EFFECTIVENESS OF TAPPING AND MASSAGE TECHNIQUE IN PROMOTING VENOUS DILATION FOR PERIPHERAL INTRAVENOUS CATHETER INSERTION: A SYSTEMATIC REVIEW

Objective: To assess the current status of peripheral intravenous catheter (PIVC) insertion, maintenance, and management in pediatric patients, and to identify associated factors. Subjects and methods: A prospective study was conducted comprising 323 observations of PIVC insertion and care in children at the Pediatric Center, Thai Nguyen National Hospital. Results: 52.4% of cases were classified as having difficult venous access, and only 20.7% were rated as “good” for venous access. In 98.8% of observations, nursing performance in the PIVC insertion protocol was rated “good”; 1.2% were “fair,” and none were “poor.” Mild pain or slight erythema at the insertion site occurred in 52.9% of children. The mean PIVC dwell time was 3 days. Child age, nursing experience, management of difficulties encountered, and procedure duration were each significantly associated with venous access quality (p < 0.05). Phlebitis was significantly associated with child age, nursing experience, troubleshooting, and dressing tubing condition (p < 0.05). Conclusions: Despite high protocol adherence, achieving venous access in children remains challenging; child age, nursing experience, procedure time, difficulty management are key correlates. Strengthen technical training in PIVC for clinical nurses and standardize with rigorous monitoring of insertion and care processes. Integrate routine Visual Infusion Phlebitis (VIP) scoring into nursing records to enable early complication alerts and catheter replacement at predefined thresholds.

Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits. To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants. Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants. The study included a total of 166 patients: IG (n = 82) and CG (n = 84), mean age 59.5 ± 16.5 years, mostly women (n = 104, 62.7%) and white (n = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% (p < 0.001), with a relative risk of 2.5 (95% CI 1.88-3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4-7) and 10 (6-27.5) min respectively (p < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% (p < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43-0.80). Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.

Children and their families have reported peripheral intravenous catheter (PIVC) insertion as the most stressful part of their emergency department (ED) encounter, with some enduring multiple attempts without a successful insertion. The purpose of this study was to identify factors associated with abandonment of paediatric PIVC insertion. A retrospective cohort study was conducted at the Gold Coast University Hospital. All patients 16 years of age and younger, presented in 2019 with a PIVC insertion attempted in the ED were eligible. The electronic medical records were screened by two reviewers to identify those who required a PIVC insertion. Logistic regression analysis was performed to assess variables associated with PIVC insertion abandonment. Of 6394 records screened, 2401 (8.3%) had a PIVC insertion attempted, with 99 (4.1%) being abandoned. Age <12 months was the strongest predictor of PIVC abandonment at a rate of 11.3% (38/336), with a >10-fold increased risk for infants less than 3 months old and 3-12 months old; adjusted odds ratio (95% confidence interval) 12.4 (5.1-30.2) and 14.8 (5.8-37.4), respectively. Indications of 'infection' or 'rehydration' were associated with a decreased likelihood of abandonment when compared to 'investigation only' in multivariate modelling (odds ratio (95% confidence interval): 0.181 (0.099-0.332) and 0.262 (0.100-0.686), respectively). This study suggests the rate of PIVC insertion abandonment in children is relatively infrequent. However, more than one in 10 children aged <12 months had PIVC attempts without successful insertion. PIVC abandonment was less likely when there was an indication that necessitated PIVC insertion, such as a serious bacterial infection.

Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001). Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

This randomized controlled crossover study, conducted in a university hospital, aimed to compare the success of the first attempt at peripheral intravenous catheter (PIVC) insertion using 2 technologies of the visualization of veins in children at risk of difficult intravenous access (DIVA) guided by light-emitting diodes (LEDs) or infrared radiation (IR). The allocation of the type of technology initially used was determined by randomization. The primary outcome was successful insertion of the PIVC on first attempt. Data were analyzed using the McNemar test, paired t-test, and multiple logistic regression models. This crossover study included 143 children: 69 in Group A and 74 in Group B. The first-attempt PIVC insertion success rate with IR and LED was 65.2% and 44.9% in Group A and 55.4% and 50.0% in Group B, respectively, without statistical significance (P =.720). The results also showed that 51.5% of patients with difficult-to-see vessels (P =.022) and 49.8% with previous complications related to intravenous therapy (P =.008) had first-attempt PIVC insertion success using either transillumination device. The first-attempt PIVC insertion success was statistically similar between the groups. The device also assists in visualizing the veins in children at risk of DIVA.

Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model. The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion. An ex vivo model was created with a vessel diameter of 2.7-3.7 mm and a depth of 2-5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs. The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.

ABSTRACTAimsThis systematic review and meta‐analysis evaluated the efficacy of infrared (IR) devices versus the traditional palpation technique for first‐attempt success of peripheral intravenous catheter (PIVC) insertion in adults.DesignSystematic review and meta‐analysis of randomised controlled trials (RCTs).Data SourcesA comprehensive search of PubMed, Embase, Cochrane Library, Scopus and CINAHL was conducted on 28 May 2024 and included articles in English or French published from 1st January 2000 onwards.Review MethodsEligible studies included RCTs comparing IR devices with the traditional palpation method for PIVC insertion in adults. The primary outcome was first‐attempt success. Secondary outcomes included overall success, number of attempts, cannulation time and patient pain. The risk of bias was assessed using the RoB2 tool, and a random‐effects model was applied for meta‐analysis.ResultsFive RCTs were included, involving 690 patients and 704 catheters, including 289 PIVCs in patients with Difficult Intravascular Access (DIVA) criteria. First attempt insertion success was similar when using infrared devices (139/331, 42%) and traditional palpation (143/373, 38%) with Risk Ratio (RR) 1.08 (95% CI, 0.69 to 1.70). No significant statistical differences were noted in secondary outcomes: overall insertion success, number of attempts, time to cannulate and patient pain. Clinical and statistical heterogeneity were substantial (primary analysis I2 = 83%).ConclusionCurrent evidence does not support the systematic use of infrared devices to improve PIVC insertion success, reduce the number of attempts or alleviate patient pain compared with traditional palpation in adults. Further high‐quality studies with suitable sample sizes and varied populations are needed to better establish the potential place of infrared devices.ImpactThis study highlights the limited benefit of IR devices in routine clinical practice and underscores the need for further research into their use in specialised settings.Patient or Public ContributionNo Patient or Public Involvement. This study did not include patient or public involvement in its design, conduct or reporting.

Improving Peripheral Intravenous Catheter Care for Children with Cancer Receiving Chemotherapy in Malawi

Highlights Catheter failure is a serious matter challenging the delivery of high-quality care for pediatric patients. Insertion modality, patient race, and an intensive care unit or emergency department setting are predictive of catheter failure and removal. Peripheral intravenous catheter insertion under ultrasound guidance had an estimated dwell time of 6.5 days compared to 4.0 days when transillumination was used. Abstract Background: Peripheral intravenous catheter (PIVC) insertion is one of the most common medical procedures experienced by pediatric patients. A high incidence of catheter failure (CF) and associated sequelae are widely documented. Methods: This single-center retrospective study was conducted at a freestanding pediatric academic center. Electronic health records were reviewed to identify variables predictive of PIVC dwell time. PIVCs inserted by the vascular access team using either ultrasound guidance (USG) or transillumination during an inpatient admission in October–December 2019 were analyzed. Results: The sample included 743 PIVCs. Survival time, or dwell time, was estimated with the Kaplan-Meier survival curve. PIVCs inserted with USG demonstrated an estimated median dwell time of 6.5 days (95% CI: 5.8, 8.0); those inserted with transillumination had an estimated median dwell time of 4.0 days (95% CI: 3.1, 5.2). Factors predictive of dwell time were insertion modality, race, and patient care setting. Catheter removal associated with failure is 1.87 (95% CI = [1.24, 2.8], P = 0.003) times more likely when the PIVC insertion modality is transillumination compared to USG. Odds of CF are 1.76 (95% CI = [1.19, 2.6], P = 0.004) times more likely in a Black/African American patient than a White patient. Odds of patients in an intensive care unit or emergency department setting are 1.34 (95% CI = [1.03, 1.7], P = 0.029) times more likely to have catheter removal due to failure than in a floor/nonemergency unit. Conclusions: Understanding factors contributing to CF gives clinicians the knowledge to improve practice and mitigate harm in pediatric patients.

