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Results for “Catheterization, Peripheral”

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PubMed2002

Experience of prophylaxis treatment in children with severe haemophilia.

The practice of prophylactic treatment of boys with severe haemophilia has been evaluated in our centre. Prophylaxis was started at the median age of 3.7 years (range 0.4-12.7 years) in 38/41 children (93%) under 17 years of age. Median follow-up was 4.1 years (range 0.4-12.7 years). The criteria of primary prophylaxis according to the definition by the European Paediatric Network of Haemophilia Management was fulfilled by 9/38 (24%). Although a majority [76%, 29/38] of the children started prophylaxis after a median number of joint bleeds of 3.5, 70% of the children in this group had clinical joint scores of 0. Intravenous catheter insertion was required at a median age of 15.5 months (range 5-36 months) in 21% of the children, resulting in a catheter infection rate of 1.74 per 1000 catheter days. None developed an inhibitor on prophylaxis and three patients who had low-titre inhibitors (< 5 Bethesda units) prior to prophylaxis had undetectable inhibitors after prophylaxis. The home-treatment training programme required considerable time and cost. As a result, 87% of the children used peripheral venous access and hospital visits declined as prophylaxis became established. Parents' incentives for prophylaxis were that the children undertook many physical activities and sports previously not recommended, there was less parental anxiety and an overall improvement in the quality of life for the whole family.

Bacterial Infections↗

PubMed1993

Peripherally-inserted central catheters: challenges for hospital management.

The peripherally-inserted central catheter (PICC) is an established technology in home intravenous (IV) therapy and its use is increasing in hospital and home-health settings. Institutions introducing PICCs as another form of IV therapy will realize cost savings. However, challenges may be encountered. Implementation and education programs for staff, patients, and home caregivers will maximize the benefits of PICC use.

Catheterization, Central Venous↗

PubMed1997

Inserting and maintaining peripherally inserted central catheters.

Peripherally inserted central catheters are a type of vascular access device that has many advantages for patients with longer-term and special infusion needs. Increasingly common in home and hospital settings, nurses should know how to insert, maintain, and educate patients and families about these devices. One hospital's experiences implementing a model program is described.

Bandages↗

PubMed2006

Predictors of topical anesthetic effectiveness in children.

UNLABELLED: Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [EDN1], endothelin receptor A [EDNRA], endothelin receptor B [EDNRB]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger (P < .0001), more active (P = .0029), scored higher for trait (P = .0009) and state anxiety (P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026). PERSPECTIVE: The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.

Administration, Topical↗

PubMed2002

[Reasons for discontinuing intravenous therapy associated with the time of in-situ permanence of peripheral venous devices].

This study aimed to relate the reasons for interrupting intravenous therapy and the time of in-situ permanence of venous devices. The results obtained showed that in 38 of the 75 punctures performed, the reason to interrupt the venous therapy took place after the end of the therapy and that time of in-situ permanence of peripheral devices varied from 24 to 48 hours. In 15 punctures, in which infiltration was the reason for interruption, the time of permanence was shorter than 24 hours. It is believed that the data gathered in this investigation should be analyzed by nursing professionals, aiming to enhance new educational programs in services related to intravenous therapy.

Catheterization, Peripheral↗

PubMedDate not supplied

Peripherally inserted central catheters--review and case reports.

Patients have been receiving intravenous therapies in their homes since the early 1980s. Peripherally inserted central catheters have recently played a major part in the successful transition from hospital to home. These catheters are less invasive, have a lower overall infection rate and are less costly than other central venous catheters. This review and presentation of two case studies illustrates the advantages of this type of catheter for patients receiving home intravenous therapy.

Adult↗

PubMed2006

Implementing best practice strategies to prevent infection in the ICU.

Critically ill patients are at high risk for infection because of many factors. Quality and regulatory groups have published guidelines regarding infection prevention in the ICU. A multifaceted, multiprofessional team approach is necessary to develop and implement strategies to prevent infection in the critically ill patient. Bundles of intervention along with daily rounds an assessment are essential program components. Ongoing surveillance and re- education and reinforcement are also part of a strong infection prevention program.

Benchmarking↗

PubMedDate not supplied

The infusion nurse and patient complication rates of peripheral-short catheters. A prospective evaluation.

The objective of this study was to compare catheter-related complication rates in patients who had infusion devices placed by infusion nurses with complication rates in patients who had devices placed by generalist nurses. The data demonstrated that peripheral infusion devices placed by infusion nurses exhibited a statistically significant lower rate of leakage, phlebitis, and infiltration complications and remained in the vein significantly longer than those placed by generalist nurses. However, significance was not achieved with pain complication rates between the two groups. The implications of these outcomes for staff development and quality of patient care are discussed.

Adult↗

PubMed2002

The use of local anaesthesia in peripheral venous cannulation: current practice of junior doctors.

