Peripheral Catheter Insertion Research Articles

Case Studies.

British Journal of NursingVol. 32, No. Sup7 Case StudiesCase StudiesGema Munoz-Mozas, Colin Fairhurst, Simon ClareGema Munoz-MozasVascular Access Advanced Nurse Practitioner and Lead Vascular Access Nurse, Royal Marsden NHS Foundation TrustSearch for more papers by this author, Colin FairhurstVascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS TrustSearch for more papers by this author, Simon ClareResearch and Practice Development Director, the Association for Safe Aseptic PracticeSearch for more papers by this authorGema Munoz-Mozas; Colin Fairhurst; Simon ClarePublished Online:10 Apr 2023https://doi.org/10.12968/bjon.2023.32.Sup7.S11AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Akhtar N, Lee L. Utilization and complications of central venous access devices in oncology patients. Current Oncology. 2021;281:367-377. https://doi.org/10.3390/curroncol28010039 Crossref, Medline, Google ScholarBD. BD ChloraPrep: summary of product characteristics. 2021. www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-smpc-pil-msds (accessed 2 November 2022) Google ScholarBD. Chloraprep 10.5ml applicator. 2022a. www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-patient-preoperative-skin-preparation-product-line/chloraprep-105-ml-applicator (accessed 26 September 2022) Google ScholarBD. Chloraprep 3ml applicator. 2022b. www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-patient-preoperative-skin-preparation-product-line/chloraprep-3-ml-applicator (accessed 26 September 2022) Google ScholarCenters for Disease Control and Prevention. 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Lancet Infect Dis. 2021;21(7):1038-1048. https://doi.org/10.1016/S1473-3099(20)30738-6 Crossref, Medline, Google ScholarGunka V, Soltani P, Astrakianakis G, Martinez M, Albert A, Taylor J, Kavanagh T. Determination of ChloraPrep® drying time before neuraxial anesthesia in elective cesarean delivery: a prospective observational study. Int J Obstet Anesth. 2019;38:19-24. https://doi.org/10.1016/j.ijoa.2018.10.012 Crossref, Medline, Google ScholarIshikawa K, Furukawa K. Staphylococcus aureus bacteraemia due to central venous catheter infection: a clinical comparison of infections caused by methicillin-resistant and methicillin-susceptible strains. Cureus. 2021;137:e16607. https://doi.org/10.7759/cureus.16607 Medline, Google ScholarLoveday HP, Wilson JA, Pratt RJ et al. Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. 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Monitoring Peripheral Intravenous Catheters Complications in Pediatric Patients in Erbil City/Iraq

Backgrounds and Objectives: Although most problems of peripheral intravenous catheterization are inconsiderable and easily treated, some are dangerous and require rapid management. This study aimed to explore peripheral intravenous catheter-related com-plications and the quality of nursing care for dressing sites of peripheral intravenous catheterization among the pediatric population. Methods: The study was conducted at Raparin Teaching Hospital for Children inpatient units in Erbil City/Iraq, using an observational study design. A purposive sample from 296 hospitalized children with peripheral intravenous catheterization was chosen for this study. The data was collected using a special check List (PIVC-miniQ) developed for checking the signs and symptoms and the quality of care for the catheter insertion site. Furthermore, the obtained data on peripheral intravenous catheterization problems was evaluated for exploring grades of phlebitis using the Phlebitis Scale developed by the Infusion Nursing Society in 2011. The data was processed and analyzed using SPSS using descriptive statistical analysis (frequency, percentage) and inferential statistical tests (Chi-squared, contingency coefficient). The probability value of ≤0.05 was regarded as statistically significant. Results: Most (82.4%) of patients were recruited in the emergency unit, with the highest percentage (36.8%) were toddlers. More than two-thirds (72.3%) of participants were assessed within the first peripheral catheter insertion. Regarding overall grades of patients’ peripheral intravenous catheterization complications (PIVC), less than a quarter (21.6%) were within the first grade, indicating being at risk for complications, and 6.8% were within the second grade, indicating slight phlebitis. Regarding the nursing care for PIVC site care, 62.5% of participants received fair care, and 22.3% received poor care. Conclusions: A quarter of observed children were at risk for having phlebitis and less than ten percent had slight phlebitis. About a quarter of patients received poor nursing care for the catheter insertion site. Most participants have not a documentation of peripheral intravenous catheter insertion date on the dressing and on the patient's chart.

