phlebitis associated with PIVC and determine its risk factors among hospitalized pediatric patients. An observational and cross-sectional design was used. Data such as patient's demographics, medical diagnosis, place of admission, and other PIVC characteristics were recorded. In addition, observations of PIVC sites over 12-hour intervals were conducted to measure PIVC complications using the Visual Infusion Phlebitis (VIP) scale. Sample and Setting. Over a period of six months, a sample consisting of 307 children from five governmental hospitals that are located in north and middle Jordan were targeted. The sample consists of patients under 12 years old with PIVCs who were hospitalized in pediatric departments. PIVC catheterization has been associated with several complications such as phlebitis (N = 164; 53.4%), extravasation (N = 107, 34.9%), pain (N = 37; 12.1%), leakage (N = 37; 12.1%), and obstruction (N = 26; 8.5%). The main risk factors for phlebitis were: children admitted to wards, PIVC inserted by novice nurse, catheter inserted in the lower limbs, and catheter with contaminated dressing. This study enriches knowledge of PIVC complications and risk factors of phlebitis to help nurses avoid complications and initiate prompt treatment, leading to decrease financial burden as well as patient pain and discomfort. [ABSTRACT FROM AUTHOR]

Urolithiasis is a disease that commonly affects the urinary organs due to blockage of crystal stones in the urinary tract of male cats. A 3.5-year-old male mixed breed domestic cat was examined at the Royal Purple Vet Clinic with complaints of a lack of appetite, fever, and vomiting. The results of the physical examination showed that the body temperature was 39.6°C, bladder distention occurred, and there was a pain response when palpated. Urinary distension was treated by inserting an intravenous catheter (26G). Supporting examinations included urinalysis and microscopic examination of urine. Urinalysis results showed the presence of red blood cells, white blood cells, and protein in the urine. Meanwhile, the results of the microscopic examination showed that there were deposits of calcium oxalate crystal particles. The cat was diagnosed with urolithiasis with a fausta prognosis. The treatment includes fluid therapy, antibiotics, anti-inflammatories, supplements, and herbal medicine. The cat experienced changes after being treated for four days, characterized by normal urination and no blood found in the urine. [ABSTRACT FROM AUTHOR]

Abstract Background Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by increasing first attempt success with ultrasound guidance. The emphasis was to provide a solution for hospitalised patients after business hours by training the after-hours clinical support team in ultrasound guided cannulation. Methods Inception cohort study of patients referred to the after-hours clinical support team including outcomes such as number of attempts at cannulation before and after referral, insertion site, type of device inserted and recorded pain score for attempts prior to referral and for attempts by the after-hours clinical support team. Results Between January and December 2016, 379 patients were referred to the after-hours clinical support team for placement of a peripheral intravenous catheter under ultrasound guidance. The median number of unsuccessful attempts before referral was 2 (IQR 2, 4), this ranged between 1 attempt to 10 attempts compared to only 1 attempt (IQR 1, 1, p

Introduction: Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods: A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results: The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion: This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion. [ABSTRACT FROM AUTHOR]

Context: Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is one of the commonest complications that develop after intravenous catheter application. Aims: This study aims to investigate the incidence of phlebitis and to evaluate factors contributing to the development of phlebitis. Settings and Design: This was a prospective observational study conducted on patients admitted at 4 Air Force Hospital Kalaikunda. Methods: Study conducted on 150 patients who were admitted to the medical and surgical division of the hospital during the period from July 2018 to April 2019. The factors studied were age, gender, site of insertion, place of insertion, cannula size, IV medications, and blood products used. Phlebitis was graded using Visual Infusion Phlebitis Score. Statistical Analysis Used: The incidence of phlebitis was expressed in percentage and odds ratio was calculated to estimate the effects of suspected risk factors. Results: Incidence of phlebitis was found to be 31.4% from our study. The increased incidence rate of phlebitis was seen in the female gender, age less than 60 years, insertion in the lower limb, large catheter size, catheters inserted in emergency situations, and IV drugs administration. Conclusion: Phlebitis is an important on-going problem in present-day clinical practice. Avoiding of preventable risk factors, proper nursing care, and daily inspection of catheters needed for prevention of phlebitis. [ABSTRACT FROM AUTHOR]

