Catheter Failure Research Articles

Investigative study of hemodilution ratio: 4Vs for vein diameter, valve, velocity, and volumetric blood flow as factors for optimal forearm vein selection for intravenous infusion.

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. 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. 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. 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.

MO694: Analysis of Mechanical Complications in Urgent-Start Peritoneal Dialysis

Abstract BACKGROUND AND AIMS Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation might depend on the chance to offer this modality of treatment to late referral patients. This approach has been recently named ‘urgent-start peritoneal dialysis’ (UPD). The major barrier to this practice is represented by the belief that peritoneal exchanges can be safely started at least 2 weeks after catheter insertion, due to the concern of early mechanical complications. The study investigated the efficacy and safety of an UPD approach in our PD program. METHOD Between 1 January 2009 and 31 December 2019 all prevalent patients needing UPD at our institution were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients (Table 1). One hundred forty-eight catheters were positioned semi-surgically, while 94 were inserted surgically. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement and peritoneal exchange scheme characterized by progressively increasing volume was used; early and late mechanical complications were also analysed. Finally, all the causes of PD technique and catheter failure were reported. RESULTS The early incidence of leakages, catheter dislocations, omental wrappings, bleeding, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively (Table 2). No bowel perforations were observed. The long-term leakage rate and catheter dislocation were 0.016 and 0.019 episodes/patient-year, respectively (Table 3). The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively (Fig. 1). The technique survival at 3, 6, 12, 24, 36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively (Fig. 2). The main cause of PD dropout was represented by infectious complications (nearly 40%) and mechanical complications (17.5%) leading to catheter failure (Fig. 3). No significant difference in the first catheter survival among the semi-surgical and the surgical arm was observed (HR 0.88 [CI 0.54–1.45], P = 0.62 [Fig. 4]). CONCLUSION A tight seal between deep cuff and surrounding tissue (double-purse string technique) with a low-volume exchange scheme allows starting UPD soon after catheter insertion minimizing mechanical complications. In patients without previous abdominal interventions semi-surgical technique is as effective as the surgical procedure in preventing early mechanical complications.

Automatic vein measurement by ultrasonography to prevent peripheral intravenous catheter failure for clinical practice using artificial intelligence: development and evaluation study of an automatic detection method based on deep learning

ObjectivesComplications due to peripheral intravenous catheters (PIVC) can be assessed using ultrasound imaging; however, it is not routinely conducted due to the need for training in image reading techniques. This...

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.

Survival Rate of Tunneled Hemodialysis Catheters in Patients on Hemodialysis due to Chronic Kidney Disease (CKD)

Objectives: To determine the survival rate and reasons of failure of tunneled hemodialysis catheters in patients on hemodialysis due to chronic kidney disease (CKD). Study Design: Prospective case series. Place and Duration of Study: Department of Nephrology, Sheikh Zayed hospital Rahim Yar Khan from 1-June-2020 to 30-June-2021. Methodology: A total number of 195 patients of CKD in whom tunneled hemodialysis catheters (HDCs) were inserted for hemodialysis were included. Data regarding baseline study variables e.g. age, and gender, site of insertion and reason for removal was also collected. All patients were followed for 06 months to determine the survival rate of tunneled hemodialysis catheters. Results: Mean age in this study was 46.79±13.54 years. There was 130 (66.7%) male population. HDC was inserted in Jugular vein in 184 (94.4%) patients and in subclavian vein in only 11 (5.6%) patients. HDCs were survived in 156 (80%) patients at 3 months and in 134 (68.7%) patients at 6 months follow-up. The reasons for removal of HDCs were sepsis in 16 (8.2%) patients, catheter clotting in 14 (7.7%) patients and mechanical damage in 8 (4.1%) patients. On univariate analysis, we did not find any statistical association of advanced age, female gender, diabetes and hypertension with failure of HDCs. Conclusion: The 06 month’s survival rate of HDCs was 68.7%. Sepsis was the predominant cause of failure of these catheters. Keywords: Chronic kidney disease, Tunneled hemodialysis catheters, Survival rate.

Incidence, causes, and timing of peripheral intravenous catheter failure related to insertion timing in the treatment cycle in patients with hematological malignancies: A prospective descriptive study.

