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Results for “Catheterization, Peripheral”

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PubMed1996

Multidimensional outcomes in intravenous access device maintenance: a pilot study.

The nursing and pharmacology literature of 1988 to 1992 generally encouraged a change in nursing practice with regard to maintenance of peripheral intravenous access devices in adults. Although recommendations were based on data, methodological limitations in many studies prevented enthusiastic change from heparinized saline to saline alone. The article describes the quality journey of one community hospital toward practice change in this frequently performed patient care procedure. The success of the change is attributed to pilot outcomes work in the regional tertiary medical center, which demonstrated the credibility of the proposed change. Four organizational processes supported the scientifically based quality change: interdisciplinary efforts of the community hospital instituting the change, a test on one nursing unit, positive recognition of staff undergoing practice change, and publication and dissemination of the clinical procedure change.

Aged↗

PubMed1992

Occurrence and management of fractured peripheral catheters in CSF shunts.

A series of 716 children underwent 2065 cerebrospinal fluid shunt procedures. Shunt failure due to fracture of the peripheral drain occurred 60 times, 38 times in ventriculo-atrial and 22 times in ventriculo-peritoneal shunts. The break occurred most commonly 2-4 cm above the neck incision in cardiac and just cephalad to the clavicle in abdominal drains. Fifty-nine ruptures occurred in Pudenz catheters (which were used in 82% of the shunts) and 1 occurred in a Holter drain (used in 17%). The fractured atrial catheters remained in situ (5/38) or were dislodged into the right cardiac ventricle (14/38), pulmonary arteries (9/38), right atrium (5/38) or hepatic veins (3/38). Two of the ruptured drains could not be located. Removal by a percutaneous transvascular snare technique was attempted in 27 cases and was successful in 24.

Adolescent↗

PubMed2004

Phlebitis rate and time kinetics of short peripheral intravenous catheters.

BACKGROUND: An observational prospective cohort study was carried out on complication rates and time kinetics of phlebitis caused by short peripheral intravenous catheters (PIVCs) in inpatients on 15 hospital wards in four hospitals in Cologne, Germany. PATIENTS AND METHODS: We observed 1,582 patients with 2,495 PIVCs daily using standardized questionnaires. Phlebitis was defined using modified Centers for Disease Control and Prevention (CDC) criteria. RESULTS: Average phlebitis rates were 27 per 100 patients and 104 per 1,000 catheter days. Median duration of PIVC was 2 days (25 percentile = 2 days; 75 percentile 3 days). Time kinetics (Kaplan-Meier) were linear. CONCLUSION: Linear time kinetics of PIVC phlebitis do not support CDC recommendations for an elective PIVC change after 72 hours, provided daily monitoring of the insertion site occurs.

Adult↗

PubMedDate not supplied

Complications of long arm-catheters: a randomized trial of central vs peripheral tip location.

BACKGROUND: This two-part study initially evaluated complications associated with catheters inserted via upper extremity veins. The second prospective phase compared thrombotic risk of peripheral catheter tips vs a central vein terminus. METHODS: Patients from public institutions with infectious diseases were observed throughout their inpatient and outpatient use of IV catheters. Seventy-two and 39 patients enrolled in phase 1 and phase 2, respectively. Phase 1 consisted of prospective observations and analysis of complications and associated risk factors. Phase 2 randomized patients to a catheter tip location in the superior vena cava or the axillosubclavian-innominate vein and compared the incidence of thrombosis, phlebitis, and infection. RESULTS: In phase 1, there was an increased risk of thrombosis with peripheral tip localization (61% vs 16%, p < .05). Phase 2 confirmed increased thrombosis with tips in the axillosubclavian-innominate vein compared with the superior vena cava (60% vs 21%, p < .05) with an improved survival for central tip catheters (p < .02). Catheters associated with thrombosis were more likely to become infected (r = 0.48, p < .02). CONCLUSIONS: The experience supports use of the long arm catheter as an effective device for parenteral therapy. A novel method for placing these catheters makes most patients candidates for this approach. Placing a long arm-catheter's tip in the central venous circulation reduces the risk of thrombosis. A high incidence of tip misdirection indicates a need for radiographic confirmation before use.

