A summary of the best evidence for preventing accidental extubation of an adult peripheral venous catheters / 中国实用护理杂志

Objective:To retrieve, appraise and summarize the best evidence to prevent accidental extubation of peripheral venous catheters in adults.Methods:According to the "6S" evidence model, computer evidence retrieval was carried out. Search relevant domestic and foreign guideline networks and databases to collect relevant evidences, including clinical decision, guidelines, evidence summary, systematic reviews, etc. The retrieval time was from the establishment of the database to September 2021. Two researchers conducted independent literature search, quality evaluation, evidence extraction and summary. If there is a disagreement between the two, the third party shall be invited to make a ruling.Result:A total of 8 articles were included, including 1 clinical decision, 1 guideline, 2 evidence summaries, 3 RCTs and 1 expert consensus. The 35 best evidences were summarized from six aspects: education and training, catheter placement selection, dressing selection, catheter fixation, catheter maintenance and timing of extubation.Conclusion:This summary of evidence provided evidence-based evidence for the standardized management of clinical prevention of accidental extubation of peripheral venous catheters. However, some of evidence is lacking and of poor quality. In the future, the evidence should be used cautiously according to the clinical situation and patient conditions.

Prática deliberada em ciclos rápidos aplicada em profissionais de enfermagem na punção venosa periférica / Rapid cycle deliberate practice applied to nurse technician professionals in peripheral venipuncture

Introdução: A Prática Deliberada em Ciclos Rápidos (PDCR) é uma estratégia educacional de simulação focada em promover um treinamento que permita o domínio de uma habilidade. A estratégia aplica o feedback direcionado e a oportunidade de repetição para que o participante alcance a maestria e/ou a alta performance. Estudos evidenciam melhorias significativas de habilidades dos profissionais de saúde quando treinados com PDCR em contexto de reanimação cardiopulmonar pediátrica. A partir da conjectura de que a PDCR pode ser aplicada em profissionais de saúde para melhoria de habilidades, formulou-se a hipótese que a PDCR melhora a performance técnica dos profissionais técnicos de enfermagem na punção venosa periférica (PVP) comparada ao treinamento de habilidade, que é outra estratégia mais comumente usada para ensino e capacitação profissional. Objetivos: Avaliar a PDCR como uma estratégia educacional e seu impacto na performance técnica dos profissionais técnicos de enfermagem na PVP; comparar a performance técnica dos profissionais técnicos de enfermagem na PVP após treinamento usando PDCR versus o treinamento de habilidade. Método: Estudo unicêntrico, experimental randomizado aberto, aplicado em 60 profissionais técnicos de enfermagem, divididos em dois grupos. A performance foi avaliada antes e após o treinamento, a partir do cálculo da taxa de acerto em 21 itens observados na execução do procedimento. A estratégia de treinamento do Grupo Intervenção (GI) foi a PDCR e do Grupo Controle (GC) foi o treinamento de habilidades de PVP. Resultados: O percentual global de acertos dos itens do procedimento de punção venosa periférica avaliados para o GC aumentou de 57,8% no pré-teste para 93,5% no pós-teste e o percentual de acertos para o GI aumentou de 59,4% para 96,0%. A variação da média no pré e pós-teste foi de 35,7% para GC e de 36,6% para o GI. Comparando pareadamente às taxas de acerto pré e pós-teste de cada grupo, ambos os treinamentos tiveram um efeito significativo em aumentar as taxas de acerto dos itens do procedimento de punção venosa periférica avaliados (p-valor <0,0001 para os dois grupos). Não houve diferença significativa entre as distribuições das taxas de acerto do pós-teste dos dois grupos (p-valor = 0,225). Usando a medida do tamanho de efeito dm de Cohen, o tamanho do efeito do treinamento do GC foi 2,95 e o tamanho de efeito do treinamento do GI foi 3,59. Usando a medida do tamanho de efeito Δ de Glass, o tamanho de efeito do treinamento do GC foi 2,24 e o tamanho do efeito do GI foi 2,63. Conclusão: Do ponto de vista da performance técnica, o treinamento com PDCR, assim como o treinamento de habilidades, resultou em melhorias de desempenho no procedimento de punção venosa periférica, evidenciadas pelo aumento de acertos no pós-teste em comparação com o pré-teste. Dessa forma, pode-se concluir que a PDCR pode ser aplicada como uma estratégia educacional para o treinamento da punção venosa periférica, não sendo inferior ao treinamento de habilidade. Sendo assim, pode-se interpretar que a aplicação da PDCR em contexto diferente do estudo original parece ser promissora e factível.

