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PubMedDate not supplied

Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines.

Central venous lines are used to care for critically ill neonates in cases of limited peripheral venous access. This prospective, randomized study evaluated the risks and benefits of the use of single- and double-lumen umbilical venous catheters for up to 14 days. Patients were randomized to one of three treatment arms: (1) single-lumen umbilical catheter, (2) double-lumen umbilical catheter, or (3) no umbilical catheter; peripheral intravenous lines only. Infants in the groups treated with an umbilical venous catheter had significantly fewer venipunctures and peripheral intravenous lines placed during their first 2 weeks of life than those in the peripheral line only group. Less time and money were spent obtaining peripheral line placement in the umbilical venous catheter groups. The incidence rates of sepsis and complications were not higher in treated patients than in control patients. The double-lumen catheter further reduced peripheral venipunctures and lines. We conclude that an umbilical venous catheter used during the first 2 weeks of life is a relatively safe, less stressful, cost-effective means of providing intravenous therapy to neonates.

Catheterization, Peripheral↗

PubMed1991

Atrial natriuretic peptide levels in brain venous outflow during cardiopulmonary bypass in humans: evidence for extracardiac hormonal production.

Atrial natriuretic peptide (ANP) is a hormone with an important role in the regulation of extracellular fluid volume. The ANP gene is not only expressed in the heart, but the high concentration of ANP in cardiac blood makes it difficult to demonstrate extraatrial hormonal secretion in vivo. This issue was addressed during complete cardiopulmonary bypass (CPB) in 13 patients undergoing elective cardiac surgery in whom ANP concentrations were followed in the internal jugular vein, representing largely brain venous outflow, as well as a peripheral vein and radial artery, after the heart and lungs were excluded from circulation. Plasma ANP levels in the peripheral venous circulation showed no significant changes during extracorporeal circulation, although they tended to decrease (from 6.75 +/- 2.16 fmol/mL to 4.76 +/- 0.69 fmol/mL; P greater than 0.05). ANP levels in the radial artery decreased significantly after the exclusion of the heart (from 16.84 +/- 3.51 fmol/mL to 6.83 +/- 0.97 fmol/mL; P less than 0.01). In contrast, ANP concentration in the internal jugular vein increased in 12 of 13 patients during the first 15 minutes of CPB (from 9.49 +/- 1.96 fmol/mL to 15.96 +/- 2.8 fmol/mL; P less than 0.01) and remained above the levels found simultaneously in other sampling sites during CPB. High-performance liquid chromatography analysis of plasma extracts showed multiple peaks of ANP, but the elution patterns of peripheral venous blood and brain outflow were similar. One of the immunoreactive peaks was located at the position of standard human ANP (Ser99-Met110-Tyr126).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Mock drug delivery to the proximal aorta during cardiopulmonary resuscitation: central vs peripheral intravenous infusion with varying flush volumes.

OBJECTIVE: To compare mock drug deliveries to the proximal aorta during CPR after peripheral vs central i.v. administration when the mock drug is followed by different postinfusion flush volumes. METHODS: Delivery of indocyanine green (ICG) dye to the proximal aorta of an instrumented 20-kg canine cardiac arrest model was examined. The ICG administration (2.5 mg) preceded either a 2-mL or a 10-mL saline flush, for either a central or a peripheral i.v. route of dye administration. Five dogs each underwent three sets of the four possible route/flush-volume combinations in a stratified randomized order. Real-time dye-absorbance-vs-time curves, as sampled from the proximal aorta, modeled central-circulation drug delivery. Systolic and diastolic blood pressures (BPs) were monitored, and the absorbance-vs-time curve upstroke phases were used to estimate cardiac output during arrest. RESULTS: Times (mean +/- SD) to onset of dye appearance did not differ significantly between peripheral/10 mL (126 +/- 35 sec) and central/10 mL (108 +/- 35 sec), or between central/2 mL (123 +/- 31 sec) and central/10 mL. Times to onset of dye appearance did differ between peripheral/2 mL (161 +/- 70 sec) and central/10 mL [analysis of variance (ANOVA) p = 0.032]. Times to peak dye concentration did not differ significantly between peripheral/10 mL (230 +/- 88 sec) and either central/10 mL (202 +/- 88 sec) or central/2 mL (215 +/- 83 sec), but differed between peripheral/2 mL (326 +/- 134 sec) and every other route/flush-volume combination (ANOVA p = 0.009). Peak dye concentrations and systolic/diastolic BPs (averaging 23/10 for all route/flush-volume combinations) did not differ significantly between any route/flush-volume combinations. CONCLUSION: An adequately sized postinfusion crystalloid flush (0.5 mL/kg) permits peripherally administered model drug to reach the central circulation as quickly and in equivalent concentration as centrally administered drug during CPR in a canine cardiac arrest model.

