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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.)

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).

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

Abstract: A systematic evaluation of vascular access device (VAD) selection incorporates patient, device, and infusate characteristics to ensure optimal device placement. This article explores VAD selection from the perspective of vessel health and preservation and describes VAD selection options and indications, VAD-related complications, and strategies to reduce those complications., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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.

Peripherally inserted central catheters (PICCs) are vital in delivering intravenous therapy. Despite their advantages, PICCs can lead to complications such as catheter exit site bleeding, which can cause patient distress and increase infection risk. This study evaluated the efficacy of StatSeal, a topical haemostatic device, in managing PICC exit site bleeding. StatSeal uses a hydrophilic polymer and potassium ferrate to form a seal, reducing access site bleeding and minimising dressing changes. For this study, Patients were recruited at Frimley Health NHS Foundation Trust; the trial involved 177 patients with StatSeal, and shows that 99% did not require additional dressing changes within the standard 7-day period. The findings demonstrate StatSeal's effectiveness in improving patient outcomes by reducing exit site bleeding and associated complications, enhancing the efficiency of vascular access maintenance and potentially lowering associated healthcare costs. The trial emphasises the importance of innovative solutions such as StatSeal to advance PICC care and improve patient experience. [ABSTRACT FROM AUTHOR]

The implementation of the Medicare Prospective Payment System (MPPS) has placed pressure on healthcare organizations to decrease patient length of stay without adversely affecting outcomes. This article discusses the impact of the MPPS on clinicians who provide infusion therapy, and examines methods for containing costs related to infusion care such as advanced planning and accurate vascular access device selection.

Intravenous administration of drugs is frequently employed to achieve rapid and effective systemic effects. However, it is undesirable to administer drugs into the tissue as a result of extravasation of the intravenous cannula. Both the closed extremities to which the IV route is applied due to the surgical method to be applied make it difficult to access the vascular access during surgery and the use of pressurised instruments in the administration of drugs through the IV route makes the work of the anaesthetist difficult. In addition, patients cannot report their pain due to unconsciousness. In the operating theater and intensive care unit for anesthesia practice, induction, fluid therapy, nutrition, etc., although rare, difficulty in vascular access maintenance and drug extravasation cause serious complications in many procedures. This study aimed to emphasize the importance of perioperative anesthetic drug extravasation and its physiopathology by presenting current information. [ABSTRACT FROM AUTHOR]

This study evaluated the association between body pH value and preoperative deep vein thrombosis (DVT) in geriatric hip fractures. Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected. Multivariate binary logistic regression and generalized additive models were used to identify the linear and nonlinear associations between pH value and preoperative DVT. Analyses were performed using EmpowerStats and R software. A total of 1465 patients were included in the study. DVT occurred in 476 (32.6%) of these admitted older adults. We observed a nonlinear association between the serum pH value and preoperative DVT in geriatric patients with hip fractures. A pH value of 7.39 was the inflection point in the curve, with pH highly correlated with DVT at pH < 7.39 (odds ratio [OR] 19.47; 95% confidence interval [CI] 1.45–260.91; P = 0.0249). Patients with lower pH had a lower chance of preoperative DVT formation, and the risk of DVT increased 18.47-fold for every 0.1 unit change in pH. Although at pH > 7.39, pH was not correlated with DVT (OR 1.26; 95% CI 0.85–1.86; P = 0.2561), the odds of DVT did not vary with pH, and the highest risk of thrombosis was reached. The body pH value is nonlinearly associated with preoperative DVT in geriatric patients with hip fractures, and it could be considered a predictor of the risk of DVT. Registered information This study is registered in the website of Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323). [ABSTRACT FROM AUTHOR]

