Peripheral Intravenous Cannula Research Articles

Drawing blood from a peripheral intravenous cannula and its effect on cannula dwell time, phlebitis, and bloodstream infection: A randomised controlled study

BackgroundRoutine blood sampling can be conducted using venepuncture, inserting a new peripheral intravenous cannula (PIVC), or utilising an existing one. The practice of blood sampling from a cannula requires handling and movement of the cannula bung. It is discouraged due to safety concerns linked to increased risk of phlebitis, infection, or reduced dwell time. AimTo assess cannula dwell time, the prevalence of phlebitis, and bloodstream infection when using a peripheral intravenous cannula compared with venepuncture for blood sampling. DesignA randomised controlled study. Reporting followed CONSORT recommendations. MethodAdult patients admitted to the emergency department whose health condition required a blood sample to be drawn and insertion of a PIVC were screened for eligibility between May and July 2022. Participants were randomised to either have blood sampled by venepuncture as the control or drawn through the peripheral intravenous cannula as the intervention. Follow-up occurred on day three post emergency department presentation. ResultsOne hundred and five participants were randomised of whom 50 had blood sampled by venepuncture and 55 through the peripheral intravenous cannula. No difference was observed in cannula dwell time, prevalence of phlebitis or signs of bloodstream infection. ConclusionThis study showed peripheral intravenous cannula outcomes were no different when the peripheral intravenous cannula was used to sample blood compared with participants whose blood was sampled by venepuncture.

A rare case of isolated persistent left superior vena cava diagnosed by echocardiography

BackgroundThe persistent left superior vena cava (PLSVC) is an infrequent vascular variant. PLSVC with absent right superior vena cava, also known as isolated PLSVC, is an exceptionally rare entity. In this case we present a patient with isolated PLSVC draining to coronary sinus, diagnosed incidentally during echocardiography.Case presentationA 35-year-old man underwent a transthoracic echocardiography which showed an enormously dilated coronary sinus. Hand-agitated saline was injected via peripheral intravenous cannulas. The contrast appeared firstly in the coronary sinus before it opacified the right atrium. Since this was also visible by the right antecubital saline injection, it indicated an extremely rare case of PLSVC with the absence of right superior vena cava which was confirmed by cardiac magnetic resonance.ConclusionsThe finding of a distinctively dilated coronary sinus in echocardiography led us to further investigation using agitated saline that revealed an infrequent anomaly termed isolated PLSVC. The in-depth diagnosis of this vascular variant is crucial considering that it may lead to important clinical implications, such as difficulties with central venous access, especially in the current era of a rapid development of cardiac device therapies.

Peripheral Intravenous Cannula Fracture: Increasing Incidence and Management

Peripheral Intravenous Cannula Fracture: Increasing Incidence and Management

Nurses’ Practice and Knowledge of Peripheral Intravenous Cannula Flushing Pre-Therapy Administration at Medical-Surgical Wards

Nurses’ Practice and Knowledge of Peripheral Intravenous Cannula Flushing Pre-Therapy Administration at Medical-Surgical Wards

A safe and effective winged peripheral intravenous cannula for use in clinical practice.

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.

Integrated short peripheral intravenous cannulas and risk of catheter failure: A systematic review and meta-analysis.

Short peripheral catheters (SPCs) are used to provide intravenous therapies in hospitalized patients. Recently, the category of SPC has become more complex, with the introduction in clinical practice of "integrated" SPCs (ISPCs), renewed regarding the material (polyurethane rather than polytetrafluoroethylene) and design (large wing; pre-assembled extension; preassembled needle-free connector (NFC)). This systematic review and meta-analysis aimed to analyze randomized controlled trials (RCTs) and quasi-randomized studies in hospitalized patients, analyzing the risk of overall catheter failure as well as the risk of each type of complication (occlusion, infiltration, thrombophlebitis, and dislodgement) for ISPCs compared to non-integrated SPCs. These systematic review and meta-analysis were registered on PROSPERO (CRD42022322970). We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical Trials register from April to November 2022. The research identified 1260 articles. After the abstract review, 13 studies were included for full manuscript review and, after that, six papers (4727 patients) were included in the meta-analysis. We found a significantly reduced risk of catheter failure (pooling all complications) for ISPCs compared to SPCs (p = 0.002 RR 0.65; 95% CI 0.63-0.9). A significant reduction in the risks of occlusion (p = 0.007 RR 0.72; 95% CI 0.56-0.92) was observed. As regards the risk of infiltration, thrombophlebitis, and dislodgement, the analysis showed a trend in favor of ISPCs, though not statistically significant (respectively p = 0.2 RR 0.84; 95% CI 0.64-1.1; p = 0.25 RR 0.91; 95% CI 0.78-1.07; p = 0.06 RR 0.72; 95% CI 0.52-1.01). ISPCs significantly reduce the risks of catheter failure (overall complications) and occlusion. More RCTs are needed to understand if the preassembled ISPC is better than the composted closed system (non-integrated SPC + extension line + NFC).

