European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project.

Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.

SecurAstaP trial: securement with SecurAcath versus StatLock for peripherally inserted central catheters, a randomised open trial.

OBJECTIVES: To assess the effect on needed nursing time for dressing change. DESIGN, SETTING, PARTICIPANTS: A parallel-group, open-label, randomised controlled trial in patients who are in need for a peripherally inserted central catheter insertion in one teaching hospital in Belgium. The follow-up lasted 180 days or until catheter removal, whatever came first. A computer generated table was used to allocate devices. Randomised patients were 105 adults (StatLock, n=53; SecurAcath, n=52) and primary analysis was based on all patients (n=92) with time measurements (StatLock, n=43; SecurAcath, n=49). INTERVENTIONS: StatLock which has to be changed weekly versus SecurAcath which could remain in place for the complete catheter dwell time. MAIN OUTCOME MEASURE: Needed time for the dressing change at each dressing change (SecurAcath) or at each dressing change combined with the change of the securement device (StatLock). RESULTS: Median time needed for dressing change was 7.3 min (95% CI 6.4 min to 8.3 min) in the StatLock group and in the SecurAcath group 4.3 min (95% CI 3.8 min to 4.9 min) (P<0.0001). The time in the SecurAcath group was reduced with 41% (95% CI 29% to 51%). Incidence rates of migration, dislodgement and catheter-related bloodstream infection were comparable across groups. Pain scores were higher with SecurAcath than with StatLock at insertion (P=0.02) and at removal (P<0.001) and comparable during dressing change (P=0.38) and during dwell time (P=0.995). User-friendliness was scored at insertion and removal. All statements regarding the user-friendliness were scored significantly higher for StatLock than for SecurAcath (P<0.05). Only for the statement regarding the recommending routine use of the device, which was asked at removal, no difference was found between the two devices (P=0.32). CONCLUSION: Use of SecurAcath saves time during dressing change compared with StatLock. Training on correct placement and removal of SecurAcath is critical to minimise pain. TRIAL REGISTRATION NUMBER: NCT02311127; Pre-results.

Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit.

Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient's condition.

Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review.

BACKGROUND AND AIMS: Catheter-related infection (CRI) is the most common and serious complication for adult patients receiving home parenteral nutrition (HPN). Our aim is to provide epidemiological data on infection incidence, infecting pathogens and contributing risk factors. METHODS: Four electronic databases (Embase, Medline, IPA, CINAHL) were screened for eligible studies published between 1970 and March 2012. Methodological quality was evaluated and terminology/definitions were re-categorized. RESULTS: Thirty-nine studies were included. Extensive variability was observed in terminology/definitions as well as in expression of CRI rate. After correct interpretation of definitions, overall catheter-related bloodstream infection rate (CRBSI) ranged between 0.38 and 4.58 episodes/1000 catheter days (median 1.31). Gram-positive bacteria of human skin flora caused more than half of infections. An analysis of the reported risk factors showed that the origin of a CRBSI is often multifactorial. The risk factors were related to the patient, the venous access device, the education, HPN therapy and follow-up. CONCLUSIONS: This review on CRI in adult HPN patients revealed that included studies are of low quality and used poorly described risk factors and different definitions. The human skin flora caused most of infections; therefore, hand hygiene and training remain essential.

Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience.

PURPOSE: Our aim is to describe the number and distribution of requests addressed to an Advanced Practice Nursing team for functional problems of totally implantable venous access devices (TIVADs) and to describe, in detail, the malfunction management by the type and number of additional investigations and treatment modalities. METHOD: The Advanced Practice Nursing team recorded data about all requests for support as part of the standard care. A specific protocol, the Leuven Malfunction Management Protocol was used for troubleshooting. In this descriptive, retrospective study, data of 3950 consecutive requests for TIVAD-related functional problems in 2019 patients were analyzed. Data collection included (1) demographic information, (2) device-related details, and (3) malfunction and follow-up details. RESULTS: 'Easy injection, impossible aspiration' was the most frequently documented functional problem (66.9%) for all requests for help. Of all malfunctions, catheter tip was in an optimal position in 73.4%, thrombolytics were administered in 59.0%, and a linogram was performed in 4.9%. TIVAD removal/exchange was advised in 4.4% of the requests. CONCLUSIONS: TIVAD malfunction-defined operationally in terms of injection and/or aspiration problems-reflect all functional complications encountered in practice. Adherence to the Leuven Malfunction Management Protocol can ensure that, in most cases, catheter patency can be fully restored without removing or replacing the TIVAD. The Advanced Practice Nursing team coordinates the following treatments, investigations, and procedures: radiological catheter tip verification; thrombolytic agent administration and, if necessary, subsequent injection of solutions to dissolve drug precipitates or lipid deposits; linogram; percutaneous sleeve stripping; and TIVAD removal/replacement.

Systematic review: malfunction of totally implantable venous access devices in cancer patients.

PURPOSE: Malfunction of totally implantable venous access devices is a common complication. The purpose was to identify definitions used to describe malfunction and to investigate the incidence of malfunction in different types of port and catheter designs. METHODS: Relevant studies were identified in PubMed that were published between January 1993 and February 2011. Empirical studies reporting functional outcomes in adults and where, at least 95% of the studied population consisted of onco-hematology patients with a newly inserted chest or arm port, were selected. The following data were extracted: patient and totally implantable venous access devices (TIVAD) characteristics, study design, definitions of malfunction, and functional outcomes. Two independent reviewers assessed the methodological quality of the series. RESULTS: Of the 4,886 potentially relevant articles, 57 were selected, involving 14,311 TIVADs. Twenty-nine percent of the studies explicitly defined malfunction. Malfunction incidence rates were expressed in six different ways, including the proportion of affected devices per inserted devices (incidence 0-47%); the number of affected devices per 1,000 catheter days (incidence 0-2.24 per 1,000 catheter days); and the number of malfunctions over the total number of accessing attempts (incidence 0-26%). CONCLUSIONS: Heterogeneity in the definitions used to describe device malfunction was evident. A broad range in the reported incidence of malfunction and in the kind of calculation and reporting methods was also found. Methodological quality of the studies was often poor. Standardization of definitions and accurate outcome measurement is needed. Calculation and report of malfunction incidence should be based on prospective data collected at the moment of an accession attempt.