Background: Skin microorganisms may contribute to the development of vascular access device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is little evidence to inform choice of VAD site selection. Objective: To compare microorganisms present at different body sites used for VAD insertions and understand the effect of transparent dressings on skin microflora. Methods: The ESCAPE observational study consisted of three phases: (1) skin swabs of four sites (mid-neck, base neck, chest, upper arm) from 48 hospital patients; (2) skin swabs of five body sites (mid-neck, base neck, chest, upper arm, lower arm) from 10 healthy volunteers; and (3) paired skin swabs (n = 72) under and outside of transparent dressings from 36 hospital patients (16 mid/base neck, 10 chest, upper arm). Specimens were cultured for 72 h, species identified and colony-forming units (CFU) counted. Ordinal logistic regression compared CFU categories between variables of interest. Results: The chest and upper arm were significantly associated with fewer microorganisms compared to neck or forearm (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.25–0.65, P < 0.05). CFU levels under transparent dressings were not significantly different from outside (OR = 0.57, 95% CI = 0.22–1.45). Staphylococci were predominant at all sites. Other significant (P < 0.05) predictors of higher CFU count included prolonged hospitalisation and medical/surgical patient status. Discussion: Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk. [ABSTRACT FROM AUTHOR]

Staphylococcus epidermidis developed to be a significant human pathogen due to the ability to produce biofilm. The most significant infections of S.epidermidis found in the use of medical devices such as an intravenous catheter. Furthermore, the biofilm is more resistant to antibiotics up to 1000 times more than free-bacteria. This simple survey aimed to describe the profile of biofilm-producing S. epidermidis from intravenous catheter colonisation of some patients in surgical and internal medicine wards at the Margono Soekarjo hospital, Purwokerto, and the antibiotics resistance pattern. A vitek® 2 compact (Enseval Medika Prima) was performed to identify the bacterial species and to examine 73 antibiotics for understanding the resistance pattern automatically. The optical density (OD) representing the ability of S. epidermidis to produce biofilms was measured by Microtiter plate biofilm assay with crystal violet staining. A scanning electron microscopy was done to compare the thickness of the ultrastructure of biofilm-producing S. epidermidis visually. The present study found that 2 of 8 Gram-positive bacteria (25%) were biofilm-producing S. epidermidis. One of S. epidermidis was moderate whereas the other was high biofilm-producing bacteria. Images of SEM showed that a high biofilm-producing S. epidermidis has a thicker ultrastructure of biofilm than the moderate biofilm-producing, whereas a control, the weak biofilm-producing S. epidermidis ATCC 12228 has the least biofilm. Both of S. epidermidis strains were sensitive to Gentamicin, Moxifloxacin, Quinupristin/Dalfopristin, Linezolid, Vancomycin, Doxycycline, Minocycline, Tetracycline, Tigecycline, and Nitrofurantoin. Furthermore, both S. epidermidis strains were resistant to the other (63) antibiotics. In conclusion, two strains of S. epidermidis in this study have different capabilities to form the biofilm which showed that high biofilm-producing strain was thicker than moderate biofilm-producing strain by scanning electron microscopy. However, both of them were resistant to the same number of antibiotics. [ABSTRACT FROM AUTHOR]

Background and aim: Phlebitis and infection at the insertion site are among the most prevalent complications of peripheral intravenous catheters. The type of topical antiseptic solution used for preparing the catheter insertion site can affect the rate and the severity of these complications. The aim of this study was to compare the effects of ethanol, Betadine, and ethanol-chlorhexidine gluconate combination on phlebitis induced by peripheral intravenous catheters. Methods: In this clinical trial, 123 patients were selected from the medical care wards of Besat Hospital, Sanandaj, Iran. Patients were randomly allocated to the ethanol, Betadine, and ethanol-chlorhexidine gluconate groups. In these three groups, the catheter insertion site was scrubbed by using 70% ethanol, 10% Betadine, or 35% ethanol-2% chlorhexidine gluconate, respectively. The rate and the severity of phlebitis and local infection were assessed by using a four-point scale. Study data were analyzed by conducting the one-way analysis of variance and the t tests by using the SPSS software. Findings: Study groups did not differ significantly from each other regarding variables such as age, gender, catheter size, and the catheter insertion site. The rates of phlebitis in the ethanol, Betadine, or ethanol-chlorhexidine gluconate groups were respectively equal to %46, %53, and %22. In total, three patients developed local infection at the catheter insertion site, all of whom were from the Betadine group. Conclusion: Compared with 70% ethanol and 10% Betadine solutions, 35% ethanol-2% chlorhexidine gluconate combination is more effective in preventing phlebitis and local infection at the insertion site of peripheral intravenous catheters.

