Intravenous Access Research Articles

Improving difficult peripheral intravenous access requires thought, training and technology (DART3): a stepped-wedge, cluster randomised controlled trial protocol

BackgroundPeripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities.MethodsA stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie’s Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention.DiscussionStudy findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities.Trial registrationProspectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).

Outpatient parenteral antimicrobial therapy (OPAT) in a safety-net hospital: Opportunities for improvement

Background: Parkland Health is a 900-bed safety-net hospital that serves Dallas County, Texas. It has an OPAT program in which patients are managed via self-administration (S-OPAT), home-health/hemodialysis (H-OPAT), and skilled nursing facilities (SNF-OPAT). We evaluated the reasons for unscheduled emergency department (ED) visits by patients in these groups to identify strategies to decrease unexpected healthcare utilization and to improve safety. Methods: We performed a retrospective chart review of all adult patients discharged from Parkland Health on OPAT between April and June 2021. Demographic, medical, and healthcare utilization information, including the date and reason of first unscheduled ED visit after discharge, was collected utilizing a standardized instrument. The institutional review board approved this study. Results: In total, 184 patients were discharged with OPAT. Among them, 32% were female and 55% identified as Hispanic; 41% were non-English speakers, and 45% were treated for a musculoskeletal infection. Among all OPAT models of care, 43.4% were S-OPAT patients, 31.5% were H-OPAT patients, and 25% were SNF-OPAT patients (Table 1). The groups differed, and fewer African Americans received H-OPAT. Also, 45% were being treated for musculoskeletal infections and were more likely to be discharged with H- or SNF-OPAT. In addition, 41% were being treated for endovascular infections and 21.7% were being treated for genitourinary infections. The total length of stay in the hospital was longer for SNF-OPAT patients and shorter for S-OPAT patients (Table 2). Among 184 OPAT patients, 41 patients (22.2%) had an ED visit: 17.3% SNF-OPAT patients, 27.6% H-OPAT patients, and 21.3% S-OPAT patients (Table 2). ED visits were attributed to intravenous (IV) access–related problems (12 of 41, 29.0%), worsening of known infection (3 of 41, 7.3%), and abnormal blood test results (2 of 41, 4.9%). Also, 24 ED visits (58%) were not related to underlying infection or OPAT. However, when examined by the OPAT care model, 41% of ED visits among S-OPAT patients, 20% among H-OPAT visits, and 25% among SNF-OPAT visits were related to IV access issues. Among S-OPAT ED visits pertaining to IV access, 71% were for minor issues such as dressing changes or line occlusion or malfunction. Conclusions: One-fifth of OPAT patients had an unscheduled ED visit, of whom 20%–41% had issues with IV access. Many of these visits could be avoided with enhanced outreach to patients discharged with OPAT and improved ambulatory capabilities to provide standard services related to maintenance of IV access.Disclosures: None

Effectiveness of Disinfecting Caps for Intravenous Access Points in Reducing Central Line-Associated Bloodstream Infections, Clinical Utilization, and Cost of Care During COVID-19.

Intravenous (IV) access point protectors, serving as passive disinfection devices and a cover between line accesses, are available to help reduce the risk of central line-associated bloodstream infections (CLABSIs). This low-maintenance disinfection solution is particularly valuable in situations with excessive workloads. This study examined the effect of a disinfecting cap for an IV access point on CLABSI rates, hospital length of stay, and cost of care in an inpatient setting during the coronavirus disease 2019 (COVID-19) pandemic. The study utilized data from the Premier Healthcare Database, focusing on 200,411 hospitalizations involving central venous catheters between January 2020 and September 2020. Among these cases, 7423 patients received a disinfecting cap, while 192,988 patients did not use any disinfecting caps and followed the standard practice of hub scrubbing. The two cohorts, Disinfecting Cap and No-Disinfecting Cap groups, were compared in terms of CLABSI rates, hospital length of stay (LOS), and hospitalization costs. The analysis accounted for baseline group differences and random clustering effects by employing a 34-variable propensity score and mixed-effect multiple regression, respectively. The findings demonstrated a significant 73% decrease in CLABSI rates (p= 0.0013) in the Disinfecting Cap group, with an adjusted CLABSI rate of 0.3% compared to 1.1% in the No-Disinfecting Cap group. Additionally, the Disinfecting Cap group exhibited a 0.5-day reduction in hospital stay (9.2 days versus 9.7 days; p = 0.0169) and cost savings of $6703 ($35,604 versus $42,307; p = 0.0063) per hospital stay compared to the No-Disinfecting Cap group. This study provides real-world evidence that implementing a disinfecting cap to protect IV access points effectively reduces the risk of CLABSIs in hospitalized patients compared to standard care, ultimately optimizing the utilization of healthcare resources, particularly in situations where the healthcare system is under significant strain or overloaded.