First-time peripheral intravenous catheter (PIVC) insertion success is dependent on patient, clinician, and product factors. Failed PIVC insertion are an under-recognized clinical phenomenon. To provide a scoping review of decision aids for PIVC insertion including tools, clinical prediction rules, and algorithms (TRAs) and their findings on factors associated with insertion success. In June 2016, a systematic literature search was performed using the medical subject heading of peripheral catheterization and tool* or rule* or algorithm*. Data extraction included clinician, patient, and/or product variables associated with PIVC insertion success. Information about TRA reliability, validity, responsiveness, and utility was also extracted. We screened 36 studies, and included 13 for review. Seven papers reported insertion success ranging from 61%-90% (4030 insertion attempts), 6 on validity, and 5 on reliability, with none reporting on responsiveness and utility. Failed insertions were associated with obesity (odds ratio [OR], 0.71-1.7; 2 studies) and smaller gauge PIVCs (OR, 6.4; 95% Confidence Interval [CI}, 3.4-11.9). Successful inser tions were associated with visible veins (OR, 0.87-3.63; 3 studies) or palpable veins (OR, 0.79-5.05; 3 studies) and inserters with greater procedural volume (OR, 4.4; 95% CI, 1.6-12.1) or who predicted that insertion would be successful (OR, 1.06; 95% CI, 1.04-1.07). Definitions of insertion difficulty are heterogeneous such as time to insert to a number of failed attempts. Few well-validated reliable TRAs exist for PIVC insertion. Patients would benefit from a validated, clinically pragmatic TRA that matches insertion difficulty with clinician competency.

Patients' experiences in ultrasound-guided intravenous catheter insertion: A qualitative study.

Background: Peripheral intravenous catheter (PIVC) insertion and maintenance are the procedures most commonly performed by nurses in clinical settings. However, current catheter failure rates are high, thus compromising the patient’s therapeutic plan and well-being. Objective: To understand nurses’ practices during PIVC insertion and maintenance. Methodology: A transversal and descriptive study was conducted in a cardiology ward in central Portugal. Nurses’ (n = 26) practices during PIVC management were observed and recorded by a research nurse during the morning shift, using a checklist based on transnational standard of care (SoC) recommendations. Results: During PIVC insertion (n = 38) the main digressive areas included glove usage (55.2%), use of the aseptic non-touch technique (44.7%), hand hygiene (18.4%-84.2%), and patient education (28.9%). Regarding PIVC maintenance (n = 66), catheter hub disinfection (78.8%), catheter flushing (53.3%- 78.8%), and patient education (24.2%) were the main deviating areas found. Significant PIVC failure rates were found (25.8%). Conclusion: Overall, a substantial number of PIVC-related practices does not comply with current SoC recommendations, which may pose a risk to patient safety and care quality

The SPECTRA study compared first-attempt success between ultrasound-guided and conventional peripheral intravenous catheter (PIVC) insertion. This subanalysis evaluated the control group results to determine the number of puncture attempts until successful or failed venous device insertion, stratified according to the Adult Difficult IntraVenous Access Scale (A-DIVA). Secondary analysis of the SPECTRA randomized clinical trial (RCT). Patients from the control group who underwent PIVC insertion without ultrasound guidance were included and stratified as high risk or low/moderate risk according to the A-DIVA. Statistical comparisons between the groups were conducted on the number of puncture attempts, insertion failures, catheter dwell time, and clinical outcomes related to PIVC insertion. Of all 84 patients analyzed, 35 were classified as high risk, and 49 as low/moderate risk; 53 (63.1%) were female, mean age 59 ± 16 years. The main reason for hospitalization was infection; high-risk patients experienced more punctures, with 20 (57%) undergoing four punctures, compared to only 8 (16%) of the low/moderate-risk group, p < 0.001; the overall success rate of PIVC insertion was 17 (48.5%) in high-risk patients versus 43 (88%) in low/moderate-risk patients. Insertion failure occurred in 18 (51.5%) high-risk versus 6 (12%) low/moderate-risk patients, p < 0.001; the high-risk group had a shorter PIVC dwell time: 3 (2-8) days versus 8 (2-8) days in low/moderate-risk group, p = 0.065; PIVC removal due to negative outcomes (obstruction, infiltration, accidental removal) was higher in high-risk patients: 32 (91%) versus 24 (49%), p < 0.001. Patients classified as high risk in the A-DIVA scale required more puncture attempts, had shorter PIVC dwell times, and experienced more negative outcomes. Using technologies such as ultrasound is beneficial for patients at high risk of failure on the first attempt.

