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Infiltration of a vesicant, called extravasation, can result in severe patient injuries. Recognition of vesicants and their relative risk of injury is essential to extravasation prevention, early recognition, and appropriate treatment. In this article, the Vesicant Task Force (VTF) updates the previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS list diverges from earlier vesicant lists, such as the 2017 VTF list, by adopting a risk stratification approach based upon documented patient outcomes, in contrast to the reliance on expert consensus or only surrogate risk indicators, such as pH and osmolarity. The methodology used to create the updated list is explained, and the criteria for high- and moderate-risk vesicants and cautionary vesicants are defined., Competing Interests: Conflicts of interest:Barb Nickel is on the Advisory Board for Baxter Healthcare; Lisa Gorski receives advisory and speaking honoraria from BD Medical and 3M (Solventum), speaking honoraria from Greiner, and holds stock in IvWatch; Lynn Hadaway was a consultant and speaker for BD Medical and B Braun Medical, and was a consultant for Atrion, AccuVein, and 3M (Solventum). These relevant financial relationships have been mitigated through peer review. There are no other relevant financial relationships for the authors or planners., (Copyright © 2024 Infusion Nurses Society.)

Purpose: This study aimed to assess subclinical peripheral diabetic neuropathy (PDN) in adolescents with type 1 diabetes mellitus (T1DM)., Methods: Subjects included 53 T1DM patients (age (mean ± SE): 15.8 ± 0.54 years, disease duration: 6.0 ± 0.51 years and HbA1c: 7.9 ± 0.19%), and 37 healthy gender matched controls (age: 15.6 ± 0.52 years). PDN was assessed by vibration perception threshold (VPT) and by quantitative sensory testing (QST). In controls, 95% confidence intervals were calculated., Results: Among patients, VPT prevalence of abnormality ranged from 60-73.4% on different sites. Higher VPT was found in patients on all examined sites (p < 0.01). In controls, VPT correlated with height (r = 0.48, p = 0.05). Regarding QST prevalence of abnormality, cold detection threshold (CDT) ranged 7.3-39.0%, cold pain threshold (CPT) ranged 22.22-29.63%, hot detection threshold (HDT) ranged 34.14-63.41%, and hot pain threshold (HPT) ranged 15.79-36.84%. In patients, CPT correlated with BMI (r = 0.42, p = 0.05) and diabetes duration, (r = 0.40, p = 0.05), HPT correlated with age (r = 0.36, p = 0.05) and height (r = 0.35, p = 0.05), while in controls with BMI (r = 0.51, p = 0.05). No correlation of VPT or QST with HbA1c was observed., Conclusion: Adolescents with T1DM in this study, although asymptomatic, showed a high prevalence of impaired indices of PDN, highlighting potential clinical implications of early identification of PDN., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F.P. received reimbursements and/or fees for lectures or consultancy from Bard, BBraun, Becton & Dickinson, Medcomp, MSD, Orion Pharma, Teleflex, and Vygon. K.A. and K.K. are employees of Becton & Dickinson and Company (Franklin Lakes, NJ, USA).

Infiltration of a vesicant medication, defined as extravasation, may result in significant patient injuries. The first step in preventing extravasation is the identification and recognition of vesicant medications and solutions. Because there is no list of noncytotoxic vesicants as established by a professional organization, the Infusion Nurses Society, as the global authority in infusion nursing, identified the need to address this gap. A task force was formed for the purpose of creating an evidence-based list of noncytotoxic vesicant medications and solutions.

Introduction: In this study we aimed to determine the normal lower limits of sensory nerve action potential (SNAP) amplitude of the radial nerve by taking into account age, height, weight, and body mass index (BMI)., Methods: Three hundred thirty-four volunteers, 168 men and 166 women, were recruited. Sensory nerve conduction studies of the radial nerve were performed, and reproducible waveforms were obtained., Results: The mean radial SNAP amplitude was 44.87 ± 14.58 (range 24-92) μV. SNAP amplitude had a statistically strong negative correlation with age, height, weight, and BMI of the subjects. A multiple linear correlation equation was computed, based on age and BMI of the subjects, to calculate the lower normal limits of radial SNAP and to construct the corresponding nomogram. Conclusion The lower limit of normal SNAP amplitude of the radial nerve, determined in individual subjects using the nomogram, is a useful tool for detection of polyneuropathy., (© 2015 Wiley Periodicals, Inc.)