A Study to Assess The effectiveness of Hot Application on Prevention of Thrombophlebitis among patients with a Peripheral Intravenous Cannula admitted in selected hospitals of Mehsana

Introduction: Thrombophlebitis occurs when a blood clot causes inflammation in one or more of the veins near the surface of the skin. Damage to a vein can occur as a consequence of indwelling catheters, trauma or the infection of the irritating substances. Objectives: 1. To assess the occurrence of thrombophlebitis among patients with a peripheral intravenous cannula by using modified thrombophlebitis scale in experimental and control group. 2. To assess the effectiveness of hot application on experimental group. 3. To compare the occurrence of thrombophlebitis among patients with an intravenous cannula in experimental and control group. 4. To find out the association between the occurrence of thrombophlebitis with their selected demographic variables. Hypothesis: H0: There will be no significant difference in the occurrence of thrombophlebitis among patients with a peripheral intravenous cannula in experimental group and control group. H1: There will be a significant difference in the occurrence of thrombophlebitis among patients with a peripheral intravenous cannula in experimental group and control group. Design: A quantitative approach using quasi experimental two group post test. Participants: 30 patient in experimental group and 30 patients in control group were selected using Non-Probability convenient sampling technique. Tool: standardized phlebitis scale for using the assess thrombophlebitis among patients with peripheral IV cannula. Results: The mean score of experimental group patients 0.46 was less than control group patients 2.83 and ‘t’ test show that there was a significant difference in the occurrence of thrombophlebitis (‘t’=8.43, p>0.05) between experimental group and control group. Conclusion: From the above findings, it evident that hot application is effective on prevention of thrombophlebitis among patients with peripheral IV cannula.

Poke Plan: An Initiative to Improve Distraction and Pain Mitigation With Venous Access in Hospitalized Children.

Adequate pain control and anxiety relief during peripheral intravenous cannula (PIV) placement improves patient, parental, and staff satisfaction and reduces health care-induced stress in children. We noted a low rate of analgesic/anxiolysis use (<20%) and child life utilization (3%) in our institution. This quality improvement project was initiated to increase pain mitigation strategies in hospitalized children requiring PIV access. From November 2020 to March 2021, we created a key driver diagram and summarized possible interventions with the aim to increase our use of pain control strategies to >40% and child life utilization to 25%. For 12 months, 8 Plan-Do-Study-Act cycles were conducted focusing on nursing education and training, improved documentation, electronic medical record optimization, easy access to analgesics and anxiolytics, family involvement, and weekly huddles. Our primary measure was the percentage use of pain medications for PIV access. The utilization of PIV experts from the ICU (advanced practice registered nurses and physicians) served as the balancing measure. A total of 883 patient charts were reviewed. The use of topical anesthetics and anxiolytics increased from 16.2% at baseline to 78.9% after the implementation of the quality improvement project. Eighty percent of parents reported their child was kept comfortable during the procedure using pain mitigation and comfort measures. A slight increase from 2% to 5.8% was noted in the utilization of advanced practice registered nurses and intensivists. Implementation of a standardized approach for PIV placement improved team communication and provided better preparation for pain control before needle insertions in hospitalized children.

Time to Develop Phlebitis and Its Predictors Among Patients with Peripheral Intravenous Cannula at Public Hospitals of Bahir Dar City, Amhara, Ethiopia, 2022: A Prospective Observational Study

Time to Develop Phlebitis and Its Predictors Among Patients with Peripheral Intravenous Cannula at Public Hospitals of Bahir Dar City, Amhara, Ethiopia, 2022: A Prospective Observational Study

Modified Intravenous Cannula Ventilation Tubes for Otic Barotrauma Prevention.

