Background: Peripheral intravenous catheter (PIVC) failures remain common, hindering patient care. Ultrasound-guided PIVC (USG-PIVC) placement offers improved first-time and overall insertion success rates, reduced complications, and enhanced patient satisfaction. Yet, in our adult intensive care unit (ICU), most USG-PIVCs were placed by physicians, a skill that nursing staff could also benefit from acquiring. Purpose: Our aim was to select the most appropriate handheld ultrasound device and develop a comprehensive USG-PIVC nursing education program to improve PIVC success rates and enhance patient care. Methods: This quality improvement initiative’s literature review guided development of an education model and evaluation of three handheld ultrasound devices. Nurses received two hours of didactic training, two hours of classroom simulation, and supervised clinical practice. Outcomes were analyzed by the lead ICU clinical educator. Results: Five ICU nurses performed 76 USG-PIVC placements with 70%–90% overall insertion success rates, i.e., within two attempts. The preferred of three ultrasound devices was selected for its highest success rate, portability, transducer probe, and screen integration lending to ease of use, quick start-up, and clinical support. Nurses were overwhelmingly positive about the education program, as evidenced by informal qualitative feedback collected at each end of session. Conclusion: Our comprehensive USG-PIVC insertion program empowers nurses to improve vascular access through a structured approach, combining online learning, simulation, and supervised clinical practice, with effective ultrasound technology selection. This approach provides other organizations with insight to equip nurses and leverage ultrasound technology toward meeting the 2024 Canadian Vascular Access Association guidelines’ (in press) recommendations for ultrasound guidance and product selection.

As end-stage renal disease (ESRD) prevalence escalates globally, hemodialysis remains a pivotal kidney replacement therapy, necessitating reliable vascular access. This paper examines transhepatic tunneled catheter placement as a non-conventional vascular access method for ESRD patients with exhausted typical sites. We discuss the clinical imperative for alternative access options due to the frequent complications associated with central venous catheters (CVCs), such as infection, stenosis, and thrombosis, which often necessitate relocation and can exhaust conventional sites. Highlighting the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for CVC placement hierarchy and the evolution of placement techniques, we emphasize ultrasound or fluoroscopy guidance to mitigate complications. Our experience with three ESRD cases demonstrates the efficacy of transhepatic catheter placement under imaging guidance, showing good clinical outcomes and patency to date. This technique offers a viable access route with fewer complications and is presented as part of an algorithm for urgent dialysis access in patients with vascular exhaustion. We advocate for pre-dialysis kidney care and peritoneal dialysis or urgent kidney transplantation as preferable treatments, but acknowledge the reality for many patients where hemodialysis is the only short-term option. Transhepatic tunneled catheters can serve as a safe and reproducible vascular access alternative, potentially improving patient survival in hemodialysis-dependent individuals with limited vascular access options.

Background: Palliative care patients often require frequent, resource-intensive, intermittent subcutaneous injections or complex infusion pumps for end-of-life symptom management. Purpose: We aimed to explore the feasibility of using non-electronic elastomeric infusion devices for continuous subcutaneous medication delivery in hospice and home care. Methods: A quality improvement initiative included an environmental scan to evaluate elastomeric devices and treatment protocols, followed by a stepwise implementation of elastomeric infusion devices for symptom management of palliative care patients. Results: During five years, 4,754 elastomeric devices were dispensed with non-narcotic medication mixtures to 265 patients in hospice and home care and 585 devices with narcotic mixtures for 62 patients during a 12-month period. No adverse events were reported. A total of 110 unique medication combinations involving 11 symptom management medications were dispensed. Qualitative feedback revealed strong nursing, physician, patient, and caregiver support. The acceptability of elastomeric subcutaneous infusions of symptom management medications was supported by the reported simplicity, safety, efficacy, and efficiency of this treatment modality. The protocol was adopted in hospice and is in the pilot phase for home care. Conclusion: Our findings suggest that continuous subcutaneous infusions via elastomeric infusion pumps offer a promising and feasible approach to end-of-life symptom management in hospice and home care. Elastomeric infusions may enhance simplicity, acceptability, safety, efficacy, and efficiency of care, compared to traditional routine subcutaneous injections. While results lay a foundation for treatment protocols that reduce care complexity, further research is warranted to optimize medication combinations and evaluate outcomes.

With a lack of standard processes in first parenteral dose medication administration in the home and community setting, a quality improvement initiative was undertaken by provincial home and community care service provider organizations (SPOs) in Ontario to support an evidence-based practice approach for administering the first dose of an intravenous (IV) medication. The project group, consisting of clinical leaders and business competitors, united to collaborate and support evidence-based, safe patient care. The group developed an evidence-based approach to screening patients for safe administration of the first dose of a parenteral medication within the home and community setting. Aligning the practice of administering the first dose of a parenteral medication is critical to providing safe, consistent, equitable, and timely care for all patients requiring a first dose in the home and community setting. From the SPO perspective, this improvement initiative has achieved the primary goal of aligning on a consistent patient safety screening tool used to support determining if first dose administration of a parenteral medication in the community is safe for the patient. Outputs of this work include collaborating with the provincial government funder and with SPOs who are competing for the same contracts within this sector, and the development of evidence-based resources to support patient screening. An exciting outcome was the opportunity to align with the Canadian Vascular Access Association (CVAA) and their mission statement of advocating for safe, quality patient care across the healthcare system (CVAA, n.d.). By developing an evidence-based approach to administering the first dose of a parenteral medication, this group has advocated for CVAA to include elements of the quality improvement (QI) initiative within the newly updated 2024 CVAA guidelines. This manuscript outlines the continued and thorough process undertaken by SPOs and the provincial government funder for home and community care to standardize best practices for administering a first dose of a parenteral medication in this unique sector. The successes and challenges encountered in aligning all those with a vested interest are highlighted.

