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Results for “Catheterization, Peripheral”

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PubMed1999

Obtaining blood samples for coagulation studies from a normal saline lock.

OBJECTIVES: To determine the amount of blood that should be discarded from a peripheral normal saline lock, a capped-off intravenous port, before a blood sample is obtained for determination of activated partial thromboplastin time from patients being treated with heparin. METHODS: A prospective, quasi-experimental design was used with 32 patients. A blood sample was obtained via venipuncture from each patient to serve as the control for that patient. The normal saline lock was flushed with 2 mL of normal saline. Four consecutive 3-mL blood samples were obtained directly from the normal saline lock, representing samples obtained after discard volumes of 0, 2, 4, and 6 times the dead space of the catheter and extension set (1.5 mL). Activated partial thromboplastin times for the venipuncture blood sample were compared with the times for the blood samples obtained from the normal saline lock. RESULTS: The only significant difference (P = .02) was that activated partial thromboplastin time was 15% higher in the blood sample obtained from the normal saline lock with no blood discarded than in the venipuncture blood sample. CONCLUSIONS: Nurses can obtain accurate measurements of activated partial thromboplastin time with blood samples obtained from normal saline locks by first discarding a volume of blood equal to 2 times the dead space of the catheter and extension set. Obtaining blood samples in this manner reduces patients' discomfort due to repeated venipuncture and diminishes blood loss.

Adult↗

PubMed2005

Radiation dose exposure during cardiac and peripheral arteries catheterisation.

BACKGROUND: Ionising radiation carries an oncogenic risk which is linearly related to the dose. An estimation of the effective dose can be obtained from the measurements of the dose-area product (DAP), which is a measure of stochastic risk and a potential quality indicator. AIM: To assess radiation exposure of patients in a large volume cardiac cath-lab. METHODS: A retrospective analysis of adult cardiac and peripheral percutaneous procedures (April to December 2004) was carried out to determine the DAP and estimated risk of malignancy. We identified 6 groups: Group 1 (n=100, coronary angiography and ventriculography); Group 2 (n=50, carotid stenting); Group 3 (n=50, aortography+coronary angiography+ventriculography); Group 4 (n=100, inferior extremities angiography+predilatation and stenting); Group 5 (n=100, coronary angiography+ventriculography+direct coronary stenting); Group 6 (n=100, coronary angiography+ventriculography+coronary predilation and stenting). Dose-area product meter attached on the X-ray unit was used for the estimation of the radiation dose received by the patient during the procedures. RESULTS: DAP values (mean+/-S.D.) ranged from 41+/-30 Gy cm2 in Group 1 (lowest) to 118+/-89 Gy cm2 in Group 6 (highest). Within each group, individual radiation exposure varies substantially: from 11 to 200 Gy cm2 in Group 1, and from 30 to 733 Gy cm2 in Group 6 patients. Average exposure in a Group 6 patient corresponds to a risk of mortality from a malignancy of about 1 in 1000. CONCLUSION: The radiation dose varies substantially across different types of procedures and up to tenfold within the same procedure. The enhanced knowledge of radiation dose might help the cardiologist to implement radiation sparing procedures eventually minimizing patient and operator radiation hazards in invasive cardiology.

Adult↗

PubMed2000

Transvenous echo Doppler in baboons: a new window to the cardiovascular system.

Ultrasound examinations of the heart and major peripheral arteries have been performed as separate procedures; both potentially limited by suboptimal views in certain subjects and the inability to obtain ideal pictures of particular intracardiac structures. Transvenous ultrasound may offer new advantages in certain areas, we therefore studied six adult baboons using a single-plane 5.5-10 MHz transducer mounted on a 10 French (10F) catheter, introduced via the right femoral vein and positioned under fluoroscopic control. Imaging and Doppler studies were performed to delineate cardiovascular anatomy as well as ventricular function response to positive (dobutamine) and negative inotropic (esmolol) agents. The procedure was safe and feasible in all cases. Clear and novel two-dimensional and flow information were obtained from the iliac arteries, descending aorta, both renal artery origins, ascending aorta, including the aortic arch, main pulmonary artery and its bifurcation, as well as head and neck vessels. Novel intracardiac views were obtained, including right ventricular long axis, left ventricular apex and 'flask' views of the left ventricle. Excellent dynamic information for left ventricular function was also available [e.g. myocardial Vmax of the anterior left ventricular wall was 6.8+/-2.5 cm/s at rest, 14.6+/-5.5 cm/s after dobutamine (P=0.009) and 4.5+/-1 cm/s after esmolol (P=0.03 compared with control)]. We conclude that, in adult primates, transvenous ultrasound safely and reliably provides novel information of cardiovascular structure and function.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

A survey of nurses' assessment of peripheral intravenous catheters.