Background:Multimodal research and guidelines recognize veins in the forearm used for peripheral intravenous catheter (PIVC) insertion can optimize dwell time. Yet, many PIVCs are still placed in areas of flexion or suboptimal locations such as the back of the hand causing premature failure of >50%. This study identified characteristics of the forearm cephalic vein that make the anatomical location highly successful for PIVC insertion. The goal was to increase the understanding of the human vasculature in association with fluid mechanics in veins above the wrist and below the antecubital fossa.Methodology:A prospective in-vivo study with 10 consented healthy human volunteers (HHVs) was performed with Color Pulse Wave Doppler Ultrasound that captured high-resolution video and images of vein diameter, velocity of blood flow, and location of venous valves in the forearm.Results:Forearm vein diameter was not directly correlated with higher or lower Velocity of Blood Flow (0.58 cm = 3.0 cm/s). However, Volumetric Blood Flow rates tended to be lower (2.51–8.28 mL/min) with Vein Diameters smaller than 0.29 cm. Ultrasound assessments and Volumetric Blood Flow calculations confirmed natural turbulence in blood and retrograde blood reflux correlated with venous valves opening and closing. Areas of turbulence, with pulse flushing, created backflow with retrograde blood flow around and into the catheter.Conclusions:Placement of long PIVCs in the cephalic veins of the upper forearm yield adequate flow and hemodilution capacity for veins with at least a 3 to 1 hemodilution ratio. The data from this study, along with previous research, suggest that PIVC placement in the cephalic vein, based on selection criteria, may help to reduce or eliminate intravenous complications such as chemical or mechanical thrombophlebitis causing premature catheter failure. Application of these investigational principles may result in better outcomes and catheter longevity for patients who require intravenous infusions.

Peripheral intravenous (PIV) catheter insertion is a frequent, painful procedure that is often performed with little or no anesthesia. Current approaches that minimize pain for PIV catheter insertion have several limitations: significant delay for onset of anesthesia, inadequate anesthesia, infectious disease exposure risk from needlestick injuries, and patients' needle phobia. Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion. A prospective, block-randomized, controlled trial comparing J-Tip jet injection of 1% buffered lidocaine to a 30-minute application of 4% ELA-Max for topical anesthesia in children 8 to 15 years old presenting to a tertiary care pediatric emergency department for PIV catheter insertion. All subjects recorded self-reported visual analog scale (VAS) scores for pain at time of enrollment and pain felt following PIV catheter insertion. Jet injection subjects also recorded pain of jet injection. Subjects were videotaped during jet injection and PIV catheter insertion. Videotapes were reviewed by a single blinded reviewer for observer-reported VAS pain scores for jet injection and PIV catheter insertion. Of the 70 children enrolled, 35 were randomized to the J-Tip jet injection group and 35 to the ELA-Max group. Patient-recorded enrollment VAS scores for pain were similar between groups (P = 0.74). Patient-recorded VAS scores were significantly different between groups immediately after PIV catheter insertion (17.3 for J-Tip jet injection vs 44.6 for ELA-Max, P < 0.001). Blinded reviewer assessed VAS scores for pain after PIV catheter insertion demonstrated a similar trend, but the comparison was not statistically significant (21.7 for J-Tip jet injection vs 31.9 ELA-Max, P = 0.23). J-Tip jet injection of 1% buffered lidocaine provided greater anesthesia than a 30-minute application of ELA-Max according to patient self-assessment of pain for children aged 8 to 15 years undergoing PIV catheter insertion.