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PubMed1995

Selection of vascular access devices and nursing care.

OBJECTIVE: To provide an overview of the patient selection criteria for a vascular access device (VAD) and its maintenance care. CONCLUSIONS: The availability of different types of devices had led to confusion on the part of many health care professionals as to which device is the best for their purpose. Selecting the appropriate VAD is an interdisciplinary decision based on patient characteristics, type of therapy, support system availability, and cost. Numerous controversial issues surround the care of VADs, and research results have not yet resolved these practice issues. Although various procedures are used throughout the country, it can be reasonably concluded that the fundamental requirement for successful maintenance of a VAD is strict adherence to established care protocols. IMPLICATIONS FOR NURSING PRACTICE: Assessment of the need for a VAD is an ongoing process. Nurses are in a perfect position to assess the factors that precede device selection, including the frequency of access, type of intravenous therapy, and the condition of the patient's peripheral veins. The vast array of devices demands specialized knowledge in selecting the appropriate VAD, providing correct care, and evaluating the device once inserted or implanted.

Catheterization, Peripheral↗
PubMedDate not supplied

Translumbar inferior vena cava catheters: safety and efficacy in peripheral blood stem cell transplantation.

Most patients who need peripheral blood stem cell transplantation do not have peripheral venous access that would allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis-related access failure. A technique has been developed for translumbar placement of permanent, subcutaneously tunneled, silicone rubber apheresis catheters into the inferior vena cava, and 40 of these catheters have been placed in 36 patients for stem cell collection. Twenty-six catheters have been left in place for venous access during the transplantation procedure. These catheters had a very low rate (2.3%) of apheresis-related related complications. Access failure was attributed to thrombosis in 10 catheters (25%) and to mechanical complications in another 9 (22%), but access was regained in all but 4 of these cases. The catheters functioned well as venous access devices during transplantation, only rarely developing complications during that time. Venograms performed at the time of removal of 16 catheters showed no case of caval occlusion. A residual fibrin sheath was found around 14 catheters. There was no clinical or computed tomographic scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed, translumbar inferior vena cava apheresis catheters provide a safe and effective route for the collection of peripheral blood stem cells for transplantation, and they can be left in place for venous access during transplantation.

Catheterization, Peripheral↗
PubMed1990

[Complications of intravenous therapy with peripheral indwelling catheter].

Intravenous fluid replacement via a peripheral catheter harbours several risks. The study presented emphasizes that about 50% of the patients show complications during the first days after positioning of an intravenous line. Women patients have been affected more often than male patients. Small catheters positioned in a major vessel away from a joint in the forearm, yield the best results. Peripheral lines should be removed within 8 to 12 hours after surgical procedures, when early symptoms are observed. Complications can be avoided by following these recommendations.

Catheterization, Peripheral↗
PubMed1991

High-level gentamicin resistance in Enterococcus faecalis bacteremia.

In a retrospective analysis, patients with bacteremia due to Enterococcus faecalis with and without high-level gentamicin resistance (GRE; MIC greater than 2000 micrograms/ml) were compared. Bacteremic patients with GRE (n = 32) had significantly higher rates of nosocomial acquisition and bladder catheterization, longer hospitalizations, and more frequent prior treatment with cephalosporins than did bacteremic patients without high-level resistance (n = 19). Overall mortality was significantly associated with septic shock, high-risk source (intraabdominal, wound, respiratory tract, multiple, unknown), and polymicrobial bacteremia. Higher mortality was observed in GRE bacteremia (47%) than in bacteremia without high-level resistance (37%), but this difference was not statistically significant. For patients with monomicrobial bacteremia, low-risk source (genitourinary tract, intravascular), or treatment with antibiotics appropriate for the enterococcus, higher mortality with GRE bacteremia approached statistical significance. These results suggest that high-level resistance adversely affects survival with a pure E. faecalis bacteremia or low-risk bacteremic source. Also, response to antibiotic therapy may be diminished by high-level resistance.

Adult↗
PubMed2004

Practical aspects of peripheral parenteral nutrition.

