Required volume for color flow injection test to confirm the intravascular placement of a peripheral venous catheter.

BACKGROUND: Confirmation of adequate peripheral intravenous catheter placement is essential before using venous catheters. The color flow injection test has been reported as a method with high sensitivity and specificity for this purpose. The technique involves administrating saline through the peripheral venous route to observe changes in the color flow pattern around the same vein at a more central location. However, the required volume of saline remains uncertain. This study aims to determine the appropriate dosage for conducting the test in pediatric patients and explore any potential correlations between dosage and patient characteristics. METHODS: A prospective study was conducted in children under 6 years of age with American Society of Anesthesiologists Physical Status 1-2 presenting for general anesthesia. After an intravenous cannula was placed in the forearm under general anesthesia, normal saline was injected at a speed of approximately 1 mL/s while the axillary artery and vein were observed with color flow Doppler imaging. The volume of normal saline required to induce a change in the color flow pattern around the vessels was measured. Measurements were performed twice and averaged for comparison with patient characteristics and other factors. RESULTS: The study cohort included 30 patients aged from 0.3 to 5.5 (2.6 ± 1.6) years. The change in color flow Doppler imaging was noted in all the patients, and the average volume was 1.40 ± 0.36 mL (95% confidence interval (CI), 1.27-1.54; p < 0.001), which was significantly correlated with age, with a correlation coefficient of 0.435 (95% CI, 0.09-0.69; p = 0.02). CONCLUSIONS: The required volume for the color flow injection test is small; therefore, the test is easy to perform and minimally invasive in pediatric patients.

Reduction in the incidence of infusion-related phlebitis in a pediatric critical care unit of Eastern India: A quality improvement initiative.

Background: Phlebitis is one of the most common complications of the peripheral venous catheter (PVC) and adversely impacts future venous access, and bacterial phlebitis may lead to bloodstream infection. The objective of the study was to reduce the to reduce the incidence of infusion-related phlebitis in children admitted to the pediatric critical care unit. Methods: This Quality Initiative was implemented in the pediatric critical care unit of a tertiary care hospital between November 2019 and April 2020. Five interventions were identified (hand hygiene, use of transparent dressing, use of extension lines with PVCs, use of hard cardboard splints for joint immobilization, use of heparinized flush after medication administration) and were introduced sequentially. Over the next five weeks, a new intervention was introduced weekly while continuing the previous ones, if found to be working well as per improvement parameter, the phlebitis rate. From the sixth week onwards, all five interventions were applied together as a bundle. Results: Total seven hundred eighteen PVCs were sited in 284 (Male: female 1.58:1) patients during study period and a total of 56 incidences of phlebitis were observed. Mean baseline phlebitis rate was 48.5%. In the next 5 weeks when interventions were implemented as planned, phlebitis rate was 35.7% (n = 10), 16.6% (n = 03), 21.6% (n = 8), 10% (n = 05), and 13.3% (n = 2) respectively. Implementation of all five interventions together as a bundle led to reduction in phlebitis rate below 5 % consistently over the next 18 weeks (n = 8). Conclusion: A consistent reduction in PVC-related phlebitis can be achieved by the implementation of evidence-based interventions for the prevention of phlebitis, as a bundle.

Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study.

OBJECTIVES: Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI. METHODS: Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors. RESULTS: A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results. DISCUSSION: Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI.

Análise das complicações locais associadas ao cateterismo venoso periférico no doente crítico / Analysis of local complications associated with peripheral venous catheterization in critically ill patients / Análisis de las complicaciones locales asociadas al cateterismo venoso periférico en el paciente crítico

