Peripheral Venous Catheter Insertion Research Articles

Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study

PurposeIntradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients. DesignA prospective observational study. MethodsAfter institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure. FindingsThe patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001). ConclusionsWe found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

Management from a multidisciplinary perspective of phlebitis related to peripheral venous catheter insertion: An international Delphi study.

To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines. PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous. Delphi method. Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them. Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work). The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities. Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice. Delphi studies (CREDES). Experts contribution.

Evaluation of the effect of proximal massage and palm fisting in reducing the risk of peripheral venous catheter-related phlebitis: randomized control study.

Peripheral venous catheter (PVC) is a clinical procedure often performed by nurses in hospitals. Phlebitis can be prevented with more nursing care by applying PVC by trained nurses and using preventive methods. The aim of this study was to investigate the effect of proximal massage and palm fisting on the prevention of phlebitis in patients with a PVC. This randomized controlled study was conducted with patients who were hospitalized in the orthopaedics and traumatology service of a state hospital and had PVC. While the study group (n = 36) received proximal massage and palm fisting on the side with a PVC, the control group (n = 36) received standard care for PVC. The data were collected by using the 'Patient Demographics and Clinical Information Form', 'Peripheral Venous Catheter-Related Phlebitis Risk Scale', and 'Visual Infusion Phlebitis Assessment Scale'. There were no statistically significant differences between the groups regarding phlebitis development based on age, sex, chronic disease status, PVC insertion site, devices in the PVC, or fluids administered from the PVC. However, there was a significantly higher risk of PVC-induced phlebitis in patients who received proximal massage and palm fisting at 48 and 96 h, when the severity of phlebitis was evaluated on daily basis. The study showed promising results, suggesting that proximal massage and palm fisting may be a simple and inexpensive technique to prevent the occurrence of phlebitis in PVC patients. ClinicalTrials.gov: NCT05714137.

Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis.

Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion,POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.

Proof of concept of a new device for the insertion of peripheral venous catheters in aseptic conditions

According to the recommendations by the World Health Organization, the insertion of a peripheral venous catheter (PVC) must be an aseptic procedure while using non-sterile gloves. To overcome this apparent contradiction we have invented and patented (WO/2021/123482) a new device to be used during PVC insertion. The device permits the PVC placement in the vein while avoiding to directly touch the catheter with the fingertips. A total of 16 PVCs were inserted in the veins of a venipuncture anatomic training model while the operator was wearing non-sterile gloves. The gloves had been previously contaminated by embedding the fingertips in an agar plate inoculated with Staphylococcus epidermidis. Following insertion, the PVCs were sterilely removed and deposited on a bacterial culture plate. The tip cultures of PVCs that had been inserted with or without the use of the device were compared. Eight out of eight cultures (100.0%) were positive for S. epidermidis when the PVC had been inserted without using the device, whereas only one out of eight (12.5%) was positive when the device had been used. The single positive tip culture in the latter group corresponded to an insertion in which the operator had inadvertently touched the sterile part of the device while manipulating it. In conclusion, an auxiliary novel device allows the aseptic insertion of PVCs while the operator is wearing non-sterile gloves. Regulatory institutions should consider to recommend the insertion of PVCs by means of devices aimed at avoiding the contamination of the catheter.

Quality of care in peripheral venous catheterization: A scoping review.

To map the current status of parameters and tools to assess quality of care related to peripheral venous catheter use in adults. Scoping review, conducted in 2022 in the MEDLINE, LILACS, CINAHL and SCOPUS databases and with a publication time limit from 2013 to 2022. The sample consisted of 15 articles, summarized in the following categories: Indication, documentation and registration, coverage assessment, connection, stabilization and signs and symptoms inherent to the catheter. The use of a complete instrument, with the domains observed in this review, may have a positive impact on a more effective and safe clinical practice. The present review mapped the evidence about the insertion and maintenance of peripheral venous catheters that can be improved with training of good practices and the quality of the team, regarding the use of tools, materials and instruments for the evaluation of care.