The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on assessment of the PVC site for infection. The survey was conducted in 20 wards by an infection control nurse (ICN), recording data on assessment, site infection and removal/resiting of PVCs. Nursing staff were interviewed on assessment of the PVC site and nursing interventions were recorded. A total of 554 PVCs in 397 patients were surveyed of which 28 (5%) had site infection. There was no related bloodstream infection (BSI). Overall, PVCs were assessed 450 (81%) times by nurses. Malfunction was reported 95 (17%) times, pain 28 (5%) times and pyrexia 10 (2%) times. Characteristics that showed significant difference between 28 infected and 526 non-infected PVCs included when nurses assessed PVCs as infected, and nurses' intervention for PVCs inserted for 1-3 days' duration. Other characteristics were resiting PVCs when associated with malfunction and also resiting because of pain. The involvement of the ICN was likely to have contributed to the low infection rate. While not conclusive this survey identified characteristics between infected and non-infected PVCs that may have been associated with this low infection rate, namely, nurses' overall intervention in PVC care and assessment that is focused on identifying infection, and resiting for malfunction and pain. These are simple assessment and intervention measures that should not require the assignment of a dedicated ICN, but which are within the capabilities of all healthcare workers entrusted with PVC care.

Catheterization, Peripheral↗

PubMed2000

Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: a prospective analysis.

An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73%), peripheral intervention (n = 7, 23%), and after a femoral line placement (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37%) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed and one (3%) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.

Adult↗

PubMed2005

Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department.

INTRODUCTION: To decrease the number of hemolyzed samples in the emergency department, performance improvement activities were implemented, including phlebotomy classes for staff, evaluation of blood draw equipment, and a study to evaluate factors attributed to hemolysis of blood samples when drawn at the time a new intravenous catheter is inserted. METHODS: In a study with an observational design conducted in June and July 2004, researchers examined the cases of 100 randomly chosen patients who had blood drawn through newly placed peripheral intravenous access. RESULTS: In this study, the blood draw collection factors with the highest hemolysis rates included blood samples drawn between 12:00 am to 5:59 am; samples drawn by patient care technicians; right-hand site; 22-gauge intravenous catheters; syringe draws; blue tubes; 6.0 mL tubes; difficulty drawing blood; 2 tries for intravenous placement; resistance when aspirating blood using a syringe; and respiratory discharge diagnoses. Statistically significant (P < .05) blood draw factors included intravenous placement sites of right hand/forearm and antecubital; intravenous catheter size 22 gauge; blood drawing categorized as difficult; number of tries for intravenous placement; blood tube size 1.8 mL; and discharge diagnoses of respiratory, gastrointestinal, reproductive, dermatologic, and endocrine. DISCUSSION: Clinically meaningful factors associated with hemolysis rates included the use of a 22-gauge intravenous catheter size, which resulted in a hemolysis rate of 60%; in addition, intravenous placement sites on the right side had statistically significant higher hemolysis rates than the left side, a finding that merits further research. As a result of the study we modified our standard operating procedure to discontinue the use of a 22-gauge or smaller intravenous catheter in adults. If required for small vein sticks, the use of a straight needle stick to obtain blood samples should be considered. The results of this study underscore the importance of education and training and the consideration for regular competency testing for staff with phlebotomy responsibilities.

Benchmarking↗

PubMed2005

Short peripheral venous catheters: effect of evidence-based guidelines on insertion, maintenance and outcomes in a university hospital.

