Catheter Failure Rates Research Articles

The impact of real-time ultrasound guidance on ventricular catheter placement in cerebrospinal fluid shunts - a single-center study.

Misplacement of ventricular catheters during shunt surgery occurs in 40% of cases using a freehand technique and therefore represents a risk for early shunt failure. The goal of this retrospective, single-center study is to analyze the impact of real-time ultrasound guidance on ventricular catheter positioning and early outcome of shunt survival. We analyzed the charts and images of all patients who underwent shunt surgery from 09/2017 to 12/2022 and compared the position of the ventricular catheter using the freehand technique and real-time ultrasound guidance. Central catheter position was graded as grade I (optimal), II (contact with ventricle structures or contralateral), and III (misplacement). A ventricular catheter was placed in 244 patients using real-time US guidance and in 506 patients using a freehand technique. The mean age (53.4 and 53.6 years, respectively) and the preoperative frontal occipital horn ratio (FOHR; 0.47 versus 0.44) were almost equal in both groups. In the study group, grade I catheter position was achieved in 64% of cases, grade II in 34%, and grade III in 2%. The control group showed grade I position in 45%, grade II in 32%, and grade III in 23% of cases (p<0.05). An early central catheter failure rate was the highest in grade III (40.5%) compared to 4% in grade I. Our data demonstrate that real-time US guidance leads to a significant improvement in ventricular catheter placement. Consequently, early shunt revisions decrease significantly. Further prospective, randomized, and controlled studies comparing the standard method to real-time ultrasound catheter placement are required.

OP157 Evaluating The Clinical And Economic Impact Of Adopting A Closed Peripheral Intravenous Catheter System In A Japanese Hospital

IntroductionUp to 90 percent of inpatients require an intravenous catheter during their hospitalization. A closed, integrated peripheral intravenous catheter (PIVC) system has been shown to protect veins for longer and reduce the risk of complications and unnecessary restarts when compared with an open system. This study evaluated the annual clinical and economic outcomes of adopting a closed, integrated PIVC system, instead of an open system, for inpatients in a Japanese hospital.MethodsA budget impact analysis was developed to estimate the clinical and economic impact for a 500-bed hospital with an 85 percent occupancy rate and a 96-hour catheter replacement protocol. For the analysis, the average length of stay for patients was 12 days and 90 percent of inpatients required a PIVC. Inputs such as catheter failure rate, complication rate, consumables costs, and complication management costs were informed by global and local data sources. The outcomes evaluated included consumables utilization, complication events, nurse time, and overall cost impact.ResultsThe analysis estimated that 12,604 patients required PIVCs. Moving from an open to a closed, integrated PIVC system resulted in a 68 percent reduction in consumables (3,786 fewer catheters and 36,315 fewer connecting accessories). Complications (occlusion, extravasation, phlebitis, and bending) were reduced by 62 percent (3,682 fewer episodes). Blood exposure was reduced by 98 percent (3,565 fewer episodes), and nurse time decreased by 17 percent (786 fewer hours). This resulted in a potential overall cost saving of JPY3,955,140 (USD28,756) annually, after offsetting the acquisition cost of JPY888,247 (USD6,458) associated with the closed system.ConclusionsPIVC is the most common vascular access device used in hospitals, and insertion and maintenance are often performed by nurses. Fewer complications can be expected with a closed system, leading to better patient outcomes. In addition, nurses spend less time managing complications and replacing PIVCs, and consumables utilization is reduced. This results in improved operational efficiency and potential cost savings for hospitals.

Tunneled femoral dialysis catheters and factors affecting their outcome: a single institution experience.

