Intravenous Site Research Articles

Improving the Visibility of Intravenous (IV) Site in Pediatric Patients to Reduce IV Site Related Complications – An Evidence-based Utilization Project

PurposeThis project aims to improve the visibility of the IV site using more adhesive transparent dressings to attain 90% compliance based on the frequent and proper inspection of the IV site and decrease the incidence of IV complications. Design and MethodThe project was conducted in a 43-bedded general pediatric ward from March 2016 to February 2017. To address the poor visibility of the IV site due to bandaging caused by poor adhesive strength of the IV securement dressing, a more adhesive securement dressing was introduced. The study team conducted pre-implementation, immediate post-implementation, and sustainment audits, cost-analysis, and comparison of the number of reported occurrences of phlebitis and extravasation between 2015 and 2017. ResultsThe post-implementation audit showed 100% visibility of the IV site, from 73% pre-implementation, and 87% compliance on frequent IV site inspection, from 70% pre-implementation. Both criteria attained 100% compliance during the sustainment audit. Incidences of extravasation and phlebitis were reduced from eight to seven, an improvement of 13%. These seven cases were also generally less severe compared to those from the previous year. ConclusionThis project has greatly improved the visibility of the IV site as well as nurses' compliance in checking the IV site. This is because nurses can monitor the IV site without having to remove any additional bandage over the site and causing unnecessary distress to fretful pediatric patients. ImplicationsThe use of an adhesive transparent dressing can lead to prevention and earlier detection of phlebitis and extravasation. Additionally, the new IV securement dressing brought about manpower cost savings enabling staff time directed to other patient care activities.

Characteristics of Observations and Procedures Followed by Expert Nurses for the Selection of the Intravenous Insertion Site for a Short Peripheral Catheter

Characteristics of Observations and Procedures Followed by Expert Nurses for the Selection of the Intravenous Insertion Site for a Short Peripheral Catheter

Effect of Intravenous Injection Site on Contrast Enhancement of CT Thorax – Comparison Between Injection on Two Sides of Cubital

Effect of Intravenous Injection Site on Contrast Enhancement of CT Thorax – Comparison Between Injection on Two Sides of Cubital

A Randomized, Double-Blind Trial to Determine if Vapocoolant in the Adult Population Improves Patient Perception of Pain With Peripheral Intravascular Access.

The purpose of this study was to investigate whether the use of a topical anesthetic spray (vapocoolant) at the site of intravenous access reduces pain and anxiety associated with peripheral intravenous (PIV) catheter insertion in an adult emergency department population. A randomized, double-blind, placebo-controlled, single-center trial, conducted from July to August, in an adult emergency department where 72 patients with orders for PIV insertion receiving either topical vapocoolant spray (n = 38) or placebo spray (n = 34). Vapocoolant or placebo was applied to the intravenous site and allowed to evaporate before cleansing and insertion. The primary outcome was patient perception of pain and anxiety with PIV needle insertion using a 0-10 Likert scale. Secondary outcomes included patient/staff preference or desire for vapocoolant/placebo use in future procedures and staff perception of patient pain and anxiety. Patient groups did not vary significantly in the history of intravenous access, nor anxiety preprocedure, and the sprays did not affect ability to obtain intravenous access. Patient perception of pain did not vary significantly between vapocoolant (2) and placebo populations (2.5), nor did the scores vary significantly for patient-forecasted anxiety in future procedures using the same methods (0.5 for vapocoolant, 0 for placebo; p > 0.05). Eighty-nine percent of nurses and patients would use vapocoolant in future procedures, whereas 74% would use placebo; the difference was not significant (p > 0.05). No skin blanching or lesions were noted. Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a topical anesthetic spray or placebo.

A Case of Metronidazole Injection Infiltration Without Sequelae.

Purpose: This report describes a case of metronidazole injection infiltration which contrasts the sole other case report in the literature at this time, as the patient described herein experienced mild signs and symptoms with prompt resolution and no significant sequelae. Summary: The patient experienced metronidazole injection infiltration during administration open to gravity via an 18-gauge peripheral catheter in the left brachial vein. The site was examined at bedside within approximately 30 minutes of the incident and was noted to be slightly edematous, erythemic, and painful in terms of a 5.5 × 6.6-cm area. No blanching, blister formation, induration, skin discoloration, or diminished capillary refill were observed. The event was conservatively managed in the form of catheter discontinuation and marking of the affected area with a patient skin marker, as hyaluronidase was not administered due to a product osmolarity of ~314 mOsM/L and pH of 5.8. A bedside evaluation the next morning revealed full resolution of the previously described symptoms. The patient was discharged from the facility 11 days later without further complications from the infiltration event. Conclusion: We describe a case of metronidazole injection infiltration which did not require pharmacologic or nonpharmacologic interventions and resulted in complete resolution. This case supplements the current literature by contrasting the sole other case report which resulted in profound necrosis near the intravenous access site. This case suggests metronidazole infiltrations may not require clinician alarm or treatment if events occur under circumstances similar to that which is presented.