This study was designed to evaluate the impact of hospital-wide guidelines for short peripheral venous catheters (SPVC) insertion on the frequency of local catheter-related complications. In a 1051-bed Parisian university hospital, two observational, point prevalence surveys were undertaken in 1996 and in 1998, separated by implementation of written guidelines for SPVC insertion. The outcomes of SPVC insertion were defined as the presence or absence of local catheter-related complications (erythema, purulence around the insertion point, tenderness or induration along the cannulated vein). The proportion of polyurethane catheter materials used (56% vs. 81%, P<0.001), correct and sterile fixation (80% vs. 92%, P<0.05), non-movable catheters (92% vs. 98%, P=0.03) and insertion record (58% vs. 76%, P<0.01) increased between 1996 and 1998. The frequency of local catheter-related complications decreased (15% vs. 4%, P<0.01). Age >73 years [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.28-28.05] was positively associated with local catheter-related complications, whereas duration of insertion (until 72 h) (OR 0.29, 95% CI 0.09-0.89) and the implementation of guidelines (OR 0.26, 95% CI 0.09-0.67) were negatively associated with local catheter-related complications. The implementation of guidelines was independently negatively associated with local catheter-related complications (OR 0.31, 95% CI 0.09-0.97). The results suggest that hospital guidelines for SPVC insertion can improve catheter care and significantly reduce local catheter-related complications.

Adolescent↗

PubMed1997

A single, double lumen high-flow catheter for patients undergoing peripheral blood stem cell transplantation. Experience at the National Cancer Institute in Mexico.

Peripheral blood stem cell transplantation (PBSCT) requires a high-flow catheter for adequate cell collection by apheresis and long i.v. support, this is usually achieved by multiple catheters. We analyzed our experience with Mahurkar or Permacath for apheresis and long-term i.v. support in PBSCT, cared for exclusively by an i.v. therapy team. Fifty-six catheters were used in 53 patients that completed PBSCT (28 Permacath and 28 Mahurkar). In 10 patients (19%) the same catheter was used for multiple PBSCT. The average stay was 58.4 days (7-219), Permacath 76.8 days (14-219) and Mahurkar 42 days (7-106). The incidence of infectious complications was 2.2 x 1000 catheter-days (1.7 Permacath and 3.0 Mahurkar); during neutropenia it was 3.7 x 1000 cathether-days. The incidence of thrombosis was 0.9 x 1000 catheter-days. There was a total of seven infectious episodes (12.7%). Five (9%) were local and two were (3.6%) bacteremias. The microorganism most commonly isolated was Staphylococcus sp. (57%). Four catheters (7.1%) were removed because of complications: one thrombosis and three infections. Both catheters have proven useful and safe for long-lasting vascular access in patients undergoing PBSCT. No statistical difference was found in infectious and non-infectious complications between either catheters.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2001

Pediatric peripherally inserted central catheters: complication rates related to catheter tip location.

OBJECTIVE: To compare complication rates between central venous catheter tip location and noncentral tip location after peripherally inserted central catheter (PICC) placement in children. METHODS: Between 1994 and 1998, data from all children who underwent PICC placement were analyzed. Patient demographics, catheter characteristics, catheter duration, infusate composition, and catheter complications were entered prospectively into a computerized database. Catheter tip locations were determined by fluoroscopy and were defined as central if they resided in the superior vena cava, right atrium, or high inferior vena cava at or above the level of the diaphragm, and as noncentral if located elsewhere. Differences in complication rates between the central and noncentral groups were analyzed. RESULTS: Data from a total of 1266 PICCs were analyzed from 1053 patients with a mean age of 6.49 +/-.2 years (range: 0-45.0 years). Of the 1266 PICCs, 1096 (87%) were central in tip location, and 170 (13%) were noncentral in tip location. The central group had 42 complications of 1096 catheters (3.8%), while the noncentral group had 49 complications of 170 catheters (28.8%). Controlling for patient age, catheter size, gender, and catheter duration with a logistic regression model, there remained a statistically significant increased likelihood of complication in the noncentral group versus the central group (adjusted odds ratio: 8.28; 95% confidence interval: 5.11-13.43). CONCLUSIONS: Centrally placed catheter tips are associated with fewer complications than are noncentrally placed catheter tips. Clinicians should ensure that catheter tips reside centrally after PICC placement in infants and children.

Adolescent↗

PubMed1995

Immediate and early follow-up results of purse spray thrombolysis in patients with peripheral ischaemia.