Right heart thrombus in transit or "free-floating right heart thrombus" is defined as thrombus(i) arising from the deep veins that embolises to the right atrium or right ventricle before reaching the pulmonary vasculature. It is almost always associated with pulmonary thromboembolism and is a medical emergency with reported mortality rates of over 40%. We present two cases of right heart thrombus in transit with pulmonary thromboembolism resulting from venous thrombosis associated with peripherally inserted central catheters that were managed with different approaches. The cases highlight that clinicians should have a low threshold to utilise imaging modalities such as computerised tomography and transthoracic echocardiography when there is an untoward change in physiological parameters among patients with peripherally inserted central catheters, particularly those with risk factors for peripherally inserted central catheter associated venous thrombosis. Furthermore, procedural optimisation surrounding peripherally inserted central catheters, such as insertion technique and choice of lumen size, is underscored. [ABSTRACT FROM AUTHOR]

Copyright of Evaluation & Analysis of Drug-Use in Hospitals of China is the property of Evaluation & Analysis of Drug-Use in Hospitals of China Editorial Board 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.)

The placement of peripheral intravenous catheters (PIVC) is potentially associated with complications that negatively impact healthcare. Our study investigated factors associated with the occurrence of PIVC-related complications in dogs and cats at a Veterinary Teaching Hospital. The second aim was to determine the prevalence of PIVC bacterial colonization. A total of 76 dogs and 40 cats with PIVCs were evaluated for the occurrence of phlebitis and mechanical complications. The devices were removed when they ceased to be functional or when complications occurred, and the content was submitted for bacterial cultures and antimicrobial susceptibility tests. Both multivariable linear regression models and ROC analysis were employed. Complications were recorded in 46.6% of cases, and 20.7% of catheters yielded a positive culture. Among the isolates, 45% were classified as multi-resistant. In dogs, a ≥36-h indwelling time was associated with an increased risk of complications. Male cats seem more prone to developing complications, while the insertion of PIVCs under sedation may represent a protective factor in this species. In conclusion, PIVC-associated complications were frequently observed, and the high rate of positive culture for PIVCs, together with the presence of multi-resistant isolates, is a cause of concern in a hospital setting. [ABSTRACT FROM AUTHOR]

Background: The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. Methods: We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The 'nurse driven protocol' utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a 'mixed protocol,' a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The 'sonographer driven protocol' involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. Results: A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The 'mixed protocol' had an average study time that was significantly less than the 'nurse driven protocol' (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The 'sonographer driven protocol' also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the 'nurse driven protocol' (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. Conclusion: Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a 'sonographer driven protocol' is more efficient with potential downstream economic benefits. [ABSTRACT FROM AUTHOR]

Objective: Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods: We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results: In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions: Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient's vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed. [ABSTRACT FROM AUTHOR]

Background: vesicant no cytotoxic drugs are used broadly in present medicine for therapy changes condition in hospitals most of them are registered to be peripheral cannulation. According to the literature, one vital complication caused by cannulation applied for intravenous fluid therapy is extravasation. Objectives: to estimate knowledge about extravasation no cytotoxic drags. Methodology: A non-experimental design was carried out to evaluate the registered nurse's knowledge regarding extravasation non- cytotoxic medication in Baghdad teaching hospital an indiscriminate sample consisting of 100 nurses was selected, and a questionnaire was distributed to measure their knowledge of the subject of the research. The statistical program version 23 Spss was used. The Results: were the majority of females with 60% and the rest males. Most of the study participants (55%) were ages between 20 and 29 years old. Study participants'. (43%) of the were secondary nursing school. The majority of participants (37%) experienced in hospital wards between 1-5years. Conclusions: The current study concluded that most of the member's nurse's deficiency necessary knowledge about extravasations of no cytotoxic medications. this study recommends that nurses have to participate in more in-depth educational programs. [ABSTRACT FROM AUTHOR]