Resumo Enquadramento: A escassez de estudos sobre complicações locais associadas ao cateterismo venoso periférico em doente crítico em Portugal compromete a implementação de medidas preventivas adequadas. Objetivo: Analisar as complicações locais associadas ao cateterismo venoso periférico no doente crítico num Serviço de Medicina Intensiva em Portugal. Metodologia: Estudo transversal analítico prospetivo, realizado através da aplicação de uma grelha de registo elaborada pelo investigador a uma amostra de 48 doentes. Resultados: Amostra maioritariamente masculina (54,2%), com média de idade de 70,13 anos, com cateter venoso periférico de calibre 20G (58,5%), colocados no membro superior (58,5%) e com diagnóstico na admissão de doenças infeciosas e parasitárias (33,3%). As complicações locais associadas ao cateterismo venoso periférico foram de 11,6%, sendo 6,4% flebites, 2,3% infiltrações e 2,9% obstruções. Estas associaram-se ao tempo de permanência do cateter (p < 0,05). Conclusão: A frequência de complicações foi significativa e o tempo de permanência do cateter influenciou a frequência de complicações. Recomendamos reduzir o tempo de permanência do cateter ou, quando possível, utilizar uma via alternativa.

Abstract Background: The scarcity of studies on local complications associated with peripheral venous catheterization in critically ill patients in Portugal compromises the implementation of adequate preventive measures. Objective: To analyze the local complications associated with peripheral venous catheterization in critically ill patients in an Intensive Care Unit in Portugal. Methodology: Prospective analytical cross-sectional study, carried out through the application of a registration grid developed by the researcher to a sample of 48 patients. Results: Mostly male sample (54.2%), with a mean age of 70.13 years, with a 20G peripheral venous catheter (58.5%), placed in the upper limb /58.5%) and diagnosed in the admission of infectious and parasitic diseases (33.3%). Local complications associated with peripheral venous catheterization were 11.6%, with 6.4% phlebitis, 2.3% infiltrations and 2.9% obstructions. These were associated with the catheter permanence time (p < 0.05). Conclusion: The frequency of complications was significant and the catheter length of stay influenced the frequency of complications. We suggest reducing catheter permanence time or using an alternative route whenever possible.

Resumen Marco contextual: La escasez de estudios sobre las complicaciones locales asociadas al cateterismo venoso periférico en pacientes críticos en Portugal compromete la aplicación de medidas preventivas adecuadas. Objetivo: Analizar las complicaciones locales asociadas al cateterismo venoso periférico en pacientes críticos de una unidad de cuidados intensivos de Portugal. Metodología: Estudio transversal analítico prospectivo, realizado mediante la aplicación de una tabla de registro elaborada por el investigador a una muestra de 48 pacientes. Resultados: La muestra fue mayoritariamente masculina (54,2%), con una edad media de 70,13 años, con catéter venoso periférico de calibre 20G (58,5%) colocado en el miembro superior (58,5%) y con diagnóstico de enfermedad infecciosa y parasitaria al ingreso (33,3%). Las complicaciones locales asociadas al cateterismo venoso periférico fueron del 11,6%, con un 6,4% de flebitis, un 2,3% de infiltración y un 2,9% de obstrucción. Estas se asociaron a la duración de la estancia del catéter (p < 0,05). Conclusión: La frecuencia de las complicaciones fue significativa y el tiempo de permanencia del catéter influyó en la frecuencia de las complicaciones. Se recomienda reducir el tiempo de permanencia del catéter o, si es posible, utilizar una vía alternativa.

Ultrasound guidance practices used for the placement of vascular accesses in intensive care units: an observational multicentre study.

BACKGROUND: Central catheters expose ICU patients at risk of catheter-related bloodstream infections. A mechanism by which these infections occur is the contamination of the catheter during its insertion if aseptic techniques are not strictly applied. Recent studies suggest that the use of ultrasound guidance (USG) may increase the risk of catheter contamination during insertion. We assessed current practices regarding the use of USG during catheter insertion, with a focus on identifying breaches of the surgical asepsis required for this invasive procedure. METHODS: In 26 intensive care units, we evaluated the use of USG during catheter insertion, using a questionnaire addressed to intensivists and direct observation of their practices. RESULTS: We analyzed 111 questionnaires and 36 observations of intensivists placing catheters. The questionnaires revealed that 88% of intensivists used USG for catheter insertion. Among those using USG, 56% had received specific training, 17% benefited from specific recommendations, 76% marked the insertion site before skin antisepsis, and during catheter insertion, 96% used sterile gel and 100% used a sterile sheath and sterile gloves. We identified potential deviations from strict aseptic technique, including contact between the sheath and the needle (19.4%), handling of the US system during catheter insertion (2.8%), and use of sterile devices, where they were not yet necessary (during the marking site or skin antisepsis), resulting in their contamination at the time of catheter insertion. CONCLUSIONS: Interventions aimed at ensuring compliance with measures to prevent CRBs should be organized to prevent an increase in infections associated with US-guided catheter insertion.