Pulse spray thrombolysis is a technique of accelerated peripheral thrombolysis which has been evaluated in 38 patients, 29 with threatened limb viability and nine with a viable but critically ischaemic limb. The median length of occlusion was 26.5 (range 3-65) cm. The lytic agent used was recombinant tissue plasminogen activator (rtPA), injected manually via a pulse spray catheter at a concentration of 0.33 mg/ml and a bolus size of 0.2 ml. The median total dose of rtPA was 18 (range 5-35)mg. Patency and flow were completely restored in 34 of 38 patients and clinical success at 30 days was maintained in 27 of 38. The median lysis time was 120 (range 35-1125) min, compared with a median duration of 1545 (range 42-5760) min in 120 consecutive patients previously treated with conventional low-dose infusion thrombolysis using rtPA. This represents a 12-fold reduction in lysis time (P < 0.001). The overall estimated cumulative limb salvage rate for the 38 patients who entered the study was 84 per cent and the cumulative patency rate for the 34 patients in whom patency was restored was 74 per cent at 18 months follow-up. Pulse spray thrombolysis rapidly restores patency with good limb salvage at 30 days; the benefit is sustained even in patients with limbs at immediate risk of irreversible ischaemic injury who are not considered suitable for conventional thrombolysis.

Adult↗

PubMed2001

Role of the peripheral intravenous catheter in false-positive D-dimer testing.

OBJECTIVE: To determine whether inserting a peripheral intravenous catheter (IV) can significantly increase the circulating D-dimer concentration. METHODS: Twenty healthy young adult volunteers underwent cannulation of an antecubital vein with a 20-gauge Teflon IV. Time 0 venous blood was drawn during IV insertion. The IV was salinelocked and left in place for 90 minutes, at which time a second venipuncture was performed in a contralateral antecubital vein (+90 min). A qualitative D-dimer assay [erythrocyte-agglutination assay, SimpliRED (SRDD)] and a quantitative spectrophotometric assay [enzyme-linked immunosorbent assay (EIA), Dimertest Gold] were performed on all samples. Time 0 means (+/-SD) were compared with +90 min means by paired t-test, and SRDD pairs were compared with McNemar's test. RESULTS: Time 0 initial venipuncture blood samples yielded a mean D-dimer concentration of 15 +/- 24 ng/mL, with 2/20 SRDD tests read as positive (95% CI = 1% to 32%). At +90 min, the D-dimer concentration was 33 +/- 21 ng/mL (p = 0.04 vs time 0), with 5/20 SRDD tests read as positive (95% CI = 9% to 49%, p = 0.248). CONCLUSIONS: Insertion of an IV increased the circulating D-dimer concentration (determined by EIA), but did not lead to a significant increase in false-positive conversion of the SRDD. An effort should be made to perform D-dimer testing on "first-stick" blood to optimize specificity. However, a strongly positive D-dimer reaction cannot be ascribed to the presence of an IV.

Adult↗

PubMedDate not supplied

Variability in the clinical practice of maintaining the patency of peripheral intravenous catheters.

OBJECTIVE: To establish variations in clinical practice associated with maintaining the patency of peripheral intravenous catheters (PIC) and to determine to what extent such clinical practice falls within the limits of the available scientific evidence, based on a random sample Spanish public hospitals. METHODS: A cross-sectional, descriptive study was carried out in non-psychiatric public hospitals and their associated medical and surgical units. Cluster (hospitals), stratified (hospital size), and single level (all units) sampling was applied. A questionnaire was mailed to all of the units involved. RESULTS: A sample of 341 valid questionnaires was analysed (response rate 54.5%). Only one praxis-modality was carried out in the majority of units. Intermittent flushing and heparin saline versus normal saline was the most frequent modality employed, over those of continuous flushing and non-heparinised saline. There was a high degree of variation in the quantity of heparin administered: 81.7% when flushing was carried out with heparinised saline and 48.2% when it was conducted with concentrated heparin. About 40% of this variation was associated with the hospital in question, rather than with the unit. The clinical practice fell within the limits of available scientific evidence in fewer than half of the units studied. CONCLUSIONS: There was a high degree of variability in the practice of maintaining PIC patency. A significant part of this variation was attributable to the hospital in which the practice was carried out. Moreover, most of this practice was carried out beyond the limits of available scientific evidence.

Analysis of Variance↗

PubMed2001

Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part I.

