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Results for “Catheterization, Peripheral”

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PubMed1994

Facilitation of peripheral intravenous access: an evaluation of two methods to augment venous filling.

STUDY OBJECTIVE: To evaluate two methods of augmenting venous filling as potential aids to i.v. cannulation. DESIGN: Comparative study of cross-sectional areas of preselected antecubital fossa veins. SETTING: Vascular laboratory of a British university teaching hospital. PARTICIPANTS: Thirty healthy, normotensive, adult volunteers. INTERVENTIONS: Vessel cross-sectional areas measured noninvasively using a color flow duplex ultrasound scanner. Measurements were taken at rest, after application of a venous tourniquet, with tourniquet and Esmarch bandage, and with tourniquet and Rhys-Davies exsanguinator. RESULTS: Mean (+/- SD) cross-sectional area at rest was 0.18 +/- 0.094 cm2 and after tourniquet was 0.28 +/- 0.14 cm2. Application of an Esmarch bandage produced an increase to 0.33 +/- 0.14 cm2, and Rhys-Davies exsanguinator produced an increase to 0.32 +/- 0.15 cm2 (P < .0001 for all comparisons except Rhys-Davies exsanguinator versus Esmarch bandage). CONCLUSION: Application of either the Esmarch bandage or the Rhys-Davies exsanguinator caused significant filling of antecubital fossa veins in excess of that produced by a venous tourniquet alone in normovolemic, normotensive volunteers.

Adult↗

PubMed1988

Bacterial colonization and phlebitis-associated risk with transparent polyurethane film for peripheral intravenous site dressings.

Previous studies of various brands of polyurethane dressings have noted differences in the rates of catheter colonization. We compared Bioclusive transparent polyurethane (TP) dressing with a cotton gauze (CG) dressing on peripheral intravenous (IV) access sites for the incidence of phlebitis, catheter tip colonization, skin colonization, and catheter-related bacteremia. The study, involving 598 ward patients, was case controlled, prospective, and randomized for a period of 4 months. Each patient was entered into the study only once, and all dressings were applied by a member of the IV therapy team. No significant difference was seen for phlebitis rate (TP: 9.8% vs. CG: 7.6%) or catheter tip colonization, defined as greater than 15 colony forming units (CFU) (5.7% vs. 4.4%) by a semiquantitative technique. Cultures of specimens from the skin and catheter tips of the majority of patients (91%) showed no growth. An association was found between those patients with greater than 15 CFU isolated from catheter tips and those with phlebitis (p = 0.022). No documented catheter-related bacteremia occurred in either study group.

Adult↗

PubMed1999

Effect of education on evidence-based care and handling of peripheral intravenous lines.

Deficient routines in use, care, handling and documentation of peripheral intravenous vein cannulae (PIV) have previously been reported, and complications have been noted in 50-75% of the patients. The aim of the study was to examine whether specially trained nurses change their actions to decrease complications when using cannulae. The study included 36 nurses assigned to experimental and control groups. The experimental group followed an education programme explaining how to use and take care of a PIV. To evaluate the intervention document analysis, observations and patient interviews were performed in 99 patients with 172 PIVs in situ for less than 24 h. After the education programme, fewer complications, more carefully performed care and handling, and better documentation and information were found in the experimental group. Nurses in the control group followed current routines, which resulted in a greater degree of complications. Education in evidence-based care and handling gives nurses the opportunity to improve their ability to use theoretical knowledge in clinical problems.

Adult↗

PubMed1989

[Rotational angioplasty--recanalization of chronic arterial occlusion using a slowly rotating catheter. Clinical results with 100 patients].

Between December 1986 and January 1989, 100 patients with chronic occlusions of peripheral arteries were treated with the new technique of low speed rotational angioplasty. This uses a relatively thick, flexible and blunt catheter, which is driven by an electric motor (100 to 200 r.p.m.). The success rate in the superficial femoral and popliteal arteries of the initial intervention for occlusions less than 10 cm was 90%, for occlusions of less than 10 cm, it was 80%. Occlusions on which conventional techniques had failed were successfully recanalized in 65%. Recanalisation was also successful in seven out of 12 patients with occluded iliac arteries. There were no perforations or other serious complications. It is concluded that the new method is particularly effective and safe for recanalisation of chronic vascular occlusions and should also be considered for cases which previously could only be treated surgically.