Analysis of Variance↗

PubMed1999

Methods of obtaining peripheral venous access in difficult situations.

Peripheral venous access is frequently required in the hospital environment. This can occasionally be difficult to obtain. We have reviewed the pertinent literature and propose a structured algorithmic approach to reduce patient discomfort and to minimise the time involved in securing venous access.

Algorithms↗

PubMed1989

New reperfusion devices: the Kensey catheter, the atherolytic reperfusion wire device, and the transluminal extraction catheter.

Substantial interest exists in the development of reperfusion and recanalization devices that would aid in the management of both peripheral vascular and coronary artery occlusive disease. Several of these devices are now in multicenter investigative trials. The atherolytic reperfusion wire incorporates a 0.035-inch guide wire with a modified tip to recanalize the lumen through the totally obstructed vascular segment. Clinical experience in the initial 12 patients has been successful. The Kensey catheter, a high-speed rotational recanalization device, has been used in 110 patients in a multicenter trial. Technical success has been reported in 77% of the patients and clinical success in 55% of the patients, with follow-up periods of 3 months to 1 year. The transluminal extraction catheter (TEC) is a torque-controlled atherectomy catheter that incorporates an aspiration device into a distal rotational cutter. Consequently, distal embolization has not been a clinical problem in the 95 patients treated with the TEC catheter for peripheral vascular disease. Technical success has been accomplished in 87 (92%) patients. Three-month follow-up studies in 16 patients showed that restenosis occurred in four, two of whom had undergone combined atherectomy and angioplasty.

Angioplasty, Balloon↗

PubMedDate not supplied

Peripheral intravenous therapy management.

Many nurses are involved in the management of peripheral intravenous therapy. Using scenarios of common presenting problems and evidence-based interventions, this article describes rationales for best practice. Readers are encouraged to critically appraise their own practice and to consider ways to improve the standard of intravenous therapy in their clinical area.

Benchmarking↗

PubMed1990

How to insert a peripheral venous cannula.

Peripheral venous cannulation is the commonest vascular surgical procedure. It is usually performed by a junior doctor who has learnt the skill from a colleague only marginally more skilled. Correct technique will improve the chances of success and patient comfort and safety.

Antisepsis↗

PubMed2001

Excimer laser-assisted recanalisation of femoral arterial stenosis or occlusion caused by the use of Angio-Seal.

The aim of this study was to demonstrate the effect of excimer laser and balloon angioplasty of femoral artery stenosis and occlusion after use of a haemostatic puncture closure device. A haemostatic puncture closure device (Angio-Seal) was used in 6000 patients after diagnostic or therapeutic artery catheterisation. In 34 of those patients symptoms of peripheral artery disease occurred. Sixteen of those 34 cases were transferred to our clinic for excimer laser angioplasty. All 16 patients presented with symptoms of acute peripheral artery disease within 1-14 days: superficial femoral artery (SFA) occlusions (4 cases); superficial femoral artery stenosis (3 cases); high-grade stenosis of the common femoral artery (CFA; 3 cases); high-grade stenosis of CFA; SFA and profund femoral artery (PFA; 3 cases); and occlusions of CFA, SFA and PFA (3 cases). Before any procedure was performed, informed consent was given by the patient, which included the use of the Angio-Seal closure device. Every patient who had to undergo recanalisation procedures gave additional informed consent which especially included the usage of the excimer laser for recanalisation. A measurement of the walking distance, ankle-brachial systolic pressure index (ABI) and diagnostic angiography was performed in 13 cases before and immediate after as well as 3 and 6 months after therapeutic percutaneous transluminal laser angioplasty followed by balloon angioplasty (PTLA/PTA). In 3 patients the risks of PTLA/PTA was considered too high; those patients underwent surgical repair. Angiographic and clinical improvement was achieved in 13 of 13 patients. The mean walking distance increased from 81 to > 400 m. The average ankle-brachial systolic pressure index (ABI) increased from 0.47 to 0.84. One patient developed a dissection of the SFA, and in 1 case a peripheral embolisation was seen. The PTLA/PTA technique is a successful therapeutic option for patients with femoral artery occlusion or high-grade stenosis after Angio-Seal application.

