Intravenous Cannula Insertion Research Articles

Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation

BackgroundPoint-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.MethodsA mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop.ResultsA total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop.ConclusionsGlobally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.

Sex Differences in Epidemiology, Care, and Outcomes in Patients With Acute Chest Pain

BackgroundDiscrepancies in cardiovascular care for women are well described, but few data assess the entire patient journey for chest pain care. ObjectivesThis study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge. MethodsThis is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses. ResultsIn 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall. ConclusionsSubstantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.

Evaluation Nurses’ Practices During Intravenous Canulation for Children in the Emergency Units

Background: Increasing risks and complications with IV cannulation making this issue a research focus of several authors around the world. In addition, it was reported that emerged complications with IV cannulation could be phlebitis, infiltration, extravasation, infection, and pain. Aims of the study: This study aimed to evaluate nurses’ practices during intravenous canulation for children in the emergency units. Methodology: A mixed method research design was used in this study specifically (Convergent parallel: Quantitative and qualitative approach). The study was initiated from October 15th, 2021, through June 28th, 2022. A non-probability (Purposive) sample was selected of 25 nurses who work at Alzahraa teaching hospital. The data was collected using a previously prepared questionnaire and official agreement to use the study questionnaire was obtained from the original author. Descriptive statistics (frequencies, percentages, mean, and standard deviation) and inferential statistics (contingency coefficient) were used in the data analysis. Results: Findings declared by most of nurses that they have practice deficit about pediatric cannulation, especially at the first time of their work. Participant 7 said that “even though we got knowledge about IV cannulation during our education journey in nursing college, but it is not enough to be proficient to perform this procedure as an expert. We have limited knowledge and practices about performing procedures in pediatric patients who are different from adult patients”. Conclusion: The study concluded that Several themes were emerged from nurses’ responses to the main research question “What are the barriers that confronting nurses' practices during insertion of intravenous cannula to children in emergency room? The major themes were nurses’ related barriers; organization’s related barriers; patients’ related barriers; and opportunities and solutions for barriers. Recommendations: Efforts from the ministry of Health in Iraq should be targeted toward supplying pediatric emergency nurses with all facilities that assist their work focusing on availability of IV viewer.

Incidence of needlestick injury among healthcare workers in western India.

Injuries occurring from contaminated sharps are a major occupational health hazard. It carries a risk of transmitting blood-borne diseases such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C. Healthcare workers (HCWs), including personnel handling biomedical waste, are at risk. The objective of this study was to determine the incidence and details of needlestick injury (NSI) among HCWs. We analyzed data of all HCWs who reported NSI over the past three years. Demographic details, type and source of injury, use of personal protective equipment (PPE), immediate post-exposure measures, hepatitis B vaccination status and HCWs and source's HIV, hepatitis B and hepatitis C serological status were studied. Fifty-six cases of NSI were recorded over three years, accounting for an incidence of 10.4/100 occupied beds per year. Maximum cases (73.2%) occurred between the 20 and 40 yr age group. The distribution among the work category was doctors (37.5%), nursing staff (26.8%), phlebotomy technicians (12.5%), housekeeping/subordinate staff (12.5%) and others (10.7%). Appropriate PPE was donned by 66 per cent of the HCWs. The majority of cases (46.4%) occurred in wards and operating rooms (23.2%). Phlebotomy (35.7%), followed by procedures, such as hemoglucotest (HGT) measurement, intravenous cannula insertion and operative procedures (33.9%), were the most common situation during which HCWs suffered NSI. While 64.2 per cent HCWs were vaccinated for hepatitis B, only 5.4 per cent of the HCWs completed post-exposure anti-retroviral regimen. We conclude that a relative lack of awareness towards preventive measures and inexperience among HCWs may be contributory to high occurrence of NSI events. This study emphasizes upon ensuring active hospital-wide hepatitis B vaccination of all HCWs and supportive therapy to improve compliance towards post-exposure prophylaxis.