It is with interest how I have seen the care, management and review of patients with intravenous catheters (IVCath) over the years. How our attitudes and approaches have (and always will) continue to change as we learn more about the body, the healing process, the dos and the don’ts through our own experiences and learning. There have been a number of articles recently that have highlighted the correct method of placing an IVCath and the management behind this; however, I feel there is a small hole here behind what is considered a patency check over that of a phlebitis check. [ABSTRACT FROM AUTHOR]

Highlights • The use of an IV catheter induced a local inflammatory response mediated by IL-6. • This inflammatory response was not enhanced by a pro-inflammatory high-fat meal. • The IV catheter distorts the assessment of inflammation in physiology testing. Abstract Aim Chronic inflammation has been associated to the development of cardiometabolic dysfunctions. The use of an intravenous (IV) catheter is highly recommended for physiology testing. Yet, the presence of an IV catheter triggers local inflammation that does not reflect systemic inflammatory status. The aim of this study was to assess the effect of an IV catheter on serum concentrations of IL-6, IL-8 and hsCRP in a fasting state and after a high-fat meal known to trigger low-grade inflammation. Methods Twenty-two healthy subjects (7 men, 15 women) were included in this study. The trial included 2 visits. After an overnight fast, a venous catheter was inserted into an antecubital vein. A first blood sample was collected through this catheter at T = 0 min. On each visit, participants were requested either to drink only water for the whole duration of the test (WO test), or to consume a high-fat meal (HFM). Blood samples were collected through the catheter at T60, T120, T180 and T300 min. Additional venous punctures were performed on the contralateral arm at T180 and T300 min. Serum inflammatory mediators were measured at each time point of both interventions. Results When serum was collected by venous punctures, IL-6 concentrations remained unchanged during both WO and HFM tests (P time = 0.15 and P time = 0.23, respectively), whereas the concentrations increased progressively over time when serum was collected through the catheter (P time < 0.001). The high-fat meal had no additional effect on IL-6 levels (P meal = 0.27) neither in serum collected by venous puncture nor in serum collected through the catheter. Serum IL-8 and hsCRP concentrations did not vary over time, and were influenced neither by the meal type nor by the blood collection method. Conclusion The insertion of an indwelling catheter is associated with a local inflammatory response possibly mediated by IL-6 but not IL-8. This inflammatory response was not enhanced by a pro-inflammatory high-fat meal. [ABSTRACT FROM AUTHOR]

Objective The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. Methods Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively. Results Different types of headache were observed, including typical orthostatic headache alone (n = 10), orthostatic headache with chronic subdural hematoma (CSDH) (n = 3), and posture-unrelated headache accompanied with CSDH (n = 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases. Conclusions We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter. Highlights • We report outcomes from 15 CSF leak cases that underwent large-volume EBPs. • Four patients who underwent other treatments at the same period are also presented. • EBPs were performed using an intravenous catheter from a single lumbar entry point. • We could control spinal CSF leaks perfectly with our therapeutic strategy. [ABSTRACT FROM AUTHOR]

Objective To assess the reaction of client-owned dogs to intravenous (IV) catheter placement after applying a local anaesthetic (EMLA) or placebo cream for either 30 or 60 minutes. Study design Prospective, randomized, blinded, placebo-controlled, clinical trial. Animals A total of 202 client-owned dogs of various breeds. Methods With owner consent, dogs were randomly allocated to one of four treatment groups: EMLA 60 minutes, EMLA 30 minutes, Placebo 60 minutes and Placebo 30 minutes. After the cream was applied for the allocated time, an IV catheter was placed and the behavioural reaction of the dog was scored. The reaction score was analysed using a Kruskal–Wallis test followed by Mann–Whitney U tests of the multiple pairwise comparisons, with Bonferroni correction. Results A large number of dogs, even in the placebo groups, did not react to IV catheter placement. However, the Kruskal–Wallis test showed an overall difference between treatment groups (χ2 = 11.029, df = 3, p = 0.012). The pairwise comparisons showed a lower overall reaction score in the EMLA 60 group than in the EMLA 30 and Placebo 60 groups (adjusted p = 0.018 and adjusted p = 0.044, respectively). Conclusions and clinical relevance This study shows that EMLA cream applied for 60 minutes reduces the behavioural reaction of dogs to IV catheter placement; therefore, this intervention can be advocated for routine use in veterinary medicine to enhance the welfare of dogs undergoing IV catheter placement. [ABSTRACT FROM AUTHOR]

Summary: This report describes a fatal pulmonary embolism in a foal, as a sequela of septic thrombophlebitis of the right jugular vein and/or a generalised hypercoagulable state. The foal underwent abdominal surgery and suffered from severe and prolonged colitis. Despite intense supportive care, the colt developed venous thrombophlebitis and subsequently died suddenly 12 days after discharge from the hospital, following an initial improvement. On post‐mortem examination, a large pulmonary embolism was discovered. Pulmonary thromboembolism is a potentially fatal sequelae of thrombus formation. It is difficult to detect and therefore likely to be underdiagnosed. [ABSTRACT FROM AUTHOR]

Aim This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon. Background Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016. Methods A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies) , pressure ulcer , pressure ulcers , decubitus ulcer , and decubitus ulcers . Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital. Results Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases. Conclusions There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended. [ABSTRACT FROM AUTHOR]