PURPOSE OF REVIEW: The purpose of this review is to provide an update on the advantages and disadvantages of using peripheral parenteral nutrition, including the techniques, indications and results. RECENT FINDINGS: The new catheters, together with a better knowledge of intermediate metabolism, permit the use of peripheral parenteral nutrition in many clinical situations during short periods of time. SUMMARY: Peripheral parenteral nutrition is an alternative to total parenteral nutrition, and is a complement to enteral nutrition and the oral route. Progress in catheter design and materials, infusion techniques and an improved knowledge of the optimal nutriments has made peripheral parenteral nutrition a safe, efficient and useful method to treat patients over certain periods of time.

Catheterization, Peripheral↗
PubMedDate not supplied

Relationship between peripheral intravenous catheter Dwell time and the development of phlebitis and infiltration.

The purpose of this study was to evaluate whether lengthening the dwell time of peripheral i.v. catheters from 72 hours to 144 hours resulted in increased rates of phlebitis and/or infiltration. The study was conducted in medical/surgical units at a 110-bed teaching hospital with an i.v. team. Kaplan-Meier estimates of the success and failure and conditional failure probabilities were calculated for phlebitis and infiltration scores. Log rank tests were used to test for an association between the covariates and the time until failure. Drug irritation was the most significant predictor of phlebitis and infiltration rates in this study. The total difference in the estimated failure rates for the catheter lasting 6 days versus a new catheter inserted for another 3 days is 1.3%. Because the conditional failure probability estimates for days 4, 5, and 6 are slightly higher than for days 1, 2, and 3, consideration may be given to extending the dwell time of a peripheral i.v. catheter beyond 72 hours under certain circumstances.

Adult↗
PubMed2003

Catheter-directed thrombolytic therapy for limb ischemia: current status and controversies.

Absence of urokinase from the United States market for the past 4 years has resulted in increasing experience with other plasminogen activators in catheter-directed thrombolytic therapy. The differences in the pharmacologic properties and biologic behavior of these agents may translate into clinical outcomes that are distinct. Some of these manifestations can be predicted based on the existing large clinical trials in the acute myocardial infarction literature. However, because of the fundamental differences in techniques and thrombolytic regimens, extrapolation of the coronary data may not always predict the performance of these agents in peripheral catheter-directed fibrinolysis. In this article, the current status of the available lytic agents in the treatment of limb ischemia is reviewed.

Arterial Occlusive Diseases↗
PubMed2004

Catheter-directed thrombolytic therapy for limb ischemia: current status and controversies.

Absence of urokinase from the United States market for the past 4 years has resulted in increasing experience with other plasminogen activators in catheter-directed thrombolytic therapy. The differences in the pharmacologic properties and biologic behavior of these agents may translate into clinical outcomes that are distinct. Some of these manifestations can be predicted based on the existing large clinical trials in the acute myocardial infarction literature. However, because of the fundamental differences in techniques and thrombolytic regimens, extrapolation of the coronary data may not always predict the performance of these agents in peripheral catheter-directed fibrinolysis. In this article, the current status of the available lytic agents in the treatment of limb ischemia is reviewed.

Arterial Occlusive Diseases↗
PubMed2006

Bleeding complications from femoral and sciatic nerve catheters in patients receiving low molecular weight heparin.

After knee replacement surgery, the use of continuous local anesthetic infusions in femoral and sciatic peripheral nerve catheters is an effective analgesic option. Limited data are available concerning the safety of peripheral nerve infusions in patients receiving low molecular weight heparin thromboprophylaxis. We report three cases of bleeding at femoral and sciatic catheter sites in patients receiving a single daily dose of enoxaparin (40 mg). In all cases, some bleeding was noticed before catheter removal; in one case involving catheter removal 3 h after enoxaparin administration, massive thigh swelling occurred. Physical therapy and discharge from the hospital were delayed in two cases but no other complications were seen. More data are needed to determine if it is necessary to use the same guidelines for managing peripheral nerve infusion catheters in patients receiving enoxaparin as with epidurals and other types of central nerve catheter infusions.

Aged↗
PubMed1994

Effects of dobutamine on hepatosplanchnic hemodynamics in patients with chronic liver disease.

