Maintenance Of Vascular Access Devices Research Articles

The impact of enhancing vascular access care quality through monitoring and training: A multicentre observational study.

This study evaluates the impact of monitoring a primary quality indicator and the effect of training on improving the care and maintenance of vascular access devices. A prospective, quasi-experimental, multicentre study with 10 periodical cross-sections from 2017 and 2020. Adult patients hospitalised over 24 h, with or without vascular access device, excluding those in emergency, psychiatry, outpatients or minor surgery units. The study included 10 cross-sections between 2017 and 2020 in all participating hospitals, using the INCATIV® (Quality Indicators in Intravenous Therapy and Vascular Access) questionnaire. Training sessions for nursing staff were conducted between cross-sections, involving face-to-face sessions in open classrooms and clinical sessions in the units, based on the study Care bundle. 53,991 vascular accesses were analysed, with an average INCATIV Index score of 8.95 (SD: 1.32), showing improvement from 8.09 in the first cross-section to 9.21 in the last. Significant variability was observed between hospitals, with secondary hospitals scoring lower on the INCATIV® Index. Training interventions 1 and 2 showed significant improvement across all hospital categories, whereas intervention 5 did not show significant effects. Compliance with main recommendations was studied, with a notable decrease in phlebitis rates from 4.45% in the first cross-section to 1.23% in the tenth. The study developed a single indicator to assess and quantify vascular access care quality. It demonstrated that implementing a care bundle through serial training interventions and continuous assessment by nursing staff, supported by process indicators and data availability on the study platform, significantly reduces complications and enhances the quality and safety of vascular access care.

Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model.

Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. Systematic review of studies which explore decision-making at the time of selecting vascular access devices. The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

Flushing in Intravenous Catheters: Observational Study of Nursing Practice in Intensive Care in Brazil.

An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.

A Revolutionary, Proven Solution to Vascular Access Concerns: A Review of the Advantageous Properties and Benefits of Catheter Securement Cyanoacrylate Adhesives

Intravascular catheters are widely used among hospitals; however, their failure rates are high, up to 50%, when secured by traditional techniques, such as tape and gauze. The use of catheter securement cyanoacrylate adhesives provides a unique approach to the issues surrounding the use of traditional securement techniques for vascular access devices by providing significant securement strength, barrier properties, antibacterial properties, hemostatic properties, and flexibility. The purpose of this research was to perform a thorough and systematic review of the current literature existing regarding the use of cyanoacrylate adhesive for the care and maintenance of vascular access devices.

Nurses' knowledge on routine care and maintenance of adult vascular access devices: A scoping review.

Vascular access devices (VAD), centrally (CVAD) or peripherally (PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices. This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs. In the fall of 2018, the following databases were searched: Medline-Ovid 1946 to current, Embase-Ovid 1947 to current, Ebsco CINAHL Plus with full text and ProQuest Nursing & Allied Health database, and articles were selected according to the PRISMA-ScR checklist. original research published in peer-reviewed journals; in English or French; and focused on practising nurses' knowledge about the routine care and maintenance of adult VADs. Of the 4,099 abstracts identified, 36 full-text articles were included. Study characteristics are reportedin addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses' CVAD/PIV knowledge and nurses' CVAD/PIV knowledge scores. Overall, significant gaps in nurses' knowledge on the care and maintenance of VADs are noted. The variability in nurses' knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training. This scoping review intends to highlight the knowledge gap of nurses with regard to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high-quality care and improved patient outcomes.

A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices

This study describes the role of a novel vascular access service in the reduction and prevention of central line-associated bloodstream infections (CLABSIs). We conducted a retrospective analysis of data obtained over a span of 24 months after implementation of our vascular access service. We identified a progressive decline in the CLABSI rate and standardized infection ratio (SIR) in 2017 (rate, 1.75; SIR, 1.25) and in 2018 (rate, 1.037; SIR, 0.91). The reduction in CLABSIs was attributed to appropriate triage, insertion, and maintenance of vascular access devices.

Addition of lipids to parenteral nutrition does not cause fungal infections

Parenteral nutrition (PN) that includes lipid emulsion is considered to increase both bacterial and fungal central venous catheter–related bloodstream infections. This concept is based on several erroneous metrics: Reports in age-old literature at a time when preparing PN admixtures lacked stringent quality control, when its infusion, the techniques of insertion, maintenance of vascular access devices, and delivery systems were not well identified or enforced. Additionally, concepts of glucohomeostasis were different and higher glucose levels were accepted. We provide updated information with supporting literature to show that associating PN with lipids with an increase in bloodstream infections is not justified.

La ética de las decisiones: catéter o fístula arteriovenosa interna

Given the clinical characteristics of incident and prevalent patients in current hemodialysis programs, the successful use of internal arteriovenous fistulas (IAVF) to provide permanent vascular access is increasingly difficult. This difficulty seems to be the cause of the increase in the number of permanent catheters detected in almost all periodic hemodialysis programs. Compliance with the recommendations of the various “guidelines” does not seem to be feasible, indicating the need not only to reconsider our final objectives but also the indications for this technique. Thus, at the present moment, IAVF are no longer the first choice of vascular access for extracorporeal therapy in some patients. Furthermore, the ethical dilemma no longer lies in the choice between a fistula or a catheter but rather in whether to give the choice of access to the patient and/or the patient's relatives, individually tailoring the distinct types of access, but without forgetting the obligation to improve our results both in terms of the choice of materials and in placement of devices, as well as in terms of the care and maintenance of vascular access devices. Time is showing us that catheters are the best – or only – vascular access option for an increasing number of patients, obliging us to significantly improve the results currently reported in most publications.

Clinical Dilemmas: Vascular Access Devices

To present an overview of clinical dilemmas regarding maintenance care and managing complications of vascular access devices (VADs). Current research and published literature. The use of VADs has increased over the past three decades because they have proven to be an effective and convenient method of accessing the venous system. The difficulty of maintaining VADs during the course of treatment however, continues to be a challenge resulting in practice dilemmas. Although VADs have been in use for more than 30 years, no universal standard of maintenance care exists. Research is still needed to establish evidence-based practice regarding the care and maintenance of VADs.

Controversial issues in the care and maintenance of vascular access devices in the long-term/subacute care client.

The aging population provides a unique challenge for the initiation and maintenance of infusion therapy. This article will highlight three common but controversial issues that have been observed by this author in the long-term/subacute care realm of infusion therapy: 1) the failure to maintain a sterile dressing over the catheter insertion site; 2) the use of heparin to maintain patency of the peripheral infusion device; and 3) the routine replacement of peripheral i.v. catheters. Several factors that contribute to the controversies will be discussed, along with some associated negative and positive outcomes.

Maintaining vascular access devices: the nurse's role

The role of the nurse in maintaining vascular access devices has altered dramatically with the advance in vascular access device technology and the greater involvement in selection of the device and its insertion, maintenance and removal. Up-to-date knowledge and the use of evidence-based practice underpinned by good scientific research is the key to vascular access device maintenance. The routine maintenance of vascular access devices is a shared responsibility between the nurse and the patient, so that the nurse has an important part to play in the adequate preparation and education of the patient. The nurse therefore has a responsibility to ensure the maintenance of vascular access devices in order to increase the benefits to the patient and decrease the risk of serious complications.