ダビガトラン過量服薬に対するイダルシズマブの静脈内投与：血漿中ダビガトラン濃度と血液凝固能の関連性(Intravenous idarucizumab for dabigatran overdose: association between plasma dabigatran concentration and coagulation profile)

要旨ダビガトランは直接トロンビンを阻害することで抗凝固作用を示す経口抗凝固薬であり，近年処方機会が急増している。過量内服症例における，血漿中ダビガトラン濃度および血液凝固能の推移に関するデータは不足している。腎機能障害のない，非弁膜症性心房細動をもつ71歳邦人女性が近医より処方されていたダビガトランを合計7,480mg自殺目的に過量内服し，当院に搬送された。過量内服4時間後の血漿中ダビガトラン濃度は4,217ng/mL（治療域濃度100～400ng/mL）であり，APTTは160.3秒，PT–INRは9.46であった。イダルシズマブ5g経静脈投与後，血漿中ダビガトラン濃度は経時的に低下し，それに伴いAPTTとPT–INRも正常化した。血漿中ダビガトラン濃度とAPTT（R2=0.9898），およびPT–INR（R2=0.9998）との間には強固な関連性が認められた。本症例は第9病日に後遺症なく独歩退院した。治療域の40倍の血漿中濃度を示すダビガトラン大量内服症例において，イダルシズマブは血漿中ダビガトラン濃度を安全に，かつ効果的に低下させた。また，血液凝固能は，血漿中ダビガトラン濃度を強固に反映した。本症例により，一般的な血液凝固能検査を用いることで，ダビガトランの血中薬物動態を推定できる可能性が示された。

Impact of Skin Disinfection on Cutaneous Microbiota, before and after Peripheral Venous Catheter Insertion.

Introduction. Patients with invasive medical devices are at high risk for infection. Skin colonization is the initial stage of these infections, leading to the recommendation of practices requiring disinfection using antiseptics. Microbial communities playing a major role in skin health could be impacted by antiseptic procedures. Aim. To characterize and compare the bacterial communities of skin samples from patients before an antisepsis procedure, and after removal of the medical device itself, according to the nature of the antiseptic molecule (povidone iodine or chlorhexidine). Methods. The study focused on alterations in bacterial communities depending on the nature of the antiseptic procedure and type of intravascular device. After amplification of 16S rDNA, libraries (n = 498 samples) were sequenced using MiSeq platform. Results. Using an in-house pipeline (QIIME2 modules), while no alteration in skin microbiota diversity was associated with antiseptic procedure or PVC type, according to culture results (p < 0.05), alterations were at times associated with restricted diversity and higher dissimilarity (p < 0.05). Antiseptic procedures and PVC types were associated with the modification of specific bacterial representations with modulation of the Bacillota/Bacteroidota (Firmicutes/Bacteroidetes) ratio (modulation of C. acnes, Prevotella, Lagierella, and Actinomyces spp.) (p < 0.05). At baseline, the microbiota shows certain bacteria that are significantly associated with future PVC colonization and/or bacteremia (p < 0.05). All of these modulations were associated with altered expression of metabolic pathways (p < 0.05). Discussion. Finally, this work highlights the need to optimize the management of patients requiring intravascular devices, possibly by modulating the skin microbiota.

Reliability of blood tests taken from the peripheral intravenous catheter.