Introduction: Rapid Cycle Deliberate Practice (RCDP) is an educational simulation strategy that focuses on promoting simulation training that allows skill mastery achievement. The strategy applies directed feedback and opportunity for repetition until participants achieve mastery and/or high performance. Studies show significant improvements in the skills of healthcare professionals when trained with RCDP in pediatric cardiopulmonary resuscitation context. Based on the conjecture that RCDP can be applied to health professionals to improve skills, authors formulated the hypothesis that RCDP improves the technical performance of nursing technicians in peripheral venipuncture (PVP) compared to skill training, another strategy commonly used for teaching and professional training. Objectives: To evaluate RCDP as an educational strategy and its influence on the technical performance of nursing technicians in PVP; to compare the technical performance of nursing technicians in PVP after training using RCDP versus skill training. Methods: Single-center, open randomized experimental study, applied to 60 professional nursing technicians divided into two groups. Performance was evaluated before and after training, based on the calculation of the correct answer rate in 21 items observed during the procedure. The training strategy of the Intervention Group (IG) was RCDP and the Control Group (CG) was the skill training of PVP. Results: The overall percentage of correct answers for the items of the peripheral venipuncture procedure evaluated for the CG increased from 57.8% in the pre-test to 93.5% in the post-test and the percentage of correct answers for the IG increased from 59.4% to 96.0%. The mean variation in the pre and post- test was 35.7% for the CG and 36.6% for the IG. Comparing the pre and post-test hit rates of each group in parallel, both training strategies had a significant effect in increasing the hit rates of peripheral venipuncture procedure items that were evaluated (p-value <0.0001 for both groups). There was no significant difference between the distributions of the post- test hit rates of the two groups (p-value = 0.225). Using Cohen's dm effect size measure, the CG training effect size was 2.95 and the IG training effect size was 3.59. Using Glass's Δ effect size measure, the GC training effect size was 2.24 and the GI effect size was 2.63. Conclusion: From the point of view of technical performance, training with RCDP, as well as skills training, resulted in performance improvements in the peripheral venipuncture procedure, evidenced by the increase of correct answers in the post-test compared to the pre-test. Thus, the study concludes that RCDP works as an educational simulation strategy for peripheral venipuncture training since it showed not to be inferior to the skill training approach. Therefore, the application of RCDP in a different context from the original study seems to be propitious and viable.

Beneficios de la asepsia del sitio de inserción del catéter venoso periférico corto. Análisis de datos secundarios / Benefits of asepsy of the short peripheral venous catheter insertion site. Secondary data analysis

Introducción: las enfermedades isquémicas del corazón ocupan los primeros lugares de morbimortalidad, lo que exige la amplia participación del profesional de enfermería en la atención de los pacientes con estos padecimientos, y el tratamiento de infusión (TI) es uno de los principales procedimientos que realiza, incluidos la instalación, el mantenimiento y el retiro oportuno de los dispositivos de acceso vascular (DAV), en especial el catéter venoso periférico corto (CVPC). Objetivo: analizar los beneficios de realizar limpieza en el sitio de inserción (LISI) del CVPC funcional como opción en el mantenimiento. Metodología: estudio prospectivo, transversal y comparativo de LISI en pacientes de una institución de tercer nivel de atención, durante abril de 2017 a junio de 2018, una muestra de 100 pacientes seleccionados por conveniencia. El grupo 1 de pacientes con CVPC muestra sangre en el sitio de inserción, se encuentra funcional y se realiza LISI; el grupo 2 tiene las mismas condiciones pero éste se retira y se instala otro dispositivo. Los datos se obtuvieron de la base de datos Análisis CVPC 2017-2019 de la Unidad de Vigilancia Epidemiológica. Resultados: el 58% de la muestra se integró con adultos mayores con una media de punciones de 2; el 25% duró más de cinco días y el 5% se retiró por aparición de alguna complicación, ninguna relacionada con la LISI. Con la LISI se obtiene un ahorro del 47.35% del costo total. Conclusión: la LISI puede evitar inserciones innecesarias, reduce costos hasta 50% y no aumenta la aparición de infecciones relacionas con el catéter.

Introduction: Ischemic heart diseases occupy the first places of morbidity and mortality, which requires the broad participation of the nursing professional in the care of patients with these conditions, infusion therapy (IT) being one of the main procedures performed, this includes the installation, maintenance and timely removal of vascular access devices (VADs), especially the short peripheral venous catheter (CVPC). Objective: To analyze the benefits of cleaning the insertion site (CIS) of the functional CVPC as an option in maintenance. Methods: Prospective, cross-sectional, comparative study of CIS in patients from a tertiary care institution, from April 2017 to June 2018, sample of 100 patients selected for convenience. Group 1 of patients with CVPC presents blood in the insertion site, it's functional, CIS is performed; Group 2 presents the same conditions but this is removed and another device installed. The data were obtained from the CVPC Analysis 2017-2019 database of the Epidemiological Surveillance Unit. Results: 58% of the sample was made up of older adults, mean number of punctures: 2, 25% lasted more than 5 days, 5% withdrew due to presenting some complication, none related to CIS. With the CIS there is a saving of 47.35% of the total cost. Conclusion: CIS might avoid unnecessary insertions, reduces costs by 50% and does not increase the presence of catheter-associated infections.