Angioplasty, Balloon, Laser-Assisted↗

PubMed2006

Variation in blood and body fluids exposure when small-gauge needles or peripheral venous catheters were implicated: results of a 4-year surveillance in France.

The blood and body fluids exposure (BBFE) risk for health care workers varies according to numerous factors. Based on a needlestick surveillance in 13 French hospitals from 1997 to 2000, we evaluated incidence and temporal trends of BBFE according to medical devices causing needlestick injuries. We observed that the BBFE incidence per 100,000 peripheral venous catheters purchased decreased from 12.9 to 4.9, whereas incidence per 100,000 subcutaneous needles purchased increased from 8.7 to 14.3.

Blood-Borne Pathogens↗

PubMed2005

[Peripheral venous placement: evaluation of guidelines respect in prehospital setting].

INTRODUCTION: Respect of guidelines for peripheral venous placement has never been studied in prehospital setting. OBJECTIVE: Describe prehospital practice in peripheral venous placement and perform comparison with guidelines. MATERIAL AND METHODS: Prospective study, in mobile intensive care unit from a university hospital, October 2002 to January 2003. Study of prehospital practice for peripheral venous placement in prehospital setting and comparison with guidelines. Guideline from Anaes: wearing a cap and a mask, washing hands, washing insertion site with water and soap, wearing sterile gloves, using sterile gauze, applying iodine solution to the insertion site, using catheter with a protective system and applying occlusive dressing. RESULTS: Six hundred seventy-three reports were studied. A cap and a mask wearing and washing insertion site with water and soap were never respected. Washing hand with antiseptic was reported in 56% of the cases, washing insertion site with iodine solution in 4%, wearing sterile gloves in 21%, using catheter with a protective system in 89%, using sterile gauze in 1% and applying occlusive dressing in 99%. For each criterion, respect of guidelines was significantly more frequent in nurse practice than in physician practice. CONCLUSION: Guidelines for peripheral venous placement were not respected in prehospital setting. Education and formation are necessary to optimize infectious risk prevention in prehospital care.

Adolescent↗

PubMed1990

[Clinical experience with the Kensey catheter system--complications and results].

Fifteen procedures have been carried out in 14 patients using the Kensey rotation angioplasty system. Sixteen occlusions of the superficial femoral artery, with an average length of 10.2 cm (3 to 24 cm) and one artery with multiple stenoses were treated. The following results were obtained: creation of a lumen, with subsequent balloon dilatation in eight out of fifteen procedures; in two patients the vessels were occluded shortly after the procedure, due to complications (one obstructive plaque and one haematoma); five perforations, three dissections and one peripheral embolus. The total complication rate was 11 out of 15 cases, clinical improvement was obtained in six out of 15 cases.

Aged↗

PubMed2003

Assessment of the infant with a peripheral intravenous device.

Inserting, monitoring, and maintaining peripheral venous access is an integral component of neonatal nursing care. Although complications associated with peripheral vascular devices are typically minor, some infants may experience life-threatening sequelae or serious and prolonged alterations in function. This article provides a review of the relevant anatomy and physiology of the peripheral venous system, techniques for maintaining catheter security, and guidelines for conducting a systematic physical assessment. The most commonly occurring complications, such as infiltration, phlebitis, and occlusion, are described. The etiology of the complications, signs and symptoms, and key evidence-based prevention strategies are outlined.

Bacteremia↗

PubMed2004

[The choice of a peripheral access catheter].

The administration of liquids, electrolytes and pharmaceutical products by intravenous means is considered to be the most rapid, effective therapy which provides the best effects in patients who require hospital care which justifies this method being a method frequently chosen for the majority of patients checked into hospital care. The choice of peripheral catheter makes it possible to achieve, in an easy and relatively bloodless manner, venous access for short or medium duration treatment with a low risk of serious complications. Due to the nurse's responsibility when a catheter is installed, and the treatment when applying and the follow up necessary for endovenous therapy, we deduce the importance to correctly evaluate the necessities, advantages and inconveniences of each type of these devices and systems at the time nurses decide which catheter should be used on a patient. The criteria used to select a peripheral catheter are basically determined by a patient's age, the quality and calibre of the access veins, the objective of their use, the foreseen time for their use, the aggressiveness of the solutions which will be passed through the catheter, and the characteristics of the catheter itself.