We aimed to reveal detailed descriptive data on peripheral intravenous catheter (PIVC) failure related to insertion timing during the treatment cycle, in patients with lymphoma, leukemia, and myeloma. We conducted a prospective descriptive study to investigate the incidence of PIVC failure, defined as PIVC removal prior to completing infusion therapy. This was judged by ward nurses for adult patients requiring PIVC insertion for chemotherapy. A research nurse confirmed the timing and determined the causes of PIVC failure using ultrasonographic imaging. Descriptive data were collected in the hematology and oncology ward of a tertiary hospital in Japan. We recruited 85 patients (with 303 PIVCs), and analyzed 67 patients (with 280 PIVCs). Of these, 118 PIVCs (42%) were inserted during the chemotherapeutic dosing period of the treatment cycle, and 106 (38%), during the rest period. The incidence of cumulative PIVC failure was 43.2% of all analyzed PIVCs (89.97 per 1,000 PIVC days). Of the PIVCs in patients with lymphoma, those inserted during the dosing period were less likely to show PIVC failure (32% vs. 57%, p < .001). Conversely, those inserted after the treatment cycle were more likely to show PIVC failure (22% vs. 7%, p=.002). This study demonstrated that the incidence of PIVC failure in patients with hematological malignancies was unacceptably high. Conceivably, the incidence of PIVC failure varies by the onset time of side effects in the treatment cycle. This should be considered when using PIVCs and selecting optimal vascular access devices for patients with hematological malignancies.

Novel technique for ventriculoperitoneal shunt placement using a neurointerventional biplanar fluoroscopy suite: a technical note

BackgroundShunt dependent hydrocephalus is an increasingly common pathology in contemporary neurosurgery. While effective, ventriculoperitoneal shunt systems (VPS) carry a high rate of failure, most commonly secondary to proximal catheter failure and inaccurate placement has been cited an independent predictor of revision surgery. In this technical note, we describe a novel method of VPS placement in a hybrid operating room equipped with biplanar fluoroscopy with 3D-fluoroscopy capabilities to ensure appropriate proximal and distal catheter placements intraoperatively. MethodsA 27-year-old male with Human Immunodeficiency Virus and recently placed left parietooccipital VPS for cryptococcal meningitis presented to our facility with global cerebral edema with slit like ventricles. A right frontal VPS with intraoperative imaging in our hybrid operating room equipped with a Philips Azurion biplane unit (Philips, Amsterdam, Netherlands) was planned. ResultsA standard right frontal VPS was conducted under neuronavigation with open distal catheter placement. Following ventricular catheter insertion, spontaneous cerebrospinal fluid (CSF) return slowed significantly prompting concern for malposition. 3D-fluoro was performed using the biplane machine, confirming accurate placement of the proximal catheter about the foramen of Monroe. Plain static fluoroscopic images were then acquired to confirm the placement and integrity of the distal catheter. The patient had a non-complicated post-operative course and experienced total symptom resolution. ConclusionsProximal and distal catheter shunt failure secondary to malposition remains a significant etiology for revision in contemporary image guided neurosurgery. Biplanar fluoroscopic intraoperative confirmation may provide an efficient and effective modality in CSF diversion. Continued experience is necessary to validate our report.

Semi-Quantitative Assay to Measure Urease Activity by Urinary Catheter-Associated Uropathogens.

Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections in the US, accounting for over 1 million cases annually and totaling 450 million USD. CAUTIs have high morbidity and mortality rates and can be caused by a wide range of pathogens, making empiric treatment difficult. Furthermore, when urease-producing uropathogens cause symptomatic CAUTI or asymptomatic catheter colonization, the risk of catheter failure due to blockage increases. The enzyme urease promotes catheter blockage by hydrolyzing urea in urine into ammonia and carbon dioxide, which results in the formation of crystals that coat the catheter surface. If CAUTI is left untreated, the crystals can grow until they block the urinary catheter. Catheter blockage and subsequent failure reduces the quality of life for the chronically catheterized, as it requires frequent catheter exchanges and can promote more severe disease, including dissemination of the infection to the kidneys or bloodstream. Thus, understanding how urease contributes to catheter blockages and/or more severe disease among the broad range of urease-producing microbes may provide insights into better prevention or treatment strategies. However, clinical assays that detect urease production among clinical isolates are qualitative and prioritize the detection of urease from Proteus mirabilis, the most well-studied uropathogenic urease producer. While urease from other known urease producers, such as Morganella morganii, can also be detected with these methods, other uropathogens, including Staphylococcus aureus and Klebsiella pneumonia, are harder to detect. In this study, we developed a high throughput, semiquantitative assay capable of testing multiple uropathogens in a rapid and efficient way. We validated the assay using Jack Bean urease, the urease producing species: Proteus spp., M. morganii, K. pneumonia, and S. aureus strains, and the non-urease producer: Escherichia coli. This modified assay more rapidly detected urease-producing strains compared to the current clinical test, Christensen Urea Agar, and provided semiquantitative values that may be used to further investigate different aspects of urease regulation, production, or activity in these diverse species. Furthermore, this assay can be easily adapted to account for different environmental stimuli affecting urease production, including bacterial concentration, aeration, or addition of anti-urease compounds.

