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Background: In 2020, as a result of evidence of demonstrated safety of an initial pilot program, our institution set out to implement a peripheral vasopressor infusion protocol. Objective: To evaluate the use of peripheral lines for vasopressor administration to reduce placement of unnecessary central lines and central line days. Methods: This is an Institutional Review Board approved, single center retrospective chart review conducted as pre/post-analysis. Our hospital is a quaternary care, level 1 trauma center in Hartford, Connecticut that serves 100,000-120,000 patients annually. Patients >18 years admitted to an intensive care unit (ICU) were included if meeting protocol specific inclusion criteria pertaining to moderate expected duration and dose of vasopressor. Patients were excluded if vasculature not supportive of placement of two peripheral intravenous (PIV) sites, PIV sites without brisk blood return, had a limb restriction, or metacarpal line. All analyses were conducted with SPSS v. 26 (IBM; Armonk, NY 2019), using an a priori alpha level of 0.05 such that all results yielding p <.05 were deemed statistically significant. Primary efficacy outcomes of this study are number of central lines placed and number of central line days. The primary safety outcome is the number of extravasation events attributed to peripheral administration of vasopressors. Results: Overall, 146 patients avoided central line placement constituting a 58.4% (p <.001) decrease in central line placement with peripheral vasopressor use. Out of 382 administrations there were a total of 14 extravasation events that occurred with peripheral vasopressor use in the post-intervention group. Implementation was associated with a statistically significant reduction in CLABSI occurrence. Conclusions: The results of this analysis demonstrate that vasopressors can peripherally administered safely, when proximal to the antecubital fossa, at lower doses, and for short durations of infusion with minimal adverse events. [ABSTRACT FROM AUTHOR]

Background: Use of ultrasound guidance for vascular access procedures is commonplace in inpatient and outpatient care settings. Standard ultrasound probes offer the operator a single-plane view, necessitating rotation of probe to attain dual complimentary views. This mechanical probe rotation increases technical difficulty of ultrasound use. The purpose of this study is to evaluate the rate of cannulation success and efficiency of a synchronous biplane ultrasound mode in ultrasound-guided arterial line placement as compared with a standard single-view ultrasound mode in the operating room setting. Methods: Patients scheduled for elective surgery in which a radial arterial catheter would be used for hemodynamic monitoring were approached for consent to this study. Patients were randomized to either undergo placement with single-plane view versus synchronous biplane view; outcomes were recorded. Providers were provided preprocedural ultrasound education as well as the option of a short hands-on experience; their level of experience was noted. Results: Placement time of a peripheral arterial catheter was longer and required more attempts to be successful using synchronous biplane imaging as compared with single-plane imaging across providers of all skill/experience levels. Subjectively, providers noted the benefit of synchronous biplane imaging in vascular access; however, disadvantages including probe size, quality of imaging, and size of the screen were noted. Discussion: Thorough education regarding the use and functionality of biplane synchronous imaging in vascular access is essential. Additional guided-practice time with experienced operators could also be helpful to overcome the challenges observed in this study. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: to cross-culturally adapt and analyze the metric properties of the Adult Difficult Intravenous Access Scale into Brazilian Portuguese. Method: methodological study carried out in two stages: 1) Translation of the scale from the original version in English to Brazilian Portuguese, including an assessment by a committee of nine judges, back-translation and semantic analysis; 2) Analysis of metric properties with 130 adults admitted to a hemodynamics unit in which difficult peripheral venipunctures occurred. Participants were followed up to check for the occurrence of difficult peripheral venipunctures. The instrument’s inter-rater reliability and predictive validity were analyzed. Data collection was carried out from February 2021 to April 2023 in Minas Gerais, Brazil. Results: in the assessment carried out by the committee of judges, the items presented a Content Validity Index above 0.80, after the second round of assessment. Regarding semantic analysis, professionals considered the scale relevant, easy to apply and understand. The Kappa coefficient for individual items ranged between 0.68 and 1.0. For each item scored, adult patients are three times more likely to have difficult peripheral venipuncture. Conclusion: the final version of the scale was considered clear, reliable, and easy to understand. The instrument enables a predictive score of difficult peripheral venipuncture in adults.

