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PubMed2004

Randomised clinical trial of elective re-siting of intravenous cannulae.

INTRODUCTION: Peripheral venous thrombophlebitis (PVT) represents a considerable source of iatrogenic morbidity, occurring in about 20% of hospital in-patients. The aim of this prospective randomised study was to investigate the effect of elective change of intravenous cannulae on the incidence of PVT in hospital in-patients. PATIENTS AND METHODS: General medical and surgical inpatients requiring intravenous therapy were randomised into control (n = 26) or study (n = 21) groups. Cannulae in the control group were only removed if the site became painful, the cannula dislodged, or there were signs of PVT. Cannulae in the study group were changed electively every 48 h. All patients were examined daily for signs of PVT. RESULTS: Peripheral venous thrombophlebitis developed in 11/26 patients in the control group and 1/21 patients in the study group (P = 0.003). Elective change of cannulae did not significantly increase the total number of cannulae sited (41 cannulae in the control group versus 43 in the study group). CONCLUSIONS: Elective change of cannulae resulted in a significant reduction in the incidence of infusion phlebitis. The authors recommend that elective re-siting of intravenous cannulae becomes standard practice for all patients requiring intravenous therapy.

Adult↗

PubMed2000

[Septicemias related to intravascular catheters].

Catheter-Related Septicemia (SRC) is an important health problem which depends on, to a large degree, a nurse's care, both concerning the insertion technique employed in cases involving peripheral catheters and centers of peripheral access (PICC) and concerning the manipulation, maintenance and treatment applied no matter what type of catheter is used. The challenge for nurses consists in minimizing the number of complications which occur. Catheter-Related Septicemia can be prevented. In order for this prevention to occur, we must unify our criteria and exercise the utmost care in carrying out our assistance to patients. Therefore, strict asepsis while inserting catheters and manipulating blood vessels acquires maximum importance.

Asepsis↗

PubMed1996

Discard volumes necessary for clinically useful coagulation studies from heparinized Hickman catheters.

PURPOSE/OBJECTIVES: Determine the blood volume that must be wasted to obtain a clinically useful prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen concentration for blood drawn from a heparinized (2.5 ml of 100 units/ml), double-lumen venous catheter. DESIGN: Prospective, nonrandomized study comparing test results obtained from blood samples drawn through the catheters with those obtained via peripheral venipuncture. Patients acted as their own control. SETTING: Inpatient and outpatient units of a cancer research center located in a mid-Atlantic city in the United States. SAMPLE: Twenty double-lumen 10 Fr. Hickman catheters (Bard Access Systems, Salt Lake City, UT) were studied in 20 adult patients with cancer who had no history of coagulation disorders. METHODS: Samples were collected from the red lumen of 20 heparinized, double-lumen Hickman catheters after 5, 10, 15, 20, and 25 ml of blood first were discarded. PTs, APTTs, and fibrinogen concentrations were measured on each sample. The results were compared with those derived from a simultaneously obtained peripheral blood sample. MAIN RESEARCH VARIABLES: PT, APTT, and fibrinogen values of blood samples after 5, 10, 15, 20, and 25 ml discards and PT, APTT, and fibrinogen of peripheral blood samples. FINDINGS: The coagulation results using peripheral blood were always within the normal range except for one slightly elevated APTT. After 25 ml of discard, all of the PTs and fibrinogen concentrations and 95% of the APTTs of catheter blood were within the normal range and therefore clinically useful. CONCLUSIONS: Clinically useful PTs, APTTs, and fibrinogen concentrations often can be derived with catheter-drawn blood when the objective is to confirm normal coagulation. However, because it is very difficult to obtain heparin-free samples through heparinized, double-lumen Hickman catheters, peripheral blood should be drawn for coagulation testing when a totally heparin-free sample is needed to make a critical clinical decision. IMPLICATIONS FOR NURSING PRACTICE: These findings provide important information for practice when nurses have to decide whether to draw coagulation tests through a heparinized catheter. Further research is needed with larger samples in varied populations (e.g., pediatrics) to study catheters made of different materials and of different calibers.

Adult↗

PubMed2005

Mycobacterium fortuitum bacteraemia in an immunocompromised patient.