Background: Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. Aim: The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. Methods: The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. Results: In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. Conclusions: Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheter (PIVC) sales per year exceed that of the number of people in the United States (US), 350 million. With only 37 million US hospital patient admissions per year, these data indicate an average usage of 10 PIVCs per patient admission, suggesting a very high failure, very low success rate, and excess cost associated with PIVC insertions. Patients often complain of multiple catheter insertion attempts, and published data reveal up to 53% of PIVCs fail before therapy ends. Methods: Hartford Hospital (Hartford, CT) conducted a prospective comparator single-center clinical superiority design study to determine the impact of bundled practices including device insertions using vascular access specialty team (VAST) intravenous trained nurses versus current practice. The study used a 5 step multimodal best practice intervention strategy designated as the PIV5Rights Bundle with an aim to determine if the intervention outcomes and dwell time improved over current PIVC practices. The study group applied a Lean health care standard work process with a Six Sigma design, define, measure, analyze, improve, control approach that included VAST PIVC dwell time, complications, and economic impact compared with current state general nursing practice. Results: Outcomes of the PIV5Rights Bundle in Group 2 (experimental) using a trained vascular access nursing team for insertion and management achieved a statistically significant result of 89% of catheters achieving end of therapy with a cost saving per bed of $3376 ($1405 versus $4781) per year as compared to standard practice (Group 1; control). Results of Group 1 reflected PIVC dwell time to end of treatment in only 15% of catheters. Prestudy catheter consumption analysis was 4.4 catheters per patient hospital admissions, reflecting waste within labor and supply costs for PIVC insertion and usage. Peripheral intravenous catheter retrospective audits for current practice demonstrated more than 50% catheters failed within the first 24 hours. This application of Lean methodology by Hartford Hospital with infusion therapy resulted in a projected $2.9 million annual savings of $3376 per bed per year for house-wide application. Conclusions: Implementation of the PIV5Rights™ Bundle with a dedicated VAST proved to be a successful model, both from a patient and financial perspective. The journey to nursing excellence included identification of core measures and best practice evidence for PIVC placements as a procedure that affects nearly every patient entering a hospital. By centralizing ownership of vascular access with the team for insertion, management, and securement, the PIV Five Rights is the right approach to achieve the right results in transformation of hospital infusion therapy practices. Bundled approaches have often been used for central catheter infection reduction. This is the first study the authors have identified focusing on 1 PIVC per patient visit as a result of an evidencebased bundle and VAST. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device. Introduction: To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation. Design: An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus. Review method: A modified version of Cooper's five‐stage method and the PRISMA guidelines were used to perform the integrative review. Results: Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision‐making process, they should take the lead in the use of the proactive approach. Conclusion: Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high‐quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach. Relevance to clinical practice: The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material. [ABSTRACT FROM AUTHOR]

Central venous catheters are used extensively throughout critical care, anesthesia, and emergency medicine, and are now growing increasingly in their use outside of the critical care arena. With the mounting need to preserve patients' vessel health for future therapies, central venous catheterization is often an essential therapeutic intervention for many patients and is not without risk. There is an ever-growing volume of published extravasation injuries associated with peripheral intravenous devices and the power injection of contrast media in both adult and child health. Compared with the pediatric and neonatal populations, there is almost no evidence related specifically to inappropriate central venous catheter length and extravasation within the adult domain. Any type of extravasation poses a serious risk for the patient, and significant tissue-related consequences require immediate attention to restrict further injury. The accurate length for any central venous catheter is considered a vital patient factor when a device is selected for parenterally administered therapies; and while this is not the sole contributory indicator, it is a consideration that should not be overlooked by the inserting clinician. This paper explores the singularity of inappropriate catheter length, through corroborating evidence and a case study, as a plausible cause for central venous catheter extravasation-related injuries, and seeks to provide a clearer understanding for all clinicians with regard to recognizing correct catheter length when inserting or when providing safe central venous catheter practices and management. [ABSTRACT FROM AUTHOR]