Adult↗

PubMed1998

Monitoring of pH and PCO2 in children using the Paratrend 7 in a peripheral vein.

PURPOSE: To determine the accuracy of the Paratrend 7 monitor inserted into a peripheral vein in providing continuous measurements of PCO2 and pH in children with respiratory failure. METHODS: In a prospective, case series at a University based PICU in a tertiary referral hospital and following informed consent, the Paratrend 7 intra-arterial blood gas monitoring system was inserted through a peripheral intravenous cannula. When clinically indicated, an arterial blood gas (ABG) was obtained. The values of pH and PCO2 from the Paratrend 7 and the ABG were compared using linear regression analysis and Bland-Altman analysis. RESULTS: Seventeen ABGs were obtained in the 4 patients. PaCO2 ranged from 29 to 51 mmHg and the pH values from 7.16 to 7.50. Linear regression analysis for the: Paratrend 7 pH vs the ABG pH resulted in an r = 0.9678 and an r2 = 0.9367 (P < 0.0001). Linear regression analysis for the Paratrend 7 CO2 vs ABG CO2 resulted in an r = 0.8273 and an r2 = 0.6845 (P = 0.01). Using a Bland and Altman analysis, the bias +/- precision of the PCO2 values was 3 +/- 1.4 and 0.036 +/- 0.02 for the pH values. CONCLUSION: The pH and PCO2 values obtained from the Paratrend 7 monitor provide a clinically acceptable correlation with arterial values.

Adolescent↗

PubMed2000

Peripherally inserted central catheters in patients with AIDS are associated with a low infection rate.

We reviewed the medical records of all human immunodeficiency virus (HIV)-infected patients who had a peripherally inserted central catheter (PICC) placed during a 1-year period. Ninety-seven PICCs were inserted in 66 patients for 8337 catheter-days. Eighty of 97 catheters were used primarily to treat cytomegalovirus disease. The mean time to any complication was 150 days. The total complication rate was 6.1 per 1000 catheter-days. The total infection rate was 1. 3 per 1000 catheter-days, and the serious infection rate was 0.8 per 1000 catheter-days. The mean time to a serious infection was 310 days. The noninfectious complication rate was 4.6 per 1000 catheter-days. PICCs were associated with a low infection rate and a moderate mechanical complication rate, which compare favorably with historical rates seen in AIDS patients with other types of central venous access devices. PICCs are a reasonable alternative to other central venous access devices in patients with HIV or AIDS.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Minimizing risks associated with peripherally inserted central catheters in the NICU.

Peripherally inserted central catheters (PICC lines) provide prolonged venous access, a means of administration of needed medications that would otherwise be irritating to peripheral vessels, and a means of assuring better parenteral nutrition to infants who are unable to tolerate enteral feedings. Not only do these central lines provide life-saving therapy, they are easily inserted, cost effective, and convenient. Although there are many benefits to the use of these catheters, physicians and nurses within the NICU must remain acutely aware of the risks involved with placement of PICC lines so that complications can be minimized. Prevention of sepsis in neonates is always a priority, and several measures can be implemented to reduce this risk, including scrupulous aseptic technique, knowledgeable selection of the insertion site, and consistent daily care. Other complications such as thrombosis, extravascular collection of fluid due to catheter migration or blockage, vessel perforation, and line leakage are all concerns when using this valuable tool in the care of infants. Careful catheter tip placement and conscientious ongoing monitoring can assist in reducing morbidity as well as mortality related to PICC lines.

Catheterization, Peripheral↗

PubMed2004

Intravenous catheter infections associated with bacteraemia: a 2-year study in a university hospital.

The aim of this retrospective study was to assess the incidence and aetiology of central and peripheral venous catheter (C/PVC) infections during a 2-year period (1999-2000) and to determine the susceptibility of isolated microorganisms to various antimicrobial agents. Catheter tips were processed using the semiquantitative method and blood cultures were performed with the BacT/Alert automated system. Antibiotic susceptibilities were performed by disk agar diffusion and MICs were determined by Etest, according to NCCLS standards. During the study period, samples from 1039 C/PVC infections were evaluated, yielding 384 (37.0%) positive cultures. Blood cultures were also available from 274 patients, of which 155 (56.6%) yielded the same microorganism as from the catheter. No bloodstream infections were detected in 104 C/PVC-positive cases. Methicillin-resistant coagulase-negative staphylococci were the most frequent isolates, followed by Gram-negative bacteria, especially Pseudomonas aeruginosa. Resistance to glycopeptides among staphylococci and enterococci was not detected, whereas 60% of Gram-negative bacilli were resistant to beta-lactams.