OBJECTIVE: To determine the rate of use of local anaesthetic in peripheral venous cannulation by pre-registration house officers and to determine reasons why they do not use it. DESIGN: Analysis of anonymous questionnaires distributed to pre-registration house officers at scheduled weekly education meetings. SETTING: One regional hospital and three district general hospitals in the United Kingdom. RESULTS: 71 questionnaires were distributed directly to respondents and subsequently analysed. 46 respondents (65%) stated that they never used local anaesthetic for peripheral venous cannulation. Of those who used local anaesthetic the average rate of use was 6%. Of those who used local anaesthetic 48% stated they used EMLA and 84% stated they used lignocaine. 4% stated they would use local anaesthetic for 22 gauge cannulae, 8% would use it for 20 gauge, 24% for 18 gauge and 40% for 16 gauge and 28% for 14 gauge cannulae. 45% stated that using local anaesthetic was too time consuming, 35% stated it was not indicated, 21% stated that it made cannulation difficult, 13% stated that local anaesthetic was not available on the ward, 13% stated that it was logistically difficult, 4% stated that there was peer pressure not to use it, 4% stated they were not allowed to use local anaesthetic and 3% stated that it was practically difficult. 20% of respondents gave no reason. CONCLUSIONS: Despite good clinical evidence that the pain of peripheral venous cannulation can be successfully obviated using local anaesthetic, the rate of use by pre-registration house officers is low. It is suggested that during formal cannulation training, more emphasis be placed on the provision of analgesia. This should aim to increase the quality of care to those patients requiring intravenous cannulation as well as offering other potential benefits to doctors.

Anesthesia, Local↗

PubMedDate not supplied

The growth and development of an Intravenous Nurses Society chapter PICC council.

Growing interest in peripherally inserted intravenous catheters led to the development of the PICC Council. This council was established to provide a resource of information for the area nurses involved in peripherally inserted intravenous catheters use and care. The group went through various developmental stages as they sought to establish cohesiveness and professional collaboration across a variety of practice settings. The outcome was the development of recommendations for vocabulary, communication, and care/maintenance activities, that could be used by intravenous nurses to enhance patient care coordination.

Catheterization, Central Venous↗

PubMed1992

Options for percutaneous coronary and peripheral revascularization.

Angioplasty has become an established treatment for both coronary and peripheral atherosclerosis, and a number of new techniques and devices promise to improve the results of percutaneous intervention during the coming decades. It is likely that balloon angioplasty will remain the percutaneous treatment of choice for both coronary and peripheral intervention; however, we look with hope toward the development of new devices that will expand the role of percutaneous angioplasty and improve the long-term success of these procedures. As technical expertise grows with the new procedures, prospective randomized trials comparing them with standard PTCA will be required to enable physicians to judge their clinical utility.

Angioplasty, Balloon, Coronary↗

PubMed1994

Peripherally-placed central venous access ports: clinical and laboratory observations.

The P.A.S. Port system is a totally implantable central venous access device consisting of a miniature titanium portal and a 5.8 French catheter that is specifically designed for implantation in the forearm. The configuration of this system combined with its unique placement technology provides a simplified alternative to conventional chest-placed systems. Our group has placed a total of 61 P.A.S. Port devices in 56 patients whose ages ranged from 9 months to 85 years and who were followed for a median of 672 days. Over this period of follow-up, these devices have demonstrated a low overall complication rate (13.1%), an infection rate of 6.6%, median event-free patency of 278 days, and exceptional patient acceptance. Placement of the P.A.S. Port system is easily performed as an outpatient procedure under local anesthesia and requires neither fluoroscopy nor a conventional operating room setting. In vitro measurement of infusion pressure across a P.A.S. Port and a conventional catheter system revealed much higher resistance in the peripherally placed device, but this was found to be of no clinical significance because infusion pressures generated by flow rates up to 750 mL/hr were well within the limits of clinically available infusion pumps. We recommend the P.A.S. Port system as a safe, durable, and effective alternative for patients in whom a chest-placed device is inappropriate or undesired.

Adolescent↗

PubMed1995

Radial nerve injury after routine peripheral vein cannulation.

The dorso-radial aspect of the wrist and hand is a common location for intravenous (IV) cannulation prior to anesthesia. The sensory branch of the radial nerve lies superficially in this area, and it can be injured during routine insertion of IV catheters. In this case, the nerve was lacerated during insertion and a painful neuroma developed after elective surgery and anesthesia. Knowledge of this complication may help with its recognition and treatment.

Adult↗

PubMed2005

Peripheral arterial cannulation for Abiomed BVS 5000 left ventricular assist device support.

The Abiomed BVS 5000 is an external, pulsatile, ventricular assist device typically used for short-term mechanical support in post-cardiotomy patients experiencing cardiogenic shock when myocardial recovery is expected. We describe an as yet unreported approach where the left common femoral artery was utilized for Abiomed left ventricular assist device cannulation after reoperative mitral valve surgery.

Aged, 80 and over↗

PubMedDate not supplied

A method for determining 4-aminopyridine in plasma: pharmacokinetics in anaesthetized guinea pigs after intravenous administration.