Emfisema Subkutis sebagai Komplikasi pada Pasien Covid-19 dengan Penggunaan Ventilasi Mekanik

Background. The incidence of subcutaneous emphysema in patients with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection has been in the spotlight recently. Subcutaneous emphysema is a rare complication. With the increasing prevalence of subcutaneous emphysema in patients with confirmed coronavirus disease (COVID-19), it is necessary to know what factors can cause this and how to treat it. Case Description. Two patients, a man and a woman aged 50 and 70 years, diagnosed with COVID-19, came to the Emergency Room (IGD) of Bunda Menteng General Hospital, Jakarta, with symptoms of acute respiratory distress syndrome (ARDS). Both patients experienced severe shortness of breath with a respiratory rate above 30 times per minute. Then the two patients were treated in the intensive care Unit (ICU) isolation room and required mechanical ventilation assistance. After 3-4 days of mechanical ventilation treatment, subcutaneous emphysema develops, characterized by subcutaneous crepitus. After chest x-rays were carried out in both patients, the results were subcutaneous emphysema and pneumomediastinum. Several invasive procedures have been performed, such as subcutaneous insertion of an intravenous cannula, mediastinoscopy, and chest tube insertion. Conclusion. Complications of subcutaneous emphysema in COVID-19 patients are rare and require further research to determine the cause, where the infection is still the focus. With this case report, it is hoped that clinicians will pay more attention to the initial clinical findings of subcutaneous emphysema to reduce even more severe complications such as pneumothorax.

Evaluation of local inflammation associated with peripheral intravenouscatheter insertion in Quang Tri General Hospital

Introduction: Local inflammation associated with peripheral intravenous cannula insertion is an important issue in taking care of patients in Quang Tri General Hospital. Objectives: Determining the rate of local inflammation associated with using a peripheral intravenous catheter (PIC) and finding out the relevant factors of local inflammation caused by the peripheral intravenous catheter. Methodology: Cross-sectional survey was applied to 340 patients in Quang Tri General Hospital by using the questionnaire with the VIP scale (Visual Infusion Phlebitis Scale). Results: The incidence of local inflammation was 7.9% after using PIC, with local inflammation Grade. I was the highest proportion (70.4%). The relevant factors of local inflammation after using PIC include age (> 70), treatment in the intensive care unit, the number of catheter placements (> 3), time remaining in place (24 - 48 h), size 20 G, and group drug chemistry. Conclusion: The incidence of local inflammation was 7.9% after using PIC. Observe to detect local inflammation soon after using a peripheral intravenous catheter to improve the quality of patient care. Key words: local inflammation, peripheral intravenous catheter

The effect of new device on pain and comfort levels in individuals undergoing peripheral intravenous cannula insertion.

The purpose of this study is to see how ShotBlocker® affects the pain and comfort level associated with short peripheral intravenous cannula (PIV) insertion. The study was conducted on a single sample group using a pre-post design. Individuals in the sample group who underwent a brief PIV insertion procedure served as both the study's control and intervention groups. In the sample group, the same nurse inserted a peripheral intravenous catheter into the cephalic veins of the right and left forearms using a standard insertion and ShotBlocker®. The pain and comfort levels were assessed using the VAS and Comfort Scale. When the distribution of the average pain and comfort scores of the individuals treated with the peripheral intravenous catheter was examined, it was found that the average pain score of the peripheral intravenous catheter insertion using ShotBlocker® was statistically significantly lower than the peripheral intravenous catheter insertion using the standard method, and the comfort score averages were statistically higher. When the correlation between the pain and comfort score averages of individuals undergoing peripheral intravenous catheter insertions was investigated, a statistically significant and strong negative relationship (p = 0.001) was discovered. As a result, the use of ShotBlocker® during the short PIV insertion procedure is an effective method to reduce the pain caused by the peripheral intravenous catheter. It was determined that the comfort level of the individuals increased as the pain due to peripheral intravenous catheter insertion decreased.