Impact of a training strategy on improving compliance of hand hygiene and gloving during the placement of a short peripheral venous catheter: the multicentre study CleanHand4.

BACKGROUND: Patients who have short peripheral venous catheters (PVC) face an elevated risk of developing bloodstream infections. Preventing catheter-related infections relies on implementing multiple measures, including practicing proper hand hygiene (HH) during catheter placement. METHODS: We conducted a four-part study: (1) an evaluation of HH practices through direct observation of PVC placements, coupled with the study of the microbial flora of the HCWs fingers just before the placement; (2) the development of an educational tool based on the collected observational and microbiological data; (3) the training to the HCWs observed during the first part, using this tool; and (4) the subsequent observation of the trained HCWs to measure the impact of the training on practice improvement. RESULTS: Compliant HH was observed in 23.5% of the 647 HCWs observed during PVC placement before training. The microbiological study revealed fewer pathogens on the fingertips of the HCWs practicing compliant HH compared other HCWs (2.6 vs 11,7%; p = 0.003). The comparison of practices before and after training, assessed among 180 HCWs, showed an increase in the proportion of HCWs performing compliant HH (25.0 vs 63.2%; p < 0.001). CONCLUSIONS: Training HCWs using our educational tool, which combines reminders of best practices and risk factors associated with PVC-related infections, engaging HCWs (presentation of practice evaluation), identifying professionals deviating from best practices (simulation videos), and objectively assessing fingertip contamination (microbiological study), significantly improved compliance with HH gestures and glove usage. We encourage infection control teams to utilize this tool to raise awareness among HCWs responsible for PVC placement about the risk of infection associated inadequate hand hygiene.

Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis.

BACKGROUND: The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. The objective of the study is to evaluate previously to the implementation whether the benefits of introducing ultrasound-guided peripheral venous catheters, midline catheters and peripherally inserted central catheters compared to current practice by a vascular access specialist team outweigh their costs. METHODS: Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when changing the current practice for the use of ultrasound-guided midline and PICC catheters, as well as the additional resources required for their use. RESULTS: The use of an ultrasound-guided device on peripherally inserted central carheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, the use of an ultrasound-guided device on a midline catheter, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. CONCLUSION: The benefits of using ultrasound-guided midline and PICC catheters compared to current practice by introducing a vascular access specialist team trained in the implantation of ultrasound-guided catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of phebitis. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.

Risk factors and incidence of peripheral venous catheters-related phlebitis between 2017 and 2021: A multicentre study (Flebitis Zero Project).

BACKGROUND: The peripheral venous catheter is one of the most frequently used devices in inpatient units worldwide. The risk of complications arising from use of peripheral venous catheters is low, but phlebitis frequently develops. METHODS: A multicentre, prospective cohort study was conducted in 65 Spanish hospitals on 10,247 inpatients who had had a total of 38,430 peripheral venous catheters inserted. Data were collected for 15 consecutive days in 2017, 2018, 2019, 2020 and 2021. Central tendency and dispersion were measured, cumulative incidence and incidence density were determined and odds ratios (OR) were also calculated using binary logistic regression. RESULTS: The incidence density of phlebitis, during the period from 2017 to 2021, was 1.82 cases of phlebitis per 100 venous catheter-days. The difference between average cumulative incidence of phlebitis per year was statistically significant as determined by ANOVA test results (F = 10.51; df = 4; p < 0.000). Unequivocal risk factors for phlebitis were revealed to be hospitals with more than 500 beds (OR = 1.507; p < 0.001), patients suffering from neoplastic disease (OR = 1.234; p < 0.001) and the first 3-4 days after insertion (OR = 1.159; p < 0.001). CONCLUSIONS: A correct knowledge of insertion technique and venous catheter maintenance is likely to reduce the incidence of phlebitis and other complications, and hence continuing education of nurses is essential.