A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four positive serial blood cultures is reported here. The patient was a known case of acute lymphoblastic leukemia (ALL) on intensive chemotherapy. The source of bacteraemia was most probably a peripherally inserted vascular catheter. After initiation, of treatment with amikacin to which the strain was sensitive and clarithromycin and removal of the central line the patient's fever defervesced and repeat blood cultures were negative. This is the first time we have encountered an immunocompromised patient with M. fortuitum septicaemia in our hospital. The possibility of an infection with rapidly growing mycobacteria is important to consider when conventional organisms are not isolated in culture especially in the context of patients with malignancy.

Adult↗

PubMedDate not supplied

Peripheral i.v. cannula dressings: advantages and disadvantages.

There are many peripheral intravenous cannula dressings being used throughout the country. This article is a review of these dressings and looks at those used in the authors' trust as well as other products on the market. The article gives an overview of the advantages and disadvantages of the different dressings, including costs, that allow medical and nursing staff to make an informed choice about the type of dressing they use. The authors felt, given all the evidence, the traditional method of using gauze, tape or mefix was no longer acceptable practice.

Bandages↗

PubMedDate not supplied

Enhancing the nursing role: why nurses want to cannulate.

This small qualitative study explored nurses' reasons for undertaking a traditional medical task, that of peripheral intravenous cannulation, and their perceptions as to how this task contributes to their nursing skills. The findings suggest that it benefits the continuity and quality of patient care and provides nurses with personal and professional satisfaction, promoting the delivery of holistic care and the opportunity to initiate autonomous clinical interventions. It is argued that the development of such nursing skills may require professional and organizational support in the form of practice guidelines, protocols and vicarious liability boundaries to enable nurses to practise effectively and efficiently.

Attitude of Health Personnel↗

PubMed2006

Uterine vein and maternal urinary levels of activin A and inhibin A in pre-eclampsia patients.

OBJECTIVES: The aims of this study were to investigate if (i) urinary concentrations of activin A and inhibin A are altered in pre-eclampsia (PE) and (ii) to study the relationship between uterine vein and peripheral vein concentrations of these hormones in PE patients. DESIGN AND METHOD: In a retrospective study, maternal peripheral vein and uterine vein serum and maternal urine samples collected at the time of delivery were analysed. There were three groups of patients; (i) group 1: term normal pregnancies (n = 19) (ii) group 2: patients who developed PE < or = 37 weeks (n = 17) and (iii) group 3: patients who developed PE 37-40 weeks (n = 8). Serum and urinary activin A, follistatin, inhibin A and pro alpha C and urinary creatinine levels were measured using enzyme immunoassays in the laboratory. RESULTS: Normal pregnant urine samples had very low levels of activin A and inhibin A. Both groups 2 and 3 PE patients had significantly higher levels of inhibin A (P < 0.001) and activin A (P < 0.001) compared to the controls. Pro-alpha C was not altered and follistatin was below the detection limit of the assay in the urine. Maternal peripheral serum activin A and inhibin A were significantly higher in groups 2 (P < 0.001) and 3 (P < 0.05) patients compared to the controls. Pro-alpha C-containing inhibins were higher in group 2 patients (P < 0.05) compared to the controls in the peripheral circulation. Uterine vein serum activin A and inhibin A levels were also significantly higher in groups 2 (P < 0.001) and 3 (P < 0.05) patients compared to the controls. There was a highly significant positive correlation between peripheral and uterine vein serum concentrations of activin A, follistatin, inhibin A and pro alpha C, suggesting the same source for these proteins in PE. CONCLUSION: Urinary activin A and inhibin A are raised in groups 2 and 3 PE patients. The magnitude of rise (> 25-fold) suggests these proteins may rise in patients before the onset of the clinical symptoms of PE. Uterine vein levels of these proteins are also raised in PE.

Activins↗

PubMed2004

Emergency nurses' utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients.

OBJECTIVES: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. METHODS: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. RESULTS: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. CONCLUSIONS: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients.

Catheterization, Peripheral↗

PubMedDate not supplied

Local anesthesia for vein cannulation: a comparison of two solutions.