BACKGROUND: It is said that catecholamines increase hepatic blood flow in patients without liver diseases, although several reports have suggested a blunted response to catecholamines in patients with liver cirrhosis. METHODS: We investigated changes in splanchnic blood flow distribution induced by the infusion of dobutamine into peripheral veins of healthy adults (NC group), patients with chronic hepatitis (CH group), and patients with liver cirrhosis (LC group), using a Doppler duplex system (protocol 1). We also investigated changes in hepatic hemodynamics induced by dobutamine infusion in patients with liver cirrhosis (cirrhosis group) and patients without liver diseases (control group), using hepatic catheterization (protocol 2). RESULTS: In protocol 1 the average increase in portal venous blood flow during dobutamine infusion was significant in the NC and CH groups but was not significant in the LC group. Changes in the blood flow in the splenic artery and vein, superior mesenteric artery and vein, and femoral artery were similar to those in the portal vein in each of the three groups. Infusion did not cause a change in the common hepatic arterial flow in any of the three groups. In protocol 2 the portal venous flow, cardiac index, and hepatic venous pressure gradient increased significantly during dobutamine infusion in both the cirrhosis and the control groups. Hepatic vascular resistance in the cirrhosis group increased slightly, whereas, in contrast, that in the control group increased significantly. The rate of change in almost all variables was lower in the cirrhosis group than in the control group. CONCLUSION: These results indicate that dobutamine has less effect on hepatic circulation in patients with liver cirrhosis than in those without liver diseases, indicating that the value of dobutamine in increasing hepatic blood flow in cirrhotic patients is very limited.

Aged↗
PubMed2003

Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of the Perclose device.

BACKGROUND: Patients with peripheral vascular disease have been excluded from initial studies of percutaneous suture-mediated closure devices (SMCD) despite representing a significant proportion of those requiring endovascular intervention. We sought to determine whether these devices could be safely used in patients with peripheral vascular disease. METHODS: Patients were stratified into two groups and five subgroups on the basis of indication for arteriography, and they were prospectively randomized at the end of the procedure to receive either the SMCD or manual compression. Ankle-brachial index was determined and duplex ultrasound scanning of the accessed femoral artery was performed, before and after the procedure. Ultrasound data included peak systolic velocity, minimum intraluminal vessel diameter, and presence or absence of calcified plaque. Time to hemostasis, ambulation, and discharge were recorded, and major or minor complications were noted. RESULTS: Of 102 patients included in the study, 52 patients were randomized to receive the SMCD. There was no difference in ankle-brachial index, minimum intraluminal vessel diameter, or peak systolic velocity in the accessed vessel after closure with SMCD or manual compression. Time to hemostasis, ambulation, and discharge was significantly less in the SMCD group (P =.001). Presence of calcified plaque was not associated with complications (P =.146). In the SMCD group, hemostasis was achieved with 49 of 52 devices (94.2%). There were six complications (5.9%), two of which were major and required operative intervention. All complications were hemorrhagic and not occlusive. There was no difference in overall complication rate between SMCD (7.7%) and manual compression (4.0%) groups (P =.678). No infection was noted in any of the 102 patients. CONCLUSIONS: Suture-mediated percutaneous arterial closure can be safely performed in patients with peripheral vascular disease, even in the presence of calcified plaque. This closure technique enables shorter time to hemostasis, ambulation, and hospital discharge. There are observed differences in minor, but not major, complication rates for MC versus percutaneous arterial closure in patients with peripheral vascular disease, but these differences did not achieve statistical significance in this small series.

Aged↗
PubMed2006

Feasibility of short-term outpatient intravenous antibiotic therapy for the management of infectious conditions in pediatric patients.

OBJECTIVE: The objective of this study was to examine the feasibility of short-term outpatient peripheral intravenous (IV) antibiotic therapy for selected emergency department (ED) patients. METHODS: Retrospective analysis of pediatric ED patients presenting with infections of presumed bacterial etiology who received IV ceftriaxone and were discharged with a "capped" IV catheter and instructions to return in 24 hours for reevaluation. Outcome measures included clinical outcome at 24 hours and catheter-related complications. RESULTS: Twenty-nine patients met study criteria. All returned for reevaluation. In one case, a parent removed the catheter when their child reported "numbness/soreness" at the catheter site. The other 28 patients were judged to be improved, received a second dose of ceftriaxone through the original catheter, and were discharged on oral antibiotic. No adverse events related to the catheter were identified. CONCLUSION: Outpatient peripheral IV catheter use appears to be a feasible method for providing serial doses of parenteral antibiotic for the treatment of selected pediatric patients with infectious conditions.

Adolescent↗
PubMedDate not supplied

Blood collection from peripherally inserted central venous catheters: an institution's effort to evaluate and update its current policy.