Bacteremia↗

PubMed1988

[Peripheral bronchopulmonary cancers. Diagnostic efficiency of fibroscopic samples. Prospective study on 561 patients].

The purpose of this french multicentric study was to evaluate the diagnostic accuracy of samples collected by fibroscopy in peripheral lung cancer with normal endoscopy. Five hundred and sixty-one patients entered the study; a tumour had been diagnosed in 350 of them (62 p. 100). Among these 350 patients, 147 were examined with the help of a light-amplifier screen, and a positive diagnosis was made in 97 (66 p. 100). Guided sample collection in the pathological area (biopsy, brushing, transcatheter aspiration) proved much more rewarding than unguided sample collection (biopsy of the bronchus, simple aspiration or cytology of 3-day sputum): 45 p. 100 positive results versus 18 p. 100 (P less than 0.001). However, sputum cytology still had good diagnostic value since it provided by itself the diagnosis in 14 p. 100 of the cases. Results were significantly inferior in tumours less than 3 cm in diameter.

Adult↗

PubMed1989

Rapid venous access using saphenous vein cutdown at the ankle.

Injured adults can usually be treated adequately with peripheral intravenous lines. However, in hypotensive patients, alternative techniques such as venous cutdown may be necessary. There are no adult studies that document the success rate or time required to complete this procedure in the emergent situation. During a 1-year period, 73 cutdowns were attempted on 56 patients. Sixty-two of these attempts resulted in venous cannulation with a free flow of fluid (84.9%). The average time required for placement was 4.9 minutes. First-year residents had a significantly lower success rate (70%) than emergency department staff (89%) or second- through fifth-year surgical residents (94%). One patient who lived developed a local cellulitis. There were no other complications. In the hands of an experienced operator, saphenous vein cutdown at the ankle is a reliable method of rapidly gaining venous access in the adult patient. There are few immediate or late complications if the catheter is removed within 24 hours.

Adult↗

PubMed2005

Evaluating the efficacy of the valsalva maneuver on venous cannulation pain: a prospective, randomized study.

UNLABELLED: Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001). IMPLICATIONS: Venous cannulation is a necessary step for safe anesthesia administration; however, the pain associated with it is sometimes very distressing. We observed that the Valsalva maneuver performed at the time of venous cannulation greatly decreases this pain.

Adult↗

PubMedDate not supplied

The use of confirming x-rays to verify tip position for peripherally inserted catheters.

The tips of long-line peripherally inserted catheters may be positioned in the superior vena cava (SVC), subclavian vein, or axillary vein. Based on current standards of practice, catheters with tips placed in the SVC are central lines that require a confirming x-ray; catheters with tips terminating in the subclavian or axillary vein are noncentral and do not require confirming x-rays. Several authors follow this standard; others, however, suggest that radiographic examination should be performed on catheters with tips lying in locations other than SVC unless numerous specific criteria are met. In this study, x-rays were obtained for 42 patients in a hospital setting to determine tip location and position. Radiographic examination revealed that six were looped and five were positioned in a branch or tributary off the axillary vein. To eliminate the complications associated with catheter tip malposition (i.e., thrombus, occlusion), x-ray confirmation should be performed on all lines placed in or beyond the axillary vein to ensure correct tip position.

Axillary Vein↗

PubMed1996

An audit of peripheral catheter care in a teaching hospital.

Post-insertion care of peripheral venous catheters (PVCs) in 100 patients on general medical and surgical wards of a teaching hospital was audited. A variety of methods were used to attach the PVC to the patients' skin including 'Vecafix' dressings, bandages and adhesive tape. Sixty-eight PVC were incorrectly attached, and of these 49 (71%) were associated with two or more symptoms or signs of inflammation at the insertion site. Of those PVC that were correctly attached only five out of 32 (16%) were associated with inflammation. There was a significant association between incorrect dressing application and inflammation (P < 0 center dot 01). Similarly, there was a direct relationship between inflammation and PVCs that had been in situ for greater than 48 h (P < 0 center dot 01). The results suggest that a significant reduction in the incidence of inflammation associated with PVC use may be achieved by correct application of dressings and replacing the catheters after 48 h in situ.