This randomized, double-blinded study prospectively compared two solutions for their anesthetic effect during initiation of peripheral intravenous catheters. Each subject received an intradermal injection of one solution at the intended venipuncture site immediately before vein cannulation. After catheter placement, the subjects rated their discomfort associated with this procedure using the Wong-Baker FACES Pain Rating Scale. Of the 47 subjects included in this study, 21 received lidocaine hydrochloride 1% with sodium bicarbonate and 26 received sodium chloride 0.9% with benzyl alcohol. No statistically significant difference in pain scores was found between the two groups (P =.429).

Adult↗

PubMedDate not supplied

The minimum discard volume: accurate analysis of peripheral hematocrit.

The purpose of this research is to quantify the minimum amount of blood that must be discarded from an indwelling peripheral intravenous catheter (deadspace 0.5 ml) to obtain an accurate hematocrit reading. Repeat blood sampling from nine subjects is used to develop a mathematical model (Michaelis-Menten curve) describing the mixing of the flush solution and the blood. This model is used to estimate the hematocrit when different volumes are discarded. Differences between the computed hematocrit and true hematocrit were determined for each subject. When 1.5 ml (three times the deadspace volume) is discarded, the 95% confidence interval is within 0.6% of the true hematocrit.

Adult↗

PubMedDate not supplied

Using normal saline to lock peripheral intravenous catheters in ambulatory cancer patients.

Previous studies examined the usefulness of saline in maintaining the patency of peripheral intravenous catheters. Although patients with cancer were included in some samples, no reports specific to these patients were found. The purpose of this study was to examine the ability of non-bacteriostatic normal saline to maintain the patency of IVs in patients with cancer and minimize phlebitis. Eighty nine IVs in 75 ambulatory cancer patients were evaluated. The occlusion rate was 8%, and the rate of phlebitis was 6%. We are of the view that this finding is reasonable, given the toxic nature of the medications administered.

Adult↗

PubMedDate not supplied

Local anesthesia prior to the insertion of peripherally inserted central catheters.

Using a randomized, controlled study, the investigators evaluated and compared the effects of local anesthesia versus no anesthesia on pain associated with peripherally inserted central catheter (PICC) insertion. A sample of 42 subjects was selected and divided into three groups. Group 1 received EMLA cream. Group 2 received buffered lidocaine. Group 3 (the control group) did not receive a local anesthetic. The short form of the McGill Pain Questionnaire was used to measure pain quality and intensity. A numerical Visual Analogue Scale accompanied the questionnaire and measured overall pain intensity. Results showed that buffered lidocaine was statistically superior to EMLA cream or no anesthetic in relieving pain associated with PICC insertion.

Adult↗

PubMedDate not supplied

Efficacy of ultrasonography in peripheral venous cannulation.

A retrospective study of 431 patients who had peripherally inserted midclavicular or central catheters placed during a consecutive 13-month period using the conventional landmark method for placement was compared with a second group of 326 patients, who during a 12-month period had such catheters placed using ultrasonography. The data demonstrate a 42% decrease in the number of needle penetrations needed to successfully cannulate veins when ultrasound was used during placement. There is a 26% greater chance of successful cannulation of the vein on the first attempt with ultrasound-guided placements than with those using the traditional landmark method.

Arm↗

PubMedDate not supplied

The peripherally inserted central catheter: a retrospective look at three years of insertions.

The advent of intravenous therapies administered in the home setting has created a demand for the peripherally inserted central catheter (PICC). A variety of PICCs is now on the market, offering choices of insertion methods as well as size and length. This article represents a retrospective look at 858 PICCs inserted over a 3-year period, using three insertion methods: 1) the Seldinger technique, 2) the peel-away sheath, and 3) the break-away needle. A brief history of PICCs along with problems encountered, an account of PICCs in immune-suppressed patients, and principles of catheter management are presented.

Adolescent↗

PubMed2003

[Infection prevention and control in intravascular devices].