To assess a single-center experience with tunneled femoral dialysis catheter usage and outcomes and to identify any operator-dependent factors related to risk of premature catheter failure. Retrospective review of the institutional radiology information system for tunneled femoral dialysis catheter placement from 2010 to 2017 was performed. Patients for whom the catheter was placed for an indication other than dialysis or who were less than 18 years of age at the time of catheter placement were excluded. Premature catheter failure rate, cause of premature failure, catheter patency (in days) and infection rate were assessed. Operator/placement characteristics, including laterality, catheter tip placement, and catheter length were also assessed. A total of 101 patients were included in the study. This included n = 116 catheter placements. Thirty-four percent of patients (n = 40) were lost to follow-up, resulting in n = 61 patients and n = 76 catheters analyzed. Premature catheter failure rate was 48% (n = 36), with low flows being the foremost cause of failure (64%, n = 23). Average primary patency of these catheters was 82.4 days (1-328 days). About 8% of catheters (n = 3) were complicated by infection, resulting in an infection rate of 0.4/1000 catheter days. None of the operator-dependent factors analyzed, including catheter laterality, catheter tip placement, and catheter length, demonstrated a significant association with premature catheter failure. Institutional primary access patency rates are comparable to or higher than previously published data, while infection rates are similar to or lower than those reported in the literature. None of the operator-dependent factors related to placement was shown to significantly decrease the risk of premature catheter failure. These findings suggest that while femoral dialysis catheters do not function well in the long term relative to internal jugular vein dialysis catheters, prior literature may undervalue their utility and function, particularly given that these catheters are used as a "last resort" for many patients.

Epidural Catheter Replacement Rates With Dural Puncture Epidural Labor Analgesia Compared With Epidural Analgesia Without Dural Puncture: A Retrospective Cohort Study

(Int J Obstet Anesth. 2022;52:103590) Lumbar epidural analgesia (LEA) is a common method of labor analgesia. Traditional LEA, dural-puncture epidural (DPE), and combined spinal-epidural analgesia (CSE) are approaches to epidural catheter placement. Epidural catheters are known to malfunction following placement (12% to 13%), requiring replacement or conversion to general anesthesia (GA) if failure occurs during emergency intrapartum cesarean delivery (CD). Factors contributing to placement failure include body mass index (BMI) or weight, procedure type (CSE vs. LEA), gestational age, anesthesiologist experience, type of epidural catheter, patient age, and mode of delivery. Few studies have compared catheter failure rates between LEA and CSE. This retrospective analysis compares epidural catheter failure rates of DPE or LEA.

Abstract No. 29 Tunneled Dialysis Catheter Placement within Intensive Care Unit (ICU) Patients: Influence of Catheter Tip Design on Clinical Performance

Tunneled dialysis catheter tip design may affect freedom from catheter dysfunction and/or infection; improved performance within a critical care setting may reduce costs and need for catheter guidewire exchange or removal. This study compared rates of catheter failure between a symmetrical, helical-tip catheter (VectorFlow) with a conventional split-tip catheter (Ash-Split) among ICU patients undergoing tunneled dialysis catheter placement. A retrospective database identified a total of 1734 tunneled dialysis catheters placed at an academic institution over a 7-year period. Of these, 340 catheters (19.6%) were placed within ICU patients, which included VectorFlow (n = 112, 32.9%) and Ash-Split (n = 228, 67.1%) catheters. Rates of catheter failure requiring guidewire exchange or removal from a composite outcome of malfunction or infection were compared with Kaplan-Meier estimates, and covariates potentially influencing catheter failure were assessed with Cox proportional hazards modeling. Catheter failure occurred within 90 days in 34.8 ± 3.4% of ICU patients. Among patients with VectorFlow catheters, primary unassisted patency at 30, 60, 90 and 180 days was 87.4 ± 3.6%, 78.0 ± 5.1%, 75.1 ± 5.0% and 60.1 ± 8.2% compared with 75.0 ± 3.3%, 62.8 ± 4.1%, 60.7 ± 4.2% and 44.3 ± 5.5% among patients with Ash-Split catheters (P = 0.022). Cox modeling of body mass index, patient age, sex, left jugular (vs. right) placement and indication for placement (initiation of hemodialysis access vs. failed surgical arteriovenous access) showed no effect on catheter patency; patients with Ash-Split catheters had a hazard ratio of catheter failure 1.72 times higher than patients with VectorFlow catheters (P = 0.024) in univariate modeling and a hazard ratio of 1.81 in multivariate modeling (P = 0.017). The VectorFlow catheter was associated with significantly higher rates of primary patency than the Ash-Split catheter among ICU patients, independent of multiple clinical and anatomic factors. These data support a VectorFlow-first placement strategy within this patient population.