What Matters Most? How to Find Joy at Work in Post-Acute and Long-Term Care

What Matters Most? How to Find Joy at Work in Post-Acute and Long-Term Care

Against All Odds

Against All Odds

Red cell haemolysis secondary to intraosseous (IO) blood transfusion in adult patients with major trauma: a systematic review

IntroductionIntraosseous (IO) administration of medications and blood products is accepted practice in major trauma when intravenous access is not immediately available. However, there is a concern that the high infusion...

The safety of intravenous peripheral administration of 3% hypertonic saline: A systematic review and meta-analysis

BackgroundThree percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It has been traditionally administered through a central venous catheter (CVC). The avoidance of peripheral intravenous infusion of 3% HTS stems theoretically from the concern about the ability of the peripheral veins to tolerate hyperosmolar infusions. The aim of this systematic review and meta-analysis is to assess the rate of complications associated with the infusion of 3% HTS using peripheral intravenous access. MethodsWe conducted a systematic review and meta-analysis to assess the rate of complications related to the peripheral infusion of 3% HTS. We searched several databases for available studies that met the criteria until February 24th, 2022. We included ten studies conducted across three countries examining the incidence of infiltration, phlebitis, venous thrombosis, erythema, and edema. The overall event rate was calculated and transformed using the Freeman-Tukey arcsine method and pooled using the DerSimonian and Laird random-effects model. I2 was used to evaluate heterogeneity. Selected items from Newcastle-Ottawa Scale2 were used to assess the risk of bias in each included study. ResultsA total of 1200 patients were reported to have received peripheral infusion of 3% HTS. The analysis showed that peripherally administered 3% HTS has a low rate of complications. The overall incidence of each of the complications was as follows: infiltration 3.3%, (95% C.I. = 1.8-5.1%), phlebitis 6.2% (95% C.I. = 1.1-14.3%), erythema 2.3% (95% C.I. = 0.3-5.4%), edema 1.8% (95% C.I. = 0.0-6.2%), and venous thrombosis 1% (95% C.I. = 0.0-4.8%). There was one incident of venous thrombosis preceded by infiltration resulting from peripheral infusion of 3% HTS. ConclusionsPeripheral administration of 3% HTS is considered a safe and possibly preferred option as it carries a low risk of complications and is a less invasive procedure compared to CVC.

Robotic Devices for Assisted and Autonomous Intravenous Access

Intravenous Access (IVA) is the most common invasive medical procedure. Globally, it is estimated that over one billion IVA devices (needles/catheters) are used annually. However, the overall failure rate in this procedure is unacceptably high, reaching values between 35 and 50%. This has driven a great deal of research and technological development over recent decades, including the integration of different levels of autonomy in IVA medical devices to greatly improve this process. This paper will review these recent technical developments, including methods and systems for vein imaging and localization, needle insertion, venipuncture detection, catheter placement, and complete robotic IVA platforms. Furthermore, this paper explores emerging technical aspects, current limitations, and new research directions that may enable wider clinical translation and better acceptance of robotic IVA technologies.

Outcomes of Ultrasound Guided Peripheral Intravenous Catheters Placed in the Emergency Department and Factors Associated with Survival.