Intravascular devices (IVD) are indispensable in the care of the critical patient; even so, their use can be complicated by infection, which is generally associated with longer hospital stay and ensuing higher hospital costs. It is therefore imperative that guidelines are applied that constitute a basis of information upon which the individual facility can develop its own strategy. The strategy can be outlined under the following points: a) staff training, b) surveillance of IVD-associated infections, c) hand washing, d) barrier measures during catheter introduction and management, e) insertion site management and medication systems for the insertion site, f) choice and replacement of the IVD, g) replacement of intravenous administration devices and liquids, h) antimicrobial prophylaxis. In the management of central venous catheters (CVC), recommendations call for: 1) the use of a single lumen CVC, unless multiple accesses are needed; 2) the peripheral placement of CVCs, both in the use of tunneled catheters and/or implantable vascular devices in patients over 4 years of age in which long-term vascular access (> 30 days) is planned; 3) the use of completely implantable devices in pediatric patients less than 4 years of age requiring long-term vascular access; 4) the use of the subclavian artery as the site of CVC insertion unless clinically contraindicated (e.g. coagulopathy, anatomic alterations); 5) the application of barrier precautions during CVC introduction and in the management of the catheter and the insertion site.

Catheterization, Central Venous↗

PubMed2004

[Phlebitis in children].

UNLABELLED: The authors' objectives are to determine the occurrence of phlebitis in patients hospitalized in the General Pediatrics Unit and to define the possible factors associated to its development. The authors carried out a prospective study in the "Sant Joan de Deu" Hospital in Barcelona during the month of July and from the 15th of September until the 15th of October in 2002. A one variant and two variant analysis using the chi squared method as the basis for estimating which associations took place. There were 153 patients admitted having 201 peripheral veins canalized; occurrence of phlebitis was 8.4%; a venous cord (53%) was the most frequent clinical sign. In cases of phlebitis, the back of a patient's hands (64.7%) was the main spot to make an insertion using a 22G "Vasocán" catheter (70.6%). Phlebitis appeared 2 days after insertion; the high number of antibiotics administered increased the risk of phlebitis (p>0.05). CONCLUSION: Phlebitis is a frequent problem in pediatrics patients having endo-venous treatment, susceptible to prevention by means of the implementation of control measures and a program of continuous vigilance.

Catheterization, Peripheral↗

PubMed1989

Arterial chemotherapy and transcatheter arterial embolization therapy for non-resectable hepatocellular carcinoma.

An assessment was made on the therapeutic effects of arterial chemotherapy and transcatheter arterial embolization (TAE) therapy on 378 cases with non-resectable hepatocellular carcinoma (HCC). For the 191 cases who had undergone arterial chemotherapy, 22% had a 1-year survival rate, 8.9% survived for 2 years, and 4.0% for 3 years. Of these, for the 128 cases who were compatible with our criteria for patient selection, the three survival rates were 31.4%, 12.2% and 5.9% respectively. However, for the other 63 cases, who were incompatible with our criteria, the 1-year survival rate was 1.6% and it was worse for the cases who had received supportive care alone. For the cases who had undergone arterial chemotherapy, the highest survival rates were obtained by the alternate administration of different anticancer agents, and the three survival rates were 39.0%, 13.1% and 4.9% respectively. For the 187 cases who had undergone TAE therapy, the 1-year survival rate was 66.2%, the 2-year survival rate 36.5%, and the 3-year survival rate 21.9%. For the 124 cases with a tumor progression rate of less than 20% in the liver (E1), the survival rates were 77.8%, 50.1% and 30.8% respectively. The peripheral venous drug concentrations of mitomycin C and adriamycin were lower, but were maintained for a longer period in TAE therapy than in arterial chemotherapy. These results suggest that consideration of the criteria for patient selection and the alternate administration of anticancer agents are necessary in arterial chemotherapy, and that the best therapeutic effects can be obtained by TAE therapy combined with chemotherapy for cases of non-resectable HCC because of the chemotherapeutic and ischemic effects on the tumors.

Carcinoma, Hepatocellular↗

PubMed1997

[Peripheral venous catheter embolism].

The accidental embolization of peripheral venous catheter fragments seems to be a rare event. Removal of the catheter embolus is usually recommended, because of the high morbidity and mortality rates from sepsis, perforation, thrombosis and arrhythmias. We report a case, in which the diagnosis was made 17 years after the embolization by the means of a systematic chest X-ray. The use of spiral CT scan with computerized post-processing 3D reconstruction confirmed the diagnosis. Because of good tolerance during this very long term, a not-to-treat decision was taken.

Adult↗