Quasi-experimental study to assess the effectiveness of squeezing ball on pain during insertion of intravenous cannula among children in selected hospitals of Pune City

Hospitalized Children suffer pain from various hospital procedures, trauma, and other illnesses. A wide variety of tools for treating pediatric pain appropriately is beneficial i.e., play therapy, distraction, relaxation, and coping skills. Aim of the study: Assess the effectiveness of squeezing ball on pain during insertion of intravenous cannula among children. Material and method: in the present study, the researcher adopted a Quantitative Approach and Quasi-experimental research design. It was carried out on 60 hospitalized children. The non-probability purposive sampling technique was used for the selection of samples, data were collected using demographic profiles and squeezing ball was given to 30 children of the experimental group. The assessment of pain was done using FLACC Pain Scale and Wong Bakers Pain Scale. The reliability of the tool was found “r=0.8 for FLACC scale and r=1 for Wong-Baker scale. The pilot study was done on 10 children, the study was found feasible.

Implementing use of sucrose analgesia (non-pharmacological management of neonatal pain) in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology

BackgroundNeonatal pain not only has negative impact on the acute physiological parameters of the neonate but also has got the potential to cause long-term neurodevelopmental disabilities. However, neonatal pain especially...

From little things, big things grow: An exploratory analysis of the national cost of peripheral intravenous catheter insertion in Australian adult emergency care.

To estimate the total economic impact of peripheral intravenous catheter (PIVC) or cannula insertion and use in adult Australian EDs, including those cannulas that remain unused for therapeutic purposes. Searches on Australian government websites were conducted to find rates of insertion, complications and cost of cannula; following this, gaps in national data sets were filled with MEDLINE and PubMed searches to estimate the total cost of cannula use in Australian EDs. Once the data were collected, totals were combined to establish an estimated cost for the listed categories. The estimated cost of cannulation in Australia may be up to A$594 million per year, including the cost of insertion (equipment and staff), cost of complications such as Staphylococcus aureus bacteraemia and phlebitis, and patient-centred costs (lost patient productivity, infiltration, occlusion and dislodgement). Approximately A$305.9 million is attributed to unused cannulas and approximately 11 790 days of clinician time is spent annually inserting cannula that remains idle. The figures developed in the present study represent an important educational opportunity to encourage thoughtful consideration of all interventions, no matter how small. ED cannula insertion represents a large economic and health cost to Australia's health system, many of which remain unused. There are no national data sets that record complications associated with PIVCs and we highlight the urgent need for improved data.

Evaluating Hand Hygiene Practices at the New-born Unit of Moi Teaching and Referral Hospital, Eldoret, Kenya

New-borns, especially preterm new-borns are at risk of developing bloodstream infections shortly after birth or later. This study aimed to evaluate the infection prevention & control measures through hand hygiene practices and determine the procedures associated with risk of infection to small and sick new-borns at the Newborn Unit of Moi Teaching and Referral Hospital. This was a hospital-based cross-sectional study carried out at the neonatal unit of the largest tertiary hospital of western Kenya. It included quantitative data collection using a standardized checklist for each of the procedures observed during day and night shifts for a period of 6 weeks, which represented a sample unit. Data were analysed using Statistical Package for the Social Sciences version 20.0. Categorical data were described using frequency and percentage. The values less than 0.05 was judged statistically significant. Out of the 553 observed contacts, the nurses did 52.4%. The intravenous cannula insertion was the most frequent procedure (11.2%), followed by newborn examination (10.7%) and medication administration (10.5%). About 69% of the procedures were classified as low risk procedures whereas high-risk procedures accounted for 31%. Most of the procedures were performed during daytime shifts. Poor hand hygiene procedures were statistically associated with risk of infection to small and sick new-borns. This risk were 2 times increased when the procedures were carried out by nurses (pv=<0.001, 95% confidence interval =1-2.9); and 6 times higher when the procedures were carried out by registrars (pv=0.008; 95% confidence interval =1.6-23). Newborn examination was statistically associated with reduced risk of infection, even after reduction of confounders (pv=0.001, odd ratio=0.0, 95% confidence interval=0.0). Hand hygiene compliance was scored at 42% and rated as poor compared to the standard (<75%) for all the service providers. However, newborn examination was the most independent risk factor. This study highlights the importance of hand hygiene compliance to prevent hospital-associated infections among small and sick newborns.

Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors

Study objectiveOur objective was to develop a clinical scale (the VENSCORE) to predict pre-operative peripheral intravenous cannula (PIVC) insertion failure at the first attempt in adults. DesignThis was a prospective multicenter cohort study that included internal validation with bootstrapping. SettingThe operating rooms of 14 hospitals in southern France from June 2016 to June 2018. PatientsConsecutive adult patients aged 18 years or older were recruited upon arrival to the operating room, regardless of American Society of Anaesthesiology (ASA) physical status. InterventionsPIVC insertion on arrival to the OR. MeasurementsPIVC insertion failure at the first attempt was the outcome of interest. Data collected included the number of PIVC insertion attempts and potential predictors of the risk of failure (including pre-operative patient characteristics and data relative to the procedure). Uni- and multivariable logistic analyses were performed. Based on these results, the VENSCORE scale was developed to predict the risk of failure of the first PIVC insertion. Main resultsIn total, 3394 patients were included, and 27 were excluded because of protocol violations. The PIVC insertion failure rate at the first attempt was 20.3%. Based on multivariable analysis, a history of difficult PIVC insertions, high-risk surgery, poor vein visibility, and moderate to poor vein palpability were identified as risk factors for insertion failure at the first attempt. The area under the curve of the predictive model was 0.82 (95% confidence interval: 0.80–0.84). A VENSCORE value of 0 points was associated with a failure rate of 7%, versus 97% for a score of 6. ConclusionsThe four-item VENSCORE scale could be useful for prospectively identifying adults at risk of first PIVC insertion attempt failure.

Acid-base and Electrolyte Disturbances in Children Presenting with Acute Watery Diarrhoea in Emergency Observation and Referral Unit of Dhaka Shishu (Children) Hospital

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality.
 Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children.
 Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20.
 Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02).
 Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases.
 DS (Child) H J 2020; 36(2): 120-124

A Quality Improvement Initiative to Reduce Blood Culture Contamination in the Neonatal Unit.

The QI team focused on standardizing processes to align with best practices using process mapping and cause and effect diagrams. Plan-Do-Study-Act (PDSA) 1: inoculation of blood culture bottles with the introduction of transfer device; PDSA 2: preparation of the skin for peripheral intravenous cannula insertion; PDSA 3: aseptic technique education package; and PDSA 4: optimizing blood volume of blood collected for culture. The team used statistical process control methodology to detect special cause variation. Compliance with the standard processes as part of PSDA 1 improved from a mean level of 50% to 100% and for PDSA 2 improved from a mean level of 50% to 95%. After implementation of PDSA 3, scores on a relevant knowledge test increased from a mean of 39% (pretraining test; n = 10) to 92% (posttraining test; n = 10) (P < 0.001). Postimplementation of the processes for PDSA 4, a minimum of 1 mL was collected in 94% of blood culture collection events (n = 450) (mean 1.1 mL; range 0.5-3.5 mL). Special cause variation occurred after the implementation of the PDSA cycles. During the baseline period, the BCC rate was 2.0% and decreased to 1.0% postinterventions implementation. Interventions focused on standardizing practices around collection of blood cultures in neonates were associated with fewer contaminants.This study is reported according to the SQUIRE 2.0 guidelines.

Effect of Active Distraction on Children’s Pain and Behavioral Response during Intravenous Catheter Insertion