Bandages↗

PubMed2000

Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts.

PURPOSE: To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients. MATERIALS AND METHODS: A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft. RESULTS: Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts. CONCLUSION: Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.

Aged↗

PubMed2006

Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs).

BACKGROUND: PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move. OBJECTIVE: To evaluate the influence of arm movement on the central tip location of PICCs placed in children. MATERIALS AND METHODS: The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement. RESULTS: The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90 degrees . CONCLUSION: Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.

Adolescent↗

PubMed2003

Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial.

OBJECTIVES: Heparin addition to infusion fluids is used to prolong catheter patency in newborns. Heparin may also induce adverse effects such as bleeding complications and immune-mediated heparin-induced thrombocytopenia (HIT). One objective was peripheral venous catheter patency with heparinization of continuous infusions (0.5 IU/mL). Secondary objectives were incidences of bleeding, clinically manifest HIT, HIT antibodies, and catheter-related complications. STUDY DESIGN: Inclusion criteria were anticipated need for intravenous peripheral infusion (>or=5 days for HIT-related endpoints) and postnatal age <28 days at study entry. Exclusion criteria were bodyweight <1000 g, congenital malformation, need for therapeutic anticoagulation or mechanical ventilation, and severe bleeding. HIT antibodies were assessed by enzyme-linked immunosorbent assay. RESULTS: A total of 145 infants received heparin, and 151 infants received saline. Patient characteristics, number of additional drugs, duration of treatment, and location and size of catheters did not differ. Patency of catheters was 7.4 hours longer in the heparin group (33.8 hours vs 26.4 hours, P<.0001), but the total numbers of catheters did not differ (565 vs 692, P=.3). No infant developed HIT antibodies. Incidences of bleeding complications and thrombocytopenia were comparable between groups. CONCLUSIONS: Balancing the benefits against the risks of heparin addition and the rare complication of HIT, we will not use 0.5 IU/mL heparin addition to parenteral fluids.

Antibodies↗

PubMed2005

Human peripheral arteries: feasibility of transvenous intravascular MR imaging of the arterial wall.

Feasibility of in vivo transvenous intravascular magnetic resonance (MR) imaging of the human arterial wall was determined. All subjects provided written informed consent, and institutional review board approved the study. Six arteries in six patients were imaged with a guidewire placed in the iliac vein (n = 5) or left renal vein (n = 1). Pre- and postcontrast T1-weighted and T2-weighted transvenous MR imaging were performed. An atherosclerotic plaque with a fibrous cap was identified on 27 (42%) of 64 images of veins without stents; intimal hyperplasia in a renal artery with a stent was identified on 12 images. Contrast-to-noise ratios (CNRs) on arterial wall postcontrast T1-weighted images were superior to those on images obtained with other sequences (P < .001), and the postcontrast images demonstrated the greatest number of plaques with a low-signal intensity core and fibrous cap. Preliminary results show that transvenous MR imaging is feasible for high-spatial-resolution imaging of the arterial wall and atherosclerotic plaque. Postcontrast T1-weighted imaging affords greatest CNR for the arterial wall.

Aged↗

PubMed1998

Handling and control of peripheral intravenous lines.

The purpose of the study was to describe nurses' routines in connection with the planning, care and handling, and documentation of a peripheral intravenous cannula (PIV) and also to examine factors that control how nurses act. Nurses and physicians in three English hospitals were interviewed. The results showed a difference between nurses' and physicians' opinions about PIV routines, except in few cases. The PIV was inserted by the physicians while the nurses took care of and documented its care and handling. In many cases the insertion of the PIV was also documented by the nurses. Although small PIVs and short insertion time had previously been recommended, many physicians preferred large cannulae and an insertion time of between 3 and 7 days. All nurses and six physicians had the opinion that the cannula should be changed more often, but this did not happen. Some physicians maintained that the nurses' care and handling varied. On the other hand some criticism had been expressed by the nurses about unclear directives from the physicians. English participants were aware that unsatisfactory routines existed and that the policy had not always been followed.

Adult↗