A stepped approach to vascular access device selection.

Infusion therapy has evolved dramatically over the past few decades. From being used only in emergencies and for critically-ill patients, intravenous (IV) therapy has become a specialized form of treatment used for almost 90% of hospitalized patients (Corrigan, 1995). Infusion therapy is the parenteral administration of fluids, medications, nutritional support, blood products and the transfusion of blood. Fluids are delivered through a vascular access device, which is inserted into a peripheral or central vein (Royal College of Nursing (RCN), 2003). The venous route is the most predictable and reliable way to administer fluids and drugs when oral administration is not longer achievable or appropriate.

State of the science of oncology vascular access devices.

OBJECTIVE: To present an overview of long-term vascular access devices (VADs), current maintenance care, controversies of care, and the need for VAD research. DATA SOURCES: Current research and published literature. CONCLUSION: Over the last four decades, VADs have become a standard part of caring for patients in all clinical settings. Despite the common use of VADs, current standardized procedures for maintenance care and managing complications are not available. IMPLICATIONS FOR NURSING PRACTICE: The key to establishing evidence-based practice is to create a network of researchers, clinicians, and policy makers in a consortium to secure funding and implement multisite research. Only through research will traditional practice be challenged.

Features and selection of vascular access devices.

OBJECTIVE: To review venous anatomy and physiology, discuss assessment parameters before vascular access device (VAD) placement, and review VAD options. DATA SOURCES: Journal articles, personal experience. CONCLUSION: A number of VAD options are available in clinical practice. Access planning should include comprehensive assessment, with attention to patient participation in the planning and selection process. Careful consideration should be given to long-term access needs and preservation of access sites. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are uniquely suited to perform a key role in VAD planning and placement. With knowledge of infusion therapy, anatomy and physiology, device options, and community resources, nurses can be key leaders in preserving vascular access and improving the safety and comfort of infusion therapy.

Insertion and placement of central catheters in the oncology patient.

OBJECTIVES: To review the current up-to-date recommendations for insertion and placement of central venous access devices and discuss the prevention of complications during and post-placement of central catheters. DATA SOURCES: Journal articles, electronic articles, organizational position papers, personal experience. CONCLUSION: There are numerous types of vascular access catheters that play an important role in the management of complex treatments for the oncology patient. Cancer patients with a catheter have a higher rate of thrombosis and infection as part of their disease process and treatment; hence, nursing care can eliminate or minimize complications. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be educated on the correct procedures and rationale for insertion and placement as well as for the care and maintenance of each specific device.

An overview of suprapubic catheter care in community practice.

This paper gives a broad overview of suprapubic catheterization. Community nurses can often feel they lack experience with suprapubic catheter general care and routine changes. This paper sets out the advantages and disadvantages of suprapubic catheters, the procedure for routine change and the golden rules for general care. The paper contains an introduction on trouble shooting.

Tracheal intubation, tracheal tubes and laryngeal mask airways.

Tracheal intubation is used when a clear airway is difficult to achieve with a face mask or laryngeal mask, or if there is a risk of dislodgement of other forms of airway control. Tracheal intubation is considered to be an important part of patient management when a major intraoperative complication develops (for example anaphylaxis, massive haemorrhage or malignant hyperpyrexia).

Choosing the right intravenous catheter.

Infusion therapy in the home has been common for many years. The therapies appropriate for home infusion are numerous. The type of access device provided for the infusion is an important consideration for safe and effective care. That choice will take into consideration physician and patient preference and length of therapy. However, paramount to this decision are the characteristics of the infusate. It is essential to know the pH and osmolality of the drug as well as its potential vesicant properties. The nurse needs to act as the patient advocate to ensure that proper catheter selection is made. Patient teaching should be aimed at recognition of complications and immediate interventions to avoid problems.

Urinary catheterization: selection and clinical management.

Urinary catheterization is a common medico-nursing procedure in both acute and primary care. There is a variety of catheters and associated equipment available on prescription in the UK, how do nurses and other healthcare staff ensure that patients are able to access the most appropriate products for their individual needs? This article will look at the common reasons for catheterization and the rationale for the selection procedures in selecting the optimum method of catheterization, equipment selection and management options to ensure best practice for patient care. Different methods of catheterization, intermittent and indwelling, both urethral and suprapubic, will be considered in regard to preventing infection and providing optimum catheter management.

Teaching children and young people intermittent self-catheterization.

The need to catheterize through the urethra can begin at any age and stage of development in a child's life and may involve different strategies for teaching. Intermittent self-catheterization, as a self-management technique, can be of benefit both physically and psychologically to children and young people. Educational strategies are available to aid health care providers in teaching children and young people self-intermittent catheterization. Use of innovative techniques and resources may assist the practitioner in teaching self-catheterization successfully to this challenging population.

Advanced practice organ procurement techniques: placement of pulmonary artery catheters.

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.

Selecting a urinary catheter and drainage system.

Selecting the most appropriate urinary catheter and drainage system is an important factor towards patient comfort. Inappropriate selection may introduce an array of unnecessary catheter-associated problems and discomfort for the patient. The author has found that nurses may be able to name or recognize catheters they use, but not other makes and models of similar products produced by other companies. Therefore, selecting a catheter and drainage system can be confusing due to the vast array of catheters, materials used and drainage systems available from various companies. Consideration should also be given as to when catheter care begins: before or following catheter insertion. This article is written to help in the selection of a urinary catheter and drainage system which is best suited for the patient.

Nursing management of paediatric urethral catheterisation.

This article outlines evidence-based approaches to paediatric catheterisation in acute care settings. The reasons for catheterisation, anatomy and physiology of the urinary system and the procedure and potential complications are discussed.