Patients with difficult peripheral intravenous (IV) access are common in emergency departments (EDs). Ultrasound-guided peripheral intravenous catheters (USIVs) are frequently used in this population; however, information regarding the effect of patient and IV characteristics on the dwell time (DT) and survival probability (SP) of USIVs is limited. Our study aimed to evaluate for associations between patient or IV characteristics and the DT and SP of USIVs. Retrospective analysis was performed on a database from an ED nurse (RN) USIV training program at an urban, academic hospital. Patients over 18 years with an USIV placed during the study period were included. Subject demographics, history, IV characteristics, insertion, and removal times were collected. Data were analyzed using descriptive statistics and univariable and multivariable Cox regression. USIV survival times for variates of interest were estimated using Kaplan-Meier curves for three censoring points. The final analysis cohort was 388 patients. Mean age was 56.6 years, 66.5% were female, mean BMI was 29.9 kg/m2, and 42.5% were obese (BMI ≥30). Median DT was 40.3 hours in admitted patients (N=340). SP for USIVs at 96 hours was 87.8%. A total of 21 of 340 (6.2%) USIVs failed. USIV location conferred a difference on DT in obese patients when dichotomized into upper arm versus antecubital fossa and forearm together (38.6 hours vs 44.6 hours, p=0.03). No factors were associated with a difference in USIV SP. Median USIV DT of 40.3 hours for admitted patients was higher than in previous studies. Only 7% of USIVs in our study failed. Overall, catheters survived longer than expected.

Genomic Analyses of a Fungemia Outbreak Caused by Lodderomyces elongisporus in a Neonatal Intensive Care Unit in Delhi, India.

Lodderomyces elongisporus is a recently emerging yeast pathogen predominantly reported in adult patients who had immunosuppression and/or intravenous access devices. Here, we report a fungemia outbreak caused by L. elongisporus in a neonatal intensive care unit (NICU) in Delhi, India, from September 2021 to February 2022. All 10 neonates had low birthweight, and nine of the patients survived after amphotericin B treatment. Whole-genome sequence analyses of the patient isolates as well as those from other sources in India grouped them into two clusters: one cluster consists of isolates exclusively from stored apples and the other cluster includes isolates from patients, clinical environments, and stored apples. All outbreak strains from patients were closely related to each other and showed highly similar heterozygosity patterns across all 11 major scaffolds. While overall very similar, strains from the inanimate environment of the same neonatal intensive care unit showed loss of heterozygosity at scaffold 2 (NW_001813676) compared to the patient strains. Interestingly, evidence for recombination was found in all samples. All clinical strains were susceptible to 10 tested antifungal drugs, and comparisons with strains with high fluconazole MICs derived from the surface of stored apples revealed significant genome divergence between the clinical and apple surface strains, including 119 nonsynonymous single nucleotide polymorphisms (SNPs) in 24 triazole resistance-related genes previously found in other Candida spp. Together, our results indicate significant diversity, recombination, and persistence in the hospital setting and a high rate of evolution in this emerging yeast pathogen. IMPORTANCE Lodderomyces elongisporus was initially considered a teleomorph of Candida parapsilosis. However, DNA sequence analyses revealed it as a distinctive species. Invasive infections due to L. elongisporus have been reported globally. We report an outbreak of fungemia due to L. elongisporus in a NICU affecting 10 preterm, low-birthweight neonates during a period of 6 months. The outbreak investigation identified two environmental sites, the railing and the temperature panel of the neonate open care warmer, harboring L. elongisporus. Whole-genome sequencing confirmed that the neonate isolates were closely related to each other whereas strains from the inanimate clinical environment were related to clinical strains but showed a marked loss of heterozygosity. Further, L. elongisporus strains recovered previously from the surface of stored apples showed high fluconazole MICs and alterations in triazole resistance-related genes. Genome-wide SNP comparisons revealed recombination as an important source for genomic diversity during adaptation of L. elongisporus to different environments.

Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty — Superior Tissue Concentrations and Improved Efficiency

BackgroundLiterature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA. MethodsThis single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into 1 of 2 groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500 mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day complications, and 90-day complications were also tracked. ResultsA statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and at the end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone. ConclusionThis study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.

Resuscitation room management of patients with non-traumatic critical illness in the emergency department (OBSERvE-DUS-study)

BackgroundFew studies address the care of critically ill non-traumatic patients in the emergency department (ED). The aim of this study was to assess the epidemiology, management, and outcome of these patients.MethodsIn this retrospective study, we identified and analyzed data from all consecutive adult critically ill non-traumatic ED patients treated from March 2018 to February 2019. Patient characteristics, major complaint leading to admission, out-of-hospital, and in-hospital interventions and 30-day mortality were extracted from medical records of the electronic patient data management system.ResultsDuring the study period, we analyzed 40,764 patients admitted to the ED. Of these, 621 (1.5%) critically ill non-traumatic patients were admitted for life-threatening emergencies to the resuscitation room (age: 70 ± 16 years, 52% male). Leading problem on admission was disability/unconsciousness (D), shock (C), respiratory failure (B), airway obstruction (A), and environment problems (E) in 41%, 31%, 25%, 2%, and 1%, respectively. Out-of-hospital and in-hospital measures included: intravenous access (61% vs. 99%), 12-lead ECG (55% vs. 87%), invasive airway management (21% vs. 34%) invasive ventilation (21% vs. 34%), catecholamines (9% vs. 30%), arterial access (0% vs. 52%), and cardiopulmonary resuscitation (11% vs. 6%). The underlying diagnoses were mainly neurological (29%), followed by cardiological (28%), and pulmonological (20%) emergencies. The mean length of stay (LOS) in the resuscitation room and ED was 123 ± 122 and 415 ± 479 min, respectively. The 30-day mortality was 18.5%.ConclusionThe data describe the care of critically ill non-traumatic patients in the resuscitation room. Based on these data, algorithms for the structured care of critically ill non-traumatic patients need to be developed.

Effect of other venous access on cardiopulmonary resuscitation quality: A prospective, randomized, controlled trial

ABSTRACT This randomized controlled study aimed to prospectively evaluate the application effects of other venous access in patients undergoing cardiopulmonary resuscitation. A total of 212 patients who underwent respiratory and cardiac arrest were randomly divided into peripheral intravenous (IV) access group (IV group, n = 69), femoral vein catheterization group (FVC group, n = 72), and internal jugular vein catheterization group (IJVC group, n = 71). The puncture time, first administration time, pressure interruption time caused by the establishment of fluid pathway, endotracheal intubation time, complications, ROSC time, and ETCO2 were recorded. The time of establishing venous access was: IV<FVC<IJVC. The once puncture success rate of the FVC group was markedly higher than that in IV and IJVC groups (P < 0.01). There was no significant difference in ROSC time between the FVC, IV, and the IJVC group (P = 0.23). The ROSC time in the FVC group was higher than in the IV and IJVC groups (P < 0.01). The success rate of ROSC in the FVC group and IJVC group were better than that in the IV group (PVC>IJVC>IV, P = 0.04). There was no significant difference in EtCO2 between the FVC, IV group, and IJVC group (PVC>IJVC>IV, P = 0.17). Due to catheterization, the time of suspending chest compression in the FVC group was significantly lower than in the IJVC group (5s vs. 12s). The time of establishing an artificial airway in the IV (38s) and FVC (35s) group were significantly longer than that in IJVC (52s) group. Central venous catheterization is more effective than peripheral venous catheterization in cardiopulmonary resuscitation. Moreover, femoral vein access was more effective than internal jugular vein access.

Case report: Intra arterial thrombolysis with iv line can save an acutely ischemic limb

Case report: Intra arterial thrombolysis with iv line can save an acutely ischemic limb

Association Between Profound Shock Signs and Peripheral Intravenous Access Success Rates in Trauma Patients in the Prehospital Scenario: A Retrospective Study.