Selection of perioperative venous access for simultaneous repair and reconstruction of oral cancer after radical resection / 口腔疾病防治

Objective@#To explore the characteristics of perioperative venous therapy in patients undergoing simultaneous repair and reconstruction of oral cancer after radical resection, and prevention of femoral vein catheterization complications, to provide clinical evidence for venous therapy.@*Methods@#A retrospective analysis was perfomed to assess the choice of venous access and its effects in 95 patients undergoing simultaneous reconstruction due to oral cancer during the perioperative period. @*Results @# In total, 95 patients underwent successful indwelling femoral vein catheterization with double lumens, and a midline catheter and peripheral intravenous indwelling needles were used to complete the intravenous therapy after surgery. Among the femoral vein complications, 1 case was complicated with lower extremity venous thrombosis (incidence was 1.1%), and 17 cases were complicated with puncture point bleeding (incidence was17.9%). Two cases of puncture site bleeding were noted among 28 cases using a midline catheter. Local phlebitis and infiltration were the most common complications of peripheral venous catheters. The difference in catheter-related complications among different types of catheters was statistically significant (P < 0.05). The complication rate of the midline catheter was lower than that noted with femoral vein catheterization and peripheral intravenous indwelling needles.@*Conclusion@#Based on the treatment characteristics of patients, proper venous catheters should be established during the perioperative period. The application of a femoral vein catheter during the operation combined with the use of a midline catheter and peripheral venous indwelling needles after the operation can satisfy intravenous therapy needs in patients undergoing simultaneous repair and reconstruction for oral cancer, and the midline catheter can effectively reduce venous catheter-related complications.

Peripheral venous catheter related blood stream infection in intensive care unit

Background: Peripheral venous catheter related blood stream infections (PVC-BSI) are a common cause of morbidity and mortality in hospitals. Most of the catheter related blood stream infections occurs due to lack of proper aseptic measures. This study points out the risk factors microbial profile and antimicrobial susceptibility of isolates associated with PVC-BSI. The common organisms causing Catheter related BSI are Staphylococcus aureus (41.1%), and Klebsiella species (17.6%) followed by CONS and Enterococcus species. Objective of present study was to isolate and identify the organisms causing PCV-BSI, perform antimicrobial sensitivity testing of isolated organisms and to identify the associated risk factors and preventive measures that should be used.Methods: The study was conducted over a period of one year from August 2015 to July 2016 in the Department of Microbiology. Study group comprised of all the patients with peripheral venous catheterization who developed signs and symptoms of septicemia after 48 hrs of insertion of PVC. These patients were followed up from the time of catheterization till discharge. Peripheral venous catheter tip was collected under aseptic condition along with peripheral blood samples from a site other than the catheterized one. Samples were collected from patients at any point of time who developed signs and symptoms of septicemia after 48 hrs of catheter insertion. The length of time for which the PVC was in place was recorded.Results: In total, 87 cases were included in the study with mean catheter duration of 4.8 days accounting for 418 catheter days. Out of these 87 cases, 17 cases developed PVC-BSI (19.5%) and 34 cases developed colonization (24.1%). Staphylococcus species (41.1%) was the most common isolate.

Effectiveness of pulsative flushing and continuous flushing for peripheral venous catheter: a Meta-analysis / 中国实用护理杂志

Objective To evaluate the effectiveness of pulsative flushing and continuous flushing for peripheral venous catheter.Methods By retrieving Cochrane Library,ProQuest Research Library,PubMed,Web of science,Ovid,Embase and CINAHL complete(EESCO),China National Knowledge Infrastructure(CNKI),Wanfang,Weipu,and China Biology Medicine disc (CBMdisc) to find the randomized controlled trials (RCT) and clinical controlled trials(CCT) that been applied to compare pulsative flushing and continuous flushing for peripheral venous catheter,and using Revman5.3 soft for a Meta-analysis.Results There were thirteen studies which had involved 1 679 patients.The Meta-analysis' results as follows:The pulsative flushing was superior than continuous flushing indecreasing intravenous catheter's blockage (P ＜ 0.01),and had prolonged more time than continuous flushing in retaining catheter (P ＜ 0.01).The two flushing methods were similar in reducing phlebitis (P＞ 0.05).Conclusions The pulsative flushing was superior to the continuous one in reducing the intravenous catheter's blockage and prolonging the catheter's times.There were similar in decreasing phlebitis.The pulsative flushing method was used with caution in chronic diseases such as angiocardiopathy.