ABSTRACT Objective: To verify the effects of instructional therapeutic play on the behavior of children during the first attempt at peripheral intravenous catheterization. Method: This is a quasi-experimental post hoc analysis with a non-equivalent control group, secondary to a randomized clinical trial. The convenience sample comprised 193 children, allocated for convenience into an intervention group (preparation for catheterization with a therapeutic play; n=101 children) and a control group (preparation with structured conversation supported by the use of a booklet; n=92 children). The Observation Scale of Behavior Distress was used to evaluate opposing behavior (attacking the professional, whining, crying, getting nervous, screaming, moving until being immobilized, and protesting) and non-opposing behavior (helping and asking for information. We conducted descriptive and inferential analyses of the data. Results: Statistically significant differences were observed between the intervention and control groups in the variables: nervousness, moving to immobilization, protest and assistance during venipuncture. The use of therapeutic play reduced the risk of being nervous during the procedure by 43%, the risk of moving did so by 51%, and the risk of not protesting by 51%. Furthermore, assistive behavior during the procedure increased by 27%. Conclusion: The instructional therapeutic play was effective in reducing behaviors competing with intravenous catheterization and favored the child's collaboration in their first attempt.

ABSTRACT Objectives: to evaluate the effectiveness of peripheral central catheterization by comparing the modified Seldinger technique and the conventional technique in critically ill newborns. Methods: randomized unmasked clinical trial conducted in a public children’s hospital. Participation of 111 newborns with randomized allocation, 56 in the control group (conventional technique) and 55 in the experimental group (modified Seldinger). Success and absence of complications were evaluated as primary outcomes. The pain scale, difficulty in hemostasis, procedure time and number of punctures were considered secondary outcomes. Results: there was no statistical significance between groups, either for success (p=0.705) or absence of complications (p=0.347). A lower pain score, improved hemostasis, increased assertiveness with fewer punctures and reduced procedure time were not observed in the experimental group. Conclusions: the modified Seldinger technique did not prove to be a more effective insertion technology compared to the conventional method. Brazilian Clinical Trial Registry: RBR-69vks36.

Malposition is a relatively rare complication associated with peripherally inserted central catheters (PICCs), particularly in cases of superficial femoral vein (SFV) catheterization. To the best of our knowledge, we are the first to report this rare case of SFV PICC malposition in the contralateral renal vein.

Aim: To develop and psychometrically test an instrument to assess nurses' evidence‐based knowledge and self‐efficacy regarding insertion and management of venous access devices (short peripheral catheter (SPC), long peripheral catheter/midline (LPC) and PICC) and the management of totally implantable central venous catheter (Port) in adult patients. Design: Multicenter cross‐sectional observational study with questionnaire development and psychometric testing (validity and reliability). Methods: An evidence‐based instrument was developed including a 34‐item knowledge section and an 81‐item self‐efficacy section including four device‐specific parts. Nineteen experts evaluated content validity. A pilot study was conducted with 86 nurses. Difficulty and discrimination indices were calculated for knowledge items. Confirmatory factor analyses tested the dimensionality of the self‐efficacy section according to the development model. Construct validity was tested through known group validity. Reliability was evaluated through Cronbach's alpha coefficient for unidimensional scales and omega coefficients for multidimensional scales. Results: Content validity indices and results from the pilot study were excellent with all the item‐content validity indices >0.78 and scale‐content validity index ranging from 0.96 to 0.99. The survey was completed by 425 nurses. Difficulty and discrimination indices for knowledge items were acceptable with most items (58.8%) showing desirable difficulty and most items (58.8%) with excellent (35.3%) or good (23.5%) discrimination power, and appropriate to the content. The dimensionality of the model posited for self‐efficacy was confirmed with adequate fit indices (e.g., comparative fit index range 0.984–0.996, root mean square error of approximation range 0.054–0.073). Construct validity was determined and reliability was excellent with alpha values ranging from 0.843 to 0.946 and omega coefficients ranging from 0.833 to 0.933. Therefore, a valid and reliable tool based on updated guidelines is made available to evaluate nurses' competencies for venous access insertion and management. [ABSTRACT FROM AUTHOR]

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

Objective: to analyze the occurrence of difficulty in the peripheral insertion of the central catheter and the presence of complications in the use of this device in hospitalized adults who received peripheral intravenous therapy through a short peripheral intravenous catheter and to identify whether there is an association between peripheral intravenous therapy and the presence of complications in the use of the peripherally inserted central catheter. Method: retrospective cohort, with patients aged 18 years or over, in a tertiary teaching hospital, with a peripherally inserted central catheter, who had at least one previous short peripheral intravenous catheter. Data were analyzed using descriptive statistics and Poisson regression. Results: the sample consisted of 76 patients. There was an association between difficulty in the insertion procedure and number of punctures (p

Abstract Background The importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals. Methods This study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé’s test, Pearson correlation, and hierarchical regression analysis. Results The mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein. Conclusions The PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice.