Hemorrhage is the leading cause of preventable death in trauma patients, and establishment of intravenous (IV) access is essential for volume resuscitation, a key component in the treatment of hemorrhagic shock. IV access among patients in shock is generally considered more challenging, although data to support this notion are lacking. In this retrospective registry-based study, data were collected from the Israeli Defense Forces Trauma Registry (IDF-TR) regarding all prehospital trauma patients treated by IDF medical forces between January 2020 and April 2022, for whom IV access was attempted. Patients younger than 16 years, nonurgent patients, and patients with no detectable heart rate or blood pressure were excluded. Profound shock was defined as a heart rate >130 or a systolic blood pressure <90 mm Hg, and comparisons were made between patients with profound shock and those not exhibiting such signs. The primary outcome was the number of attempts required for first IV access success, which was regarded as an ordinal categorical variable: 1, 2, 3 and higher and ultimate failure. A multivariable ordinal logistic regression was performed to adjust for potential confounders. Patients' sex, age, mechanism of injury and best consciousness level, as well as type of event (military/nonmilitary), and the presence of multiple patients were included in the ordinal logistic regression multivariable analysis model based on previous publications. Five hundred thirty-seven patients were included, 15.7% of whom were recorded as having signs of profound shock. Peripheral IV access establishment first attempt success rates were higher in the nonshock group, and there was a lower rate of unsuccessful attempts in this group (80.8% vs 67.8% for the first attempt, 9.4% vs 16.7% for the second attempt, 3.8% vs 5.6% for the third and further attempts, and 6% vs 10% unsuccessful attempts, P = .04). In the univariable analysis, profound shock was associated with requirement for an increased number of IV attempts (odds ratio [OR], 1.94; confidence interval [CI], 1.17-3.15). The ordinal logistic regression multivariable analysis demonstrated that profound shock was associated with worse results regarding primary outcome (adjusted odds ratio [AOR], 1.84; CI, 1.07-3.10). The presence of profound shock in trauma patients in the prehospital scenario is associated with an increased number of attempts required for IV access establishment.

Utilizing Eye Tracking to Assess Medical Student Non-Technical Performance During Scenario-Based Simulation: Results of a Pilot Study.

Non-technical skills (NTS) are essential for safe surgical patient management. However, assessing NTS involves observer-based ratings, which can introduce bias. Eye tracking (ET) has been proposed as an effective method to capture NTS. The purpose of the current study was to determine if ET metrics are associated with NTS performance. Participants wore a mobile ET system and participated in two patient care simulations, where they managed a deteriorating patient. The scenarios featured several challenges to leadership, which were evaluated using a 4-point Likert scale. NTS were evaluated by trained raters using the Non-Technical Skills for Surgeons (NOTSS) scale. ET metrics included percentage of fixations and visits on areas of interest. Ten medical students participated. Average visit duration on the patient was negatively correlated with participants' communication and leadership. Average visit duration on the patient's intravenous access was negatively correlated with participants' decision making and situation awareness. Our preliminary data suggests that visual attention on the patient was negatively associated with NTS and may indicate poor comprehension of the patient's status due to heightened cognitive load. In future work, researchers and educators should consider using ET to objectively evaluate and provide feedback on their NTS.