We aimed to compare the reliability of laboratory blood tests using 2 sampling methods, via a peripheral venous catheter (PVC) vs direct venipuncture stab (DVS), we evaluated the effect of time elapsed since PVC insertion, PVC diameter, and administration of saline and/or antibiotic infusion through PVC on the blood test results. A prospective comparative study was conducted between May 2018 and July 2019. Patients aged ≥ 18 years and admitted to our department with a 20G/22G PVC inserted within the last 24 hours were enrolled. Blood samples were collected from each participant in the morning, and a second sample was drawn using PVC. Dependent variables included the percentage of hemolysis, failure rate, complete blood count, biochemical testing parameters, and coagulation functions. A total of 211 patients participated in the study. In total, 237 blood tests were conducted, of which 167 were performed on day 1 and the remaining on day 2, with a second blood sample collected from 26 patients on day 2. Twenty-one participants received 22G PVC, and 23 participants received active infusion. No significant differences were found in failure rates when each subgroup was compared with the primary day 1 group. The intraclass correlation coefficient indicated significant correlations among all the indices in all groups. Both blood sampling methods (PVC and direct venipuncture) can be used interchangeably for routine laboratory tests on days 1 and 2 after PVC insertion using 20G/22G PVC or infused PVC.

Midline catheter insertion: focused on the procedure

Midline catheters (MCs), which are placed into the main veins of the upper arm, are a middle-ground option between peripheral venous catheters (PVCs) and central venous catheters (CVCs). New-generation MCs can be easily inserted at the bedside by a single operator and can be used until 29 days. Therefore, for a certain group of patients, new-generation MCs can potentially resolve the problems associated with CVCs and the need for recurrent PVC insertion. Therefore, this study aimed to present how to insert new-generation MCs.

Evidence of learning on the insertion and care of peripheral venous catheters in nursing students: A mixed study

Objectives1) To assess nursing students' evidence-based knowledge on the use of PVCs, and 2) to examine the perception of learning and teaching strategies aimed at this skill. BackgroundInsertion and care of Peripheral Venous Catheters (PVCs) are essential skills in undergraduate nursing education. Appropriate knowledge of this skill is crucial to improve clinical practice and patient safety. Therefore, training becomes an enabler for safe practice. DesignA multi-centre convergent parallel mixed-methods. Setting and participantsA total of 675 second-, third- and fourth-year nursing students from 3 nursing schools took part in the study. MethodsQuantitative data collection used a validated 15-question survey on knowledge of PVC management, and a descriptive and inferential analysis was carried out. Qualitative data were collected via a questionnaire consisting of 4 open-ended questions assessing knowledge, teaching methodologies and scenarios, and points for improvement. ResultsMost participants were female (74.04%), with a mean age of 22.45 (SD = 4.65), who had no experience in the health field (61.8%). They obtained a mean knowledge score of 7.27 (SD = 2.64) out of 15. The students who obtained higher scores had a mean professional experience of 7.96, SD = 2.66 (p 0.000) and were in their final year, with a mean of 8.59, SD = 2.56, (p 0.000). On the other hand, the students assessed their knowledge as basic but improving year by year. They also identified a need to apply more active and experiential methodologies that would allow for reflection. ConclusionLevel of educational level and experience is associated with increased knowledge. In order to improve knowledge, changes must be made in the training process to incorporate methodologies such as simulation and online training. There is a need to develop programmes that favour the alignment of theory with clinical practice.

First human case of catheter-related blood stream infection caused by Staphylococcus schleiferi subspecies coagulans: a case report and literature review

BackgroundStaphylococcus schleiferi is a gram-positive pathogenic coccus which causes canine skin and ear infections. Only four cases of human infection caused by Staphylococcus schleiferi subspecies coagulans have been reported. Herein, we present the first case of catheter-related bloodstream infection caused by S. schleiferi subspecies coagulans.Case presentationA 62-year-old Japanese man was admitted to our hospital for examination of sigmoid colon tumor. During hospitalization, he had fever, shaking chills, and swelling at the peripheral venous catheter insertion site. Two sets of blood cultures were positive for S. schleiferi subspecies coagulans which was confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), 16S ribosomal RNA sequencing and the coagulase test. The patient was successfully treated without relapse.ConclusionTo our knowledge, this is the first report of catheter-related bloodstream infection caused by S. schleiferi subspecies coagulans. S. schleiferi subsp. coagulans can be pathogenic in humans, and MALDI-TOF MS can contribute to accurate identification of S. schleiferi subspecies coagulans.