Surgical instruments and catheter damage during ventriculoperitoneal shunt assembly.

Current surgical techniques use common surgical instruments for sterile shunt assembly. This study investigated the impact of using these techniques and surgical instruments on the mechanical integrity of the ventriculoperitoneal shunt system, specifically shunt catheters. The authors conducted failure testing on 85 rifampin-coated catheters and 85 barium-impregnated catheters using 5 different surgical instruments and 2 different surgical techniques. In technique A, the distal end of the catheter was pushed onto the shunt valve inlet connector with the surgical instrument. In technique B, the catheter was pulled over the inlet connector. One hundred sixty catheters underwent 10-repetition-maximum testing, in which the catheter either failed before completion of 10 consecutive assembly/disassembly repetitions or the catheter completed 10 consecutive repetitions. The authors also conducted 100-repetition-maximum tests on 5 barium-impregnated and 5 rifampin-coated catheters using technique A. Catheter failure rates were significantly different among the different instruments used in assembly (p ≤ 0.001). Post hoc analysis showed that using mosquito forceps with shods resulted in a significantly lower catheter failure rate than the other instruments (p < 0.0005). The catheter failure rate of technique A was significantly lower than that of technique B (5% vs 81%, p < 0.001). There was no statistical difference between the failure rates of the barium and rifampin catheters (42% vs 44%, p = 0.9), but the barium catheters outperformed the rifampin catheters in the 100-repetition-maximum trials (p = 0.02). Instrument type (p = 0.0232) and catheter type (p = 0.0096) were both significant factors in determining the number of assembly/disassembly repetitions needed to cause catheter failure. It took an average of 2.79 repetitions of assembly/disassembly to cause catheter failure. DeBakey forceps had significantly lower mean repetitions to failure (mean 1.38) than the Gerald forceps without teeth (mean 2.73, p = 0.05) and bayonet (mean 3.25, p = 0.02). This study was the first of its kind to analyze how physical manipulation affects the mechanical integrity of ventriculoperitoneal shunt components. The authors demonstrated a significantly lower shunt catheter failure rate when mosquito forceps with shods and technique A were used in assembly. Moreover, the authors established that use of DeBakey forceps resulted in failure with fewer assembly/disassembly repetitions than use of the Gerald and bayonet forceps, suggesting that DeBakey forceps are the most damaging instrument.

Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study

BackgroundLumbar epidural analgesia (LEA) is commonly used for labor analgesia but up to 13% of epidural catheters fail and require replacement. Combined spinal-epidural analgesia is associated with a lower catheter failure rate. Few data exist regarding catheter replacement rates after dural-puncture epidural (DPE). We conducted a retrospective analysis comparing catheter failure rates between epidural and DPE techniques. MethodsThis retrospective single-center trial reviewed all labor neuraxial analgesia procedures among 18 726 women across five years, and identified 810 DPE and 2667 LEA procedures. Catheter failure rates, consisting of replacement or requirement of general anesthesia for cesarean delivery, were compared. Propensity score matching was used to balance the groups. ResultsDural-puncture epidural was associated with significantly fewer catheter failures compared with LEA (74/759 vs. 49/759, odds ratio 0.64, 95% CI 0.44 to 0.93, P=0.02). Sensitivity analysis excluding cases of general anesthesia confirmed this relationship. Risk factors identified for catheter failure included age, body mass index, and nulliparity. Dural-puncture epidural was associated with a longer mean time to catheter replacement (918 min vs. 609 min, P=0.04). Kaplan-Meier and Cox multivariate analyses confirmed this relationship. There was no significant difference in the requirement for epidural analgesia supplementation, but DPE required supplementation significantly later than LEA. There was no difference in the rate of headache or epidural blood patch between groups. ConclusionsDural-puncture epidural is associated with fewer catheter failures and replacements than LEA, without an increase in the rate of post-dural puncture headache or epidural blood patch.

Neuraxial labor analgesia: Initiation techniques.