Suspect the Unsuspected: An Unusual Case of Primary Cutaneous Mucormycosis at a Peripheral Intravenous Catheter Insertion Site. A Case report and Literature review

Fungal Infections can have atypical presentation This makes the diagnosis of fungal infections very challenging and in many cases increases morbidity and in unfortunate cases causes rsquo mortality Mucormycosis is a rare fungus which can present with wide clinical spectrum and can mislead as other etiologies This fungus manifests itself mostly in immune compromised hosts High index of suspicion is needed for accurate diagnosis Prompt treatment includes combination of surgical debridement and antifungals Early diagnosis and initiation of appropriate management can significantly decrease morbidity and mortality Histological diagnosis is the only means of confirming mucormycosis infection Our case is a typical example of atypical presentation of mucormycosis in an immune compromised patient which resulted in limb amputation

Quality of Computed Tomography Pulmonary Embolism and Aortic Phase Images Acquired with Power Injection via an Arm Port

BackgroundThe safety of power-injectable implanted arm ports is well established, but there is insufficient data to conclude that image quality of computed tomography resulting from contrast introduced via the port is of equal quality to images derived from contrast introduced via traditional peripheral access. The objective of this study was to determine whether the image quality of computed tomography pulmonary embolism and computed tomography aorta studies would differ when injecting contrast via an implanted arm port vs a peripheral intravenous site. We hypothesized that injecting via an implanted arm port would produce better-quality images, the result of more appropriate timing and less streak artifact. MethodsScans from a provincial database search for patients who underwent a computed tomography pulmonary embolism or aorta study with contrast injection via the implanted arm port and thin section images available, were reviewed (pulmonary embolism studies n = 3, aorta studies n = 3). Only a limited number of patients were available for review because there are currently few patients with these ports in place and we limited evaluation to thin section images. Comparison was made with 6 control patients who did not have a port and had received a peripheral arm intravenous contrast injection for these study types. Objective measurements included signal-to-noise ratio and contrast-to-noise ratio of the pulmonary arteries (4 sites) and aorta (2 sites) as appropriate for scan type. Subjective analysis of image quality was performed by 2 radiologists. ResultsAlthough sample size was limited, the implanted arm port group had similar or higher mean signal-to-noise ratio and contrast-to-noise ratio values at all sites. Subjective assessments showed the implanted arm port group to have similar or better opacification and diagnostic confidence; similar or less streak artifact was also observed at each of the sites. ConclusionsThese exploratory results suggest that studies with implanted arm port injection can generate high-quality images on both objective and subjective assessment, similar to, or possibly better than, images generated from usual peripheral intravenous access for contrast injection.

IV cannula site management.

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article discussed management of intravenous (IV) cannula sites, including cannula insertion, care of the device and potential complications related to cannula use.

The Effects of Child Life Specialists on Success Rates of Intravenous Cannulation

BackgroundChild life specialists (CLS) work with children directly to minimize long-term psychological sequelae of traumatic or medical events such as intravenous cannulation. There has been little done to measure how CLS impact outcomes of medical procedures. The objective of this study is to determine the impact of interventions by CLS upon successful attainment of intravenous (IV) cannulation among pediatric patients in the emergency department setting. MethodThis was an eight month retrospective review within an urban tertiary-care freestanding pediatric Emergency Department (ED), using nursing and CLS documentation of ED patients younger than 21years who underwent IV cannulation. CLS self selected which children received procedural support, and the duration of CLS staffing was not a full 24h. Children with CLS documentation were compared against those without documented interventions by CLS. IV cannulation success and number of IV cannulation attempts were the primary outcomes. Confounding variables such as location of intravenous site, intravenous gauge, and professional qualifications were added. Chi-square determined the impact of CLS on primary outcomes. Logistic regression examined the association between successful IV cannulation with age. ResultsIn all, 5460 children had documented IV cannulation, and 240 of those received CLS intervention. CLS intervention was not associated with IV cannulation success (p=0.5). The only significant association for successful IV cannulation was intravenous site (p<0.001). There was no interaction effect between patient age and CLS (p=0.12). ConclusionInterventions by CLS do not affect the procedural outcome of intravenous cannulation success. Benefits of CLS are likely better measured in psychological impact of anxiolysis and improved experience, rather than in procedural outcome.