Purpose: Haemato-oncology patients who require treatment for infections in the hospital receive intravenous antibiotics (IVABs) and intravenous therapy (IVT) via an infusion pump attached to a pole on wheels. This IV pole can hinder a patient’s mobility and ability to perform activities of daily living. A computerized ambulatory delivery device (CADD), often used in the outpatient or home setting, is a portable infusion pump that delivers IVABs and IVT without the need of a wheel-based pole. This study will investigate the use of portable CADDs in the inpatient setting to determine if they improve patients’ mobility when compared with using the IV pole. Methods: A randomized controlled trial of patients requiring IVABs or IVT, of two haemato-oncology wards in a large, quaternary hospital, will recruit 110 adults randomized on a 1:1 basis into either a CADD arm or an IV pole arm. The primary outcome is mobility as assessed by number of steps per day (recorded via accelerometer). Secondary outcomes include sleep disturbance, quality of life, and hospital-acquired complications. All randomized patients will be analyzed by intention to treat.

Background: Insertion of peripheral vascular access devices (PVADs) is the most commonly performed invasive medical procedure worldwide. Peripheral vascular access devices pose a significant risk of complications, especially in older adults, who experience age-related changes in skin, connective tissue, and veins. Adults older than 65 years old have the highest rate of hospital admissions, and a higher prevalence of co-morbid conditions than do younger adults. Despite the risks, PVADs in this population have not been well-explored. Aim: To identify the available evidence on PVADs in older adult populations, including patient experience. This scoping review protocol will function as a framework for a review, using a systematic process of published and grey literature. The population is adults 65 years of age and over. Methods: The Johanna Briggs Institute methodology, built on the Arksey and O’Malley framework, will guide this scoping review. A search of electronic medical databases will be conducted. Grey literature searches will supplement the electronic database searches. A data extraction tool will be employed for screening and data extraction. The PRISMA-ScR flow chart will be used to present the methodological process, and the extracted data will be tabulated with a narrative summary. Conclusion: This scoping review protocol provides the framework that underpins the scoping review, which will explore the existing evidence to inform future research.

Peripheral intravenous catheter (PIVC) insertion is a frequent procedure for hospitalized pediatric and neonatal patients. Timely and successful PIVC insertion can be challenging in pediatric and neonatal patients due to small or fragile veins, younger age, obesity, and patient activity (Alberto et al., 2023; Ben Abdelaziz et al., 2017; Girotto et al., 2020; Schults et al., 2019, 2022). First attempt insertion success ranges from 64% to 74%, with an average of 2.1 attempts prior to insertion of a functional PIVC (Kleidon et al., 2022). In children with difficult intravenous access (DIVA), the average number of attempts increases to four prior to an insertion of a functional PIVC (Kleidon et al., 2019; Schults et al., 2019). In addition to insertion difficulty, once a functional PIVC is successfully inserted, it is reported that 34% to 56% will fail prior to treatment completion, often necessitating the need for additional attempts to replace the failed PIVC (Indarwati et al., 2020; Kleidon et al, 2019; Kleidon, Rickard et al., 2020; van Rens, 2021).

Ultrasound is commonly used to assist with peripheral vascular access and there is growing evidence that there is an advantage to using guidewires to aid insertion. This prospective observational study compares outcomes in ultrasound-guided peripheral cannulation using either standard catheter-over-needle devices or a single lumen arterial catheter inserted using the Seldinger technique. Analysis of results demonstrated a clear advantage in terms of device survival to completion of therapy in the guidewire group.

Aims: To assess the feasibility of a randomized controlled trial using virtual reality (VR) intervention to manage anxiety in adult patients during painful needle-related procedures in an emergency department (ED). Background: The often overlooked or insufficiently managed needle-related anxiety in adults negatively impacts patient satisfaction and experience, necessitating innovative solutions. While VR has shown potential benefits for children, its efficacy has yet to be evaluated within the adult population. Design: A pilot randomized controlled trial. Methods: A single-site, two-arm, parallel randomized controlled trial will be conducted in an Australian ED. Eligible adult patients (n = 60) needing painful needle-related procedures will be randomly assigned to either a VR intervention group (wearing a VR headset) or a standard care group. Anxiety, stress, and pain levels will be measured during three time points, pre-, during, and post-interventions. It is expected to see a reduction in anxiety, stress, and pain levels in the VR intervention group. Discussion: The findings will demonstrate the feasibility of conducting a fully powered trial. Conclusion: This study will provide insights into the potential of VR intervention as a management strategy for anxiety in ED patients undergoing painful needle-related procedures.

Purpose: This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. Methods: A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. Results: Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20–40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day-1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. Conclusion: This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended. Keywords: peripheral intravenous catheter, phlebitis, nursing care, Pakistan