ABSTRACT Background Relief of pain and suffering is an important responsibility of nurses caring for children, and intravenous cannula insertions is the most common sources of pain in hospitalized children. Distraction is recommended to help in minimizing the discomfort of painful procedures. The aim of the study is to examine the effects of pressing a soft ball on children’s behavioral response and pain level during and after intravenous catheter insertion. Methods: Research design Quasi-experimental design was used. Setting: The study was conducted at surgical ward at pediatric hospital, Zagazig university hospitals. Sample: A convenient sample of 100 children aged 4–10 years. Tools: Four tools were used to collect the study data: (I): Demographic data (child’s age, gender, birth order and cause of surgery). (II): Vital signs sheet (heart rate and respiratory rate) measured before and after intravenous cannula insertion in both intervention and control groups. (III): Behavioral response scale “FLACC” included five criteria (Face, Legs, Activity, Cry, Consolability). (IV): Wong–Baker FACES Pain Rating Scale (WBFPS) to assess children’s pain. Findings: After performing the procedure 46% of intervention group experienced moderate pain, compared to 56% of the control group. Statistically significant correlation between children behavioral response and pain score in both intervention and control groups (P = 0.001, P = 0.01) respectively. Highly statistically significant correlation between respiratory rate after intervention and children face rating scale in intervention group (P < 0.001). Conclusion: the study concluded that pressing a soft ball is an effective and easily accessible technique to decrease pain during IVCI in children between 4 years and 10 years. Practice implication: The results have implication for how health care professionals should implement distraction techniques to relieve children’s pain during painful invasive procedures such as IVCI.

Local anesthesia before intravenous cannula insertion: Recommendations for registered nurses in practice

Objective: The purposes of this project were to educate registered nurses of the intradermal, pretreatment procedure; provide education on the hospital’s current IV therapy pretreatment policy; and increase the usage of intradermal, local anesthesia for cannulation for adult patients’ comfort level.Methods: A mixed method of nonexperimental descriptive pre- and post-survey was used. The data was collected from 48 registered nurses’ pre- and post-surveys indicating descriptive analysis. The descriptive analysis identified barriers as to why registered nurses were not using pretreatment prior to IV insertion. Results: The results revealed the majority of the participants (83%) were not aware of the hospital’s IV pretreatment policy of intradermal anesthesia with Lidocaine before IV insertion prior to the DNP project. Evidence indicated inconsistency in the use of pain management strategies during these procedures. The conclusions of this project provided an important overview of the barriers to change in clinical practice for registered nurses with IV skills.Conclusions: An improvement project educational program, such as an educational video on how to preform intradermal pretreatment to an IV site prior to IV insertion and utilization of a manikin IV arm for simulation practice, was developed and recommended to a nursing IV therapy practice for registered nurses. Local anesthetic, such as intradermal, should become standard practice for registered nurses regarding pretreatment for pain control prior to intravenous insertion.

A retrospective study on end-of-life care in the emergency department of a tertiary hospital in Singapore

Introduction: The emergency department receives a whole breadth of patient types. Those who are imminently dying may attend the emergency department in the hours or days leading up to their demise, necessitating the initiation of end-of-life care in the emergency department. Aim: The aim of our study was to describe the characteristics and management of imminently dying patients who had presented to our emergency department to identify opportunities for improvement in the provision of end-of-life care in the emergency department. Methods: A retrospective study involving patients who died in the emergency department within 48 hours of registration presenting between 1 January 2018 and 31 December 2018 was carried out. Results: Out of 59 included patients, 91.5% had pre-existing medical conditions; 25.4% had end-stage organ failure of which renal and cardiac were most common. Only 15.3% had preferred care plans documented and among these, only a minority (33.3%) had undergone formal advance care planning. The most common presenting symptom among patients who died within 48 hours was dyspnoea (44.1%). The most common investigation done was capillary blood glucose (84.7%) and the most common procedure was an intravenous peripheral cannula insertion (84.7%). Antibiotics were given in 30.5% of the patients and fentanyl was administered in 20.3% for symptom control. Conclusion: The majority of patients presenting to the emergency department within hours or days of their demise had pre-existing chronic or terminal conditions but only a few had specified their preferences for end-of-life care. Investigations and procedures that do not affect patient comfort or outcomes should be minimised.

Prevalence of and factors associated with difficult peripheral venipuncture in adult surgical patients.