Evaluation of the Duration of Peripheral Venous Catheter in Vein in Hospitalized Children

Aim:This study was conducted to evaluate the duration of the peripheral venous catheter in vein, which is widely employed in the treatment of children who are hospitalized in pediatric clinics.&#x0D; Materials and Methods: The study was conducted as a prospective and observational-descriptive study. The sampling of the study consisted of the parents/children (N=249), who were admitted to the pediatric clinic, who underwent peripheral venous catheter insertion, and who agreed to participate in the study. Institution and ethics committee permission was obtained for the study. The data were collected with the “Peripheral Venous Catheter Monitoring Form” and “Phlebitis Scale”, which were prepared according to the literature by the research nurse.&#x0D; Results: It was determined that a total of 57.8% of the children who were included in the study were 1-36 months old, 42.2% were older than 37 months and 60.6% were male. It was also determined that the duration of the catheter in children was 58.76±28.07 hours and catheter was inserted 3,61±1,68 times during hospitalization. The negative correlation between “durations of peripheral ıntravenous catheters in veins" and "number of peripheral ıntravenous catheters inserted from hospitalization to discharge” was found to be statistically significant. It was determined that 73.5% of the catheters were removed because of the obstruction. &#x0D; Conclusion: As a result of the present study, it was determined that the peripheral venous catheter in children under three years of age had a shorter duration of remaining in the veins, and these children were subjected to repeated peripheral venous catheter attempts because of obstructions before their treatments were completed.

Infrared augmented reality device versus standard procedure for peripheral venous catheterisation in children less than 3years old: A quasi-experimental cluster randomised controlled trial.

The objective of this study was to evaluate the AccuVeinAV400® viewing device for peripheral venous catheter insertion in children on the first try. Inserting a peripheral venous catheter is the most frequent invasive procedure carried out by healthcare professionals in hospitalised children. Several attempts are sometimes necessary, and veins can be damaged. A quasi-experimental cluster randomised controlled trial based on the CONSORT 2010guidelines. This randomised study comparing standard practice to the use of AccuVein400® was carried out on children who were less than 3years old, with difficult intravenous access (DIVA Score), hospitalised in three paediatric units and who needed cannulation. A total of 304 children were included (156 in the AccuVein arm and 148 in the standard arm). There was no significant difference between AccuVein and standard groups in age (respectively, 2.5±0.9years vs. 2.5±0.8), or mean DIVA score (respectively 5.9±1.3 vs. 5.5±1.2). The success of cannulation on the first attempt was 40.38% in the AccuVein arm vs. 41.2% in the standard arm (p=.6). The caregiver's assessment of pain on the Face Legs Activity Cry Consolability scale was 4.8±0.2 in the AccuVein arm vs. 5.0±0.2 (p=.4). The use of AccuVein400® did not lead to greater success in intravenous insertion at the first attempt in children under 3years of age with difficult intravenous access. This device can therefore be used according to the healthcare professionals' situation and needs. It is widely used in paediatric wards, and our study shows that it offers a support tool that reassures healthcare professionals and helps validate their choice of vein easiest to catheterise.

Documentation of the vascular catheterization in the multidisciplinary healthcare setting as a component of epidemiological surveillance for intravascular catheter-related infections