The ideal technique for labor analgesia would have a quick onset, predictable quality, and adjustable depth and duration. Moreover, it would be easy to perform and have minimal maternal and fetal side effects. A catheter-based neuraxial approach encompasses these desirable characteristics and includes the epidural, combined spinal epidural, dural puncture epidural, and intrathecal catheter techniques. In this review, we outline the unique technical considerations, analgesic characteristics, and side effect profiles for each technique that can ultimately impact the maternal-fetal dyad. The selection of neuraxial analgesia techniques should consider the patient and team's goals and expectations, the clinical context, and the institutional culture. Labor analgesic techniques that initiate with an intentional dural puncture component have a faster onset, greater bilateral and sacral spread, and lower rates of epidural catheter failure. Further elucidation of the mechanisms, benefits, and risks of each neuraxial initiation technique will continue to benefit patients and care providers.

Reducing the risks of proximal and distal shunt failure in adult hydrocephalus: a shunt outcomes quality improvement study.

Patient outcomes of ventriculoperitoneal (VP) shunt surgery, the mainstay treatment for hydrocephalus in adults, are poor because of high shunt failure rates. The use of neuronavigation or laparoscopy can reduce the risks of proximal or distal shunt catheter failure, respectively, but has less independent effect on overall shunt failures. No adult studies to date have combined both approaches in the setting of a shunt infection prevention protocol to reduce shunt failure. The goal of this study was to determine whether combining neuronavigation and laparoscopy with a shunt infection prevention strategy would reduce the incidence of shunt failures in adult hydrocephalic patients. Adult patients (age ≥ 18 years) undergoing VP shunt surgery at a tertiary care institution prior to (pre-Shunt Outcomes [ShOut]) and after (post-ShOut) the start of a prospective continuous quality improvement (QI) study were compared. Pre-ShOut patients had their proximal and distal catheters placed under conventional freehand approaches. Post-ShOut patients had their shunts inserted with neuronavigational and laparoscopy assistance in placing the distal catheter in the perihepatic space (falciform technique). A shunt infection reduction protocol had been instituted 1.5 years prior to the start of the QI initiative. The primary outcome of interest was the incidence of shunt failure (including infection) confirmed by standardized criteria indicating shunt revision surgery. There were 244 (115 pre-ShOut and 129 post-ShOut) patients observed over 7 years. With a background of shunt infection prophylaxis, combined neuronavigation and laparoscopy was associated with a reduction in overall shunt failure rates from 37% to 14%, 45% to 22%, and 51% to 29% at 1, 2, and 3 years, respectively (HR 0.44, p < 0.001). Shunt infection rates decreased from 8% in the pre-ShOut group to 0% in the post-ShOut group. There were no proximal catheter failures in the post-ShOut group. The 2-year rates of distal catheter failure were 42% versus 20% in the pre- and post-ShOut groups, respectively (p < 0.001). Introducing a shunt infection prevention protocol, placing the proximal catheter under neuronavigation, and placing the peritoneal catheter in the perihepatic space by using the falciform technique led to decreased rates of infection, distal shunt failure, and overall shunt failure.

Nurses' Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study.

A significant number of adult oncology patients require at least one peripheral intravenous catheter to fulfill their therapeutic plan. Recent evidence indicates that catheter failure rates are high in this cohort, impacting care outcomes and patient experience during cancer treatment. This reality represents a challenge to nurses worldwide since in most international settings they are responsible for delivering quality care during the insertion and maintenance of such devices. This study aims to explore current nursing practices regarding the insertion, maintenance, and surveillance of peripheral intravenous catheters in oncology patients. A two-phase mix-method study was conducted with the nursing team from the surgical ward of a large oncology hospital in Portugal. In phase one (observational prospective study), nurses’ practices during catheter insertion and maintenance were observed by the research team and recorded using standardized instruments and validated scales. In phase two, three online focus groups were conducted with the nursing team to present the results observed in phase one and explore their perceptions of current practices. All ethical principles were assured throughout the study. Significant divergent practices were observed and identified by the nurses, especially concerning patient involvement, nurses’ adherence to the aseptic, non-touch technique, catheter stabilization and dressing, and catheter flushing and locking. Such practices may partially explain the high complication rate found (26%) and substantiate the need for future intervention in this field.