Catheterization↗

PubMedDate not supplied

Use of midline catheters in low birth weight infants.

Prolonged intravenous access is an important consideration in the treatment of premature neonates. Because peripheral intravenous catheters have short dwell times, centrally positioned percutaneous catheters have been used increasingly in neonatal intensive care. Midline catheters are peripherally inserted long catheters advanced only to the proximal portion of a limb or to the neck, with the tip remaining outside the thoracic and abdominal cavities. Midline catheters were placed with use of an innovative technique via a 24-gauge Angiocath catheter (Becton Dickinson, Sandy, Utah). This study compared dwell time and reason for removal of midline catheters with respective data for peripheral intravenous catheters. Dwell time was found to be 9.0 +/- 1.4 days for the midline catheters versus 3.1 +/- 0.5 days for peripheral intravenous catheters placed in the same patients (p < 0.05). No significant complications occurred with the use of midline catheters. These data suggest that midline catheters may be useful in neonates who require a limited duration of intravenous therapy.

Catheterization, Peripheral↗

PubMed2002

Peripheral Teflon catheters: factors determining incidence of phlebitis and duration of cannulation.

BACKGROUND: Catheter-related phlebitis is a frequent problem in the clinical setting. Risk factors for catheter-related phlebitis were assessed at a single tertiary-care institution where no routine change policy for peripheral intravenous catheters is in place. METHODS: In a nonrandomized, observational trial, peripheral intravenous Teflon catheters were inserted in patients with a diagnosis of leukemia, lymphoma, solid tumor, acquired immunodeficiency syndrome, other serious infection, or autoimmune disorder. Underlying disease, age, white blood cell count at the time of insertion, physician placing the catheter, catheter bore, duration of cannulation, reason for removal of the catheter, and visual inspection of the insertion site were recorded. RESULTS: Four hundred twelve catheters were inserted in 175 patients. The number of catheterizations per episode varied between 1 and 7. Three hundred sixty-four (88.3%) catheter placements were evaluable. The mean duration of cannulation was 4.2 days. The overall incidence of phlebitis was 12.9%. Catheters in leukopenic patients showed a longer duration of cannulation compared with catheters in nonleukopenic patients, but no difference regarding the phlebitis rate. CONCLUSION: Findings in this study partly contrast with data reported in the literature. In particular, leukopenia, female gender, prolonged duration of cannulation, antibiotics, and choice of insertion site could not be shown to be risk factors.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Correct utilization and management of peripherally inserted central catheters and midline catheters in the alternate care setting.

Based on patient condition, intravenous therapies, caregiver support, and organizational policy, correct device selection plays an integral part in the overall care and management of the alternate care setting i.v. therapy patient. This paper will identify the various aspects of appropriate device selection for i.v. therapy prescriptions.

Catheterization, Central Venous↗

PubMed1997

Performing peripheral intravenous cannulation.

Nurses need to be aware of their level of accountability when performing i.v. cannulation. Nurse cannulation should be incorporated into practice as part of holistic patient care. When introducing nurse cannulation into a department, a commitment is required from the individual nurse and the organisation. i.v. cannulation is a skilled technique, best performed as a staged process.

Catheterization, Peripheral↗

PubMed2006

Peripheral arterial sheath removal program: a performance improvement initiative.

The increasing number of endovascular procedures by both cardiologists and vascular surgeons strain available resources, such as recovery space, creating delays in the throughput of patients. The use of alternative settings, personnel, and approaches to postprocedural care has been proposed to maximize the number of procedures that can be done with existing procedure rooms. However, a key question remains about whether this can be done safely and achieve good patient outcomes. A performance improvement project was conducted to evaluate the safety and effectiveness of shifting postprocedural care and removal of intraarterial sheaths by the staff in the cardiac catheterization laboratory to specially trained acute care nurses on an inpatient vascular surgical unit. The purpose of this project was to develop a performance improvement project that included administrative, educational, and clinical components and to evaluate effects on key patient outcomes, prospectively, over 15 months.

Adult↗