Adult↗

PubMed2000

Peripheral vascular brachytherapy: an introduction.

The response of cells to ionising radiation has been extensively studied for the past 30 years. When radiation is absorbed in biological material, it can directly ionise a critical site (direct effect) or interact with other molecules to produce reactive free radicals, which can subsequently damage critical biological molecules (indirect effect). DNA is considered the critical target damaged by ionising radiation by both direct and indirect processes. Since radiotherapy had proven to be effective in the treatment of non-malignant proliferative processes, it was assumed that this adjunctive treatment would also inhibit vascular restenosis. The major difference between external and intravascular radiation is dose distribution. Intravascular delivery results in extremely high doses to the lumen with a fall-off in dose as a function of distance from the source; whereas, external beam would deliver a uniform dose over the entire volume of tissue treated. Unlike in the coronary circulation most of the peripheral vessels treated are greater than 3 mm in diameter; in fact many are 7 to 10 mm in diameter. Since beta radiation is related to lower penetration properties and more heterogeneous distribution of radiation in comparison to gamma radiation, it is therefore necessary to use a gamma radiation source because it would be difficult to irradiate the sub-intimal tissue with a beta source centred in a large vessel. Radiation can and does have the potential to destroy blood vessels. The challenge in vascular brachytherapy is to treat blood vessels to a point where restenosis is inhibited; yet the vessel is not irreparably damaged.

Animals↗

PubMed1988

Life span of intravenous cannulas in a neonatal intensive care unit.

Peripheral intravenous cannula use in a neonatal intensive care unit was surveyed prospectively to ascertain the rate of complications and the factors influencing the life span of an intravenous cannula. During a three-month period in which 199 intravenous cannulas were inserted in 69 patients, only two significant infiltrations (1%) were observed in more than 5000 hours of intravenous therapy. None of the factors studied, including weight, age, type and rate of fluid administration, and type of medication (except pancuronium bromide), had any discernible effect on the functional life span of intravenous cannulas. Pancuronium was associated with a significant prolongation of cannula life span--from 30 to 50 hours. We conclude that in this setting, the rate of clinically significant complications from intravenous cannula therapy is low.

Catheterization, Peripheral↗

PubMedDate not supplied

A theory-based intervention to improve nurses' knowledge, self-efficacy, and skills to reduce PICC occlusion.

The peripherally inserted central catheter (PICC) is an effective intermediate and long-term central vascular access device. Its functions are comparable with those of other percutaneously placed central venous catheters. However, its high occlusion rate and the consequent infection risk may disrupt therapy for patients. The primary investigator in this study developed an educational intervention based on Albert Bandura's social learning theory, and hypothesized that increasing nurses' knowledge and self-efficacy related to PICCs would have a positive impact on patient outcomes related to occlusion and infection rates. The study outcome showed an overall increase in nurses' knowledge and self-efficacy related to PICC care, and a significant reduction in the catheter occlusion rate, from 29% to 8.5%, over a 6-month period.

Attitude of Health Personnel↗

PubMedDate not supplied

Patency of 24-gauge peripheral intermittent infusion devices: a comparison of heparin and saline flush solutions.

The purpose of this study was to compare the effectiveness of heparin and normal saline flush solutions in maintaining the patency of 24-gauge peripheral intermittent infusion devices (PIIDs). A prospective, non-randomized, sequential, blinded study design was conducted on a pediatric and a neonatal intensive care unit. The sample consisted of 134 catheters in 61 patients. Heparin and saline flush groups were similar for age, PIID placement site, irritating substances infused, and initial IV function. The median duration of catheters flushed with heparin was 42 hours and with saline was 35.3 hours. Kaplan-Meier Survival Analysis indicated that the duration of catheters flushed with heparin was significantly longer than those flushed with saline (p = .02). More catheters flushed with saline were removed because of problems (p = .027). Results of this study suggest that heparin is more effective than saline in maintaining the patency of small, 24-gauge catheters.

