Peripheral Vascular Access Research Articles

Postmortem Identification of a Foreign Body in the Heart: A Case Report.

The presence of a foreign body in the heart have been reported, mostly in adults. Deaths and injuries can result from the breakage or rupture of angiography catheters. We present a case in which an angiocath tip was identified in the right ventricle of a pediatric patient, and the patient died as a result thereof. As no similar cases have been reported, we would like to draw attention to this subject. A 4.5-month-old female patient who was hospitalized 3 times during her life had a history of peripheral venous access establishment in the extremities with angiocatheters. During these hospital admissions, a central catheter was not inserted, and no additional problems were identified. Emergency personnel responded and found the patient at home, experiencing bradycardia and arrhythmia. She was resuscitated and taken to the hospital, where she died. The autopsy revealed, the tip of a 1.5cm long, 1mm wide lumen catheter had penetrated the right ventricular wall (Fig.1) (Fig.2), thus her death was attributed to complications that developed as a result of the peripheral vascular access catheter tip breaking and migrating to the right ventricle. Although the patient did not have an ECG, physical examination by the emergency ambulance personnel revealed an irregular and bradycardic heartbeat, suggesting that the child may have developed arrhythmia and atrioventricular conduction block. Health care professionals must check upon removal of peripheral intravenous access, and record whether the integrity of the peripheral catheter tip was compromised to prevent similar events in future. Fig.1 Angiocath tip piercing the right ventricular wall and exiting the heart Fig.2 a A 1.5cm long, b 1mm wide lumen catheter tip penetrating the right ventricular wall.

Review of venipuncture and intravenous catheterization techniques in pigs.

The number of companion pigs in the US is increasing, as is the frequency with which they present to primary companion care practices. However, pigs are often an understudied species in veterinary curricula, and many students graduate from veterinary school with minimal porcine handling experience. Coupled with the poor peripheral vascular access associated with pigs, this presents a challenge for many new graduates and other primary care veterinarians seeking to improve their knowledge of porcine handling, anatomy, and medical care. Furthermore, much of the available veterinary literature regarding porcine venous access is dated, limited to technical notes, or inaccessible to many primary care veterinarians. This review aims to supplement this lack of knowledge by discussing techniques in restraint, sedation, venipuncture, and catheterization of companion pigs as a reference for veterinarians and researchers alike.

The Effect of Finger Puppet Play on Pain and Anxiety during Peripheral Vascular Opening Attempts in Preschool-age Children during Emergency Room Visits: Randomized Controlled Study

Objective: The pupose of this study is to examine the effect of finger puppet play on pain and anxiety during peripheral vascular access in preschool-age children in the emergency room. Design and methods: The study was conducted in a randomised controlled manner. The study population consisted of children aged 4–6 years who came to the paediatric emergency room of a hospital in Turkey between 25 May and 25 June 2022. The sample consisted of 97 children who met the research criteria between these dates (49 in the control group, 48 in the finger puppet play group). Stratification and block randomisation methods were used to determine the experimental and control groups.The data were collected with the Survey Form, Child Fear and Anxiety Inventory (CFAI) and Wong-Baker Facial Expression Rating Scale (WB-FAS) through interviews conducted by the researchers. Finger puppet play was shown to the experimental group during the procedure. Results: In the experimental and control groups, the child's pain and anxiety were evaluated by the child, parent, and researcher before the procedure, and similar pain and anxiety values were found from each source (p>0.05). During the procedure, the child's pain and anxiety were evaluated by the child, the parent, and the researcher, and it was found that the children in the finger puppet game group experienced significantly less pain and anxiety than the children in the control group (p < 0.05). Results: According to these results, the application of finger puppetry to children aged 4–6 years undergoing peripheral vascular access was effective in reducing pain and anxiety.

Multicenter randomized controlled trial to assess the effectiveness of PASSEO-LUX DCB® drug coated balloon compared to plain balloon angioplasty of arteriovenous fistulae for hemodialysis: Two-years results.

To compare primary patency after angioplasty with drug-coated balloon (DCB)-Passeo-18Lux, BIOTRONIK versus uncoated balloon in dysfunctional peripheral vascular access (PVA) for hemodialysis. A total of 133 patients from four hospitals were randomized to receive DCB or plain old balloon angioplasty (POBA) after satisfactory treatment (residual stenosis <30%) with high pressure balloon (HPB). The primary endpoint was clinical patency of PVA 2 years after angioplasty. Secondary endpoints included the relationship between the location of stenosis and patency and also, other covariates. Mortality at 2 years was compared between both groups. Patency measured in days after angioplasty was higher in fistulae dilated with DCB than HPB. Kaplan-Meier survival curves showed the next percent of success (free time restenosis) after DCB versus POBA at 6 months-77.1% versus 58.2% (160.41-143.72 days until restenosis), 12 months-51.4% versus 44.3% (274.1-237.23), 18 months-38.6% versus 38% (350.74-305.18), and 24 months-37.1% versus 30.4% (419.04-369.1). At 6 months, this difference was statistically significant (p = 0.018), but not at 12 (p = 0.225), 18 (p = 0.471), or 24 months (p = 0.236). Mortality was similar in both groups. DCB angioplasty resulted in superior target lesion primary patency (TLPP)-free survival at 6 months of follow-up. No significant improvements in TLPP-free survival long term were observed. Mortality observed at 1 and 2 years was similar in DCB and POBA: there was no significant difference, and a safety study demonstrated no difference between the two groups (complications and mortality): DCB is safe to use in stenosis treatment in patients who are PVA carriers. Level Ia, therapeutic study, RCT. EBM ratings will be based on a scale of 1-5.