Comparison of hematocrit and platelet levels obtained from peripheral venous catheter vs venipuncture in patients admitted at Philippine Children’s Medical Center for dengue fever

OBJECTIVES@#To determine the statistical agreement between hematocrit and platelet counts obtained via peripheral venous catheters and venous puncture. It also aims to compare the success rate of obtaining samples via PVC and the hemolysis rate between different gauges of IV catheter.@*DESIGN@#Prospective Cross-sectional Study.@*PARTICIPANTS@#Clinically stable patients admitted for dengue aged 1 to 18 years old and are eligible to be enrolled in the study. Twenty-two patients were enrolled and completed the study.@*INTERVENTION@#Paired samples of venous blood collection using venipuncture and PVC on the contralateral arm was done during daily serial CBC monitoring. Hematocrit and platelet values between the two methods were analyzed using Bland-Altman Analysis.@*MAIN OUTCOME MEASURES@#Statistical agreement of platelet and hematocrit levels obtained using PVC and Venipuncture.@*RESULTS@#We had 22 patients and a total of 67 paired samples. Out of the 67 samples submitted, two samples each from PVC (2.9%) and venipuncture (2.9%) were clotted. There was100% success rate in both methods at the first attempt of collection. None on the samples had hemolysis. On the average, hematocrit measurements from venipuncture are increased by 1.17 (units) compared to PVC, while platelet measurements from PVC are increased by 4.83 (units) compared to venipuncture. There is no significant difference in both platelet count and hematocrit between the two methods, demonstrating agreement between the two methods.@*CONCLUSIONS@#There is statistical agreement between samples drawn from PVC and venipuncture in terms of hematocrit and platelet counts in dengue pediatric patients. Success rate and hemolysis rates between the two methods are the same. PVC is an acceptable alternative to venipuncture.

Conocimiento y criterios de enfermería para evitar flebitis en neonatos con catéter venoso periférico / Knowledge and nursing criteria to avoid phebitis in neonates with peripheral venous catheter

Introducción: el proceso cotidiano en la atención y cuidado de los neonatos brinda la oportunidad de conocer, observar e implementar procedimientos que contribuyan al bienestar del neonato. Objetivo: analizar el conocimiento y el criterio de enfermería para evitar se presente flebitis en el neonato con catéter venoso periférico. Metodología: estudio descriptivo, transversal a 17 enfermeras y 43 neonatos ingresados al servicio de infectología pediátrica. Se aplicó un instrumento con 37 reactivos, se evaluaron tres dimensiones: conocimiento, criterio y técnica. Una lista de cotejo para medir la flebitis de acuerdo a los indicadores de calidad de la Norma Oficial en la Vigilancia y Control de Venoclisis Instaladas de la SSA. 2001. Resultados: se identificó la evidencia que la flebitis es uno de los principales problemas del uso de catéteres intravenosos cortos. En el grupo de edad entre 20 a 25 años aportó significancia estadística, en la técnica (F = 4.663, gl = 3, sig: = 0.020) es quien mejor lo realiza con un promedio de ejecución de 2.25, con respecto a conocimiento y criterio no hay cifras estadísticamente significativas. Discusión: los resultados encontrados muestran que el riesgo de flebitis se incrementa con el tiempo de permanencia de los dispositivos intravasculares periféricos, al presentar flebitis en las primeras 24 a 48 horas de instalado un catéter venoso periférico.

Background: the daily care of the newborn offers the opportunity to know, to observe and to implement procedures that contribute to the well-being of them. Objective: to analyze the knowledge and the criteria in the nursery to avoid phlebitis in the newborn with a peripheral venous catheter. Methodology: the design was cross-sectional, descriptive and observational. Seventeen nurses and 43 newborns from a pediatrics infectious hospital. An instrument was applied where three dimensions were evaluated: knowledge, criterion and technique. Another instrument was a matching list to measure the phlebitis according to Official Norm for the monitoring and control of intravenous treatment. Results: this study showed that the phlebitis is one of the main problems in the use of intravenous catheters. In the group of age 20 to 25 years statistical significance, in the technique (F = 4.663, gl = 3, sig: = 0.020) is the highest average of performance was 2.25, With regard to knowledge and criterion there were not statistically significant values. Discussion: the results found in this study reveal that the risk phlebitis is proportional to the inawelling time of the devices. This complication presents with in the first 24 to 48 hours after the placement of an intravenous catheter. Conclusions: the flebitis in the neoborn one with hospitalized peripheral venous catheter appears in a one hundred percent.