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Claire M. Rickard - One of the best experts on this subject based on the ideXlab platform.
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Skin complications associated with Vascular Access Devices: A secondary analysis of 13 studies involving 10,859 Devices.
International journal of nursing studies, 2018Co-Authors: Amanda J Ullman, Christine Woods, Nicole Marsh, Gabor Mihala, Kate O’leary, Simon Bugden, Mark Scott, Claire M. RickardAbstract:Abstract Background Vascular Access Devices are widely used in healthcare settings worldwide. The insertion of a Vascular Access Device creates a wound, vulnerable to irritation, injury and infection. Vascular Access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives To estimate the incidence of Vascular Access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of Vascular Access Devices in clinical settings between 2008 and 2017. Settings Six hospitals (metropolitan and regional) in Queensland, Australia. Participants The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 Devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous Access (n = 585) Devices. Analysis Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-Device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p Results Over 12% of Devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial Devices (95% confidence interval, CI 42.1–50.7), and 22.5 per 1000 catheter days for central Devices (95% CI 16.5–306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral Devices (n = 296; 2.9%), and dermatitis for central Devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to Device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral Device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Conclusions Significant skin complications can develop during the life of peripheral and central Vascular Access Devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with Vascular Access Devices.
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Evaluation of Skin Colonisation And Placement of Vascular Access Device Exit sites (ESCAPE Study).
Journal of infection prevention, 2018Co-Authors: Nancy Moureau, Marie Cooke, Nicole Marsh, Li Zhang, Michelle J Bauer, Emily Larsen, Gabor Mihala, Amanda Corley, India Lye, Claire M. RickardAbstract:Background:Skin microorganisms may contribute to the development of Vascular Access Device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is litt...
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nursing and midwifery practice for maintenance of Vascular Access Device patency a cross sectional survey
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Nicole Marsh, Samantha Keogh, Julie Flynn, Niall Higgins, Karen Davies, Claire M. RickardAbstract:Background - Up to 85% of hospital in-patients will require some form of Vascular Access Device to deliver essential fluids, drug therapy, nutrition and blood products, or facilitate sampling. The failure rate of these Devices is unacceptably high, with 20–69% of peripheral intravenous catheters and 15–66% of central venous catheters failing due to occlusion, depending on the Device, setting and population. A range of strategies have been developed to maintain Device patency, including intermittent flushing. However, there is limited evidence informing flushing practice and little is known about the current flushing practices. Objective - The aim of the study was to improve our understanding of current flushing practices for Vascular Access Devices through a survey of practice. Method - A cross-sectional survey of nurses and midwives working in the State of Queensland, Australia was conducted using a 25-item electronic survey that was distributed via the local union membership database. Results - A total of 1178 surveys were completed and analysed, with n = 1068 reporting peripheral Device flushing and n = 584 reporting central Device flushing. The majority of respondents were registered nurses (55%) caring for adult patients (63%). A large proportion of respondents (72% for peripheral, 742/1028; 80% for central, 451/566) were aware of their facility’s policy for Vascular Access Device flushing. Most nurses reported using sodium chloride 0.9% for flushing both peripheral (96%, 987/1028) and central Devices (75%, 423/566). Some concentration of heparin saline was used by 25% of those flushing central Devices. A 10-mL syringe was used by most respondents for flushing; however, 24% of respondents used smaller syringes in the peripheral Device group. Use of prefilled syringes (either commercially prepared sterile or prefilled in the workplace) was limited to 10% and 11% respectively for each group. The frequency of flushing varied widely, with the most common response being pro re nata (23% peripheral and 21% central), or 6 hourly (23% peripheral and 22% central). Approximately half of respondents stated that there was no medical order or documentation for either peripheral or central Device flushing. Conclusions - Flushing practices for Vascular Access Device flushing appear to vary widely. Specific areas of practice that warrant further investigation include questions about the efficacy of heparin for central Device flushing, increasing adherence to the recommended 10 mL diameter syringe use, increased use of prefilled flush syringes, identifying and standardising optimal volumes and frequency of flushing, and improving documentation of flush orders and administration.
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Vascular Access specialist teams for Device insertion and prevention of failure
Cochrane Database of Systematic Reviews, 2014Co-Authors: Peter J Carr, Marie Cooke, Gabor Mihala, Niall Higgins, Claire M. RickardAbstract:Background Most people admitted to hospitals worldwide require a Vascular Access Device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes. Objectives To compare the use of the Vascular Access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, Device failure, and cost-effectiveness. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018. Selection criteria We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes. Data collection and analysis We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management. Main results We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication. Authors' conclusions This systematic review failed to locate relevant published RCTs to support or refute the assertion that Vascular Access specialist teams are superior to the generalist model. A Vascular Access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of Vascular Access Devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for Vascular Access Devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a Vascular Access specialist team approach for Vascular Access Device insertion and care for the prevention of failure.