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.

Outcome of all Tunneled Catheters for Dialysis Access: a Single Center Study

Renal failure affects up to 18% of hospitalized patients and is associated with significant morbidity, mortality, and resource utilization. Hemodialysis is used mostly as renal replacement therapy method all over the world. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Objective: The objective of this study was to determine the outcome of all tunneled catheters placed in a single center for dialysis access over a period of six months. Study Design: Descriptive case series study Setting: Study was conducted in Dialysis Department, Combined Military Hospital, Lahore. Duration of Study: Present research was conducted from 6th May 2019 to 5th Nov 2019. Methodlogy: A total of 145 patients were enrolled after informed consent. Demographic information with duration of hemodialysis was also noted. In all patients tunneled catheter was placed for dialysis, by primary investigator. Then patients were followed-up for 2 months and were assessed for catheter in next visit. If there was redness, pain, and pus present then infection labeled. On assessment of catheter condition, if it was found damaged, fell out, exposed cuff, or fractures, blocked then catheter failure was noted. All this information was recorded through proforma. Results: Mean age was 45.72 ± 15.31 years; Mean duration of dialysis was 7.66 ± 2.93 months. Male were 53.8% and female were 46.2%. Placement of catheter was at internal jugular 116 (80%) patients, at subclavian 21 (14.5%) and at femoral 8 (5.5%). Infection was present in 13.1% patients while it was absent in 86.9% patients. Catheter failure was seen in 4.1% patients, there was no significant association between presence of catheter failure and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.322, 0.849, 0.741, 0.716 and 0.457 respectively. Significant association was not found between presence of infection and age group, gender, BMI, duration of dialysis and site of catheter having p-value = 0.591, 0.380, 0.081, 0.538 and 0.540 respectively. Conclusion: Presence of Infection was observed in 13.1% patients and catheter failure was present in 4.1% patients with chronic kidney disease on maintenance hemodialysis. Effect modifiers like age group, gender, BMI, duration of dialysis and site of catheter did not show significant association. Keywords: Chronic Kidney Disease, Infection, Catheter Failure, Hemodialysis.

Solving the problem of IV dislodgement.

Most patients in hospital will have some form of intravenous (IV) catheter in situ at some time to facilitate the administration of IV therapy. Accidental dislodgement, although widespread, is often unrecognised as a contributor to IV catheter failure. Dislodgement usually contributes to the delay in the administration of treatment, time-consuming IV restarts and a potential need for more invasive procedures. Dislodgement has serious implications, with costs to both patient and healthcare costs. Historically, prevention of IV catheter dislodgement has focused on the use of the correct securement methods and technique; however, these fail in many occasions, for example, where patients are confused or during bed transfers. In the recent years, new breakaway connector systems, such as ReLink, have been designed, which allow the tubing to become disconnected when undue pressure or pull is placed on it. This is done by a safety release valve that breaks apart, sealing off both ends of the tubing in an aseptic manner, while shutting off medication flow and preserving IV catheter integrity. Awareness raising and education focusing on accidental IV catheter dislodgement and the different ways to reduce its incidence in clinical practice would improve patient safety and potentially have significant healthcare savings.

Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data.

Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose-related impact of these caustic medications on ultrasound-guided (US) PIVC survivorship. We performed a secondary analysis of a randomized control trial that compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. This study involved reviewing and recording all vesicants infusions through the PIVCs. Type and number of vesicants doses were extracted and characterized as one, two or multiple. The most commonly used vesicants were individually categorized for further analysis. The primary outcome was PIVC failure accounting for use and timing of vesicant infusates. Between October 2018 and March 2019, 257 subjects were randomized with 131 in the UL group and 126 in the SL group. Vesicants were infused in 96 (37.4%) out of 257 study participants. In multivariable time-dependent extended Cox regression analysis, there was no significant increased risk of failure due to vesicant use [adjusted hazard ratio, aHR 1.71 (95% CI 0.76-1.81) p = 0.477]. The number of vesicant doses was not significantly associated with the increased risk of PIVC failure [(1 vs 0) aHR 1.20 (95% CI 0.71-2.02) p = 0.500], [(2 vs 0) aHR 1.51 (95% CI 0.67-3.43) p = 0.320] and [(≥ 3 vs 0) aHR 0.98 (95% CI 0.50-1.92) p = 0.952]. Vesicant usage did not significantly increase the risk of PIVC failure even when multiple doses were needed in this investigation. Ultrasound-guided PIVCs represent a pragmatic option when vesicant therapy is anticipated. Nevertheless, it is notable that overall PIVC failure rates remain high and other safety events related to vesicant use should be considered when clinicians make vascular access decisions for patients.