Peripheral venous catheter colonization after skin disinfection with 0.5% aqueous sodium hypochlorite, preceded or not by one application of 70% ethanol (DACLEAN): a single-centre, randomized, open-label, pilot study

Few data are available on the efficacy of 0.5% aqueous sodium hypochlorite (SH) for skin disinfection before peripheral catheter insertion. A total of 239 patients were randomly assigned to either one application of SH alone or one application of SH preceded by one application of 70% ethanol (ET-SH). Catheter colonization, defined as a catheter tip culture growing >1000cfu of a micro-organism per millilitre, occurred in 29 patients (33% of 89 colonizations per 1000 catheter-days) in the SH group and in 31 patients (33% of 126 colonizations per 1000 catheter-days) in the ET-SH group.

Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention.

Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures. The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses. The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure. A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan-Meier survival probabilities than PIVs (p < 0.001). The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.

Effectiveness of ultrasonography for peripheral catheter insertion and catheter failure prevention in visible and palpable veins.

The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein's visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

Best practice skin antisepsis for insertion of peripheral catheters.

This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.

A Qualitative Study of Adult Hospitalized Patients With Difficult Venous Access Experiencing Short Peripheral Catheter Insertion in a Hospital Setting.

Hospitalized patients require venous access for procedures, treatments, or therapies. The short peripheral catheter (SPC) is one option for patients who need intravenous (IV) access for treatment. Patients with difficult vasculature sometimes require multiple attempts to obtain SPC access. The aim of this study was to gain an understanding of adult patients' experiences with SPC insertion, specifically those with difficult venous access. Ten participants were purposely sampled over a 2-month period for semistructured interviews from the medical, surgical, and telemetry units at an inner city, 750-bed trauma hospital in the southwestern United States. Four key themes developed from the interview data: skills and techniques of the clinicians, distress and the SPC insertion experience, physical and emotional pain, and patient/clinician communication. These themes provided ways that clinicians might improve the patient experience, including: ensuring experienced and confident inserters are available to insert SPCs, utilizing distraction and pain methods to decrease pain perception, communicating with patients regarding site selection and expectations during SPC insertion, and identifying patients with difficult vascular access to limit attempts per patient to preserve vascular sites.

Factors affecting Intravenous Infiltration among Hospitalized Children

Peripheral intravenous (PIV) insertion is one of the most common procedures undertaken for pediatric patients requiring short-term infusion therapy. Infiltration, which considered one of the most common complications of PIV insertion, may cause discomfort, pain, inconvenience or delay in treatment due to reinsertion of the IV catheter, or more serious negative consequences, such as tissue ulceration or necrosis. Such complications have not only increased the length of hospital stay and care costs for additional treatments, but also resulted in permanent damage and limitations of physical functions in pediatric patients. Nurses working at the children’ hospitals should consider the risk of IV infiltration for children receiving intravenous infusion therapy and make efforts to identify IV infiltration in high-risk children at an early stage to prevent damage. Therefore, this study aimed, firstly, to investigate the risk factors for intravenous infiltration among hospitalized children and, secondly, to develop clinical guidelines for nurses for early recognition, prevention and management of intravenous infiltration. A descriptive correlative research design was used. The study was conducted at pediatric inpatient medical and surgical wards of Children's University Hospital in Mansoura city, Egypt. The participants werehospitalized children (253) from less than one year to 16 years who received peripheral IV insertions.Interview questionnaire sheet was developed by the researcher to collect relevant data. The results indicated that the infiltration rate was 23.3% and it was from stage 1 and 2. Conclusion: the most important risk factors for infiltration were the child weight, previous experiences of insertion of peripheral catheter, dwell time, site of insertion, catheter size, repeated insertion on the same site, infusion of antibiotics and IV fluids. Recommendation:in future studies, it would be important to account for nurse-associated factors in the study design, including, educational status, experience of the nurses, the nurses' potential preference for a particular insertion site or method and catheter insertion skills.

