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Claire M Rickard - One of the best experts on this subject based on the ideXlab platform.
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peripheral Intravenous Catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity a secondary analysis of 40 637 Catheters
International Journal of Nursing Studies, 2019Co-Authors: Amanda Corley, Gabor Mihala, Amanda J Ullman, Gillian Raybarruel, Evan Alexandrou, Claire M RickardAbstract:Abstract Background With over 2 billion peripheral Intravenous Catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective Catheter dressing and securement is a key nursing strategy to reduce Catheter failure and resultant patient harm. Objectives To describe global Catheter dressing and securement practices and policy; and identify factors associated with Catheter insertion site complications, and suboptimal dressing and securement. Design Secondary analysis of a global cross-sectional study of peripheral Intravenous Catheter characteristics, management and outcomes. Setting Four hundred and seven rural, regional and metropolitan hospitals in 51 countries. Participants Paediatric and adult patients with 40,637 Catheters. Methods Patient-, Catheter-, and institution-related factors which could be associated with Catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in Catheter dressing and securement policy and practice were described. Potential predictors of Catheter and dressing complications were explored using logistic regression. Results Dressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of Catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50–0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59–0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22–2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51–1.75). Two ‘bundled’ dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local Catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1–3 days were associated with better Catheter dressing integrity. Conclusion Modifiable risk factors for peripheral Intravenous Catheter site and dressing complications were identified and are amendable to further interventional testing.
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effectiveness of insertion and maintenance bundles in preventing peripheral Intravenous Catheter related complications and bloodstream infection in hospital patients a systematic review
Infection Disease and Health, 2019Co-Authors: Gillian Raybarruel, Nicole Marsh, Marie Cooke, Claire M RickardAbstract:Abstract Background Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral Intravenous Catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000–December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral Intravenous Catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2–7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between ‘low' and ‘fair'. Conclusions The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
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observational study of peripheral Intravenous Catheter outcomes in adult hospitalized patients a multivariable analysis of peripheral Intravenous Catheter failure
Journal of Hospital Medicine, 2017Co-Authors: Gabor Mihala, Nicole Marsh, Joan Webster, Emily Larson, Marle Cooke, Claire M RickardAbstract:BACKGROUND: Almost 70% of hospitalized patients require a peripheral Intravenous Catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE: To identify risk factors associated with PIV failure. DESIGN: A single center, prospective, cohort study. SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS: Adult patients requiring a PIV. MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the Catheter had complications at removal. RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included Intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06). Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)–(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% CI 0.22-0.46)–(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
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varied flushing frequency and volume to prevent peripheral Intravenous Catheter failure a pilot factorial randomised controlled trial in adult medical surgical hospital patients
Trials, 2016Co-Authors: Gabor Mihala, Samantha Keogh, Nicole Marsh, Julie Flynn, Karen M Davies, Claire M RickardAbstract:Research has identified high failure rates of peripheral Intravenous Catheter (PIVC) and varied flushing practices. This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis. PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3–3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0–2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1–1.4], p < 0.01) significantly predicted PIVC failure. Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required. Australian and New Zealand Clinical Trials Registry: ACTRN12615000025538 . Registered on 19 January 2015.
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Skin Glue Reduces the Failure Rate of Emergency Department–Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial
Annals of emergency medicine, 2015Co-Authors: Simon Bugden, Gabor Mihala, Karla Shean, Mark Scott, Sean Clark, Christopher Johnstone, John F. Fraser, Claire M RickardAbstract:Peripheral Intravenous Catheters are the most common invasive device in health care yet have very high failure rates. We investigate whether the failure rate could be reduced by the addition of skin glue to standard peripheral Intravenous Catheter care. We conducted a single-site, 2-arm, nonblinded, randomized, controlled trial of 380 peripheral Intravenous Catheters inserted into 360 adult patients. The standard care group received standard securement. The skin glue group received standard securement plus cyanoacrylate skin glue applied to the skin insertion site. The primary outcome was peripheral Intravenous Catheter failure at 48 hours, regardless of cause. Secondary outcomes were the individual modes of peripheral Intravenous Catheter failure: infection, phlebitis, occlusion, or dislodgement. Peripheral Intravenous Catheter failure was 10% lower (95% confidence interval -18% to -2%; P=.02) with skin glue (17%) than standard care (27%), and dislodgement was 7% lower (95% confidence interval -13% to 0%; P=.04). Phlebitis and occlusion were less with skin glue but were not statistically significant. There were no infections. This study supports the use of skin glue in addition to standard care to reduce peripheral Intravenous Catheter failure rates for adult emergency department patients admitted to the hospital. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Scott A Engum - One of the best experts on this subject based on the ideXlab platform.
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Intravenous Catheter training system computer based education versus traditional learning methods
American Journal of Surgery, 2003Co-Authors: Scott A Engum, Pamela Jeffries, Lisa M FisherAbstract:Abstract Background Virtual reality simulators allow trainees to practice techniques without consequences, reduce potential risk associated with training, minimize animal use, and help to develop standards and optimize procedures. Current Intravenous (IV) Catheter placement training methods utilize plastic arms, however, the lack of variability can diminish the educational stimulus for the student. This study compares the effectiveness of an interactive, multimedia, virtual reality computer IV Catheter simulator with a traditional laboratory experience of teaching IV venipuncture skills to both nursing and medical students. Methods A randomized, pretest-posttest experimental design was employed. A total of 163 participants, 70 baccalaureate nursing students and 93 third-year medical students beginning their fundamental skills training were recruited. The students ranged in age from 20 to 55 years (mean 25). Fifty-eight percent were female and 68% percent perceived themselves as having average computer skills (25% declaring excellence). The methods of IV Catheter education compared included a traditional method of instruction involving a scripted self-study module which involved a 10-minute videotape, instructor demonstration, and hands-on-experience using plastic mannequin arms. The second method involved an interactive multimedia, commercially made computer Catheter simulator program utilizing virtual reality (CathSim). Results The pretest scores were similar between the computer and the traditional laboratory group. There was a significant improvement in cognitive gains, student satisfaction, and documentation of the procedure with the traditional laboratory group compared with the computer Catheter simulator group. Both groups were similar in their ability to demonstrate the skill correctly. Conclusions This evaluation and assessment was an initial effort to assess new teaching methodologies related to Intravenous Catheter placement and their effects on student learning outcomes and behaviors. Technology alone is not a solution for stand alone IV Catheter placement education. A traditional learning method was preferred by students. The combination of these two methods of education may further enhance the trainee’s satisfaction and skill acquisition level.
Nicole Marsh - One of the best experts on this subject based on the ideXlab platform.
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peripheral Intravenous Catheter non infectious complications in adults a systematic review and meta analysis
Journal of Advanced Nursing, 2020Co-Authors: Gabor Mihala, Amanda J Ullman, Nicole Marsh, Joan Webster, Marie Cooke, Vineet ChopraAbstract:AIMS: The aim of this systematic review and meta-analysis was to summarize and quantify peripheral Intravenous Catheter-related complications. DESIGN: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019. REVIEW METHODS: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models. RESULTS: Seventy observational studies and 33 randomized controlled trials were included (76,977 Catheters). Peripheral Intravenous Catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted Catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies. CONCLUSION: Peripheral Intravenous Catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. IMPACT: Peripheral Intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for Catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral Intravenous Catheters.
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effectiveness of insertion and maintenance bundles in preventing peripheral Intravenous Catheter related complications and bloodstream infection in hospital patients a systematic review
Infection Disease and Health, 2019Co-Authors: Gillian Raybarruel, Nicole Marsh, Marie Cooke, Claire M RickardAbstract:Abstract Background Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral Intravenous Catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000–December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral Intravenous Catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2–7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between ‘low' and ‘fair'. Conclusions The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
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observational study of peripheral Intravenous Catheter outcomes in adult hospitalized patients a multivariable analysis of peripheral Intravenous Catheter failure
Journal of Hospital Medicine, 2017Co-Authors: Gabor Mihala, Nicole Marsh, Joan Webster, Emily Larson, Marle Cooke, Claire M RickardAbstract:BACKGROUND: Almost 70% of hospitalized patients require a peripheral Intravenous Catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE: To identify risk factors associated with PIV failure. DESIGN: A single center, prospective, cohort study. SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS: Adult patients requiring a PIV. MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the Catheter had complications at removal. RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included Intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06). Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)–(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% CI 0.22-0.46)–(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
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varied flushing frequency and volume to prevent peripheral Intravenous Catheter failure a pilot factorial randomised controlled trial in adult medical surgical hospital patients
Trials, 2016Co-Authors: Gabor Mihala, Samantha Keogh, Nicole Marsh, Julie Flynn, Karen M Davies, Claire M RickardAbstract:Research has identified high failure rates of peripheral Intravenous Catheter (PIVC) and varied flushing practices. This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis. PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3–3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0–2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1–1.4], p < 0.01) significantly predicted PIVC failure. Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required. Australian and New Zealand Clinical Trials Registry: ACTRN12615000025538 . Registered on 19 January 2015.