To determine the prevalence of difficult venous access in adult patients admitted to a surgical unit. This observational prospective cohort study included 235 patients from a Brazilian hospital. Clinical data were collected by direct observation and analyzed by descriptive, inferential statistics, and multiple binomial logistic regressions. Odds ratios were also calculated. Most of the patients (66.4%) were men and self-reported as white (59.2%). The prevalence of difficult intravenous access was 32.8%. Predictors of peripheral intravenous cannula insertion failure were history of difficult intravenous access and nonvisibility of the vein. History of difficult intravenous access and a nonvisible venous network were significant predictors of peripheral cannula insertion failure in adults undergoing clinical surgery. The prevalence of difficult intravenous access was 32.8%.

Supporting the use of sildenafil infusions in paediatric and neonatal intensive care – A compatibility study

ObjectiveIntravenous (IV) sildenafil, a phosphodiesterase type 5 inhibitor, is increasingly being used for the treatment of pulmonary hypertension (PH) in the paediatric population. Sildenafil (Revatio®) is approved for the treatment of pH in adults where it is administered as a bolus injection. However, in paediatrics it is used off-label and administered by continuous IV infusion. In the critically unwell child, limited IV access necessitates the administration of multiple IV infusions through a single IV lumen. The absence of compatibility data between sildenafil and other IV medications commonly used in this context necessitates the use of a dedicated IV line for sildenafil. The overall aim of this study was to establish the physical and chemical compatibility of sildenafil with commonly administered infusions in the paediatric and neonatal intensive care setting. DesignThis study evaluated the chemical and physical compatibility of binary and multiple combinations (n = 42) of sildenafil with adrenaline, noradrenaline, milrinone, vasopressin and heparin. These were tested using three diluents (NaCl 0.9%w/v, Glucose 5%w/v, and Glucose 10%w/v) and two environmental conditions (room temperature and 37 °C) frequently encountered in paediatric or neonatal intensive care units. Prior to drug combination analysis, HPLC methods were developed and optimised to allow for the quantification of drugs in accordance with current pharmaceutical guidance. Binary and multiple drug mixtures of sildenafil were examined for physical and chemical compatibility to establish compatibility. Measurements and main resultsOf the drug combinations not containing heparin, all were deemed compatible with the exception of the five drug mix of Sildenafil 800 μg/mL, Milrinone 200 μg/mL, Vasopressin 0.4Units/mL, Noradrenaline 60 μg/mL, Adrenaline 60 μg/mL at 37 °C, in 10%w/v glucose. All binary or multi drug combinations containing heparin were deemed incompatible. ConclusionsThis research provides support and information to clinicians looking to co-administer sildenafil with other IV medicines thus removing the requirement to subject their patients to multiple intravenous cannula insertion points where IV access is restricted. Article TweetNew evidence to support administration of sildenafil infusions in #PedsICU and #nicu– collaboration between @RCSIPharBioMol@FionaSOBrien1 and @OLCHCrumlin @RCSI_Irl @MoninneHowlett #CHI

Peripheral intravenous cannula insertion and use in a tertiary hospital emergency department: A cross-sectional study

IntroductionPeripheral intravenous cannula is often a first line invasive intervention for patients in the emergency department. It is used to facilitate blood sampling, deliver essential fluids, blood products and medication. However, the insertion and use of the peripheral intravenous cannula is not without complication. This study surveyed the number of peripheral intravenous cannulas inserted in the emergency department and identify the level of and reason for use. MethodsA cross-sectional study was conducted in the emergency department of a large tertiary hospital in Queensland. Descriptive and inferential statistics were used to describe peripheral intravenous cannula use and to explore associations. ResultsOf the 224 patients assessed, 159 (71%) had at least one peripheral intravenous cannula inserted in emergency department. Of the 159 peripheral intravenous cannulas inserted, 54 (34%) remained unused while the patient was in the emergency department. For patients classified as Australasian Triage Scale categories 3, 4 and 5, 40% of peripheral intravenous cannulas remained unused. Overall, poor documentation was observed with 29% of peripheral intravenous cannulas insertions not documented at all. ConclusionThis study identified a high proportion of unused peripheral intravenous cannulass in the emergency department and inadequate documentation. An intervention to promote best practice, raise awareness of the risks of peripheral intravenous cannulas use, possible alternatives therapies, and improve documentation is required.