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications.

No evidence that medicinal honey reduces bacterial skin colonisation at a peripheral catheter insertion site in dogs.

To determine whether topical exit-site application of medicinal honey at the catheter insertion place reduces bacterial skin colonisation. Dogs were selected at random and divided into the honey or the control group. When the catheter was removed, an area of approximately 3×3 cm of the skin at the insertion site was sampled with a sterile cotton swab. The catheter stayed in place for a median of 84 hours. Out of 46 patients, 6 patients in the honey group and 5 out of 54 patients in the control group had a positive skin culture at the time of catheter removal (P=0·547). Infection was clinically suspected in 1 of those 11 dogs; catheter-associated complications were observed in 8 additional dogs that did not have a positive skin culture. Few catheter-associated complications were observed. Extra attention to hygiene by working with a standardised catheter placement and handling protocol might have resulted in this low incidence. In this study topical application of a medicinal honey did not reduce bacterial skin colonisation at the insertion site of peripheral catheters in dogs.

Development and Testing of an Instrument to Measure Short Peripheral Catheter Insertion Confidence.

The Peripheral Intravenous Insertion Confidence Assessment for short peripheral catheters is a 10-item, 5-point Likert scale, self-administered tool to measure a person's confidence in his or her personal intravenous insertion skills, including site selection and assessment, procedure, dressing, and documentation. Expert opinion validity was obtained from a panel of 3 infusion therapy leaders. Two-day test-retest reliability and internal consistency were determined using 22 practicing nurses. Individual question correlations ranged from r = 0.93 to 0.16, and the total score correlation was r = 0.96. Using first-test results only, internal consistency was 0.85 (α = 0.85, n = 22). Overall, the insertion confidence assessment is valid and, in the present study, a reliable tool to measure the short peripheral catheter insertion confidence of staff nurses.

The Effect of Intravenous Infiltration Management Program for Hospitalized Children

This study aimed to identify the effect of IV infiltration management program among hospitalized children. This was a quasi-experimental study with history comparison group design with 2,894 catheters inserted during 3 months comparison phase and 3,651 catheters inserted during 4 months experimental phase. The intervention was composed of seven activities including applying poster, documentation of catheter insertion, parents education, making infiltration report, assessment of vein condition before inserting catheter, appropriate site selection, and documentation of catheter insertion, and assessment of peripheral catheter insertion site every shift. Data were analyzed using of X2-test, Fisher's exact test. The infiltration incidence rate was 0.9% for experimental group and 4.4% for comparison group, which was significantly different (x2=80.42, p<.001). The catheter maintenance period (p=.035) and infiltration state (p=.039) were significantly different among participants with infiltration between comparison and experimental groups. IV Infiltration management program was founded to be effective in reducing the IV infiltration incidence rate and increasing early detection of IV infiltration. Considering the effect of IV Infiltration management program, we recommend that this infiltration management program would be widely used in the clinical settings.

Prevention of Peripheral Venous Catheter Complications With an Intravenous Therapy Team

More than 25 million patients have peripheral intravenous (IV) catheters placed each year in US hospitals. Infusion therapy is believed to account for one third of all nosocomial bacteremias.We performed a randomized, prospective, controlled study in a university-affiliated hospital to determine whether the use of an IV therapy team decreases peripheral venous catheter-related complications in adult medical patients. Patients were randomized to undergo peripheral catheter insertion and/or maintenance either by the IV team or by medical house staff. A dedicated observer reviewed catheter sites daily; findings were applied to a scoring system to define the severity of complications. Bacteremic complications were reviewed by a physician.Patients with catheters started by the house staff and maintained by ward nursing staff more often had signs or symptoms of inflammation (21.7%) than did patients with catheters maintained by the IV team (7.9%) (P<.001). Patients monitored by the IV team had a greater mean number of catheters placed per patient than did patients monitored by house staff (2.1 and 1.6, respectively) (P<.01). Three episodes of catheter-related sepsis occurred in house staff patients and none in IV team patients (P=.004).An IV therapy team significantly reduced both local and bacteremic complications of peripheral IV catheters. Timely replacement of the catheter appeared to be the most important factor in reducing the occurrence of complications.