Isabelle Veys - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable Vascular Access Device (TIVAD) placement
Supportive Care in Cancer, 2016Co-Authors: Gabriel Liberale, Michel El Houkayem, Claire Viste, Fikri Bouazza, Michel Moreau, Issam El Nakadi, Isabelle VeysAbstract:Purpose Totally implantable Vascular Access Devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients’ perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients’ comfort level and aesthetic satisfaction with regard to TIVAD insertion. Methods Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location). Results Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction. Conclusions Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.
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Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable Vascular Access Device (TIVAD) placement.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2016Co-Authors: Gabriel Liberale, Michel El Houkayem, Claire Viste, Fikri Bouazza, Michel Moreau, Issam El Nakadi, Isabelle VeysAbstract:Purpose Totally implantable Vascular Access Devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients’ perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients’ comfort level and aesthetic satisfaction with regard to TIVAD insertion.
Gabriel Liberale - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable Vascular Access Device (TIVAD) placement
Supportive Care in Cancer, 2016Co-Authors: Gabriel Liberale, Michel El Houkayem, Claire Viste, Fikri Bouazza, Michel Moreau, Issam El Nakadi, Isabelle VeysAbstract:Purpose Totally implantable Vascular Access Devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients’ perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients’ comfort level and aesthetic satisfaction with regard to TIVAD insertion. Methods Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location). Results Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction. Conclusions Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.
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Totally implantable Vascular Access Device (TIVAD) placement: a modified technique that takes post-procedure aesthetic aspects into account
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2016Co-Authors: Gabriel LiberaleAbstract:Major progress has been made in breast cancer reconstruction surgery. The standard technique for totally implanted Vascular Access Device (TIVAD) implantation generally requires an incision for port insertion on the anterior part of the thorax that leaves a scar in the middle of the neckline in patients who have undergone mastectomy with complex breast reconstruction. The aim of this technical note is to report our revised surgical technique for TIVAD placement. In patients with breast cancer, we take a lateralized approach, performing an oblique incision on the lowest part of the deltopectoral groove. This allows us to introduce the port and to place it on the anterolateral part of the thorax, thus avoiding an unaesthetic scar on the anterior part of the thorax. Our modified technique for TIVAD implantation is described.
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Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable Vascular Access Device (TIVAD) placement.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2016Co-Authors: Gabriel Liberale, Michel El Houkayem, Claire Viste, Fikri Bouazza, Michel Moreau, Issam El Nakadi, Isabelle VeysAbstract:Purpose Totally implantable Vascular Access Devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients’ perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients’ comfort level and aesthetic satisfaction with regard to TIVAD insertion.
Amanda J Ullman - One of the best experts on this subject based on the ideXlab platform.
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international recommendations for a Vascular Access minimum dataset a delphi consensus building study
BMJ Quality & Safety, 2020Co-Authors: Jessica A Schults, Marie Cooke, Tricia Kleidon, Nicole Marsh, Gillian Raybarruel, Amanda J Ullman, Vineet Chopra, Rebecca Paterson, Jocelyn HillAbstract:BACKGROUND: Data regarding Vascular Access Device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a Vascular Access minimum dataset. METHODS: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international Vascular Access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in Vascular Access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for Vascular Access Devices. RESULTS: A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), Device characteristics (n=5; eg, Device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate Vascular Access Device use and outcomes. CONCLUSION: We developed and internally validated a minimum dataset for Vascular Access Device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful Vascular Access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.
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Skin complications associated with Vascular Access Devices: A secondary analysis of 13 studies involving 10,859 Devices.
International journal of nursing studies, 2018Co-Authors: Amanda J Ullman, Christine Woods, Nicole Marsh, Gabor Mihala, Kate O’leary, Simon Bugden, Mark Scott, Claire M. RickardAbstract:Abstract Background Vascular Access Devices are widely used in healthcare settings worldwide. The insertion of a Vascular Access Device creates a wound, vulnerable to irritation, injury and infection. Vascular Access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives To estimate the incidence of Vascular Access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of Vascular Access Devices in clinical settings between 2008 and 2017. Settings Six hospitals (metropolitan and regional) in Queensland, Australia. Participants The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 Devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous Access (n = 585) Devices. Analysis Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-Device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p Results Over 12% of Devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial Devices (95% confidence interval, CI 42.1–50.7), and 22.5 per 1000 catheter days for central Devices (95% CI 16.5–306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral Devices (n = 296; 2.9%), and dermatitis for central Devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to Device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral Device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Conclusions Significant skin complications can develop during the life of peripheral and central Vascular Access Devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with Vascular Access Devices.
