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Olivier Mimoz - One of the best experts on this subject based on the ideXlab platform.
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skin antisepsis with chlorhexidine alcohol versus povidone iodine alcohol combined or not with use of a bundle of new devices for prevention of short term Peripheral Venous Catheter related infectious complications and Catheter failure an open label single centre randomised four parallel group two by two factorial trial clean 3 protocol study
BMJ Open, 2019Co-Authors: Jeremy Guenezan, Bertrand Drugeon, Roderick Oneill, Diane Caillaud, Clement Senamaud, Catherine Pouzet, Sabrina Seguin, Denis Frasca, Olivier MimozAbstract:Introduction Short Peripheral intraVenous Catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality. Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible Catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central Venous and arterial Catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as Catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain Catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use. Methods and analysis The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the Catheters (colonisation, local infection or bloodstream infection) and (2) the time between Catheter insertion and Catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement. Ethics and dissemination This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number EudraCT 2018-A02535-50; NCT03757143.
Katarina Goransson - One of the best experts on this subject based on the ideXlab platform.
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measurement of Peripheral Venous Catheter related phlebitis a cross sectional study
The Lancet Haematology, 2017Co-Authors: Katarina Goransson, Ulrika Forberg, Eva Johansson, Maria UnbeckAbstract:Summary Background Many instruments for measurement of Peripheral Venous Catheter (PVC)-related phlebitis are available, but no consensus exists on their applicability in clinical practice. This absence of consensus affects the ability to identify and compare proportions of PVCs causing phlebitis within and across hospitals as the range varies between 2% and 62% in previous studies. We hypothesised that the instruments' ability to identify phlebitis varies. The aim of this study is to illustrate the complexity of application of phlebitis instruments to a clinical dataset. Methods In this cross-sectional study, we applied 17 instruments for phlebitis identification (divided into three groups [instruments using definitions, severity rating systems, and scoring systems]) to PVCs in adult patients admitted to 12 inpatient units at Karolinska University Hospital in Sweden. We calculated the proportion of PVCs causing phlebitis on the basis of each instrument's minimum criterion for phlebitis. We also analysed each instrument's face validity. We compared proportions using the Z test. Findings On the basis of data collected between Feb 2, 2009, and Feb 20, 2009, May 18, 2009, and June 5, 2009, and Feb 8, 2010, and Feb 26, 2010, we applied 17 instruments for phlebitis identification (eight instruments using definitions, seven severity rating systems, and two scoring systems) to 1175 observed PVCs in 1032 patients. The highest number of PVCs causing phlebitis generated by definitions was 137 (11·7%), by severity rating systems was 395 (33·6%), and by scoring systems was 363 (30·9%). The proportion generated by instruments using definitions was significantly different to that of both the severity rating (difference 21·9% [95% CI 18·6–25·2]; p Interpretation Our study highlights several concerns regarding instruments to measure phlebitis published in the scientific community. From a work environment and patient safety perspective, clinical staff engaged in PVC management should be aware of the absence of adequately validated instruments for phlebitis assessment. We suggest that researchers within the field of PVC come together in a joint research programme aiming to develop valid and reliable methods that accurately identify PVC-related adverse events that also includes decision support for clinical staff concerning clinical indications for PVC removal. Such actions could lead to a revised view on what is best practice for management of PVCs. Funding None.
Jeremy Guenezan - One of the best experts on this subject based on the ideXlab platform.
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skin antisepsis with chlorhexidine alcohol versus povidone iodine alcohol combined or not with use of a bundle of new devices for prevention of short term Peripheral Venous Catheter related infectious complications and Catheter failure an open label single centre randomised four parallel group two by two factorial trial clean 3 protocol study
BMJ Open, 2019Co-Authors: Jeremy Guenezan, Bertrand Drugeon, Roderick Oneill, Diane Caillaud, Clement Senamaud, Catherine Pouzet, Sabrina Seguin, Denis Frasca, Olivier MimozAbstract:Introduction Short Peripheral intraVenous Catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality. Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible Catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central Venous and arterial Catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as Catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain Catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use. Methods and analysis The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the Catheters (colonisation, local infection or bloodstream infection) and (2) the time between Catheter insertion and Catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement. Ethics and dissemination This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number EudraCT 2018-A02535-50; NCT03757143.
Maria Unbeck - One of the best experts on this subject based on the ideXlab platform.
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measurement of Peripheral Venous Catheter related phlebitis a cross sectional study
The Lancet Haematology, 2017Co-Authors: Katarina Goransson, Ulrika Forberg, Eva Johansson, Maria UnbeckAbstract:Summary Background Many instruments for measurement of Peripheral Venous Catheter (PVC)-related phlebitis are available, but no consensus exists on their applicability in clinical practice. This absence of consensus affects the ability to identify and compare proportions of PVCs causing phlebitis within and across hospitals as the range varies between 2% and 62% in previous studies. We hypothesised that the instruments' ability to identify phlebitis varies. The aim of this study is to illustrate the complexity of application of phlebitis instruments to a clinical dataset. Methods In this cross-sectional study, we applied 17 instruments for phlebitis identification (divided into three groups [instruments using definitions, severity rating systems, and scoring systems]) to PVCs in adult patients admitted to 12 inpatient units at Karolinska University Hospital in Sweden. We calculated the proportion of PVCs causing phlebitis on the basis of each instrument's minimum criterion for phlebitis. We also analysed each instrument's face validity. We compared proportions using the Z test. Findings On the basis of data collected between Feb 2, 2009, and Feb 20, 2009, May 18, 2009, and June 5, 2009, and Feb 8, 2010, and Feb 26, 2010, we applied 17 instruments for phlebitis identification (eight instruments using definitions, seven severity rating systems, and two scoring systems) to 1175 observed PVCs in 1032 patients. The highest number of PVCs causing phlebitis generated by definitions was 137 (11·7%), by severity rating systems was 395 (33·6%), and by scoring systems was 363 (30·9%). The proportion generated by instruments using definitions was significantly different to that of both the severity rating (difference 21·9% [95% CI 18·6–25·2]; p Interpretation Our study highlights several concerns regarding instruments to measure phlebitis published in the scientific community. From a work environment and patient safety perspective, clinical staff engaged in PVC management should be aware of the absence of adequately validated instruments for phlebitis assessment. We suggest that researchers within the field of PVC come together in a joint research programme aiming to develop valid and reliable methods that accurately identify PVC-related adverse events that also includes decision support for clinical staff concerning clinical indications for PVC removal. Such actions could lead to a revised view on what is best practice for management of PVCs. Funding None.
Pascal Astagneau - One of the best experts on this subject based on the ideXlab platform.
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Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project)
PLoS ONE, 2017Co-Authors: Katiuska Miliani, Raphaël Taravella, Denis Thillard, Valérie Chauvin, Emmanuelle Martin, Stéphanie Edouard, Sté Phanie Edouard, Pascal AstagneauAbstract:Introduction Peripheral Venous Catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after Catheter removal, and to identify practice-mirroring risk factors. Methods A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Results Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Conclusion Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings.