Peripheral Venous Catheter Insertion Research Articles

Indication and Usage of Peripheral Venous Catheters Inserted in Adult Patients during Emergency Care

The aim of this study was to identify the underlying decisions taken regarding the insertion of prehospital peripheral venous catheters in adult patients and, additionally, to ascertain peripheral venous catheter insertion rate and explore prehospital and hospital (within 24 hours of insertion) pharmaceutical treatment via peripheral venous catheters. This cross-sectional study gathered data through a study-specific questionnaire and patient record auditing. We distributed a study-specific questionnaire to be completed by ambulance crews, and carried out patient record auditing for 345 patients (median age 64 years, range 18-97 years) arriving at the emergency department at a Swedish level-1 trauma center in October 2008. Of 135 patients (39%) arriving at the emergency department with a peripheral venous catheter, 94 (70%) had received the device because the ambulance crews intended to use it for intravenous therapeutics (of which analgesics, intravenous fluids, and psycholeptics were most frequently used). In 30 patients (22%), the prehospital inserted device was not used by the ambulance crews or at hospital within 24 hours. The corresponding rate of unused peripheral venous catheters inserted in patients after arrival at the hospital was 35%. We found that the main reason for the ambulance staff to insert a peripheral venous catheter in a prehospital setting was that they intended to use the device. Further, the rate of unused peripheral venous catheters was lower among prehospital peripheral venous catheters than hospital.

Postgraduate educational pictorial review: Ultrasound-guided vascular access.

Over the last few years the role of ultrasound has steadily increased and has now an established role in anesthesia and critical care. The various applications of this technology in this field include ultrasound-guided insertion of central lines (internal jugular, subclavian, axillary, femoral) and peripheral venous catheters, arterial line insertion, regional blocks etc. The simple reason of using this technology is “You believe what you see”. In this text we will mainly focus on central line, peripheral venous placement and arterial blood flow patterns under ultrasound guidance.In our institution at KFMC, internal jugular vein cannulation is preferred to cannulation of the subclavian vein because of the higher incidence of pneumothorax and subclavian artery puncture associated with the later. The incidence of carotid artery puncture is higher in children younger than five years than in older children during this procedure. The use of ultrasonography has been shown to increase the success rate and decrease the incidence of complications associated with IJV cannulation in adults.We will go through a stepwise approach in identifying and confirming the required blood vessels for ultrasound-guided cannulation using B-mode (2D), color flow doppler and Pulse Wave Doppler

Documentation of PVC insertion needs to be standardised

Precision and standardisation of the terms used for anatomic insertion sites would improve the record of peripheral venous catheter (PVC) cannulation, according to this examination of Swedish nursing practice.

Accuracy in documentation – a study of peripheral venous catheters

The aim was to explore the extent of postinsertion documentation of peripheral venous catheters (PVCs) in patients' medical records, including the descriptions used to explain the PVC insertion site and determinants of PVC documentation. Documentation in medical records is an important precondition for the safe handling of patients PVC. However, factors associated with documentation of PVCs and how the insertion site is described in medical records has not previously been studied. This was a cross-sectional and descriptive study. A sample of 933 adult inpatients (women 45.7%) with PVC was recruited from medical and surgical wards at one university hospital and two general hospitals. A data collection form was used for registration of the insertion site of the PVC, hand side, lumen size, patient's age and gender. PVC documentation from medical records was transcribed. Factors associated with the documentation were analysed using logistic regression. Ten descriptions used to explain the insertion site of the PVCs were identified in the patients' medical record. Any kind of PVC documentation was found in 71.8% and documentation that included insertion site, hand side and lumen size was recorded in 46.2% of the observed PVCs. Multivariate logistic regression revealed that PVC documentation was associated with medical wards at general hospitals (OR 4.59; 95% CI 3.10-6.81; p < 0.0001) and smaller lumen size (22 gauge) (OR 1.81; 95% CI 1.19-2.84, p = 0.006). The extent of PVC documentation in medical records was low and descriptions used to explain the PVC insertion sites were found to vary appreciably. General hospitals and in particular medical wards and smaller lumen size, were associated with PVC documentation that included insertion site, hand side and lumen size. Development of terms is needed to assure standardisation of postinsertion PVC documentation. Education of nurses on proper PVC documentation should be given priority.

Failure of a poster-based educational programme to improve compliance with peripheral venous catheter care in a tertiary hospital. A clinical audit

The objective of this audit was to determine the prevalence of recording the date and time of insertion of peripheral venous catheters (PVCs) in a tertiary hospital setting, and whether this could be improved by a simple poster-based educational programme. The two-phase point prevalence audit covered 1109 adult inpatients at the Royal Darwin Hospital, Australia. The presence or otherwise of a PVC was recorded, along with whether the date and time of insertion of the device was recorded in situ, in the bedside chart or in the clinical notes. Background demographic data were collected along with any identifiable risk factors for catheter-associated bacteraemia. The process was then repeated in the same hospital units following implementation of a simple poster-based educational programme. The prevalence of any dating method (in situ, in the bedside chart or in the clinical notes) was low, at 13.4% and 16.1% in the pre- and post-intervention groups respectively. This difference was not statistically significant (P=0.27). Independent of the poster campaign, patients with risk factors for catheter-associated bacteraemia were more likely to have the insertion date recorded compared to those without (P=0.03). Given the potential cost of catheter-associated bacteraemia to the patient, hospital and community, it is surprising that compliance with an in-house infection control recommendation was so poor. A poster-based education programme alone had little effect in improving the situation.

Impact d’un programme prolongé d’amélioration continue de la qualité sur le risque infectieux lié aux cathéters veineux périphériques

Although peripheral venous catheter (PVC) placement is one of the most common invasive procedures used in hospitals, data about the infectious risk associated with it are sparse. Nurses and physicians often underestimate this risk. We describe here a 10-year continuous quality improvement program in a large university hospital. The prevention program included: 1/ an observational audit of practices of PVC insertion and maintenance (1996), 2/ two studies of incidence and risk factors for PVC-related infection (1996 and 1999), 3/ 8 annual (1996 to 2006) cross-sectional studies that collected information about duration of PVC placement and other process indicators, 4/ surveillance of nosocomial bacteremia from 2002 through 2006, and 5/ continued education sessions for healthcare workers, based on local surveillance data. Rates of colonization and infection (0.7 cases of bacteremia/1000 PVC days) were similar to data from other studies. PVC that remained in place for more than three days was associated with a higher risk of catheter-related bacteremia in both incidence studies. The annual prevalence studies showed that 15 to 20% of PVCs remained in place for more than three days from 1996 through 2002, but this rate decreased thereafter; it was 6.7% in 2005 and 10.7% in 2006. Practices audits indicated room for improvement in prevention measures. The absolute number of PVC-related bacteremia decreased by more than 50% from 2002 (n=23) to 2006 (n=10). This prolonged multifaceted program, including practice audits, continued medical education and monitoring of PVC-related infection, has led to a substantial decrease over time in the infectious risk related to PVC placement.

Inserción y mantenimiento de catéteres venosos periféricos en neonatos

Insertion of peripheral venous catheters in premature and term newborns is a common practice in neonatology units and neonatal intensive care units. Nurses are responsible for the insertion and maintenance of peripheral venous catheters and for the prevention of complications. Although this technique is routine, a series of recommendations, supported by evidence-based practice, should be bourne in mind when inserting these catheters. Following these recommendations guarantees successful insertion, and the absence of risks and complications. To achieve this aim, the following steps should be carried out: preparing the material, selecting the vein, selecting the catheter, cleaning and disinfecting the area, inserting the catheter, fixing the catheter, and restoring intravenous therapy. In addition, attention must be paid to potential risks in order to resolve them as quickly as possible, thereby avoiding complications.

A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters

This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.

Efficacy and safety of a two-step method of skin preparation for peripheral intravenous catheter insertion: a prospective multi-centre randomised trial.

We have developed a two-step procedure for preparing the skin before peripheral venous catheter (PVC) insertions. This procedure involves two successive swabbings with wipes soaked in alcoholic antiseptic. We investigated whether this two-step procedure was as effective and safe as the standard four-step procedure – washing with detergent, rinsing, drying, applying antiseptic – by carrying out a multicentre randomised equivalence study comparing the frequency of precursor signs of infection at the site of insertion for the two skin preparation procedures. The study was carried out over an eight-month period, and 248 PVC insertion sites were evaluated. The two-step procedure was used for 130 subjects and the standard procedure for 118. Taking into account all the confounding factors predisposing patients to the complications studied, the characteristics of the two groups of patients were found to be similar, with no significant differences noted. The incidence of precursor signs of infection was 11 % 24 hours after PVC insertion (27/248), 25 % at 48 hours (50/203) and at 29 % at 72 hours (34/119). Eleven patients had complications necessitating the withdrawal of the PVC: sensitivity of the insertion site, with redness and/or slight swelling and/or a palpable venous cord. No major complications were observed in this study. The frequency of local complications associated with PVCs reported in this study, whether simple or severe, was not affected by the skin preparation procedure used for PVC insertion (two-step or four-step procedure).

Distal phalanx necrosis after intra-arterial injection of phenobarbital during treatment of subtle generalized convulsive status epilepticus

Prolonged convulsive status epilepticus with mild clinical seizure activity has been categorized as subtle generalized convulsive status epilepticus (SGCSE). There is a well known risk that SGCSE may go undiagnosed and adequate treatment may be delayed. We report on the acute therapy of a 7-year-old child with infantile cerebral palsy and poorly controlled symptomatic epilepsy who presented with SGCSE lasting more than 60 minutes. A peripheral venous catheter insertion was attempted at the volar site of the wrist and due to the reduced arterial oxygen saturation following the prolonged SE the intra-arterial position of the intravascular catheter was not apparent. Phenobarbital was injected at a dose of 12mg/kg BW intra-arterially. There is no product information regarding this problem for Phenobarbital, but according to pharmacological data about barbiturates it is probable, that the iv solution with a pH of 8.5 and a high viscosity leads to distal vascular occlusion, possibly mediated by thrombocyte aggregation. In spite of surgical intervention and hyperbaric oxygen therapy the development of distal phalanx necrosis D III-V could not be prevented. Amputation of the distal phalanges was performed but did not lead to additional functional deficit in the patient who suffers from infantile cerebral palsy with tetraparesis. In view of this case the following issues will be discussed:

Short peripheral venous catheters: effect of evidence-based guidelines on insertion, maintenance and outcomes in a university hospital

This study was designed to evaluate the impact of hospital-wide guidelines for short peripheral venous catheters (SPVC) insertion on the frequency of local catheter-related complications. In a 1051-bed Parisian university hospital, two observational, point prevalence surveys were undertaken in 1996 and in 1998, separated by implementation of written guidelines for SPVC insertion. The outcomes of SPVC insertion were defined as the presence or absence of local catheter-related complications (erythema, purulence around the insertion point, tenderness or induration along the cannulated vein). The proportion of polyurethane catheter materials used (56% vs. 81%, P<0.001), correct and sterile fixation (80% vs. 92%, P<0.05), non-movable catheters (92% vs. 98%, P=0.03) and insertion record (58% vs. 76%, P<0.01) increased between 1996 and 1998. The frequency of local catheter-related complications decreased (15% vs. 4%, P<0.01). Age >73 years [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.28-28.05] was positively associated with local catheter-related complications, whereas duration of insertion (until 72 h) (OR 0.29, 95% CI 0.09-0.89) and the implementation of guidelines (OR 0.26, 95% CI 0.09-0.67) were negatively associated with local catheter-related complications. The implementation of guidelines was independently negatively associated with local catheter-related complications (OR 0.31, 95% CI 0.09-0.97). The results suggest that hospital guidelines for SPVC insertion can improve catheter care and significantly reduce local catheter-related complications.

Relevance and complications of intravenous infusion at the emergency unit at Nice university hospital.

Insertion of peripheral venous catheters (PVCs) is current practice within the hospital environment and particularly in the emergency department (ED). This simple yet invasive technique may result in venous thrombosis, infection or mechanical complications. We conducted a prospective study at the Nice University Hospital ED in order to determine the frequency, relevance and complications of peripheral venous cannulation. Fourteen 24 h periods were surveyed over the months of May and June 2000, during which 2515 patients over 16 years of age attended the unit. Demographic and medical data were recorded for every patient who received a PVC. These patients were followed at 12 h intervals until the catheter was removed. Reasons for PVC, time left in place, and eventual complications were recorded. Justification for PVC was evaluated upon arrival at the ED, upon exiting the ED and in some cases within the hospital ward. Six hundred and thirty of 2515 patients (25%) received a PVC (290 women (46%) and 340 men (54%); meanage 58 years). Indication for the PVC was considered unjustified in 24.8% of cases upon arrival at the ED, and 33.8% upon leaving the ED. Upon admission in a hospital ward after passing through the ED, out of 318 patients, the PVC was left in place for no reason in 63 (20%). Overall, 390 PVCs were followed until the time of their removal. Mean duration of IV infusion was 28 h. Among these 390 patients, 62 (15.9%) developed complications, of which 54 (13.6%) had thrombophlebitis and 9 (2.3%) developed local infection. Mean duration of PVC left in place for patients with complications was 50 h vs 25 h for patients with no complications (P<0.001). Insertion of a PVC is common practice especially in EDs. The excessive use of this procedure leads to extra cost and iatrogenic complications. A renewed definition of its indication and raised awareness among hospital staff concerning the risks involved with this standard procedure should result in less use of PVC and fewer complications.