Background: The importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals. Methods: This study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé's test, Pearson correlation, and hierarchical regression analysis. Results: The mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein. Conclusions: The PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the efficacy of the topical anesthetics lidocaine and benzocaine in reducing pain associated with peripheral intravenous catheterization and in enhancing patient satisfaction in the emergency department. Materials and Methods: This randomized-controlled, parallel-group, doubleblind, experimental, and Phase III clinical trial involved 120 individuals admitted to the Emergency Department of a University Hospital. Data were collected using an Individual Information Form, Visual Analog Scale, and Patient Satisfaction Scale about Catheterization. Participants were divided into three groups (lidocaine 10% spray, benzocaine 20% spray, and placebo groups) according to a computer-generated randomization table. Results: The average pain scores were lower and satisfaction levels with catheterization were higher in the lidocaine and benzocaine groups compared to the placebo group (p<0.001). A strong negative correlation was observed between the groups' pain scores and satisfaction levels with catheterization (Lidocaine Spray Group r=-0.636 p<0.001; Benzocaine Spray Group r=-0.651 p<0.001; Placebo Group r=-0.877 p<0.001). Conclusion: Topical lidocaine and benzocaine have been proven to reduce pain from peripheral intravenous catheterization and improve patient satisfaction. These agents can be routinely used to alleviate injection pain and improve patient satisfaction with the procedure. [ABSTRACT FROM AUTHOR]

Purpose: As a safe and reliable alternative to central venous catheters (CVCs), peripherally inserted central catheters (PICCs) are commonly used in clinical practice. However, the insertion of PICCs by nurse practitioners (NPs), especially in Japan, has not been reported extensively. Thus, we investigated the safety and efficiency of PICC insertions by NPs. Methods: The participants were 1322 patients who underwent PICC insertion by NPs at Fujita Health University Hospital (FNPs). The basilic vein in the brachium was the preferred vein for insertion; the brachial vein was the alternative. Patients were monitored from the time of PICC insertion until its removal. Ultrasonography-guided puncture was used for all catheter insertions, and the catheter tip was replaced into the superior vena cava under fluoroscopic imaging with maximal sterile barrier precautions. The outcomes of the PICC insertions by the FNPs were evaluated retrospectively. Results: Overall, 23 FNPs inserted a collective total of 1322 PICCs, which remained in place for a collective total of 23,619 catheter days. The rate of successful PICC insertion was 99% (1310 patients). The median time taken for PICC insertion was 12 min (interquartile range, 10–15 min). Intraoperative complications occurred in two patients (0.2%). The confirmed incidence of central line–associated bloodstream infection was 3.4% (45 patients), and these infections occurred on 1.9 per 1000 catheter days. The median duration of PICC placement was 15 days (range, 10–23 days). Conclusion: PICC insertion by NPs is safe and a potential alternative to CVC insertion by surgeons. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care. Objective: To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units. Methods: A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤.05 as significance level. Results: There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p =.376). However, longer training time was associated with a lower rate in performing such procedure (p <.001). Conclusion: Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time. [ABSTRACT FROM AUTHOR]

Objective: to analyze the effectiveness of peripherally inserted central catheter insertion techniques in preventing the occurrence of complications related to this device in newborns. Method: a paired and network systematic literature review and meta-analysis, with its search carried out in seven databases and in the Grey Literature, including randomized and non-randomized clinical trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias In Non-randomized Studies of Interventions tools. Certainty of the evidence was assessed by means of the Grading of Recommendations Assessment, Development and Evaluation. A meta-analysis was carried out with the aid of the R statistical program. Results: eight studies with 1,126 newborns were included and six insertion techniques were identified: intracavitary electrocardiogram; intracavitary electrocardiogram associated with ultrasound; ultrasound; formula; anatomical landmark; and modified anatomical landmark. Five techniques significantly decreased primary tip malpositioning when compared to the control ( p