BACKGROUND Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect. Objectives To determine the incidence and contributing factors of amiodarone-induced phlebitis and examine phlebitis severity. METHODS A systematic review was conducted of articles published before February 2016 in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, MEDLINE, Embase, Web of Science, and gray databases (Bielefeld, Lenus, EUGrey, RIAN, and DART). All studies in which amiodarone-induced phlebitis was a primary or secondary outcome were included. Meta-analysis was not appropriate because of study heterogeneity. Studies of the same contributing factors were analyzed together. RESULTS In the 20 included studies, phlebitis incidence ranged from 0% to 85%. Increasing the infusion concentration from 1.2 mg/mL to 1.8 mg/mL increased the phlebitis rate (P < .001). Total amiodarone doses greater than 1 g resulted in higher phlebitis rates than did doses less than 0.45 mg (P < .001). Most infusion durations and rates were not correlated with phlebitis incidence. However, phlebitis incidence was lower with bolus administration than with longer infusions (P = .002). The use of in-line filters and nursing guidelines significantly reduced phlebitis rates (P < .001) and phlebitis severity. The most common phlebitis severity grades, in descending order, were 0, 1, 2, 3, and 4. CONCLUSIONS Understanding factors that increase the risk of amiodarone-induced phlebitis can guide better practice. In-line filters and nursing guidelines should always be implemented when administering intravenous amiodarone. Increased surveillance is required when higher dosages and concentrations are used. [ABSTRACT FROM AUTHOR]

Background Bedside vascular access options have been limited to the short peripheral intravenous, midline catheter, peripherally inserted central catheter, and central venous catheter (CVC) insertion sites such as the jugular, subclavian, and femoral vein. Many patients with limited options for upper extremity, subclavicular, supraclavicular, and cervical limitations have traditionally received a femoral CVC in the inguinal region. This insertion site is considered a high risk for infection because of its location in the inguinal region and associated difficulties with maintaining the dressing integrity. An alternative location was selected for the insertion of a femoral vein central venous catheter in the midthigh to reduce the risk of infection. Methods After a multiple-year implementation process, midthigh femoral (MTF) insertions were performed on a select group of patients. The case studies that are included in this report outline the indications, procedures, and other pertinent aspects of the MTF placement. Patients at this institution with contraindications to upper extremity and thoracic catheter insertion received a MTF vein CVC in place of a traditional common femoral vein catheter insertion in the inguinal area. All procedural consents include permission for photography of procedure sites. Results All but a single patient completed their therapy without complication; 1 intentional dislodgement by a patient was recorded. There were no MTF catheter-related bloodstream infections and 2 confirmed central line associated bloodstream infections ( n  = 2 of 100) with the second noted as probable contaminated specimen. Outcomes reflected no procedural complications (eg, expanding hematoma or femoral nerve injury or any other femoral artery or vein injuries) and 1 nonocclusive deep vein thrombosis ( n  = 1 of 100). Conclusions The MTF CVC provides an alternative to traditional common femoral vein catheter placement for nonemergent patients with upper extremity and thoracic contraindications to central line placement. [ABSTRACT FROM AUTHOR]

The primary study objective was to evaluate insertion success rates. Secondary objectives included patient satisfaction, procedure time, complication rates, completion of therapy and dwell time of the novel AccuCath® 2.25″ Blood Control (BC) Catheter System (FDA approved) placed in difficult-access patients. This was a single-arm feasibility trial evaluating the AccuCath® 2.25″ BC Catheter System in a convenience sample of DIVA patients defined as at least two failed initial attempts or a history of difficult access plus the inability to directly visualize or palpate a target vein. All enrolled patients were 18 years of age or older. A total of 120 patients were enrolled. These patients had an average of 3.7 and median of 3 prior attempts at vascular access prior to AccuCath placement. Successful access was gained in 100% of the patients, 77% on the first attempt and all within three attempts; 88.5% of patients completed therapy, with the remaining 12.5% experiencing minor complications that required discontinuation of the catheter. The average patient satisfaction score on a 5-point Likert scale was highly positive at 4.6. Preliminary results show that the AccuCath® 2.25″ BC Catheter System has excellent success rates in gaining vascular access in an extremely difficult patient population. The device did not lead to any significant complications. Patients were also very satisfied with the procedure. [ABSTRACT FROM AUTHOR]