Transcatheter endovascular procedures are increasingly used to treat symptomatic peripheral atherosclerosis. This two-part review identifies the existing evidence supportive of the application of transcatheter treatments for peripheral atherosclerotic lesions. The first part addresses the treatment of obstructive lesions that cause limb claudication and critical ischemia, renovascular hypertension and azotemia, and mesenteric ischemia. Studies were identified via a search of MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective randomized trials or other high-quality studies were unavailable, a preference was given to studies with at least 50 patients per treated group and a minimum mean follow-up duration of 6 months. Data presented in tables are proportionally weighted averages from included studies. For each application, the authors assessed the quality of evidence (QOE; efficacy, safety, and, where available, cost-effectiveness) and made recommendations with appropriate caveats. There is higher QOE supporting the more established treatments such as lower limb percutaneous transluminal angioplasty (PTA) with stent placement and thrombolysis. Treatments such as renal artery PTA and stent placement and mesenteric and brachiocephalic PTA are in wide use, but high QOE supporting general application is lacking. Blanket recommendations based on established efficacy and cost-effectiveness cannot be made. However, the use of transcatheter therapies can be supported in specific circumstances based on an expected reduction in procedure-related morbidity and/or mortality rates. It is hoped that the identification of deficiencies in the literature will inform and inspire critically needed research in this area.

Angioplasty, Balloon, Coronary↗

PubMed2001

Inhaled nitrous oxide versus placebo as an analgesic and anxiolytic adjunct to peripheral intravenous cannulation.

The objective was to determine whether an inhaled 50:50 mixture of nitrous oxide and oxygen (N(2)O/O(2)) provides significant pain and anxiety relief during intravenous cannulation in healthy adults. The study was conducted at the ED of a military teaching hospital. Participants included adult volunteers aged 18 to 50 years. Excluded were those with allergy to N(2)O, anemia, cardiac disease, pregnancy, asthma, or bone marrow disorder. A prospective, randomized, double-blind, placebo-controlled crossover design was used comparing a 50:50 mixture of N(2)O/O(2) versus O(2). After recording baseline nonhatched 100mm visual analog scales (VAS) for pain and anxiety, subjects inhaled gas 1 for 120 seconds, followed by antecubital intravenous cannulation, discontinuance of gas and VAS rating of procedural pain and anxiety. After 15 minutes, the experiment was repeated with gas 2. Ten subjects would detect a 12mm difference in pain or anxiety with a standard deviation of 10 mm, an alpha error under 0.05 and a power over 80%. Differences between VAS were compared by matched 2-tailed t-test. Eleven subjects were enrolled. One withdrew because of dizziness while inhaling gas (N(2)O). The 10 remaining subjects reported significantly less pain (N(2)O/O(2) 14.5mm, SD 18; O(2) 34.3mm, SD 23.4; P < .01) and anxiety (N(2)O/O(2) - 7.9mm, SD 7.8; O(2) 6.0mm, SD 11.6; P < .02) when inhaling N(2)O/O(2) than when inhaling O(2) alone. N(2)O/O(2) provided significant pain and anxiety reductions during intravenous cannulation. Some patients may experience adverse perceptions while using N(2)O, limiting its utility. Further studies defining the role of N(2)O as an anxiolytic agent, efficacy in actual patients, and cost comparisons with intravenous conscious analgesia/sedation, are warranted.

Administration, Inhalation↗

PubMed1996

Safe use of power injectors with central and peripheral venous access devices for pediatric CT.

PURPOSE: We report our experience in the safe use of power injectors with central and small-gauge peripheral venous access devices for intravenous administration of contrast agent to children undergoing computed tomography (CT) examinations. MATERIALS AND METHODS: We reviewed the medical records of 500 patients randomly selected from the 3121 children who underwent intravenous contrast-enhanced CT examinations at our institution from November 1993 through July 1995. RESULTS: The group of 500 patients, all younger than 18 years of age, accounts for 16 % of the contrast-enhanced CT examinations performed during the study period. Medrad MCT 311 Mark V or Medrad MCT Plus 311 power injectors were used to intravenously administer Omnipaque 300 (2 ml/kg, maximum dose = 150 ml) through venous access devices. These devices comprised Hickman or Broviac lines (n = 228), subcutaneous Port-A-Caths (n = 55), small-gauge butterfly needles (n = 215), and percutaneous intravenous central lines (n = 2). Two complications, one involving a Hickman line and the other a subcutaneous Port-A-Cath, occurred in the study population. These complications correspond to a frequency of 0.4 %. Six cases of contrast extravasation, all of them with the use of 23- (n = 1) and 25-gauge (n = 5) butterfly catheters (frequency = 0.2 %), occurred among the remaining 2621 cases. CONCLUSION: In light of the low frequency of complications, power injectors and central venous access devices or small-gauge butterfly catheters are safe systems for delivery of intravenous contrast material to pediatric patients. We feel that our strict adherence to manufacturers' guidelines and previously reported techniques partially accounts for our success with these modes of delivery.