What do we know about flushing for intravenous catheter maintenance in hospitalized adults?

to evidence the use of flushing to prevent complications from intravenous therapy. an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis. it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals. there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.

Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study.

The erector spinae block is an efficacious analgesic option for the management of rib fracture--related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anesthesia techniques in patients at risk of complications. The primary aim of this study was to characterize the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aim of this study was to characterize the incidence of late adverse events, as well as the erector spinae plane block catheter failure rate. We analyzed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 and September 2020. To assess early adverse events, data collection included hypotension, hypoxemia, local anesthetic systemic toxicity, and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site hematoma. A total of 224 patients received 244 continuous erector spinae catheters during the study period. After insertion of the erector spinae, there were no immediate complications such as hypotension, hypoxia, local anesthetic toxicity, or pneumothorax. Of all blocks inserted, 7.7% were removed due to catheter failure (8.4 per 100 catheters; 95% confidence interval [CI], 5.1-13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95% CI, 1.1-6.7 catheter days). Late complications included 2 erythematous catheter sites and 2 small hematomas not requiring intervention. The incidence of a minor late complication was 16.7 per 1000 catheters (95% CI, 6.1-45.5 per 1000 catheters). This study supports the statements made by regional anesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low-risk analgesic technique that may be performed in the presence of abnormal coagulation status or systemic infection.

Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study)

BackgroundThe lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU).MethodsThis prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay.ResultsWe included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively.ConclusionPIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients.Trial registrationUMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

Areview of 92 obstetric patients with COVID-19 in the Bronx, New York and their peripartum anaesthetic management.

The Bronx is a borough of New York City that has been profoundly affected by the COVID-19 pandemic. Limited reports exist discussing the anaesthetic management of obstetric patients infected with COVID-19. We review a cohort of obstetric patients in the Bronx with COVID-19 and report their delivery data, anaesthetic management, and maternal-fetal outcomes. We reviewed 92 pregnant patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered between 1 February 2020 and 1 May 2020. Medical records were reviewed for patient characteristics, anaesthetic management, and clinical outcomes. Patients were stratified by mode of delivery and COVID-19 disease severity. Of the 92 deliveries, 49 (53%) were vaginal, 14 (15%) were scheduled caesareans, and 29 (32%) were unscheduled caesareans. 64 patients (70%) were asymptomatic for COVID-19 (mild disease: 18 patients [19%], moderate disease: 7 patients [8%], severe disease: 2 patients [2%], critical disease: 1 patient [1%]). 83 patients (90%) received neuraxial analgesia and/or anaesthesia, with combined spinal-epidural (CSE) and dural puncture epidural (DPE) as the most common techniques. 5 patients (5%) required general anaesthesia (GA) for caesarean delivery, 3 (3%) of whom were intubated for severe or critical COVID-19 disease. Given the risks associated with SARS-CoV-2 aerosol transmission, GA was avoided in all but the most critically ill patients. CSE and DPE were optimal for minimizing catheter failure rates and risk of conversion to GA. SARS-CoV-2 infection in obstetric patients may be associated with an increased risk for adverse outcomes including preeclampsia, preterm delivery, unscheduled caesarean delivery, and mechanical ventilation.

The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study.

The purpose of this study was to evaluate the feasibility of a new long peripheral catheter (LPC) program at a large academic center in an effort to reduce the use of peripherally inserted central catheters (PICCs) and their related complications. The pilot participants were hospitalized children, age >2 years, with a need for noncentral intravenous access for 2 to 29 days, or laboratory blood draw >5 times per day. Patients expected to discharge with intravenous access were excluded. Included in the pilot program development were a literature review, 1-year baseline data analysis, and program design and implementation. A multidisciplinary committee developed and implemented the program from December 2018 to September 2019. LPCs were placed from August to September 2019. Regarding the baseline data, between July 2018 and June 2019, 584 PICCs were placed in 461 patients. Of these, 139 PICCs (24%) did not meet requirements necessitating central access and, potentially, could have been avoided if an LPC alternative were available at the time. For the LPC pilot program, 20 LPCs were placed in 19 patients. The median age was 11 (interquartile range of 7-15). The insertion success rate was 83%. There were no serious complications, such as venous thrombosis or catheter-related bloodstream infection. The total rate of minor complications was 35%: the rate of occlusions was 10% (n = 2), and the rate of dislodgement was 25% (n = 5). The catheter failure rate was 74 per 1000 catheter-days. The mean line duration was 6 days. There is a role for LPCs in hospitalized children requiring durable vascular access. Multispecialty designed pilot implementation of an LPC program was successful at an academic pediatric hospital.