Vascular catheterization is associated with a risk of infection. Today in Ukraine there aren't legal documents that regulate the record of the vascular catheterization and the epidemiological surveillance of intravascular catheter-related infections (ICRI). The purpose of the study is to evaluate the completeness of documentation of peripheral and central vascular catheterization, and interventions, related with the catheters insertion and care in the multidisciplinary healthcare setting. According to the results of a retrospective epidemiological analysis which was conducted in 2020 regarding 131 medical records (MR) of inpatients with neurosurgical diseases who were in the anesthesiology and intensive care unit in 2019, the lack of proper documentation of the vascular catheterization procedure was revealed. Documentary confirmation of the vascular catheterization was found in 82 MR, which was (62.6±4.23)% of the analyzed MR. In the most cases the documented information included the following: catheter type, insertion site, size of catheter, indications for central venous catheterization, technique of central venous catheters inserting and the fact of using aseptic dressing. Indications for the insertion of peripheral venous catheters in MR were almost never recorded. Information about the expected duration of catheterization, data of daily monitoring of the insertion site, interventions related with the catheter care (catheter cleaning prior to accessing and/or after accessing, and changing dressing), indications for catheter removal weren't recorded in MR. Documenting the daily monitoring of the catheter insertion site allows to assess dynamic changes and choose the optimal strategies to prevent the development of catheter-associated complications. Insufficient documentation of the vascular catheterization makes it difficult to monitor the use of intravascular catheters. This makes impossible to identify risk factors that can affect the incidence of ICRI in the healthcare setting. The documentation of the vascular catheterization is an integral component in the system of epidemiological surveillance of ICRI, and helps to manage the risks of catheter-associated infectious complications. Keywords: venous catheter, retrospective epidemiological study, in-patient medical record, checklist, infection control.

Predictive Factors for Anxiety during Blood Sampling and Insertion of Peripheral Intravenous Catheters in Paediatric Patients in Spain

IntroductionInvasive procedures for diagnosis purposes such as venepuncture and peripheral venous catheter insertion are painful procedures that cause great stress for paediatric patients. The objective of this study is to find out the factors that have an impact on the level of anxiety experienced by children undertaken these procedures. Design and methodsProspective study, 359 children between 2 and 15 years old were included, treated in a tertiary reference hospital in the region of Navarra (Spain). The impact of the variables recorded was analysed using a regressive analysis, the Wong-Baker and FLACC scales were used to measure the level of pain and the PACBIS scale to measure the level of stress and anxiety. ResultsThe average age of the participants was 7.93 years (SD: 4.04), with 51.8% (n = 186) boys and 48.2% (n = 173) girls. The mean value of pain recorded was 4.43 (SD:3.10). 45.7% (n = 123) of the venepuncture techniques was associated with minimum level of anxiety, including 11.1% of intravenous catheterization. Variables determining the anxiety has been detected such as age, sex, level of pain, parental conduct and time spent on the procedure. ConclusionsPaediatric patients experience high levels of anxiety when undergoing painful procedures which are conditioned by multifactorial reasons. The increase in stress is directly related to the older age (>6 years old) of the patient, and statistically significant by the female gender, the longer duration of the technique and the parental block. Practice implicationsHealthcare professionals should work on some of the variables and apply measures aimed to mitigate anxiety levels. For example, reducing the duration of the procedure, training parents, and distracting techniques.

Intravenous access placement and fluid administration appropriateness in the emergency department

The aim of this study is to assess practice and effectiveness of Peripheral Venous Catheter (PVC) insertion and intravenous fluid administration in the Emergency Department (ED). A prospective study was conducted at a single primary ED in Brescia, Italy. 455 participants were included in the analysis. PVC were placed in 88 % of patients, 18 gauge catheters were the most frequently used (63%). In 360 patients PVC placement required one attempt. In 99 % of patients PVCs were used at least once. Fluid administration was considered appropriate in 23 patients. Out of 402 PVC placements, 244 were not necessary (in 225 patients PVCs were used only for blood samples withdrawal, and in 16 patients they were used for blood samples withdrawal, and inappropriate fluid administration). We concluded that a large number of PVC placements in the ED was potentially avoidable, and, when PVCs were used for IV fluid administration, the indication was often inappropriate. Physicians should carefully assess the real need of PVC placement in patients admitted to the ED and critically assess some issues of everyday practice, like PVC placement or IV fluids prescription, with evaluation of cost savings.