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complication and failures of central Vascular Access Device in adult critical care settings
Critical Care Medicine, 2018Co-Authors: Mari Takashima, Jessica A Schults, Gabor Mihala, Amanda Corley, Amanda J UllmanAbstract:Objectives To examine the proportion and rate of central venous Access Device failure and complications across central venous Access Device types in adult intensive care. Data sources A systematic search was undertaken in the electronic databases Cochrane Central Register of Controlled Trials, Embase, U.S. National Library of Medicine National Institutes of Health, and Cumulative Index to Nursing and Allied Health in September 2017. Study selection Included studies were of observational (prospective and retrospective) or interventional design and reported central venous Access Device failure and complications in adult ICU settings. Studies were excluded if they were published prior to November 2006 or not reported in English. Two reviewers independently screened articles, assessed eligibility, extracted data, and assessed risk of bias. Data extraction Data were extracted on the primary outcome, central venous Access Device failure, and secondary outcomes: central venous Access Device complications (central line-associated bloodstream infection, catheter-related bloodstream infection, catheter-related thrombosis, occlusion, catheter removal due to suspected infection, dislodgement, breakage, and local infection). Patient and Device data and study details to assess the study quality were also extracted. Data synthesis A total of 63 studies involving 50,000 central venous Access Devices (396,951 catheter days) were included. Central venous Access Device failure was 5% (95% CI, 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days (95% CI, 2.31-6.86), with the highest rate in nontunneled central venous Access Devices. Removal of central venous Access Device due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI, 15.7-25.2). Conclusions Central venous Access Device complications and Device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous Access Devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous Access Devices suspected of infection.
Gabor Mihala - One of the best experts on this subject based on the ideXlab platform.
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Skin complications associated with Vascular Access Devices: A secondary analysis of 13 studies involving 10,859 Devices.
International journal of nursing studies, 2018Co-Authors: Amanda J Ullman, Christine Woods, Nicole Marsh, Gabor Mihala, Kate O’leary, Simon Bugden, Mark Scott, Claire M. RickardAbstract:Abstract Background Vascular Access Devices are widely used in healthcare settings worldwide. The insertion of a Vascular Access Device creates a wound, vulnerable to irritation, injury and infection. Vascular Access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives To estimate the incidence of Vascular Access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of Vascular Access Devices in clinical settings between 2008 and 2017. Settings Six hospitals (metropolitan and regional) in Queensland, Australia. Participants The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 Devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous Access (n = 585) Devices. Analysis Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-Device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p Results Over 12% of Devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial Devices (95% confidence interval, CI 42.1–50.7), and 22.5 per 1000 catheter days for central Devices (95% CI 16.5–306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral Devices (n = 296; 2.9%), and dermatitis for central Devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to Device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral Device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Conclusions Significant skin complications can develop during the life of peripheral and central Vascular Access Devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with Vascular Access Devices.
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complication and failures of central Vascular Access Device in adult critical care settings
Critical Care Medicine, 2018Co-Authors: Mari Takashima, Jessica A Schults, Gabor Mihala, Amanda Corley, Amanda J UllmanAbstract:Objectives To examine the proportion and rate of central venous Access Device failure and complications across central venous Access Device types in adult intensive care. Data sources A systematic search was undertaken in the electronic databases Cochrane Central Register of Controlled Trials, Embase, U.S. National Library of Medicine National Institutes of Health, and Cumulative Index to Nursing and Allied Health in September 2017. Study selection Included studies were of observational (prospective and retrospective) or interventional design and reported central venous Access Device failure and complications in adult ICU settings. Studies were excluded if they were published prior to November 2006 or not reported in English. Two reviewers independently screened articles, assessed eligibility, extracted data, and assessed risk of bias. Data extraction Data were extracted on the primary outcome, central venous Access Device failure, and secondary outcomes: central venous Access Device complications (central line-associated bloodstream infection, catheter-related bloodstream infection, catheter-related thrombosis, occlusion, catheter removal due to suspected infection, dislodgement, breakage, and local infection). Patient and Device data and study details to assess the study quality were also extracted. Data synthesis A total of 63 studies involving 50,000 central venous Access Devices (396,951 catheter days) were included. Central venous Access Device failure was 5% (95% CI, 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days (95% CI, 2.31-6.86), with the highest rate in nontunneled central venous Access Devices. Removal of central venous Access Device due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI, 15.7-25.2). Conclusions Central venous Access Device complications and Device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous Access Devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous Access Devices suspected of infection.
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Evaluation of Skin Colonisation And Placement of Vascular Access Device Exit sites (ESCAPE Study).
Journal of infection prevention, 2018Co-Authors: Nancy Moureau, Marie Cooke, Nicole Marsh, Li Zhang, Michelle J Bauer, Emily Larsen, Gabor Mihala, Amanda Corley, India Lye, Claire M. RickardAbstract:Background:Skin microorganisms may contribute to the development of Vascular Access Device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is litt...
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Vascular Access specialist teams for Device insertion and prevention of failure
Cochrane Database of Systematic Reviews, 2014Co-Authors: Peter J Carr, Marie Cooke, Gabor Mihala, Niall Higgins, Claire M. RickardAbstract:Background Most people admitted to hospitals worldwide require a Vascular Access Device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes. Objectives To compare the use of the Vascular Access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, Device failure, and cost-effectiveness. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018. Selection criteria We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes. Data collection and analysis We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management. Main results We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication. Authors' conclusions This systematic review failed to locate relevant published RCTs to support or refute the assertion that Vascular Access specialist teams are superior to the generalist model. A Vascular Access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of Vascular Access Devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for Vascular Access Devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a Vascular Access specialist team approach for Vascular Access Device insertion and care for the prevention of failure.