Abstract Aim To develop and psychometrically test an instrument to assess nurses' evidence‐based knowledge and self‐efficacy regarding insertion and management of venous access devices (short peripheral catheter (SPC), long peripheral catheter/midline (LPC) and PICC) and the management of totally implantable central venous catheter (Port) in adult patients. Design Multicenter cross‐sectional observational study with questionnaire development and psychometric testing (validity and reliability). Methods An evidence‐based instrument was developed including a 34‐item knowledge section and an 81‐item self‐efficacy section including four device‐specific parts. Nineteen experts evaluated content validity. A pilot study was conducted with 86 nurses. Difficulty and discrimination indices were calculated for knowledge items. Confirmatory factor analyses tested the dimensionality of the self‐efficacy section according to the development model. Construct validity was tested through known group validity. Reliability was evaluated through Cronbach's alpha coefficient for unidimensional scales and omega coefficients for multidimensional scales. Results Content validity indices and results from the pilot study were excellent with all the item‐content validity indices >0.78 and scale‐content validity index ranging from 0.96 to 0.99. The survey was completed by 425 nurses. Difficulty and discrimination indices for knowledge items were acceptable with most items (58.8%) showing desirable difficulty and most items (58.8%) with excellent (35.3%) or good (23.5%) discrimination power, and appropriate to the content. The dimensionality of the model posited for self‐efficacy was confirmed with adequate fit indices (e.g., comparative fit index range 0.984–0.996, root mean square error of approximation range 0.054–0.073). Construct validity was determined and reliability was excellent with alpha values ranging from 0.843 to 0.946 and omega coefficients ranging from 0.833 to 0.933. Therefore, a valid and reliable tool based on updated guidelines is made available to evaluate nurses’ competencies for venous access insertion and management.

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Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem 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.)

Abstract Aim To evaluate complications after PICC use in cancer patients. Design This was a clinical and retrospective study in which the risk factors and complications of PICC use were evaluated. Methods This study was carried out in the patient, emergency room, and intensive care units through the evaluation of electronic medical records. To assess the association between qualitative variables, the chi‐squared test or Fisher's exact test was used, and to compare the reason for withdrawal, the Kruskal–Wallis test was applied. Results A total of 359 patients (53.5% men) with 43.1 ± 14 years who had a PICC (88% with solid tumours) were evaluated. The most common complications were mechanical complications (61.2%), infection (38%), and thrombosis (57.1%). Patients with double‐lumen catheters experienced thrombosis (85.7%). This study demonstrated the effectiveness of PICC and that patients with haematological cancer are more prone to multiple PICC passages and more mechanical complications and infections.

To compare the efficacy of the ultrasound-guided approach with and without dynamic needle-tip positioning and the palpation technique regarding success for peripheral venous catheterization in children. A systematic review with network meta-analysis. Databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials. Patients (<18 years) undergoing peripheral venous catheter insertion. Randomized clinical trials were included to compare the following techniques: the ultrasound-guided short-axis out-of-plane approach with dynamic needle-tip positioning, the approach without dynamic needle-tip positioning, and the palpation technique. The outcomes were first-attempt and overall success rates. Eight studies were included in the qualitative analyses. According to the estimate of network comparison, dynamic needle-tip positioning was associated with higher first-attempt (risk ratio [RR] 1.67; 95% CI 1.33-2.09) and overall success rates (RR 1.25; 95% CI 1.08-1.44) than palpation. The approach without dynamic needle-tip positioning was not associated with higher first-attempt (RR 1.17; 95% CI 0.91-1.49) and overall success rates (RR 1.10; 95% CI 0.90-1.33) than palpation. Compared to the approach without dynamic needle-tip positioning, dynamic needle-tip positioning was associated with a higher first-attempt success rate (RR 1.43; 95% CI 1.07-1.92), but not a higher overall success rate (RR 1.14; 95% CI 0.92-1.41). Dynamic needle-tip positioning is efficacious for peripheral venous catheterization in children. It would be better to include dynamic needle-tip positioning for the ultrasound-guided short-axis out-of-plane approach. [ABSTRACT FROM AUTHOR]

Aim: To evaluate complications after PICC use in cancer patients. Design: This was a clinical and retrospective study in which the risk factors and complications of PICC use were evaluated. Methods: This study was carried out in the patient, emergency room, and intensive care units through the evaluation of electronic medical records. To assess the association between qualitative variables, the chi‐squared test or Fisher's exact test was used, and to compare the reason for withdrawal, the Kruskal–Wallis test was applied. Results: A total of 359 patients (53.5% men) with 43.1 ± 14 years who had a PICC (88% with solid tumours) were evaluated. The most common complications were mechanical complications (61.2%), infection (38%), and thrombosis (57.1%). Patients with double‐lumen catheters experienced thrombosis (85.7%). This study demonstrated the effectiveness of PICC and that patients with haematological cancer are more prone to multiple PICC passages and more mechanical complications and infections. [ABSTRACT FROM AUTHOR]

Rationale: Little is known about the safety of infusing vasopressors through a midline catheter. Objectives: To evaluate safety outcomes after vasopressor administration through a midline. Methods: We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared with those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Results: Our cohort included 287 patients with midlines through which vasopressors were administered, 1,660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] yr) and gender (percentage female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%; P, 0.001) but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%; P = 0.49). After adjustment, administration of vasopressors through a midline was not associated with catheterrelated complications compared with PICCs with vasopressors (adjusted odds ratios [aOR], 0.65 [95% confidence interval, 0.31-1.33]; P = 0.23) or midlines with vasopressors elsewhere (aOR, 0.85 [0.46-1.58]; P = 0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs. PICCs with vasopressors: aOR, 2.69 [1.31-5.49]; P = 0.008; vs. midlines with vasopressors elsewhere: aOR, 2.42 [1.29-4.54]; P = 0.008) but not thromboses restricted to the ipsilateral upper extremity (vs. PICCs with vasopressors: aOR, 2.35 [0.83-6.63]; P = 0.10; model did not converge for vs. midlines with vasopressors elsewhere). Conclusions: We found no significant association of vasopressor administration through a midline with catheterrelated complications. However, we identified increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation. [ABSTRACT FROM AUTHOR]

Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size. [ABSTRACT FROM AUTHOR]

Background: Previous studies have investigated the safety of peripherally inserted central catheters (PICCs) in the intensive care unit (ICU). However, it remains uncertain whether PICC placement can be successfully carried out in settings with limited resources and a challenging environment for procedures, such as communicable-disease isolation units (CDIUs). Methods: This study investigated the safety of PICCs in patients admitted to CDIUs. These researchers used a handheld portable ultrasound device (PUD) to guide venous access and confirmed catheter-tip location with electrocardiography (ECG) or portable chest radiography. Results: Among 74 patients, the basilic vein and the right arm were the most common access site and location, respectively. The incidence of malposition was significantly higher with chest radiography compared to ECG (52.4% vs. 2.0%, p < 0.001). Conclusions: Using a handheld PUD to place PICCs at the bedside and confirming the tip location with ECG is a feasible option for CDIU patients. [ABSTRACT FROM AUTHOR]

For adolescents with suspected polycystic ovary syndrome (PCOS) and severely elevated testosterone concentrations, imaging is recommended to assess for neoplasm. Selective venous sampling (SVS) can be considered when imaging is nondiagnostic. An adolescent female treated for PCOS had a peak testosterone of 344 ng/dL (11.9 nmol/L). Imaging did not localize a mass. SVS implicated the right ovary as the source of hyperandrogenism. Following laparoscopic right oophorectomy, pathology excluded a neoplasm and confirmed PCOS. She subsequently had rapid and persistent improvement in her hyperandrogenism. Striking testosterone elevation can occur with adolescent PCOS. SVS is a tool for localizing the source of severe hyperandrogenism, yet unilaterality is not always diagnostic of a neoplasm. Unilateral oophorectomy could nonetheless be therapeutic for severe PCOS. [ABSTRACT FROM AUTHOR]

Intravenous cannula insertion is important, given that it is the most common invasive procedure in the emergency department for blood sampling, fluid resuscitation, and intravenous drug administration. Complications of intravenous catheterization include pain, phlebitis, extravasation, inflammation, and embolization. Fracture of an intravenous cannula is rare, but delayed removal may result in secondary damage, such as vasculitis or embolization, with critical consequences. Here, we report a case of intravenous cannula fracture that occurred in our emergency department. A 63-year-old woman with a history of left ovarian cancer visited our emergency department owing to poor oral intake and general weakness. Intravenous catheterization using an 18 gauge cannula was attempted for intravenous fluid administration by a skilled operator, but it failed owing to collapsed veins and poor skin condition. After several attempts, a vein in the patient's hand was ruptured, and the patient complained of severe pain. The cannula was removed, but one-third of the cannula tip could not be seen. X-ray imaging was performed to locate the fragment of the cannula, and venotomy was performed for removal of the foreign body in the emergency department. Emergency physicians and nurses should be vigilant about potential risk factors that can cause fracture of an intravenous cannula, and after the fracture is discovered, rapid removal of the cannula tip should be performed in the emergency department. [ABSTRACT FROM AUTHOR]