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risk factors for peripheral Intravenous Catheter failure a multivariate analysis of data from a randomized controlled trial
Infection Control and Hospital Epidemiology, 2014Co-Authors: Marianne Wallis, Nicole Marsh, Joan Webster, Matthew Richard Mcgrail, John Gowardman, Geoffrey Playford, Claire M RickardAbstract:Objective. To assess the relative importance of independent risk factors for peripheral Intravenous Catheter (PIVC) failure.Methods. Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal.Setting. Three acute care hospitals in Queensland, Australia.Participants. The trial included 3,283 adult medical and surgical patients (5,907 Catheters) with a PIVC with greater than 4 days of expected use.Results. Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28–1.68], 1.27 [95% CI, 1.08–1.49], and 1.25 [95% CI, 1.04–1.50], respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08–2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 ...
Joan Webster - One of the best experts on this subject based on the ideXlab platform.
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peripheral Intravenous Catheter non infectious complications in adults a systematic review and meta analysis
Journal of Advanced Nursing, 2020Co-Authors: Gabor Mihala, Amanda J Ullman, Nicole Marsh, Joan Webster, Marie Cooke, Vineet ChopraAbstract:AIMS: The aim of this systematic review and meta-analysis was to summarize and quantify peripheral Intravenous Catheter-related complications. DESIGN: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019. REVIEW METHODS: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models. RESULTS: Seventy observational studies and 33 randomized controlled trials were included (76,977 Catheters). Peripheral Intravenous Catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted Catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies. CONCLUSION: Peripheral Intravenous Catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. IMPACT: Peripheral Intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for Catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral Intravenous Catheters.
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observational study of peripheral Intravenous Catheter outcomes in adult hospitalized patients a multivariable analysis of peripheral Intravenous Catheter failure
Journal of Hospital Medicine, 2017Co-Authors: Gabor Mihala, Nicole Marsh, Joan Webster, Emily Larson, Marle Cooke, Claire M RickardAbstract:BACKGROUND: Almost 70% of hospitalized patients require a peripheral Intravenous Catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. OBJECTIVE: To identify risk factors associated with PIV failure. DESIGN: A single center, prospective, cohort study. SETTING: Medical and surgical wards of a tertiary hospital located in Queensland, Australia. PARTICIPANTS: Adult patients requiring a PIV. MEASUREMENTS: Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the Catheter had complications at removal. RESULTS: We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included Intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.19-3.31), 22-gauge PIVs (HR, 1.43; 95% CI, 1.02-2.00), and female patients (HR, 1.48; 95% CI, 1.10-2.00). Phlebitis was associated with female patients (HR, 1.81; 95% CI, 1.40-2.35), bruised insertion sites (HR, 2.16; 95% CI, 1.26-3.71), IV flucloxacillin (HR, 2.01; 95% CI, 1.26-3.21), and dominant side insertion (HR, 1.39; 95% CI, 1.09-1.77). Dislodgement risks were a paramedic insertion (HR, 1.78; 95% CI, 1.03-3.06). Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03-1.20)–(HR 1.14, 95% CI 1.08-1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% CI 0.22-0.46)–(HR 0.63, 95% CI 0.48-0.82) occlusion/infiltration, phlebitis and dislodgement. CONCLUSION: Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
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risk factors for peripheral Intravenous Catheter failure a multivariate analysis of data from a randomized controlled trial
Infection Control and Hospital Epidemiology, 2014Co-Authors: Marianne Wallis, Nicole Marsh, Joan Webster, Matthew Richard Mcgrail, John Gowardman, Geoffrey Playford, Claire M RickardAbstract:Objective. To assess the relative importance of independent risk factors for peripheral Intravenous Catheter (PIVC) failure.Methods. Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal.Setting. Three acute care hospitals in Queensland, Australia.Participants. The trial included 3,283 adult medical and surgical patients (5,907 Catheters) with a PIVC with greater than 4 days of expected use.Results. Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28–1.68], 1.27 [95% CI, 1.08–1.49], and 1.25 [95% CI, 1.04–1.50], respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08–2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 ...