Objectives: Middle ear barotrauma is a common complication of hyperbaric oxygen therapy (HBOT). Tympanostomy tube placement prevents barotrauma by facilitating middle ear equalization. We describe variations on techniques published by Mooney et al and Zhang et al for placing modified peripheral intravenous cannula (PIVC) ventilation tubes, which can be performed at the bedside under topical anesthesia. We aim to evaluate the safety and efficacy of this technique when performed to prevent otic barotrauma in patients undergoing HBOT. Methods: We performed an analytical observational study at a tertiary metropolitan Australian hospital with a state-wide adult hyperbaric service between 2018 and 2022. Patients were identified via unit audits. Patient, HBOT, and procedural factors were analyzed against complications using Fisher's exact test with Bonferroni correction and simple logistic regression. Results: Over 4 years, 112 patients (220 ears) underwent modified PIVC ventilation tube insertion. Mean age was 58.6 years (95% CI: 55.7-61.6, SD: 15.9). Thirty-eight patients (33.9%) were female, 74 (66.1%) were male. Thirty-four ears (15.5%) had preexisting barotrauma at the time of tympanostomy tube insertion. Patients underwent a mean of 11.5 dives (95% CI: 9.0-14.0, SD: 13.4), with ventilation tubes being required for a mean of 15.0 days (95% CI: 9.0-14.0, SD: 24.0) to complete HBOT. Fourteen ventilation tubes (6.4%) developed blockage during HBOT, and 12 (5.5%) prematurely extruded. Sixteen ears (7.3%) required reinsertion of ventilation tubes. Nine ears (4.1%) suffered barotrauma despite ventilation tube insertion. Conclusions: Otic barotrauma prophylaxis is paramount for safety during HBOT. We describe a safe, effective, and convenient technique for barotrauma prevention using modified PIVCs.

Effect of Nursing Training Regarding Peripheral Intravenous Cannula on Nurses Performance and Incidence of Complications

Effect of Nursing Training Regarding Peripheral Intravenous Cannula on Nurses Performance and Incidence of Complications

Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial.

To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC.Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. Splint application did not affect functional PIVC duration and its related complications in neonates.

Effectiveness of Magnesium Sulphate with Glycerine Versus Ice Chips on Patients with Peripheral Intravenous Cannula Induced Phlebitis

Effectiveness of Magnesium Sulphate with Glycerine Versus Ice Chips on Patients with Peripheral Intravenous Cannula Induced Phlebitis

Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation

BackgroundPoint-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.MethodsA mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop.ResultsA total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop.ConclusionsGlobally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.

Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq

BackgroundObedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure’s success.ObjectivesTo determine the peripheral cannulation technique evaluation among nurses working in the emergency departments.MethodsThis descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses’ general characteristics and an observational checklist to assess the nurses’ pre, during and post practices regarding peripheral cannulation technique.ResultsAccording to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique.ConclusionsNurses were not practised peripheral cannulation technique appropriately; however, half of the nurses’ had an average level of practice, although their practices were not followed the standard protocols.

Peripheral parenteral nutrition in surgery – a systematic review and meta-analysis

Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains under-utilised in peri-operative care. This is despite purported advantages which includes avoiding the risks associated with central venous lines and preventing potential delays to the initiation of nutrition support. This systematic review and meta-analysis will detail the available evidence for PPN use in surgery. A comprehensive search of the EMBASE and Medline databases was undertaken to identify randomised control trials (RCTs) involving PPN use in surgical patients published until July 30th 2022. Three domains of PPN use were reviewed including: PPN compared to crystalloid intravenous fluids on nutritional and clinical outcomes; PPN compared to Central PN (CPN) on nutritional outcomes and complications; and strategies to prevent thrombophlebitis associated with PPN. The meta-analysis included 8 studies which included 698 patients. Use of PPN led to reduced post-operative weight loss (% body weight change) with a mean difference of-1.45% (95% CI -2.9 to-0.01, p=0.05). There was no statistically significant difference in terms of length of stay, infectious/non-infectious complications, surgical site infections or phlebitis. 42 RCTs were included in the systematic review. 14 RCTs compared PPN to crystalloid infusion. There was significant heterogeneity in the trial populations, interventions and measured outcomes. Most trials found that PPN may improve nitrogen balance and positively impact nutritional markers. Quality of life and post-operative complications were either improved or no difference found in trials assessing these outcomes. Four RCTs showed that PPN is a safe and feasible alternative to CPN. 22 RCTs reported on measures that may impact on thrombophlebitis rates associated with PPN. These included lower osmolality of PPN solution, cyclical PPN delivery, use of a small gauge polyurethane cannula in an upper limb vein, addition of heparin/hydrocortisone to PPN solutions and placement of a GTN patch over infusion sites. PPN is a safe and effective mode of delivery of peri-operative nutrition. It is a feasible short-term alternative to central-line delivered PN. There are a number of strategies to reduce thrombophlebitis associated with PPN use. Further high-quality RCTs are required to assess the use of PPN in contemporary surgical practice.