A Chest Tube Inadvertently Inserted into Tracheal Lumen

The accompanying images demonstrate the presence of the distal end of a chest tube in the tracheal lumen just above the carina. These images are from a patient who developed coughing and massive air leak after chest tube placement. Inadvertent tracheal injury during chest tube placement should heighten suspicion for concomitant lung injury.1 Massive air leak in tracheobronchial disruption leads to low tidal volumes, lung atelectasis, and increased work of breathing. Consequently, respiratory distress may ensue, necessitating urgent intubation. In hemodynamically stable patients, bronchoscopy-guided endotracheal intubation is encouraged. This allows for airway examination, confirmation of tracheal injury site, and determination of the best strategy for achieving lung isolation to facilitate surgical repair.Lung isolation allows for mechanical ventilation of the uninjured lung and helps avoid pressurization of surgical repair site, minimizing risk of further disruption. In patients with bronchial injury, advancing the single-lumen endotracheal tube or placing a double-lumen endotracheal tube into the contralateral uninjured bronchus are possible options. In patients with carinal injury, creation of a large tracheostomy through which small endotracheal tubes are advanced into bilateral main stem bronchi allows delivery of mechanical ventilation while minimizing pressurization of the repaired carina.2 Tenuous cardiopulmonary status before induction of anesthesia or inability to maintain adequate oxygenation during one-lung ventilation may necessitate institution of peripheral extracorporeal membrane oxygenation to facilitate surgical repair. Importantly, removal of the chest tube leads to loss of its tamponade effect on lacerated pulmonary vessels. As this can precipitate massive hemorrhage, it is important to establish invasive arterial monitoring and large-bore intravenous access before anesthesia induction.3The authors declare no competing interests.

Is routine intravenous access commonly established before interventional pain procedures? Results of a spine intervention society practice pattern survey

Summary of background dataEstablishing routine intravenous (IV) access prior to interventional pain procedures performed without sedation is controversial. Anecdotally, practices very in terms of their use of routine IV access. ObjectivesTo determine the frequency with which routine IV access is obtained for various common interventional pain procedures among interventional pain providers. MethodsAn anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on 08/13/2020, and remained open until 10/13/2020. Respondents provided information regarding demographics and current practice patterns. Results141 SIS members completed the survey. A bimodal distribution was noted for most procedures, with most providers obtaining routine IV access either 0% of the time or 81–100% of the time. Routine IV access was used more frequently when performing cervical spine procedures, splanchnic or hypogastric plexus blocks, lumbar sympathetic blocks, and spinal cord stimulator trials. Excluding cases where IV's were used for sedation, the only procedures which providers obtained routine IV access more often than not were spinal cord stimulator trials, splanchnic/celiac plexus blocks, and hypogastric plexus blocks. Over half (52.5%) of respondents reported using an IV for an emergent situation in their career. While most providers would not modify their IV usage based on practice location, those that would were significantly more likely to decrease IV use if working in clinic-based procedures suites (n ​= ​25) compared to hospital-based surgical centers (n ​= ​2) or ambulatory surgical centers (n ​= ​9, p ​< ​0.001). Discussions/conclusionsThere remains wide variation among practitioners in establishing routine intravenous access prior to interventional procedures. Most providers surveyed do not routinely establish IV access for the majority of interventional pain procedures. Routine IV access is more commonly obtained for cervical spine procedures than other spinal regions. Overall, complications precipitating the need for IV use are rare in interventional spine but likely to happen over the course of a career.

Sledování ošetřovatelské péče o periferní intravenózní vstupy u hospitalizovaných dětí

Sledování ošetřovatelské péče o periferní intravenózní vstupy u hospitalizovaných dětí

The Adult Difficult Intravenous Access (DIVA) Cognitive Aid: An Evidence-Based Cognitive Aid Prototype for Difficult Peripheral Venous Access.

Difficult intravenous access (DIVA) is common, with imperfect solutions. Cognitive aids are widespread in anaesthesia; however, a standard DIVA cognitive aid is lacking. This article describes a cognitive aid for DIVA. It has been developed using evidence-based techniques for DIVA. The effects of heuristics, biases, and automatic thinking on procedural decision-making are briefly discussed. While often useful, shortcut decision-making can impair the performance of apparently simple tasks. Cognitive aids may lead to better outcomes by providing choice architecture. This resource is intended as a cognitive aid prototype for difficult peripheral venous access, incorporating both modern behavioural psychology principles and evidence-based medicine. It may be used as both an educational tool, or as a cognitive aid to assist in situations where DIVA is encountered or expected. The adult DIVA cognitive aid is intended for use in both elective and emergency scenarios by practitioners adequately trained in ultrasound-guided or ultrasound-assisted vascular access and Seldinger-based techniques. Clinical implementation and audit of the adult DIVA cognitive aid, or similar locally developed cognitive aids based on this prototypeare recommended.