Lower risk of peripheral venous catheter-related bloodstream infection by hand insertion.

INTRODUCTION: Little is known about the bloodstream infection (BSI) risk associated with short-term peripheral venous catheters (PVCs) and no large study investigated the insertion site-related risk for PVC-BSI. METHODS: We performed a cohort study at the University of Geneva Hospitals using the prospective hospital-wide BSI surveillance database. We analyzed the association between insertion site and risk of PVC-BSI on the upper extremity using univariable and multivariable marginal Cox models. RESULTS: Between 2016 and 2020, utilization of 403'206 peripheral venous catheters were prospectively recorded in a 2000-bed hospital consortium with ten sites. Twenty-seven percent of PVC (n = 109'686) were inserted in the hand. After adjustment for confounding factors, hand insertion was associated with a decreased PVC-BSI risk (adjusted hazard ratio [HR] 0.42, 95% CI 0.18-0.98, p = 0.046) compared to more proximal insertion sites. In a sensitivity analysis for PVCs with ≥ 3 days of dwell time, we confirmed a decreased PVC-BSI risk after hand insertion (HR 0.37, 95% CI 0.15-0.93, p = 0.035). CONCLUSION: Hand insertion should be considered for reducing PVC infections, especially for catheters with an expected dwell time of more than 2 days.

Knowledge and Practice Of Peripheral Intravenous Catheter Among Nurses in a Teaching Hospital in Malaysia: Universiti Kebangsaan Malaysia Medical Centre

@#Introduction: Insertion of Peripheral intravenous catheter (PIVC) is a common invasive procedure performed on patients that may contribute to several complications. Nurses are required to have adequate knowledge and practice to ensure the successful of the procedure. The objective of this study was to determine the knowledge and practice of nurses towards PIVC insertion procedures. Methods: A descriptive cross-sectional study design was conducted at Universiti Kebangsaan Malaysia Medical Centre. A total of seventy- seven nurses working in the emergency department, obstetrics & gynecology patient admission centre, daycare oncology were participated in this study. The data was gathered using a modified questionnaire and standard PIVC insertion guidelines. Results: 21 (27.3%) nurses had high knowledge and 56 (72.7%) had low knowledge of PIVC insertion (M=7.77, SD=1.87). All 77 (100%) nurses performed insertion of PIVC according to the standard of practice (M=23.16, SD=1.51). A positive correlation between age and knowledge (rho=0.123) but a negative correlation towards practice (rho=-0.413). A positive correlation between working experience and knowledge (rho=0.094) but a negative correlation towards practice (rho=-0.047). There was a positive correlation between nurses’ knowledge and practice (rho=0.038). Conclusion: Nurses with good knowledge of PIVC insertion performed better as they were aware of the negative consequences of the procedure if conducted incorrectly. Knowledgeable and competent nurses are essential to ensure the quality of nursing care and safe practice towards patients. Future studies with larger samples of nurses involved in more hospitals in Malaysia are recommended.

Reassessing standards of vascular access device care: a follow-up audit.

This article reports on the findings of a repeat audit of vascular access devices (VADs) in a district general hospital undertaken 4 years after a previous audit. The first demonstrated poor standards of care and low compliance with evidence-based guidelines, indicating that a change in practice was necessary. A strategy of training, education and standardisation for intravenous devices was introduced, with the goal of transforming practice to raise standards and improve compliance. The findings of the follow-up audit show that the strategy has been successful in raising standards of care and reducing infections.

Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study.

BACKGROUND: Inserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement. OBJECTIVE: To determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence. DESIGN: Cross-sectional. SETTINGS: The study was carried out (March-September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna). PARTICIPANTS: A convenience sample of NSs (n = 1056) was involved. METHODS: We collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample. RESULTS: Most participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%). In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores. "Infusionset removal after 24 h when lipids or blood products are administered" (75.4%). CONCLUSIONS: NSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.

Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study.