Catheterization, Peripheral↗

PubMed2006

Angioseal versus manual compression for haemostasis following peripheral vascular diagnostic and interventional procedures--a randomized controlled trial.

The aim of this study was to compare the angioseal device to manual compression for femoral artery puncture following peripheral vascular procedures, in the context of day case vascular procedures. One hundred patients were prospectively randomised to haemostasis using the angioseal device or manual compression following arterial puncture for peripheral vascular diagnostic or intervention procedures. Data were collected regarding time to haemostasis and complications immediately post-procedure, at 1h, 2h and at 1 week. There were 50 patients in each group. There were no significant differences in demographic variables, or in complication rates immediately, at 1h, 2h and at 1 week (Chi-squared). The only significant difference between the two groups was time to haemostasis. The mean time to haemostasis in the compression group was 10.6 min and 2.0 min in the angioseal group (t-test p<0.0001). In conclusion, no significant differences in complications were found between manual compression and angioseal. However, there was a significant difference in time to haemostasis.

Aged↗

PubMed1998

Prevalence of primary bloodstream infections in representative German hospitals and their association with central and peripheral vascular catheters.

The prevalence of noncentral and central lines and the prevalence of nosocomial primary bloodstream infections was investigated in 72 representative German hospitals (NIDEP Study). Data from a total of 14,966 patients were documented. On the prevalence day, it amounted to 23.9% for noncentral and 5.1% for central lines. The total prevalence of nosocomial primary bloodstream infections was 0.3%, 8.3% of all nosocomial infections recorded were primary bloodstream infections. The device utilization rate of vascular catheters was retrospectively observed for both the prevalence day and another 6 days. The device utilization rate was 27.3% for peripheral and 6.1% for central catheters with higher rates in west Germany. The associated incidence density of primary nosocomial bloodstream infections per 1000 catheter-days was 0.3 for noncentral and 0.8 for central lines. In 61.4%, the primary bloodstream infections were microbiologically confirmed. In 52.6% of cases, Gram-positive bacteria were isolated (Staphylococcus aureus: 15.8%, other coagulase negative Staphylococcus species: 34.2%) and in 47.4%, Gram-negative ones (mostly: Escherichia coli: 13.2% and Klebsiella species: 10.5%). Prevention to reduce nosocomial bloodstream infections is possible by antimicrobial establishing specially trained infusion therapy teams, using antimicrobial or antiseptic impregnated bloodstream catheters and a strict review of the indication for a vascular catheter together with a minimization of catheter days.

Bacterial Infections↗

PubMedDate not supplied

Use of an indwelling peripheral catheter for 3-5 day chemotherapy administration in the outpatient setting.

Registered nurses (RNs) and clinical pharmacists in the Hematology-Oncology Clinic at Walter Reed Army Medical Center conducted a descriptive study to determine the effectiveness and safety of using indwelling peripheral intravenous catheters (pics) for daily administration of various chemotherapeutic agents given intermittently over a 3-5 day period to outpatients. Eighty-nine adult outpatients requiring daily doses of chemotherapy including Fluorouracil (5-FU) (Solopak, Elk Grove Village, IL), Leucovorin (Immunex, Seattle, WA), Cisplatin (CDDP) (Bristol-Meyers, Princeton, NJ), Etoposide (VP-16), (Gensia, Irving, CA), Topotecan (SmithKline Beecham, Philadelphia, PA), or Taxol (Mead Johnson, Princeton, NJ), plus antiemetics were studied. Vialon 20-, 22-, or 24-gauge indwelling PICs (Becton Dickinson, Sandy, UT), were placed. Approximately 80% of patients successfully completed treatment with the original PIC in place. Daily flushing of the PIC with 2 ml [corrected] of Heplock U100 (Elkins-Sinn, Cherry Hill, NJ), maintained Heplock patency.