Adolescent↗

PubMedDate not supplied

Effect of the continuous administration of fat emulsion on the infiltration of intravenous lines in infants receiving peripheral parenteral nutrition solutions.

Animal data and anecdotal human experience suggest that vascular damage induced by the infusion of dextrose/amino acid solutions may be ameliorated by the concomitant administration of fat emulsion. We prospectively evaluated the effect of the continuous infusion of peripheral nutrition solutions with and without fat emulsion on the incidence of, probability of, and time to infiltration of peripheral venous lines in infants (median age: 1.0 month; range 1 day-11.9 months). Ninety-seven peripheral venous lines were studied in 53 infants who received 10% dextrose (n = 34), 10% dextrose/2% amino acids (n = 30), or 10% dextrose/2% amino acids/fat emulsion (n = 33). Solutions were administered by positive pressure infusion devices through Teflon catheters with similar gauge. Dextrose, amino acid, electrolyte, and mineral content was standardized for the dextrose/amino acid and dextrose/amino acid/fat emulsion groups. The three groups were similar with respect to age, race, gender, weight, administration of intravenous medications, and catheter site (p greater than 0.05). Patients receiving dextrose/amino acid or dextrose/amino acid/fat emulsion had greater rates of solution administration than those receiving dextrose alone (p less than 0.002). Infiltration occurred in 71% of dextrose, 66% of dextrose/amino acid, and 67% of dextrose/amino acid/fat emulsion solutions (p greater than 0.05). The probability of infiltration was greater for infants receiving dextrose/amino acid than for those receiving either dextrose or dextrose/amino acid/fat emulsion (p = 0.01). The mean +/- SEM length of time the intravenous sites were viable was significantly shorter for the dextrose/amino acid solutions (26.3 +/- 3.3 hr) compared to the dextrose (54.9 +/- 7.8 hr) and dextrose/amino acid/fat emulsion (43.6 +/- 4.2 hr) groups. No site complications were associated with the infiltration of any solution. We conclude that the incidence of infiltration among the three solution groups studied is not different. However, the time to infiltration is prolonged and the probability of infiltration is decreased following the infusion of either dextrose alone or dextrose/amino acid/fat emulsion solutions when compared to the administration of dextrose/amino acid solutions without concomitant fat emulsion infusion.

Amino Acids↗

PubMed2001

Peripherally inserted central catheters: outcome as a function of the operator.

PURPOSE: To determine the natural history of and outcome involved with peripherally inserted central catheters (PICCs) placed at a single institution and examine potential differences in the natural history of PICCs placed by interventional radiologists (IRs) versus registered nurses (RNs). MATERIALS AND METHODS: A prospective analysis of all patients receiving PICCs at one academic medical center over a period of 6.5 months was conducted. At our institution, PICCs are placed primarily by RN members of the intravenous team. Placement procedures deemed unfeasible or problematic by RNs are referred to an IR for insertion under fluoroscopic guidance. A total of 322 PICCs (130 by IRs, 192 by RNs) were successfully placed in 256 patients. In three patients, placement was attempted but was a technical failure by both RNs and IRS: Seven patients in each group were lost to follow-up. PICCs were classified as successfully completed therapy or as having been prematurely removed, which was further stratified into suspected infection, occlusion, phlebitis, mechanical failure, inadvertent patient removal, and other. RESULTS: Overall rate of premature removal for PICCs placed by IRs versus RNs was not significantly different (30.8% vs 23.4%, respectively). PICCs placed by IRs had an increased rate of occlusion (IRs = 9.2%, RNs = 3.6%; P =.02). Other reasons for premature removal did not differ in incidence. Overall, PICCs were successfully placed in 99.1% of all patients and the course of therapy was completed in 69.3%. CONCLUSION: It is reasonable and cost-effective for trained RNs to place PICCs whenever feasible and refer complicated placements to IRS:

Adolescent↗

PubMed1997

The risk of peripheral vein phlebitis associated with chlorhexidine-coated catheters: a randomized, double-blind trial.

OBJECTIVE: To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins. DESIGN: A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters. SETTING: A university hospital. PATIENTS: Adult medicine and surgery patients. INTERVENTIONS: Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture. RESULTS: Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P = .32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P = .06), but not when all catheters were considered in both patient groups (P = .31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P = .85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P = .07). CONCLUSION: The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidine-coated polyurethane catheters compared to otherwise identical uncoated catheters.

Adult↗