BACKGROUND: The placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors. OBJECTIVE: Our aim was to determine the incidence of complications from the administration of vasopressors through peripheral venous catheters (PVC) in patients with circulatory shock, and to identify the factors associated with these complications. METHODS: This was a prospective, observational study conducted in the emergency department (ED) of a tertiary care medical center. Patients presenting to the ED with circulatory shock and in whom a vasopressor was started through a PVC were included. Research fellows examined the i.v. access site for complications twice daily during the period of peripheral vasopressor administration, then daily up to 48 h after treatment discontinuation or until the patient expired. RESULTS: Of the 55 patients that were recruited, 3 (5.45% overall, 6% of patients receiving norepinephrine) developed complications; none were major. Two developed local extravasation and one developed local thrombophlebitis. All three complications occurred during the vasopressor infusion, none in the 48 h after discontinuation, and none required any medical or surgical intervention. Two of the three complications occurred in the hand, and all occurred in patients receiving norepinephrine and with 20-gauge catheters. CONCLUSIONS: The incidence of complications from the administration of vasopressors through a PVC is small and did not result in significant morbidity in this study. Larger prospective studies are needed to better determine the factors that are associated with these complications, and identify patients in whom this practice is safe.

Assessing nursing students' knowledge and skills in performing venepuncture and inserting peripheral venous catheters.

Venepuncture and the insertion of peripheral venous catheters are common tasks in health care, and training in these procedures is included in nursing programmes. Evidence of nursing students' knowledge and skills in these procedures is limited. The main aim of this study was to assess nursing students' knowledge and skills when performing venepuncture and inserting peripheral venous catheters. Potential associations between level of knowledge and skills, self-training, self-efficacy, and demographic characteristics were also investigated. The assessment was performed by lecturers at a university college in Sweden using the two previously tested instruments "Assess Venepuncture" and "Assess Peripheral Venous Catheter Insertion". Between 81% and 100% of steps were carried out correctly by the students. The step with the highest rating was "Uses gloves", and lowest rating was 'Informs the patients about the possibility of obtaining local anaesthesia'. Significant correlations between degree of self-training and correct performance were found in the group of students who registered their self-training. No associations between demographic characteristics and correct performances were found. Assessing that students have achieved adequate levels of knowledge and skills in these procedures at different levels of the nursing education is of importance to prevent complications and support patient safety.

Devices and dressings to secure peripheral venous catheters: A Cochrane systematic review and meta-analysis.

BACKGROUND: Peripheral venous catheterisation is the most frequent invasive procedure performed in hospitalised patients; yet over 30% of peripheral venous catheters fail before treatment ends. OBJECTIVES: To assess the effects of peripheral venous catheter dressings and securement devices on the incidence of peripheral venous catheter failure. DATA SOURCES: We searched the Cochrane Wounds Group Register, The Cochrane Central Register of Controlled Trials, MEDLINE; EMBASE and CINAHL for any randomised controlled trials comparing different dressings or securement devices used to stabilise peripheral venous catheters. The reference lists of included studies were also searched for any previously unidentified studies. RESULTS: We included six randomised controlled trials (1539 participants) that compared various dressings and securement devices (transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster). Trial sizes ranged from 50 to 703 participants. The quality of evidence ranged from low to very low. Catheter dislodgements or accidental removals were lower with transparent dressings compared with gauze (two studies, 278 participants, risk ratio (RR) 0.40; 95% confidence interval (CI) 0.17-0.92, P=0.03%). However, the relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47-1.68) and infiltration (RR 0.80; 95% CI 0.48-1.33) are unclear. A single study identified less frequent dislodgement or accidental catheter removal with bordered transparent dressings compared to a securement device (RR 0.14, 95% CI 0.03-0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03-64.02). A comparison of a bordered transparent dressing and tape found more peripheral venous catheter failure with the bordered dressing (RR 1.84, 95% CI 1.08-3.11) but the relative effect on dislodgement was unclear. CONCLUSIONS: There is no strong evidence to suggest that any one dressing or securement product for preventing peripheral venous catheter failure is more effective than any other product. All of the included trials were small, had high or unclear risk of bias for one or more of the quality elements we assessed, and wide confidence intervals, indicating that further randomised controlled trials are necessary. There is a need for suitably powered, high quality trials to evaluate the newer, high use products and novel - but expensive - securement methods, such as surgical grade glue.

Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016.

Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.

What Registered Nurses Do and Do Not in the Management of Pediatric Peripheral Venous Catheters and Guidelines: Unpacking the Outcomes of Computer Reminders.

BACKGROUND: Clinical practical guidelines (CPGs) may enhance evidence-based practice, but require implementation. Computer reminders have previously shown various effects in supporting implementation; in a concomitant study, we found no effect on complications in peripheral venous catheters (PVCs) or registered nurses' (RNs) adherence to a CPG in pediatric care. Yet, there is a need to determine how reminders operate in particular contexts. AIM: To depict if, in what context, and how computer reminders regarding evidence-based management of PVC in pediatric care are applied according to RNs' actions and experience. METHODS: Qualitative data from nonparticipant observations and interviews with 18 RNs in four intervention units at a pediatric hospital were analyzed with content analysis. FINDINGS: Attention given to the computer reminders varied; the RNs noticed them in units where there was an agreement about the management and recording of PVCs, but not elsewhere. Rather, computer reminders did not facilitate adherence to the PVC-CPG where the CPG was not acknowledged from the start. RNs who knew how to manage PVCs had peer support and received additional reminders, which suggested that the computer reminders added to the significance of PVCs in pediatric care. LINKING EVIDENCE TO ACTION: While the computer reminders alone did not support CPG implementation, they further increased the attention to PVCs in contexts where there was a readiness to change along with a supportive culture. We suggest further studies tailoring implementation strategies to include electronic means if there is a beneficial context.

[Peripheral venous catheter use in the emergency department: reducing adverse events in patients and biosafety problems for staff]. / Estudio sobre la reducción de eventos adversos en pacientes y problemas de bioseguridad de los profesionales derivados de la aplicación de catéteres vasculares en urgencias.

OBJECTIVES: To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. MATERIAL AND METHODS: Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. RESULTS: A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). CONCLUSION: Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety.

OBJETIVO: Reducir la tasa de eventos adversos (EA) derivados de catéteres vasculares periféricos (CVP) en pacientes atendidos en servicios de urgencias (SU), así como accidentes de bioseguridad en profesionales, mediante una estrategia que combine formación, protocolización de la indicación y catéteres de bioseguridad. METODO: Estudio prospectivo, multicéntrico, observacional no postautorización en pacientes atendidos en el SU que precisen de CVP. El estudio tiene dos fases: en la primera se procede a formación, protocolización y monitorización mediante ua lista de comprobación, utilizando CVP convencionales. En la segunda fase se introducen CVP de bioseguridad. Se comparan ambas fases y sus resultados en la reducción de EA y bioseguridad. RESULTADOS: Se incluyeron un total de 520 pacientes: 180 en fase I y 340 en fase II. Se evidencian deficiencias en la técnica relacionadas con la desinfección, mantenimiento del campo estéril y manejo de equipo y apósitos; algunos mejoran significativamente con la progresión del estudio en fase II. Se observaron 86 EA, 34 en Fase I (18,8%) y 52 en fase II (15,4%) (p = ns). Destaca una reducción del 50% de flebitis en fase II. Sobre bioseguridad se detectaron 8 casos (7 salpicaduras, 1 pinchazo accidental) con CVP convencionales (fase I) y 2 salpicaduras con CVP de bioseguridad (fase II), equivalente a una reducción del 36% de accidentes (p = 0,04), especialmente con catéteres de corta duración (p = 0,02). CONCLUSIONES: La combinación de formación, protocolización de la indicación y empleo de CVP de bioseguridad se muestra como una intervención más efectiva para mejorar la seguridad del paciente y del profesional.

Peripheral venous catheter related complications are common among paediatric and neonatal patients.

AIM: The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications. METHODS: We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses. RESULTS: Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5 days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR 2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99). CONCLUSION: PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age.