A prospective, randomized, interventional, comparative study between dexmedetomidine and propofol infusion for monitored anesthesia care during internal jugular vein chemoport insertion

Background: Chemotherapy through peripheral intravenous cannula causes severe thrombophlebitis. Chemoport is a best and favorable alternative for the same. It is done under local infiltration along with monitored anesthesia care with sedation. However, due to the lack of any fixed regimen, overt to under sedation is more common. To maintain an effective, consistent, and continuous level of sedation, we compared dexmedetomidine and propofol infusion in patients requiring monitored anesthesia care (MAC) for chemoport insertion. Methodology: Fifty patients posted for internal jugular vein chemoport insertion were randomly distributed into two groups: the propofol group and dexmedetomidine group. In Group P-injection, propofol infusion started at 125 μg/kg/min. Once observer's OAAS score 3 was achieved, propofol infusion was reduced to 25–75 μg/kg/min, whereas in Group D-Injection, dexmedetomidine bolus infusion was started at 1 μg/kg for 10 min and followed by 0.3–0.7 μg/kg/h and titrated to an OAAS score of 3. Results: OAAS score 3 was achieved significantly earlier in the propofol group as compared to the dexmedetomidine group (3.12 ± 1.7 vs. 8.04 ± 2.07, respectively). We were also able to maintain the desired sedation level throughout the procedure. Satisfaction scores in both the groups were comparable and patients in both the groups were hemodynamically stable throughout the procedure. Conclusion: In the current study, we found that propofol infusion was better regarding early onset and maintenance of OAAS score 3 with no requirement of rescue sedation during the procedure. The hemodynamic parameters and satisfaction scores were comparable in both groups. Hence, we suggest the use of injection propofol infusion for MAC under sedation in a patient requiring internal jugular vein chemoport insertion when compared to dexmedetomidine.

A study to assess the level of pain and procedural anxiety among intravenous cannulation patients admitted in emergency department of sree mookambika medical college hospital

Vein puncture is one of the most commonly experienced procedures among hospitalized patients. Most hospitalized patients require a peripheral intravenous cannula to administer drugs, fluids, and parental nutrition. Pain and anxiety are major complaints among patients during procedures. The main aim of the study was to assess the levels of pain and procedural anxiety during intravenous cannulation among patients. Additionally, the study aimed to investigate the association between pain level and procedural anxiety, and explore selected demographic variables like age, sex, education, occupation, and previous experience of intravenous cannulation. The study had a non-experimental descriptive research design with a quantitative research approach. It was conducted at the Sree Mookambika Institute of Medical Science in Kanyakumari, Tamil Nadu, India. Thirty samples were selected using the convenience sampling technique. The tools used for data collection were demographic variables, clinical variables, a visual analog scale, and a procedural anxiety scale. The data were analyzed and interpreted using objective, descriptive, and inferential statistics. The study findings showed that 33.33% of the samples had mild pain, 60% had moderate pain, and 6.66% had severe pain. In terms of anxiety levels, 63.33% of patients had a mild level of anxiety, 30% had a moderate level of anxiety, and 6.66% of patients had a severe level of anxiety. There was no significant association between anxiety and selected demographic or clinical variables. However, a significant association was found between the level of pain and demographic variables such as gender.

Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports.

Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits. To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning. Twenty benchtop PIVC set-ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set-up was injected with 10ml ultrapure water, and samples tested by liquid chromatography-electrospray tandem mass spectrometry for entrained chlorhexidine. Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One-way ANOVA indicated a statistical difference between at least two groups (df=2, F=24.11, p< .00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p< .01). Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk-benefit assessments for its use in PIVC maintenance antisepsis policies and protocols.

Evaluation of local inflammation associated with peripheral intravenouscatheter insertion in Quang Tri General Hospital

Introduction: Local inflammation associated with peripheral intravenous cannula insertion is an important issue in taking care of patients in Quang Tri General Hospital. Objectives: Determining the rate of local inflammation associated with using a peripheral intravenous catheter (PIC) and finding out the relevant factors of local inflammation caused by the peripheral intravenous catheter. Methodology: Cross-sectional survey was applied to 340 patients in Quang Tri General Hospital by using the questionnaire with the VIP scale (Visual Infusion Phlebitis Scale). Results: The incidence of local inflammation was 7.9% after using PIC, with local inflammation Grade. I was the highest proportion (70.4%). The relevant factors of local inflammation after using PIC include age (&gt; 70), treatment in the intensive care unit, the number of catheter placements (&gt; 3), time remaining in place (24 - 48 h), size 20 G, and group drug chemistry. Conclusion: The incidence of local inflammation was 7.9% after using PIC. Observe to detect local inflammation soon after using a peripheral intravenous catheter to improve the quality of patient care. Key words: local inflammation, peripheral intravenous catheter