A discussion of complications related to the use of central venous catheters (CVCs), literature review, and a retrospective study were performed to see if blood collection from peripherally inserted central catheters (PICCs) in the treatment of oncology patients was a feasible option. The results were used to evaluate and update the institution's policy.

Adult↗
PubMed1989

Limited usefulness of quantitative culture of blood drawn through the device for diagnosis of intravascular-device-related bacteremia.

The use of a differential quantitative blood culture technique (Isolator) to diagnose intravascular-device-related bacteremia (IDRB) was studied prospectively. During septic episodes in 44 patients, blood was obtained simultaneously through the suspected infected device and from a peripheral venipuncture. The blood samples were processed by the Isolator technique, which enables easy quantification of microorganisms. The cannula was removed, and its tip was cultured semiquantitatively. Of the 52 cannulas studied, 15 were the cause of IDRB, but only 7 of these showed a significantly higher bacterial count in blood obtained through the device compared with peripheral blood. The bacterial count was higher in blood drawn through the device than in peripheral blood in four of six cases that did not fulfill the definition of IDRB. Some blood cultures obtained through the device were positive despite negative cultures of peripheral blood and cannula tips (six cannulas). Quantitative blood cultures were not useful in diagnosing IDRB in this study.

Adult↗
PubMed2005

Reliability of nesiritide infusion via non-primed tubing and heparin-coated catheters.

BACKGROUND: Prescribing information for nesiritide mandates priming of intravenous tubing prior to connecting to the patient's intravenous access because the drug may adsorb to the line. As of this writing, no published study has quantified the binding effect of nesiritide to intravenous tubing. OBJECTIVE: To investigate whether priming of peripheral intravenous tubing is necessary and whether nesiritide can be reliably delivered through central intravenous lines, including heparin-coated catheters, where priming cannot occur. METHODS: A 23.3-mL bolus of nesiritide followed by a 7-mL/h 2-hour infusion were run through (1) polyvinylchloride (PVC) peripheral intravenous tubing primed with nesiritide, (2) non-primed PVC peripheral intravenous tubing, (3) non-primed polyethylene peripheral intravenous tubing, (4) non-primed PVC peripheral intravenous tubing connected to a central intravenous polyurethane catheter, and (5) non-primed PVC peripheral intravenous tubing connected to a heparin-coated pulmonary artery PVC catheter. Nesiritide concentrations were measured in the intravenous bags and in samples collected from the 5 intravenous settings. RESULTS: Priming of intravenous tubing with nesiritide did not increase drug recovery: at least 94% of the bolus dose and 96% of the total drug were recovered from all intravenous sets. CONCLUSIONS: Infusion of nesiritide via non-primed peripheral and central intravenous tubing, including heparin-coated pulmonary catheter, is reliable. Changes in nesiritide labeling appear to be warranted.

Catheterization, Central Venous↗
PubMed1998

Hand-held Dopplers in central catheter insertion.

Peripherally inserted central catheters benefit many patients requiring repeated intravenous treatment. This study investigated the effect of using a hand-held Doppler to aid insertion where a patient's veins are not visible or palpable.

Catheterization, Central Venous↗
PubMed2003

Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition.

BACKGROUND: The contribution of glyceryl trinitrate (GTN) to prevention of peripheral vein thrombophlebitis (PVT) during peripheral intravenous nutrition delivered by fine-bore midline intravenous catheter is unclear. The aim of this study was to establish its role. METHODS: Two consecutive randomized clinical trials were conducted. In trial 1 patients were randomized to receive standard peripheral intravenous nutrition containing heparin and hydrocortisone with or without the placement of a topical GTN patch (triple therapy or dual therapy). In trial 2 patients were randomized to receive standard peripheral intravenous nutrition with either dual therapy or topical GTN alone (monotherapy). RESULTS: Dual therapy was as effective as triple therapy in preventing PVT (incidence 10 of 37 versus 11 of 39 patients respectively). Dual therapy reduced the incidence and increased the time to onset of PVT compared with monotherapy (14 of 41 versus 22 of 35 patients respectively, P = 0.012; median 17.3 (95 per cent confidence interval (c.i.) 13.4 to 21.1) versus 8.9 (95 per cent c.i. 6.7 to 11.0) days, P = 0.007). CONCLUSION: Use of a topical GTN patch confers no benefit when peripheral intravenous nutrition is delivered via a fine-bore midline intravenous catheter.

Administration, Topical↗