The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present study aimed to critically appraise the quality of (i) assessment instruments and (ii) clinical practice guidelines (CPGs) or escalation pathways for identifying and managing patients with DIVA. Cochrane Central Register of Controlled Trials, EBSCO MEDLINE, EMBASE (OVID) and EBSCO CINAHL databases were searched on 22 March 2021. Studies describing a DIVA assessment measure, CPG or escalation pathway for PIVC insertion in adults (≥18 years of age) were included. Data were extracted using a standardised data extraction form including study design, type of resource and reported clinical outcomes. Quality of DIVA assessment instruments were reviewed using the COnsensus‐based Standards for the selection of health Measurement Instruments checklist. Methodological quality of CPGs and escalation pathways was assessed using the Appraisal of Guidelines for Research and Evaluation‐II (AGREE‐II) instrument. Overall, 24 DIVA resources comprising 16 DIVA assessment instruments and nine CPGs or escalation pathways (including one combined assessment instrument and escalation pathway) were identified. Instruments commonly focused on vein visibility and palpability as indicators of DIVA. CPGs and escalation pathways unanimously recommended use of vessel visualisation technology for patients with or suspected of DIVA. Methodological quality of the resources was mixed. Consensus and standardisation of resources to identify DIVA and recommendations for managing patients with DIVA is limited. Adopting consistent, evidence‐based CPGs, escalation pathways or DIVA assessment instruments may significantly improve clinical outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To validate the Brazilian Portuguese translation and analyze the cultural adaptation of the Venous International Assessment Scale. Methods: Observational study by employing the Delphi technique and an equivalence evaluation by experts. The results were analyzed using item scores and by content validity index calculations of item, scale, and universal agreement. Results: Three rounds of evaluation were necessary for consensus. Explanatory contents were incorporated into the original scale throughout the process, resulting in a new version: VIA Scale - Revised. This scale obtained a content validity index of 0.96 and a universal agreement of 0.78. In the cross-cultural adequacy analysis phase, a score of 0.77 was obtained. The majority (90.5%) of the participants judged the scale’s decision support property as positive. Conclusion: The VIA Scale was validated and culturally adapted to the Brazilian Portuguese language, resulting in the VIA Scale - Revised (VIA-R).

Objectives: Peripheral intravenous (IV) access is a standard procedure in clinical settings. Nevertheless, previous studies have indicated that difficult peripheral IV access is prevalent in children. This study aimed to determine the prevalence and factors contributing to difficult peripheral IV cannulation in children admitted to a tertiary care hospital in Oman. Methods: This cross-sectional study was conducted from September to December 2015 at Sultan Qaboos University Hospital in Muscat, Oman. Nurses collected data concerning factors contributing to difficult IV access in children. Results: A total of 511 children undergoing cannulation during the study period were included in the analysis. Overall, 23.3% of the children experienced two or more cannulation attempts. The study identified three variables associated with successful cannulation in cases of difficult IV access. Visible veins were 2.72-times (95% CI: 1.58--4.68) more likely to be associated with success (p < 0.001), while palpable veins were 2.22-times (95% CI: 1.29--3.83) more likely to be associated with success (p = 0.004). However, scarring from previous IV access attempts was half (95% CI: 0.31--0.77) as likely to be associated with successful cannulation (p = 0.002). Conclusions: We identified statistically significant variables related to difficult IV cannulation in children, which we used to develop a prediction tool to assess the likelihood of difficult IV access in pediatric patients. Further research is necessary to validate the use of the difficult IV access prediction tool in this population. [ABSTRACT FROM AUTHOR]

Background Peripherally inserted central catheter (PICC) use among critically ill patients with or without acute kidney injury (AKI) has gradually increased. Ultrasound-guided bedside PICC insertion in intensive care units (ICU) has been reported to be safe and effective. Reports of PICC insertion by a nephrologist without fluoroscopy, however, are relatively rare. Methods This retrospective study included patients (n = 224) who had a PICC inserted by a single nephrologist at Samsung Changwon Hospital from January 2019 to June 2020. Group 1 patients (n = 98) had PICCs inserted under ultrasound guidance, while group 2 patients (n = 126) had PICCs inserted under fluoroscopic guidance. Success rates, multiple puncture rates, and malposition rates were compared between the two groups. Results Underlying comorbidities (sepsis, AKI, ventilator use, and shock) were more common in group 1 than in group 2. Success rates were comparable between the two groups (93.9% vs. 97.6%, p = 0.171). Multiple puncture rate among successful cases (4.1% vs. 0.0%, p = 0.035) was higher in group 1 than group 2. Excluding central vein occlusion cases, malposition occurred only one in group 1. Conclusion Bedside PICC insertion by a nephrologist is easy and safe to perform in comorbid patients who are difficult to move to the angiography room. The success rate of ultrasound-guided PICC insertions was comparable to that of PICC insertion performed under fluoroscopic guidance. In the life-threatening ICU setting, PICCs can be successfully placed by the interventional nephrologists.