Biomechanical analysis of practitioner's gesture for peripheral venous catheter insertion

Peripheral venous catheter insertion (PVCI) is one of the most common procedures performed by healthcare professionals but remains technically difficult. To develop new medical simulators with better representativeness of the human forearm, an experimental study was performed to collect data related to the puncturing of human skin and a vein in the antebrachial area. A total of 31 volunteers participated in this study. Force sensors and digital image correlation were used to measure the force during the palpation and puncturing of the vein and to retrieve the kinematics of the practitioner's gesture. The in vivo skin rupture load, vein rupture load, and friction loads for skin only and for both the skin and vein were (mean ± standard deviation) 0.85 ± 0.34 N, 1.25 ± 0.37 N, –0.49 ± 0.19 N, and –0.51 ± 0.16 N, respectively. The results of this study can be used to develop realistic skin and vein substitutes and mechanically assess them by reproducing the practitioner's gesture in a controlled fashion.

Effect of motor imagery and actual practice on learning professional medical skills

BackgroundThe peripheral venous catheter is the most frequently used medical device in hospital care to administer intravenous treatment or to take blood samples by introducing a catheter into a vein. The aim of this study was to examine the effect of motor imagery associated with actual training on the learning of peripheral venous catheter insertion into a simulated venous system.MethodThis was a prospective monocentre study in 3rd year medical students. Forty medical students were assigned to the experimental group (n = 20) performing both real practice and motor imagery of peripheral venous catheter insertion or to the control group (n = 20) trained through real practice only. We also recruited a reference group of 20 professional nurses defining the benchmark for a target performance.ResultsThe experimental group learned the peripheral venous catheter insertion faster than the control group in the beginning of learning phase (p < 0.001), reaching the expected level after 4 sessions (p = .87) whereas the control group needed 5 sessions to reach the same level (p = .88). Both groups were at the same level at the end of the scheduled training.ConclusionsTherefore, motor imagery improved professional motor skills learning, and limited the time needed to reach the expected level. Motor imagery may strengthen technical medical skill learning.

Incidence and Predictors of Peripheral Venous Catheter-Related Complications in Hospitals in Burkina Faso

Introduction: Peripheral venous catheters (PVCs) are the most commonly used medical devices in hospitals for the administration of medications. Their use can lead to complications of varying severity. Objective: Determine the incidence and factors associated with the occurrence of PVC-related complications. Methods: This was a two-month prospective observational study conducted in the Medical Emergency Department (MED) of Yalgado Ouedraogo Teaching Hospital in Ouagadougou. All patients admitted during the study period who had a PVC inserted and removed were included in the study. Logistic regression analysis was used to identify the factors associated with the occurrence of complications. Results: In total, 459 PVCs were inserted and removed in 415 patients hospitalized at the Medical Emergency Department during the study period. The placement of 37.7% (n = 173) of PVCs resulted in complications in 131 patients (31.6%). For 644.3 days of catheterization, the incidence density was estimated at 6.5 complications per 1000 patient days. Phlebitis (24.0%), infection (5.7%), and accidental removal (2.8%) were the most frequently identified complications. The average age of the patients was 46.8 ± 18.9 years with a sex ratio of 1.22. The average patient hospitalization duration was 2.5 ± 2.6 days. In multivariate analysis, the factors significantly associated with the occurrence of complications after PVC insertion were patient’s state of agitation during the procedure (aOR = 12.59; 95% CI = 4.12 - 38.49), placement of the PVC at the elbow bend (aOR = 2.17; 95% CI = 1.86 - 5.52), multiple attempts (aOR = 3.18; 95% CI = 1.49 - 6.75), administration of 10% hypertonic glucose solution (aOR = 3.67; 95% CI = 1.62 - 8.33), and duration of catheterization beyond 72 hours without being changed (aOR = 33.00; 95% CI = 14.19 - 76.75). Conclusion: The incidence of PVC-related complications was relatively high. The identification of the factors that can lead to these complications is relevant to the delivery of quality healthcare to patients.