Hiromi Sanada - One of the best experts on this subject based on the ideXlab platform.
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preventing peripheral Intravenous Catheter failure by reducing mechanical irritation
Scientific Reports, 2020Co-Authors: Toshiaki Takahashi, Mari Abedoi, Ryoko Murayama, Chieko Komiyama, Maki Miyaharakaneko, Chiho Kanno, Miwa Nakamura, Mariko Mizuno, Hiromi SanadaAbstract:Peripheral Intravenous Catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic "pre-scan" for selecting a large-diameter vein before Catheterization, a "post-scan" for confirming the Catheter tip position after Catheterization with ultrasonography, and the use of a flexible polyurethane Catheter to reduce the mechanical irritation that contributes to the incidence of Catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was Catheter failure, which was defined as accidental and unplanned Catheter removal. We used Kaplan-Meier survival curves to compare rates of time until Catheter failure. We analysed 189 and 233 Catheters in the intervention and control groups, respectively. In the control group, 68 Catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 Catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of Catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for Catheter failure was 0.60 (95% CI: 0.47-0.71). Care protocols, including assessment of vein diameter, vein depth, and Catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce Catheter failure incidence.
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ultrasonographic assessment of an induration caused by extravasation of a nonvesicant anticancer drug a case report
Medicine, 2019Co-Authors: Mari Abedoi, Ryoko Murayama, Koichi Yabunaka, Hidenori Tanabe, Chieko Komiyama, Hiromi SanadaAbstract:AbstractRationale:Induration may occur after an anticancer drug extravasation in patients who recurrently receive chemotherapy because of reduced choice of an appropriate vein for inserting a peripheral Intravenous Catheter, resulting in Catheter placement difficulty. Although induration affects tre
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exploring the causes of peripheral Intravenous Catheter failure based on shape of Catheters removed from various insertion sites
Drug discoveries and therapeutics, 2018Co-Authors: Ryoko Murayama, Koichi Yabunaka, Hidenori Tanabe, Chieko Komiyama, Toshiaki Takahashi, Hiromi SanadaAbstract:The risk of peripheral Intravenous Catheter failure varies according to the insertion site. This study examined Catheter shape just after removal to evaluate the causes of Catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral Catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the Catheter insertion site before Catheter removal and clinical images of the removed Catheters. We analyzed 184 Catheters from 142 participants. There were no significant differences in the Catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the Catheter was present in 9.2% of cases; the median bend angle at the Catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of Catheters inserted in the upper arm was significantly greater than of Catheters in the forearm (p = 0.013). Catheter curvature was related to Catheter failure (14.8% of failed Catheters had curvature; p = 0.035) and occlusion (35.3% of occluded Catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed Catheters than for surviving Catheters. To prevent Catheter failure, especially occlusion resulting from Catheter curvature, a Catheter should be inserted at an appropriate insertion site far from the antecubital fossa.
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ultrasonographic classification of subcutaneous edema caused by infusion via peripheral Intravenous Catheter
Journal of Medical Ultrasound, 2016Co-Authors: Koichi Yabunaka, Ryoko Murayama, Hidenori Tanabe, Toshiaki Takahashi, Maiko Oya, Masayuki Fujioka, Hiromi SanadaAbstract:Abstract Background Our aim in this study was to determine the ability of ultrasonography (US) to assess and classify the degree of subcutaneous edema caused by infusion via peripheral Intravenous Catheter, compared to assessment by the Infusion Nurses Society infiltration scale. Methods This prospective study included 64 adult patients who underwent infusion via peripheral Intravenous Catheter. All patients underwent US imaging of the subcutaneous tissue just after the insertion of indwelling Catheters and just before Catheter removal. The grade of swelling was then assessed using the infiltration scale. Subcutaneous edema and edema thickness were analyzed on transverse US images, and the edema was classified as normal, mild, or severe. The relationship between US-determined subcutaneous edema and that determined by using the infiltration scale was evaluated. Results Among the 64 patients, US images of the subcutaneous edema were classified into three groups: normal in 15 patients, mild subcutaneous edema in 41 patients, and severe subcutaneous edema in eight patients. Thus, US classification of subcutaneous edema could provide more detailed information than the infiltration scale. Conclusion The results of the present study suggest that US imaging of subcutaneous tissue could help classify the degree of subcutaneous edema.