Metacarpal shaft fracture fixation with intramedullary k-wire: Surgical and Clinical outcomes

Background: Metacarpal fractures are among the most common fractures. The majority of metacarpal shaft fractures can be treated conservatively. There are numerous indications for operative treatment and various fixation techniques. The purpose of this prospective study was to assess the surgical and clinical outcomes of metacarpal shaft fractures using intramedullary fixation by K-wire (Kirschner wire). Materials and Methods: 15 cases of Metacarpal shaft fractures underwent surgery with Intra medullary fixation by K-wire. The study was conducted from March 2015 to February 2016 admitted to Navodaya Medical College and research center, Raichur. We evaluated the DASH score to determine the outcomes. Results: All fractures got united in our study and all patients were available for follow up. Two superficial wound (pin site) infections noted which healed with intravenous antibiotic treatment and regular pin site dressing. There were no major complications noted. All patients regained full flexion at the MCP and IP joints but two patients had a mild extensor lag of about 10°. At final follow up the mean DASH score in our study was 4.3 (range: 0-7.2). Conclusion: Closed or minimally invasive fixation with Kirschner wire (k-wire) is a safe method and can be performed with minimal complications. It can be seen as good choice in selective metacarpal shaft fractures.

LALF32-51-E7 therapeutic vaccine induces antitumor immunity against human papillomavirus type 16 E7-expressing murine tumor metastases in the lungs

One important goal of cancer immunotherapy is to prevent and treat tumor metastasis. We have previously reported the significant antitumor effect induced by the immunization with our human papillomavirus therapeutic protein-based vaccine (LALF32-51-E7) without adjuvant and admixed with clinically relevant adjuvants in the subcutaneous TC-1 tumor challenge model. In the present study, we evaluated the efficacy of the above mentioned vaccine formulations in controlling the hematogenous spread of TC-1 tumor cells using a more tumourigenic clone named TC-1* and other intravenous injection site less stressful than the tail vein. We generated a lung metastasis model by injecting TC-1* cells into the retro-orbital venous sinus and this is the first study describing it. Also, this is the first study that demonstrates the efficacy of the immunization with LALF32-51-E7 without adjuvant and admixed with VSSP or Al(OH)3 in controlling metastatic tumors increasing the survival of the mice. Our TC-1 lung metastasis model can be used to test the efficacy of other immunotherapeutic strategies based on E6/E7 antigens.

Comparing the Postoperative Complications, Hospitalization Days and Treatment Expenses Depending on the Administration of Postoperative Prophylactic Antibiotics to Hysterectomy.

This study was conducted to compare postoperative complications, hospitalization days and treatment expenses to postoperative prophylactic antibiotics administrated to hysterectomy or not. A retrospective survey study was performed with 128 cases in which elective hysterectomy had undergone. They were divided into two groups by identifying whether postoperative prophylactic antibiotics was administered for hysterectomy: a) one group who received postoperative prophylactic antibiotics and; b) those who did not. Data were collected using the electric medical record at a hospital and analyzed by SPSS 23.0 for χ2 test, t-test and ANCOVA. Postoperative complications including wound infection (p=1.000), pneumonia (p=.496), hematoma (p=.530), and pneumoperitoneum (p=.496) showed no significant differences between two groups. Hospitalization days for the prophylactic antibioticsadministrated group were significantly longer than the non-administered for prophylactic antibiotics (p=.004). The treatment expenses of the prophylactic antibiotics-administrated group were significantly higher than those of the non-administered prophylactic antibiotics (F=4.31, p=.040). These results can be provided for the evidence of administrating postoperative prophylactic antibiotics to hysterectomy. Additionally, it can contribute to decreasing the medication errors caused by infrequently administrating postoperative prophylactic antibiotics as well as to lessening likelihood of infection of intravenous injection site.

Intravenous cannula site management.

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article provided information about safe and effective practice in intravenous cannulation, including indications for cannulation, appropriate cannulation sites, types and sizes of cannula, cannula maintenance, recognising and avoiding complications.

Intravenous cannula site management.

Intravenous cannulation is becoming one of the most common procedures in healthcare as increasing numbers of patients are treated for acute and chronic illnesses. The use of an intravenous cannula is not without risk, so it is essential that the healthcare practitioner can justify why the patient requires cannulation, as well as being able to safely manage and provide ongoing care for patients with the device. This article provides an overview of intravenous cannulation, including the selection of appropriate cannulation sites, identification of the different types and sizes of cannula used, and cannula maintenance. Specific complications related to intravenous cannulation are discussed and guidance is given on how to recognise and avoid potential complications to ensure that practice is safe and effective.

Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized, double-blind controlled trial

BackgroundLidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain. ObjectiveTo compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain. DesignProspective, double-blind, randomized controlled trial. SettingThe 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea. ParticipantsA total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group. MethodsAll three groups received 2% propofol with an effect-site target at 3μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30s after 1% lidocaine 30mg. The local warming group received 2% propofol after warming of the intravenous access site for 1min using 43°C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI). ResultsPain VCS of the LA group (mean±SD, 1.11±0.45) was significantly reduced (U=−3.92, p<.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group (mean±SD, 0.76±0.44) was significantly reduced (U=−5.17, p<.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U=−3.33, p=.001]. Pain NRS of the LA group (mean±SD, 4.31±2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63–3.00; p=.003) compared to the control group (mean±SD, 6.13±2.39). Pain NRS of the LW group (mean±SD, 3.06±2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63–4.51; p<.009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09–2.42; p=.035). SPI of the LA group (mean±SD, 64.1±16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64–15.1; p=.016) compared to the control group (mean±SD, 72.5±9.56). SPI of the LW group (mean±SD, 55.0±16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8–24.0; p<.001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02–17.1; p=.028). ConclusionLocal warming of the intravenous access site by 43°C forced air for 1min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.

Will Patients Perceive a Numbing Spray to Be an Effective Method of Anesthetizing an Intravenous Site?

The purpose of this study was to determine if patients would perceive a numbing spray to be an effective method of anesthetizing an intravenous (IV) site. A quasi-experimental design was used. The first 50 patients were given no pain management strategy before their IV insertion, and the next 50 patients were given a numbing spray. The hypothesis that pain scores reported from the numbing spray group would be less than pain scores reported from the non-numbing spray group was not supported. The numbing spray is an effective method of anesthetizing an IV site based on both groups' responses to the other research questions. Both groups indicated they would try a numbing spray with future IV insertions,would prefer a numbing spray over a numbing injection, and were satisfied with their IV insertion. Patients wanted a less intrusive method than intradermal lidocaine.

Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care

The role of anesthesia providers in dispersing potentially pathogenic material from one patient to another during intraoperative care needs further study. In this study we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's mouth to the anesthesia workstation during routine anesthetic induction, (2) to test the hypothesis that there would be fewer contamination sites by providers who used a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia apparatus disinfection. Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved group (group 2) and completed a simulated general anesthesia induction, completing a standardized set of interventions. Dispersion of a surrogate pathogen dye placed in the oral cavity of the simulated patient was tracked by a blinded observer and photography. Standard cleaning of the workstation was performed, and residual dye was quantified. Group performance was plotted using regression analysis and rate of contamination compared using parametric statistics. Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2, who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials, medication vials, and ventilator controls were significantly contaminated by group 1, but not by group 2 (P < .05 in all cases). There were similar rates of contamination in both groups for the airway equipment, breathing system, intravenous access ports, and the roll of tape used to secure the endotracheal tube. Once the airway management phase of the induction ended, new site contamination continued at a high rate in group 1 but not group 2. A double-gloving technique was associated with less spread of an oral inoculum to the workstation but was not uniformly protective. Between-case cleaning was ineffective in removing the contaminant, indicating that biologic material from one patient may be present when subsequent patients are cared for. This suggests risks for the current patient (eg, skin or oral site transfer to an intravenous site) and also may place future patients at risk. Importantly, using models that simulate actual clinical events can inform clinical practice and decipher challenging areas of ergonomics.

Demented Love

Demented Love

Effect of Observation Window at Peripheral Intravenous Catheter Site on Early Recognition of Infiltration among Hospitalized Children

The aim of this study was to identify the effect of an observation window (OW) at peripheral intravenous (IV) catheter sites on early detection of IV infiltration among hospitalized children. This was a retrospective observational study with history control group design. Participants were children who had IV infiltration after peripheral catheterization when hospitalized from January to May, 2014 and January to May, 2015 at a children's hospital located in Yangsan city, Korea. The 193 patients, who were hospitalized from January to May, 2014 formed the control group and did not have OW, and the 167 patients, who were hospitalized from January to May, 2015 formed the window group and had OW. Data were analyzed using χ²-test, independent samples t-test and multiple logistic regression. First stage IV infiltration was 39.5% for the window group and 25.9% for the control group, which was significantly different (p=.007). The likelihood of 2nd stage and above IV infiltration decreased by 44% in the window group, which was significantly different (p=.014). OW at the peripheral IV catheter site was found to be an effective measure in early recognition of IV infiltration. Considering the effect of OW, we recommend that nurses should make an OW with transparent dressing during stabilization of the IV catheter site in hospitalized children in clinical settings.

Virtual ultrasonic probe system to support peripheral intravenous catheter site selection

Virtual ultrasonic probe system to support peripheral intravenous catheter site selection