The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter, were filled in at the time of insertion and removal of catheters.In comparison with simple hand washing, disinfection of hands before the insertion or wearing of gloves resulted in significantly fewer complications (relative risk 0.59 and 0.66, respectively). Normal hand washing was no better than no hand hygiene (relative risk 1.13), with regard to reduction of complications. This underlines the necessity of employing more effective measures of hand hygiene. The frequency of complications was dependent on the duration of peripheral venous catheterization. Catheters inserted in the operating room had a significantly lower risk of complications than catheters inserted on the ward or in the outpatient unit.

The Role of the Advanced Practice Nurse in the Care of Organ Transplant Recipients

The role of the advanced practice nurse (APN) in transplantation has evolved from the role of the clinical transplant coordinator. This report attempts to define the credentials, practice domains, barriers to practice, and reimbursement issues related to APN practice while contrasting the role with that of clinical transplant coordinator. The nephrology APN working in a collaborative transplant practice can be an integral part of a multidisciplinary health care team. The APN's education and credentials empower them to provide a wider scope of services than transplant coordinators who are "experts by experience." These services can include providing primary care and performing procedures such as percutaneous transplant biopsies, insertion of peripheral and central venous catheters, and wound debridement as well as management of patients along their continuum of transplant care. Patient education and advocacy also are key components of APN practice. In addition, the services the APN provides generally are reimbursable and therefore can provide revenue for the practice.

Yes, Virginia, Aseptic Technique Is Very Important: Maximal Barrier Precautions during Insertion Reduce the Risk of Central Venous Catheter-Related Bacteremia

Yes, Virginia, there is a Santa Claus. -Frances Pharcellus Church There long has been controversy over the level of sterile barrier precautions that should be used during the insertion of a short-term, noncuffed central venous catheter. Most authorities stress the need for good aseptic technique, stringent asepsis, or asepsis, and many explicitly advocate use of maximal sterile barriers,1-9 namely the use of sterile gloves, a long-sleeved surgical gown, a large sterile drape, and possibly a surgical cap and mask as well. However, most authors have not addressed the issue explicitly or endorsed the widespread practice of using only sterile gloves and drapes.1~19 Even the expert panel that wrote the first Centers for Disease Control and Prevention (CDC) Guideline for Prevention of Intravascular Infections could not bring itself to recommend sterile barriers beyond gloves and drapes.20 No cardiologist performing a cardiac catheterization would use less than complete barrier precautions, despite the fact that the catheter remains in place for only an hour or two in most cases and rarely for more than 24 hours, even when the introducer is left in place for a percutaneous transcoronary angioplasty the following day. Realizing that a short-term, percutaneously inserted, noncuffed central venous catheter is the intravascular device most likely to cause nosocomial bloodstream infection,8,21,22 I have long believedadmittedly without conclusive supportive data-that maximal sterile barrier precautions should be mandat ry during the insertion of any central venous catheter (realizing that such precautions are unnecessary and would not be cost-effective for insertion of peripheral venous catheters or intraarterial catheters used for hemodynamic monitoring in an ICU).8 The problem with imposing such a standard on the 5 million short-term central venous catheters placed in U.S. hospitals each year has been the lack of scientific data affirming clearcut benefits in terms of reduction of device-related infection and, in the maelstrom of impending healthcare reform, economic cost-benefit. As a consequence, central venous catheters currently are inserted by physicians who wear sterile gloves, but often use little else in terms of barrier precautions. Personally having inserted hundreds of central venous catheters and supervised the insertion of several thousand over the past 20 years using a long floppy guidewire (as is the common practice), I would submit that without maximal sterile barriers-including a longsleeved gown and a large sterile sheet-drape-touch contamination of the guidewire, the catheter, or both is very common (but rarely appreciated).

Topical nitroglycerin ointment as an aid to insertion of peripheral venous catheters in neonates

Topical nitroglycerin ointment as an aid to insertion of peripheral venous catheters in neonates