Peripherally inserted central catheter use has increased dramatically over the past decade, parallel to health care costs. Traditional bedside peripherally inserted central catheter placement requires anthropometric measurements of estimated catheter length and confirmation of appropriate tip positioning via chest radiograph. Newer bedside technology, using magnet and electrocardiogram capabilities, seeks to replace the traditional method with equal efficacy but less overall cost. The need for follow-up chest radiograph can been removed, a significant cost savings in direct patient care. In this retrospective case control study, we examine costs related to these 2 tip confirmation methods while assessing overall cost savings to the health care industry. [ABSTRACT FROM AUTHOR]

Purpose: To report the chest radiograph measurement technique for placing bedside peripherally inserted central catheters (PICCs).Materials and Methods: Two hundred and thirty-two consecutive pediatric patients, mean age of 56.3 months (range: 0-203 months), underwent PICC placement from January 2015 to May 2017 (28 months) with a total of 232 PICCs placed. Measurements were taken from the cavoatrial junction to clavicle, clavicle to medial margin of mid-humeral head, and medial margin of mid-humeral head to mid-humerus. The difference between total radiographic measured length and actual PICC length was then calculated, and the percent difference (from actual cut length) was recorded. An equivalence test was performed using the two, one-sided test method.Results: Mean ± standard deviation cavoatrial junction to clavicle length was 5.29 ± 2.20 cm (range: 2.1-12.6 cm). Mean clavicle to shoulder length was 8.20 ± 3.59 cm (range: 3.23-19.06 cm). Mean shoulder to mid-humerus length was 7.88 ± 3.87 cm (range: 2.01-16.8 cm). Mean total radiographic measured length was 21.37 ± 9.19 cm (range: 7.42-43.6 cm). Mean actual cut PICC length was 20.64 ± 8.72 cm (range: 8.5-44 cm). The mean difference between predicted, or total radiographic measured length, and actual cut PICC length was 0.73 ± 2.51 (range: - 5.42-8.60 cm). The mean percent difference was 4.07 ± 12.65% (range: - 23.84-47.80%). An equivalence test rejected the null hypothesis of the true percent difference greater/less than ± 6.67% with a p value of 0.002.Conclusion: The chest radiograph measurement technique is an accurate method to determine catheter length for PICC placement at bedside in the pediatric population. [ABSTRACT FROM AUTHOR]

Aims and objectives To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. Background In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. Design A cross-sectional study was conducted. Methods 'Highly complex' patients ( n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. Results The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. Conclusions The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. Relevance to clinical practice The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado 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.)

Introduction Establishing an effective midline program involves more than simply learning an insertion technique for a new product. Midline catheters provide a reliable vascular access option for those patients with difficult venous access who would otherwise require multiple venipunctures or the use of higher-risk central lines to maintain access. An effective midline program establishes a protocol for device selection and includes standing orders to facilitate speed to placement. Methods Our retrospective descriptive review evaluated the successful integration of midline programs into existing vascular access bedside insertion programs in 2 acute care hospitals. The investigator reviewed a convenience sample of hospital patients. Participants in the study included vascular access team managers and team members from the sample sites. Results The results of this 2-hospital study demonstrate successful integration of a midline program into a bedside insertion program with 0 midline-related infections since initiation. Documentation of overall central line-associated bloodstream infection rates for hospital 1 changed from 1.7/1000 catheter-days to 0.2/1000 catheter-days, reflecting a 78% reduction in infections and a projected cost avoidance of $531,570 annually. Both hospitals demonstrated reduced rates of infection following implementation of a midline program. Conclusions Midlines have a history of lower risk for both infection and thrombosis compared with central venous devices. Although more research is needed on the more recently developed midline catheters, available evidence suggests that midlines provide a safe and reliable form of vascular access, reducing costs and the risk of infection associated with central venous catheters, especially those placed solely for patients with difficult venous access. [ABSTRACT FROM AUTHOR]

Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal. [ABSTRACT FROM AUTHOR]

Background: Current peripheral intravenous catheter (PIV) first attempt success averages 47%, complications 47%, and dwell time 44 hours. Multiple intravenous (IV) access lines requiring replacement during each admission result in poor satisfaction and unnecessary costs. With 2011 Infusion Nursing Society standards allowing IV lines to dwell until complication, there is incentive to explore improvement opportunities. Purpose: A new, proprietary coiled tip guidewire PIV was compared with conventional IV catheters in adult patients. The experimental IV catheter was projected to have a higher rate of successful placement on first attempt, fewer complications, longer dwell times, higher completion of therapy, higher user satisfaction, and lower overall costs than conventional catheters. Methods: Adult patients requiring nonemergent IV catheters provided consent and were enrolled and randomized. The study, conducted over 4 months, included 248 patients (experimental IV group n = 123, conventional IV group n = 125). Results: Experimental IV first attempt success was 89% compared with 47% for the conventional catheter. Fifty percent of conventional IV placements required a second attempt. Experimental IV complications occurred 8% of the time and complications occurred with the conventional catheter 52% of the time. Completion of therapy was 89% with the experimental IV versus 34% with the conventional IV (P < .001). Dwell time improved with the experimental IV (mean 4.4 days [105 hours] vs conventional IV at 1.5 days [35 hours]) (P < .001). Overall patient satisfaction using a 5-point Likert scale scored an average of 4.5 with the experimental IV compared with the conventional IV, which scored 3. Conclusions: A new, proprietary coiled tip guidewire-delivered PIV demonstrated clear superiority over the conventional catheter in our study. Clinical outcome results showed statistically significant improvements in first attempt success, complications, completion of therapy, dwell time, and overall patient satisfaction. [ABSTRACT FROM AUTHOR]

Central venous access devices (CVADs) are an essential part of patient therapy and provide a route for the delivery of intravenous medications, solutions, and blood sampling, as well as for hemodialysis. Complications such as CVAD occlusions can have a significant impact on the patient and health care system, causing suboptimal treatment, yet there is a lack of standard practices for CVAD occlusion management outside of hemodialysis. A national task force of Canadian clinicians was formed to review the published literature and develop a clinical guideline for the management of catheter occlusions - for CVADs not used specifically for hemodialysis. The recommendations are presented here. Clinical practice tools and templates that support the application of this guideline will be available to ensure safe and effective management of CVAD occlusions. [ABSTRACT FROM AUTHOR]

Background and Significance: Many hospitalized patients require an intravenous (IV) catheter to maintain vascular access or for administration of fluids and medications. The best approach to attaining peripheral intravenous (PIV) access for long term therapy is unknown, particularly in patients with a history of difficult IV placement. Purpose: To measure clinical outcomes using a Modified Seldinger Technique (MST) with ultrasound (US) guidance to achieve and maintain PIV for long term IV therapy. Methods: Subjects were patients with a history of difficult peripheral intravenous catheter placement and need for IV therapy longer than 72 hours. Modified Seldinger Technique was used with US guidance to place all PIVs in the deep veins of the upper extremities. Results: A convenience sample of 157 subjects was enrolled in the study. Mean dwell time for catheter duration was seven days. First attempt placement success was 95%, 88.5% of patients had completion of IV therapy, and a low overall complication rate (9.57/1000 catheter days). Conclusion: Using MST for access for long term PTV therapy was associated with low complications and effective in our study population. Using MST requires specialized knowledge and skills, including the use of US and specialized insertion techniques. In patients who require extended PIV therapy with a history of difficult IV placement, this type of insertion technique may have benefit. [ABSTRACT FROM AUTHOR]

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