Regional Catheters for Postoperative Pain Control: Review and Observational Data.

ContextPerioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against ‘aggressive’ measures.Evidence AcquisitionThis is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences.ResultsAs evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other.ConclusionsEffective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from ‘moderate, severe or worst’ pain.

The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study.

Short peripheral venous catheters are one of the most frequently used devices in hospitals. Peripheral venous catheter failure, defined as the unscheduled dysfunction of peripheral venous catheter, is common and frequently entails a new invasive procedure. Flushing the catheter maintains patency and could prolong peripheral venous catheter dwell time. The introduction of pre-filled saline flushing syringes as compared to manually filled saline flushing syringes could facilitate the frequency of catheter flushing, and subsequently it could reduce peripheral venous catheter failure rate. To demonstrate differences in overall peripheral venous catheter failure rates before and after the introduction of pre-filled saline flushing syringes and to assess the risk factors for peripheral venous catheter failure. Quasi-experimental design, before-and-after intervention study. Intervention: introduction of pre-filled saline syringes for flushing. Multicenter study conducted in medical and surgical wards of three European hospitals during a 9-month period (4 months pre-intervention, 5 months intervention). A multivariate Cox proportional model was used to identify factors associated with the occurrence of peripheral venous catheter failure. Data from 3853 peripheral venous catheters in 1915 patients were analyzed. Compared to pre-intervention period, a significant decrease in peripheral venous catheter failure rate was observed in the intervention period (57% vs 43.4%, p < 0.001). Independent factors associated with peripheral venous catheter failure were as follows: Charlson score ⩾4 (hazard ratio: 1.648; 95% confidence interval: 1.069-2.527), days of hospital stay ⩾10 (hazard ratio: 1.468; 95% confidence interval: 1.172-1.837), and catheter "D" (hazard ratio: 1.758; 95% confidence interval: 1.058-2.919). The use of pre-filled saline syringes significantly reduced peripheral venous catheter failure and increased catheter dwell time. Thus, it is important to reinforce the use of the pre-filled syringes for flushing to reduce the incidence of peripheral venous catheters' failure.

Management of Hospital In The Home (HITH) Peripherally Inserted Central Catheters: A Retrospective Cohort Study

Worldwide, there has been a shift in health care delivery, with an increasing emphasis on avoiding hospital admissions and providing treatment such as intravenous antibiotics for patients at home, using peripherally inserted central catheters (PICCs). However, there is inadequate data to demonstrate if rates of PICC failure are similar for hospital inpatients, currently understood to be between 7% and 36%, than those cared for at home. The objective of this study was to identify prevalence, dwell time, and complications associated with PICCs in the home setting. This single-center, retrospective cohort study of adults treated by the “Hospital in the Home” (HITH) program in Queensland, was conducted between June 1, 2017 and June 15, 2018. Clinical data were collected for patient and PICC characteristics. Variables were described as frequencies and proportions, means and standard deviations, or medians and interquartile ranges. In total, 304 patients treated by HITH during this timeframe, and 164 (54%) patients with 181 PICCs were included in this study. These patients were predominately male (n = 105, 64%), with a mean age of 54 years. The most common reason for admission was a wound infection and/or bone infection (n = 120, 33%). Most PICCs were single lumen (n = 120; 67%), inserted in the basilic vein (n = 137; 80%) by nurses (n = 122; 67%). Peripherally inserted central catheter failure occurred in 10% (n = 19); the most common complications were dislodgement (n = 9; 5%) and thrombosis (n = 4; 2%). There were no confirmed catheter-related blood stream infections. Peripherally inserted central catheter failure rates are similar between hospitalized inpatients and those cared for at home.

A Cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis.

A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.

Nurses’ peripheral intravenous catheter-related practices: a descriptive 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