Limited methods exist to confirm the position of cardiovascular devices in the heart. In our earlier work, an optical fiber was enclosed in a central catheter and guided to known positions in the superior vena cava and right atrium in the heart of a living sheep. The tissues were illuminated with two wavelengths of visible light and the reflections were analyzed using frequency domain techniques. In this follow‐up work, the data were reanalyzed using statistical estimates of skew and kurtosis as a function of anatomic position. Skew values from a 520 nm laser were able to determine catheter tip position near the cavoatrial junction as validated against known positions previously determined with electrocardiogram and contrast‐enhanced video fluoroscopy. This method successfully confirmed the location of the catheter tip at the cavoatrial junction in 84% of 840 trials. Further research with refined apparatus and algorithms on additional animal subjects is strongly suggested. [ABSTRACT FROM AUTHOR]

To identify the fundamentals that guide decision making to use or not to use ultrasound in peripheral puncture in clinical nursing practice. This is an integrative review of articles published in full, in journals indexed on national and international bases. 2,247 articles were identified according to the selected descriptors and among these, 36 met the inclusion and exclusion criteria, according to three categories: technology, patient experience and training for use. Both the need and the importance of using ultrasonography were highlighted in the studies, however, gaps to support the nurse's decision to use this technology or not in clinical practice were observed in the studies. Ultrasonography has been used in peripheral venipuncture, contributing to patient safety, however, decision tools are needed to support the professional regarding the use of technology. [ABSTRACT FROM AUTHOR]

Background: Neonates require continuous and reliable intravenous routes to receive fluids, intravenous nutrition, and medications; accordingly, repeated interventions are essential to implant these routes. Percutaneous catheterization is a technology used for this purpose. Considering that central line infections are a major concern in neonatal intensive care units (NICUs), the present study aimed to assess the effects of using a care package on the incidence of infections and shelf life of peripheral central catheterization in the premature infants admitted to the NICU. Methods: This quasi-experimental study was a process assessment research conducted on 131 premature catheterized infants who were admitted to the NICU of Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2019. The study sample included 131 neonates who met the inclusion criteria. The neonates were enrolled in the study at two levels, including 53 subjects in the first four months before the intervention, and 78 in the second four months after application of the care package. The infants were selected via the convenience sampling method. Data were collected using the central line maintenance bundle and central line maintenance bundle daily checklists. The catheter insertion method and the degree of catheter tip infection were evaluated before and after the protocol training program for the nurses. The results of catheter tip culture after removal were considered as the training outcomes. Data analysis was performed in SPSS V. 16, using descriptive statistics, independent t test, the Fisher exact test, and the chi-squared test. Results: The results of the catheter tip culture confirmed the presence of pathogens in the catheter and culture of 18 samples (34%), before the intervention, while a reduction was denoted in 14 samples (17.9%) after the intervention; the reduction was statistically significant (P=0.036). Furthermore, the shelf life of the catheter increased after the intervention, however, the difference was not significant. Conclusion: According to the results, applying the care package reduces the incidence of central peripheral venous catheter infection in neonates admitted to the NICU. Therefore, it is suggested to incorporate this package into the care instructions of neonatal wards.

Abstract Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.

Background: Peripheral intravenous catheterization is a painful and uncomfortable procedure and is the most commonly used invasive procedure in healthcare institutions. Compare procedure-related pain and patient satisfaction according to catheter size and insertion site in peripheral intravenous catheterization., Methods: The study was comparative prospective randomized study. Individual Information Form, Visual Analog Scale, and Patient Satisfaction Scale about Catheterization were used for data collection., Results: The highest pain score and the lowest patient satisfaction were determined in 20 gage insertion in the dorsum of the hand. It was less painful to perform the procedure in the forearm than in the dorsum of the hand. Moreover, there was a significant negative correlation between the level of pain experienced due to peripheral intravenous catheterization and patient satisfaction with catheterization., Conclusions: A smaller peripheral intravenous catheter inserted in the forearm resulted in less pain sensation and higher patient satisfaction., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits., Objective: To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants., Method: Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants., Results: The study included a total of 166 patients: IG ( n  = 82) and CG ( n  = 84), mean age 59.5 ± 16.5 years, mostly women ( n  = 104, 62.7%) and white ( n  = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% ( p  < 0.001), with a relative risk of 2.5 (95% CI 1.88-3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4-7) and 10 (6-27.5) min respectively ( p  < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% ( p  < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43-0.80)., Conclusion(s): Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study presents a deep learning model to predict phlebitis in patients with peripheral intravenous catheter (PIVC) insertions. Leveraging electronic health record data from 27,532 admissions and 70,293 PIVC events at a hospital in Seoul, South Korea, the study involved analyzing patient demographics, PIVC-specific features, and drug-related information. The developed deep learning model was benchmarked against various machine learning models, demonstrating superior performance with an accuracy of 0.93 and an AUC of 0.89. This highlights its potential as an effective tool for early detection of phlebitis, promising enhanced patient outcomes and healthcare efficiency. [ABSTRACT FROM AUTHOR]