Adult↗

PubMed2003

Peripheral parenteral nutrition.

BACKGROUND: Peripheral parenteral nutrition (PPN) currently accounts for almost 20 per cent of all parenteral nutrition administered in the UK. In the absence of consensus guidelines there is wide variation in practice. Heterogeneity of clinical trials has made direct comparisons difficult and meta-analysis impossible. METHODS: Medline, Embase and Cochrane databases were searched for all clinical trials relating to the use of PPN in adults. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. RESULTS AND CONCLUSIONS: Effective PPN is possible in about 50 per cent of inpatients requiring parenteral nutrition. Evidence relating to optimal feed composition, choice of cannula, infusion technique and pharmacological manipulation is discussed, along with practical recommendations for the administration of PPN.

Administration, Topical↗

PubMed2002

Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications.

Inserting, maintaining, and monitoring vascular access are integral components of neonatal care. Advances in vascular access technology have led to the insertion of peripherally inserted central catheters (PICC) to provide stable venous access for early and aggressive parenteral nutrition. Medications that are irritating or damaging, or those with a high osmolality or a nonphysiologic pH, can also be safely administered into the central venous system. The need for repeated peripheral intravenous attempts, as well as the associated pain and physiologic instability, are virtually eliminated once a PICC line is placed. Complications related to PICCs may occur at any phase of therapy: during insertion, while indwelling, or after discontinuing the line. The risk factors associated with PICCs are distinctly different from peripheral intravenous lines because of their long dwell time, central placement, and potential to migrate. Part 1 of Focus on the Physical offers a review of the relevant anatomy of the vascular system and a discussion of the appropriate sites for catheter tip placement. Guidelines for a systematic physical assessment, along with recommendations for standardized PICC documentation, are provided. A review of the signs and symptoms of more frequently occurring complications, such as catheter occlusion and bloodstream infections, is presented to enhance awareness of PICC-specific complications in the neonate and to expedite early detection and treatment. Part 2 of this series will focus on systematic assessment for less common complications such as catheter migration, dislodgement, breakage, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion.

Bacteremia↗

PubMedDate not supplied

A retrospective look at tip location and complications of peripherally inserted central catheter lines.

In 1982, Southern Regional Medical Center in Riverdale, Ga, instituted a program for selected intravenous nurses to insert and manage peripherally inserted central catheters (PICCs). At present, approximately 125 to 150 PICCs are inserted annually by eight experienced IV nurses. In this retrospective study, the authors review medical record data on PICC insertions that occurred between January 1987 and December 1991. The optimal tip location is defined as the superior vena cava (SVC) and an anterior-posterior one-view chest x-ray is performed to confirm tip location. This study focuses on the initial location of the PICC and actions taken to correct the initial tip placement if not in the SVC. Medical records were reviewed for complications including mechanical phlebitis, infections, ruptured catheters, clotted catheters, or vein thromboses. The frequency of these complications, their prevention, and management are discussed.

Adolescent↗

PubMedDate not supplied

Does the Kensey catheter keep a coaxial position inside the arterial lumen? An in-vitro angioscopic study.

Angioscopy was used to evaluate the "self-centering" ability of three Kensey catheters (KC) with different flexibility: one 8Fr "peripheral" and two 5Fr "coronary" (I & II). Angioscopic observations were made inside arteries, 5-18 mm in diameter. There was a good correlation between flexibility and self-centering of the KC [r = 0.83, p less than 0.05]. Increasing the flow rate of rinsing solution from 18 to 60 ml/min prolonged coaxial position from 8.9 +/- 3.3 to 36 +/- 2.2 sec/min of activation [p less than 0.001]. A smaller effect on coaxial position was exerted by increasing cam speed from 5.2 +/- 0.7 to 19.2 +/- 1.6 sec/min (p less than 0.001). In conclusion, angioscopy showed that the KC has a limited ability to maintain a coaxial position inside the arterial lumen and operators cannot rely on its self-centering property.