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.

Incidence and Associated Factors of Failed First Peripheral Intravenous Catheters among Adult Patients at Medical Surgical Wards in Public Referral Hospitals of West Amhara, Ethiopia, 2021.

Background Complications of peripheral intravenous catheters cause problems in clinical practice and bring high costs in terms of morbidity and mortality of patients. Therefore, this study aimed to assess the incidence and associated factors of failed first peripheral intravenous catheters among adult patients in selected Public Referral Hospitals of West Amhara Regional State, Ethiopia, 2021. Materials and Methods An institution-based prospective observational study was conducted among 423 adult patients from January to February 2021. Patients were selected using systematic random sampling techniques. The data were collected using interviewer-based, structured questionnaires and observational checklists. EPI-DATA 3.1 and SPSS version-23 were used for data entry and analysis, respectively. Frequency, percentages, and means were calculated. The outcome variable was determined and graded based on phlebitis and infiltration scales. Binary and multivariable logistics regressions were computed. Results Four hundred and seventeen first peripheral cannula sites from 418 patients were followed for 2,565 peripheral catheter hours. A failed first peripheral intravenous catheter was observed in 124 (29.7%, CI: 25.6–34) adult patients. Patients who were female (AOR = 0.4, 95% CI: 0.22–0.74) had cannula duration of 49–72 hours (AOR = 0.31, 95% CI: 0.14–0.7) and 73–96 hours (AOR = 0.39, 95% CI: 0.17–0.9), and patients who had been given electrolytes (AOR = 0.31, 95% CI: 0.11–0.86) were more likely to have failed first peripheral intravenous cannula. Conclusions Failed first peripheral intravenous cannula is much higher as compared to the acceptable rate of ≤5% by the Infusion Nurses Society. Hence, all patients with peripheral intravenous catheters are screened for catheter failure at least once a day. Providing appropriate nursing care and patient education is also required to reduce the risks.

On a quest to prevent harm and safeguard paediatric venous catheters – A randomized control trial protocol

Aim: This study will evaluate the most effective peripheral intravenous catheter securement in paediatric emergency departments to reduce catheter failure, healthcare costs, patient distress, and improve satisfaction. Design: A multisite, three-arm, parallel, superiority, randomized controlled trial of 506 children requiring peripheral intravenous catheter in the emergency department. The trial will be reported following CONSORT guidelines, is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12619001026112) and ethics is approved via Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/45567). Methods: Staff screen patients, six months to eight years old, requiring peripheral intravenous catheters and inpatient stay of more than 24 hours. Written informed consent is obtained from the legal guardian with 1:1:1 randomization ratio allocation: 1. Standard care: Bordered polyurethane dressing (Tegaderm Advanced®; 3M) 2. Integrated dressing and securement: SorbaView SHIELD® (Centurion Medical Products) 3. Integrated dressing and securement with tissue adhesive: SorbaView SHIELD® (Centurion Medical Products) and Tissue Adhesive Secureport IVTM (Adhezion Biomedical) Primary outcome is peripheral intravenous catheter failure; secondary outcomes are peripheral intravenous catheter complications, pain and distress, healthcare costs, and staff satisfaction or acceptability. Intention-to-treat analysis of timeto-event data will be completed using adjusted Cox regression. Direct costs calculated from the hospital perspective and costeffectiveness analysis will estimate the incremental cost of each treatment option. Discussion: Most hospitalized children require a peripheral intravenous catheter, although persistent high rates of failure are recognized as a patient safety concern. The outcomes of this trial will directly inform clinical care for peripheral intravenous catheter securement in children in emergency departments. Charters1,2, RN, PG Paed Acute Care, Kelly Foster2 , MNRS, RN, Dip HS, PG Crit Care, PhD Candidate, Benjamin Lawton1 , BSc, MBCHB, FRACP, Mph, Corey Cassidy3 , BSc (Hons), MBBS (Hons), FACEM, Joshua Byrnes4 , BEcon, BComm, MEcon, MHealth Econ, PhD, Gabor Mihala4,5, MEng (Mech), Gcert (Biostat), PhD, Jessica Schults5-8, RN, PhD, Tricia Kleidon5,6,8, RN, MNSci (Nurse Prac.), PhD candidate, Ruth McCaffery3 , RN, Kristy Van9 , RN, MNrs, and Amanda Ullman5-8, RN, PhD

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.

LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER PLACEMENT WITH RECTUS SHEATH TUNNELING: A ONE-PORT SIMPLIFIED TECHNIQUE.

ABSTRACT - BACKGROUND:The success of peritoneal dialysis depends on the proper placement and functional longevity of the dialysis catheter. Laparoscopic implantation of a catheter through a rectus sheath tunneling can minimize the risks of catheter failure.AIMS: This study aims to describe one-port simplified technique for laparoscopic placement of a peritoneal dialysis catheter with rectus sheath tunneling.METHODS: The simplified laparoscopic insertion of a Tenckhoff catheter with rectus sheath tunneling was performed in 16 patients with chronic renal failure.RESULTS: During the follow-up period, no major complications occurred. Three patients were excluded. One was referred to the renal transplant some weeks after implantation, and one died for other reasons during the follow-up. Another patient needed adhesiolysis due to previous surgery, so an additional port was necessary. The other 13 catheters worked properly, and no postoperative hemorrhage, early leaks, hernia, or catheter migration occurred. One patient had a tunnel infection 11 months after the implant. No peritonitis was observed during the follow-up.CONCLUSIONS: The technique is simple, reproducible, and safe, with good results in catheter function, few complications, and a high catheter survival rate. It does not require a special device or trocar and avoids excessive port sites.

Interventions to Reduce Peripheral Intravenous Catheter Failure: An International Delphi Consensus on the Relevance and Feasibility of Implementation (Reference)

Interventions to Reduce Peripheral Intravenous Catheter Failure: An International Delphi Consensus on the Relevance and Feasibility of Implementation (Reference)

CUIDADOS DE ENFERMAGEM NA CATETERIZAÇÃO INTRAVENOSA PERIFÉRICA EM CRIANÇAS HOSPITALIZADAS: REVISÃO INTEGRATIVA

ABSTRACT Objective: to describe nursing care in peripheral intravenous catheterization in hospitalized children. Method: integrative review carried out in November 2020 in LILACS, CINAHL, MEDLINE, SciELO, BDENF and COCHRANE databases. The analysis was constructed from the processes of this review. Results: 19 articles were analyzed, classified according to the level of evidence: level II (5%), level IV (21%), level V (5%), level VI (63%) and level VII (5%). Analytical category "Care for hospitalized child requiring peripheral intravenous catheter". Ultrasound was considered a useful technology. The most used and recommended catheter is the 24 Gauge caliber and the ideal dressing is to use sterile transparent film. Venipuncture in children is more difficult than adults and is often associated with adverse events. Elective catheter replacement is not recommended in children, but there are still doubts. The Difficult Intravenous Access score determines the probability of catheterization failure. Specialized and trained nursing professionals make a difference in this procedure. One should be concerned with pain, using pharmacological and non-pharmacological devices to minimize it. Conclusion: this review contributes to good practices in the care of peripheral intravenous catheterization in children and was based on data on the main technologies used, forms of prevention of adverse events, as well as nursing actions that ensure the safest and least stressful process for children and their families.

Medical analysis of the contribution of sialendoscopy in managing non-tumoral main salivary gland pathology in Reunion Island: Observational study following STROBE guidelines

GoalsTo perform a medical analysis of the contribution of sialendoscopy in the treatment of non-tumoral pathologies of the main salivary glands, in Reunion Island, a French overseas territory. Material and methodA multicenter retrospective observational study was conducted for an 8-year period, before and after introduction of sialendoscopy (2011–2014 and 2015–2018), following STROBE guidelines. ObjectivesTo compare populations treated before (period A) and after (period B) the introduction of sialendoscopy in terms of clinical characteristics, and analyze the characteristics of patients treated by sialendoscopy. ResultsTwo hundred and sixty-five patients were included: 74 in 2011–2014 and 191 in 2015–2018; 139 had sialendoscopy. Populations A and B were comparable except for the proportion of parotids treated (9% vs. 31%, respectively; P<0.0001), and smaller stones (11mm vs. 7.4mm, respectively; P=0.003). One hundred and ten pure sialendoscopies and 29 combined routes (20.8%) were performed: 63% submandibular and 37% parotid. Median age was 46 years. The M/F sex ratio was 0.96. Thirty-seven patients presented stenosis. There were 10 cases of papillary catheterization failure (7.1%), and 16 false routes or creation of false channels (11.5%), including 9 during the learning period. The rate of crossover to gland resection decreased: 10.45% for 2015–2016 and 5.56% for 2017–2018. ConclusionAlthough follow-up ranged between 12 and 55months (median, 30months), sialendoscopy appeared to be a useful and reliable technique, with a role in therapeutic strategy for the management of non-tumoral salivary pathologies in Reunion Island.