Objective: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. Method: an observational, descriptive and multicenter study. The consecutive and nonprobabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. Results: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). Conclusion: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis. [ABSTRACT FROM AUTHOR]

Objective: to analyze the handling of the safety device with engineering control in peripheral venous catheter and the adherence to Standard Precautions by nursing professionals during peripheral venous puncture in adults. Method: observational, descriptive study, with quantitative approach, performed in a surgical clinical hospitalization unit. Data collected through a semi-structured instrument, containing variables related to the catheter and the observation of the procedure. The data were analyzed using descriptive statistics. Results: the study sample consisted of 28 professionals, and 235 procedures were observed. Hand hygiene with antiseptic was performed in 23% (54); alcohol solution in 10.6% (25). Procedure gloves and goggles were used in 56.6% (133) and 2.1% (5), respectively. The catheter with retractable device was incorrectly activated in 45.1% (106). Conclusion: most professionals used the peripheral venous catheter with inadequate engineering control and the standard precautions were low. [ABSTRACT FROM AUTHOR]

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Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to patient care and may affect patient outcomes. Baseline data of PIVC insertions at a large medical center revealed that catheters required multiple insertion attempts, catheter hubs were manipulated to place extension sets, increasing the risk of complications, dwell times did not meet current standards, nurses experienced blood-exposure risk, and overall compliance with the hospital documentation policy was suboptimal. A 3-phase quality improvement project was conducted to address these concerns. Methods: In Phase 1, an assessment of the current state of PIVC insertions and care was conducted using a mixed-methods approach consisting of an observational audit of insertion and maintenance practices, and retrospective chart reviews. In Phase 2, PIVC policies and practices were updated to reflect current standards. A new advanced design PIVC device was adopted, and education was provided to all staff. In Phase 3, the impact of these changes on key PIVC measures was assessed 1 year later. Results: The analysis of the data found several improvements following implementation of an integrated IV catheter system: first-stick success rate increased from 73% to 84%, staff blood exposure was reduced from 46.67% to 0% (P = .01), improper securement of PIVC catheters was reduced from 11% to 0% (P = .002), and documentation compliance rate increased from 68% to 80%. The median PIVC dwell time doubled (from 2 days to 4 days). Conclusion: Changes to policy, practices, and products plus education can improve the PIVC first-stick success, dwell time, documentation, and staff safety. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Neonatal is the property of Fundacion para la Salud Materno Infantil (FUNDASAMIN) 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.)

Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes. Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes. Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization. Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations. [ABSTRACT FROM AUTHOR]

Background: Obtaining peripheral venous access, especially in children, is usually a challenging procedure for nursing professionals. In pediatric patients this is because of the small caliber of the vessels, deep localization in the tissue, and multiple previous attempts of venipuncture. This experiment compared the success in obtaining venous access in pediatric patients with the use of near-infrared light and with the conventional technique. Method: True experiment, developed in a large private general hospital and a public general hospital under the same management. The study included children aged 0 to 6 y (including newborns and pediatric patients up to 5 y, 11 mo and 29 d) under clinical or surgical treatment, undergoing peripheral venous puncture both for laboratory test collection and for infusion of medications and solutions. A total of 144 punctures were analyzed, 51.4% with the conventional technique and 48.6% using the device with near-infrared light. Results: The success for the conventional technique was 89.2%, and 97.1% on the technique with near-infrared light, P = 0.098, with no evidence of significant differences. Conclusion: The success rate for obtaining peripheral venous access in children was similar in the study groups. This study expands the knowledge about the success in the peripheral venous puncture by considering that this is not exclusively related to the use of supportive technologies. [ABSTRACT FROM AUTHOR]

Copyright of Koomesh: Journal of Semnan University of Medical Sciences is the property of Koomesh: Journal of Semnan University of Medical Sciences 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.)

Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber‐based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser‐based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction. The time series data were postoperatively analyzed using methods of joint time‐frequency analysis and validated against catheter positions determined with fluoroscopy and ECG. The system was successful in distinguishing the location of the superior vena cava from the right atrium. [ABSTRACT FROM AUTHOR]

Background: More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups. Methods: A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ², Student’s t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA. Results: We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596. Conclusions: Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts. [ABSTRACT FROM AUTHOR]