Angioplasty, Balloon, Coronary↗

PubMed1995

Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous system.

BACKGROUND: During a 2-week period, seven cases of nosocomial polymicrobial gram-negative rod bacteremia occurred on a 39-bed medical and cardiac step-down unit. Combinations of Enterobacter cloacae (seven isolates), Klebsiella pneumoniae (five isolates), and Citrobacter freundii (two isolates) were isolated from blood cultures. METHODS: Concurrent and retrospective chart reviews were used to look for further cases and common exposures. Epidemiologic methods were used to refine determination of common exposure. Restriction enzyme DNA analysis was performed on the isolates. RESULTS: Concurrent and retrospective chart reviews revealed four additional possible cases during the same period. All case patients were exposed, through peripheral saline solution locks or central venous catheters, to saline solution "flush" from a central 0.9% saline solution bag and a needleless dispensing pin. Epidemiologic methods implicated probable extrinsic contamination of a single bag and pin used during a 24-48-hour period (Fisher's Exact Test, p < 0.002). There were no other common exposures. Restriction enzyme DNA analysis of the isolates further supported a common source for the outbreak. CONCLUSIONS: The introduction of needleless intravascular systems has been embraced for employee protection. Our report is the first to raise the question of patient safety with such systems. This outbreak highlights the inherent risks in rapid introduction of new technologies and points out the delicate balance among patient health, employee safety, and cost containment.

Bacteremia↗

PubMed2003

Vascular access.

Vascular access is the cornerstone of medical therapy in the pediatric population and presents unique challenges. The vessels are small, often exceedingly so, and gaining access may require considerable patience and skill. Peripheral IVs are difficult to place in children, both because of lack of patient cooperation and because of the very small size of many veins. In addition, repeated venipuncture has been identified as one of the greatest stresses in hospitalized children. In the recent past, all forms of central venous access were the preserve of surgeons and were placed in the operating room under general anesthesia. In recent years, pediatric interventional radiologists have described placing peripherally inserted central catheters (PICCs), subcutaneous venous access ports, hemodialysis catheters, and a variety of temporary and permanent central lines even in the smallest children. This has been achieved safely, reliably, and, by dispensing with general anesthesia and operating room time in most cases, at considerable cost savings to the entire health care system. In addition, new forms of reliable, stable access such as the PICC line have made possible outpatient treatment of a wide variety of conditions, particularly infectious, which previously necessitated hospital admission. This has resulted not only in considerable cost saving for the health care system but also improved quality of life for the patient and their family. In this section, I review the current state of pediatric vascular access with emphasis on those areas where pediatric differs from adult practice.

Adolescent↗

PubMedDate not supplied

Lower incidence of peripheral catheter complications by the use of elastomeric hydrogel catheters in home intravenous therapy patients.

A prospective study was conducted to compare the performance of a nonconventional short peripheral catheter made of elastomeric hydrogel material with that of the conventional short peripheral catheters used to administer intravenous therapy to patients before this study was undertaken. The catheters were inserted in home care patients, primarily diagnosed with Lyme disease, for the delivery of I.V. antibiotic therapy. The study results showed that the institutional 48-to-72-hour removal policy for conventional catheters is not practical for the elastomeric hydrogel test catheter. However, this policy indeed appears appropriate for conventional catheters because one half (50%) of the control catheters in this study and in other published studies failed within 72 hours compared with only 19% of the test catheters. This demonstrates that catheter material significantly affects catheter performance because the nonconventional catheters could be kept in place more than twice as long before causing the complication rates seen with the conventional control catheters at 3 days of dwell.

Adult↗