An HPLC assay has been developed to measure 4-aminopyridine (4-AP) in guinea pig plasma. For the assay, all plasma samples (50 microL) were microfiltered following the addition of an internal standard (3,4-diaminopyridine). Filtrates (10 microL) were directly injected into a spherical silica column (100 x 2.1 mm; 5 microns); detection was achieved at 266 nm. Standard curves had correlation coefficients ranging from 0.9923 to 0.9992 and coefficients of variation expressed as a percentage (% CV) of below 8%. Precision was expressed as between-day and within-day variability of five test sample concentrations. Between-day % CV ranged from 4.0 to 6.5%. Within-day % CV ranged from 3.6 to 6.9%. Accuracy was assessed by examining expected within-day test sample concentrations against calculated concentrations; per cent errors were all below 10%. Stability studies demonstrated % CV below 5% after repeated freezing. The method was employed to study the pharmacokinetics of 4-AP after intravenous administration to anaesthetized guinea pigs. Serial blood samples (150 microL) were collected at predetermined time intervals up to 4 h post-4-AP (2 mg/kg, i.v.) administration. 4-AP demonstrated a biexponential decline in the plasma-concentration curve as a function of time indicating a two compartment model for this drug. Selected mean pharmacokinetic parameter estimates were alpha-half-life, 0.37 min; beta-half-life (biological half-life) for terminal slope, 109 min; and volume of distribution at steady state, 1036.18 mL/kg. 4-AP was found to rapidly and extensively partition into a peripheral tissue compartment and demonstrated a relatively long biological half-life. The findings from the current pharmacokinetic experiments support the pharmacology of 4-AP in its role for reversing saxitoxin (STX)- and tetrodotoxin (TTX)-induced diaphragmatic failure in terms of onset of action and duration of effect in anaesthetized guinea pigs.

4-Aminopyridine↗

PubMedDate not supplied

Peripheral intravenous therapy-related phlebitis rates in an adult population.

To determine the incidence of peripheral intravenous therapy-related phlebitis in an adult population, 305 peripheral i.v. catheter sites were observed from the time of admission of the patient (or initiation of the first peripheral i.v. catheter) to the time of the participant's discharge from the facility (or 48 hours after the removal of the final catheter). Parameters monitored included patient demographics, diagnosis, i.v. fluids and medications, type of peripheral catheter, dwell time, and dressing integrity. Results showed that of the 10 cases of phlebitis found in nine study subjects, all were associated with catheters indwelling less than 72 hours. In three cases, although the catheter site was clear at the time of catheter removal, postinfusion phlebitis developed within 24 hours. Catheter site locations, diagnoses, medications, and i.v. fluids in these cases were varied.

Adult↗

PubMed1997

Silastic catheters for home antibiotic therapy in patients with cystic fibrosis.

UNLABELLED: Repeated 14-day courses of intravenous antibiotic therapy for patients with cystic fibrosis (CF), who have been colonized with Pseudomonas aeruginosa (PA), is one currently accepted treatment. Conventional intravenous cannulas for antibiotic delivery often have a short line life leading to frequent venipunctures. Therefore we used silastic catheters as a peripheral venous access. Silastic catheters (15 cm, 0.6 mm diameter) were inserted 10 cm into a cubital vein in 15 patients with CF (age 5-32 years) for 20 antibiotic courses. After the antibiotic infusion the catheter was flushed with 200 U heparin (2 ml Vetren). In all patients the antibiotic therapy was delivered as a home therapy. In 15 antibiotic courses the silastic catheter could be continuously used for 14 days. One patient with methicillin resistant Staphylococcus aureus received antibiotic therapy for 54 consecutive days using the same silastic catheter. The catheter had to be removed in four courses: once because of thrombophlebitis with local inflammation, once because of burning pain during infusion and occlusion twice. In one case the patient removed his catheter because of technical problems. No other serious side effects occurred. Ten patients had previously received intravenous antibiotics at least once. The median line life of the last used conventional peripheral cannula of all patients was 4 days versus 14 days with the use of the silastic catheter (P < 0.005). All patients preferred the silastic catheter to other venous access. CONCLUSION: Because of the long line life and easy handling, silastic catheters may be an alternative venous access to perform home antibiotic therapy in patients with CF.

Adolescent↗

PubMed2000

Saline for peripheral intravenous locks in neonates: evaluating a change in practice.

PURPOSE: To evaluate the efficacy of saline versus 10 units/ml heparin for peripheral i.v. flushes in neonates. DESIGN: A nonexperimental group design was used to compare the longevity of heparin and saline i.v. locks. A research utilization method was chosen to increase the study power while simultaneously implementing a practice change and evaluating the outcomes. Power analysis showed that a sample size of approximately 120 per group was needed to decrease the risk of beta error to 0.1. SAMPLE: Subjects included neonates in the Special Care Nurseries at a Level III large midwestern university teaching hospital. Data were collected from a convenience sample of 123 neonates receiving 10 units/ml heparin flush into a peripheral i.v. Practice was then changed to preservative-free normal saline, and data collection continued for 117 neonates. MAIN OUTCOME VARIABLE: I.v. catheter longevity. RESULTS: There was no significant statistical difference in i.v. catheter longevity between i.v. locks flushed with 10 units/ml heparin and those flushed with normal saline. Patient weight accounted for a significant proportion of the variance in i.v. catheter life.

Catheterization, Peripheral↗