Implementation of a midline catheter service in a regional setting

Abstract Introduction: Midline catheters have been reported to be an effective and safe means of providing patients with intravenous access within the hospital and community setting. With minimal experience in the introduction of a midline service across the local health network, a regional hospital pursued this task. This observational study assesses the provision of a safe clinical framework for midline insertion, and the improvement of patient care and experiences by avoiding treatment interruptions and unnecessary cannulation attempts from failed traditional peripheral vascular access devices. Methods: From the introduction of the midline service in June 2018, outcome measures of all patients who received a midline over the following two-year period were documented including rate of line success, complication rates, dwell time, and the number of insertion attempts. Results: The midline service provided 207 lines over a two-year period with a total dwell time of 1,585 days. Project goals were achieved with 85% (Aim ≥ 85%) of all lines completing treatment prior to removal. First attempt insertion was 86% (Aim ≥ 80%) with a maximum insertion attempt of two. Rates of line-related complications were less than 8%, with five documented cases of phlebitis (2.5%) and one deep vein thrombosis with no infections documented. Conclusion: Despite limited resources, a successful midline service was introduced. Future expansion will see an increase in insertor numbers providing improved access to the service.

Assessment of Nurses’ Performance Regarding Factors Contributing to Complication of Peripheral Vascular Access Device in Neonatal Intensive Care Unit

Assessment of Nurses’ Performance Regarding Factors Contributing to Complication of Peripheral Vascular Access Device in Neonatal Intensive Care Unit

Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening.

Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture. This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow. Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P<0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P<0.001). In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.

The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study

BackgroundPlacement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes.MethodsThis study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable.ResultsBetween January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001).ConclusionsBlack females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.

The Scrotal Displacement of the Catheter After Femoral Venous Cutdown: A Neonatal Case Report from Iran

Introduction: One of the most preferred cutdown access sites in neonates is the femoral vein; however, the medical staff should be aware of the associated complications. In this study, we present a case where the displacement of the catheter tip after femoral vein cutdown resulted in a scrotal hematoma. Case Presentation: A neonate with a gestational age of 39 weeks and a birth weight of 3740 grams was born in an academic hospital in Tehran, Iran, in 2022. The newborn gradually showed symptoms of respiratory distress and was immediately transferred to the neonatal intensive care unit (NICU). Within the first minutes of NICU admission, the newborn developed acute respiratory distress, and a chest X-ray revealed congenital pneumonia. The patient was promptly intubated, and endotracheal surfactant was administered. Simultaneously, peripheral vascular access was established. On day 3, the vascular access failed, and multiple attempts at percutaneous venipuncture were unsuccessful. A consultation with an expert pediatric surgeon led to the decision to perform a surgical venous cutdown. A 22-gauge catheter was inserted into the external iliac vein through the right femoral access to initiate intravenous fluid and antibiotics. Within the next four hours, the neonate developed right scrotal edema, discoloration, localized erythema, and clear fluid leakage from the right scrotum. Intravenous infusion was urgently clamped. The pediatric surgeon recommended catheter removal, suspecting displacement of the catheter. A sonography examination revealed a hypoechoic 11 × 10 × 4 mm region, indicating a hematoma at the inferior pole of the right testis. The neonate was placed under serial follow-up to monitor vital signs and local manifestations. The patient was managed with conservative treatment and discharged in good condition on the 10th day of NICU admission. Conclusions: The presented case demonstrated scrotal damage following femoral cutdown catheterization. This unexpected complication was effectively managed by the immediate removal of the catheter, close monitoring, conservative therapy, and serial follow-ups, which prevented the progression of local signs. NICU staff should be aware of the potential for testicular injuries in such cases.

Improving healthcare professionals' ultrasound-guided peripheral vascular access ability utilizing self-assembled ultrasound phantoms: A prospective, observational quality improvement project.

Ultrasound guidance can reduce the number of attempts to gain peripheral IV access while improving the success rate and satisfaction in patients with difficult IV access. Education and simulation are effective tools for improving the skills and knowledge related to ultrasound-guided peripheral IV access. Ultrasound phantom models allow for skill development without the risk of patient harm. Twenty-nine registered nurses and nurse practitioners were recruited for education and simulation regarding ultrasound-guided peripheral IV (USGPIV) placement. Participants completed a survey evaluating the efficacy of the phantom models in addition to pre- and post-intervention confidence, perceived competence, knowledge surveys, and a Directly Observed Procedural Skills Evaluation (DOPSE). The intervention included an educational PowerPoint and open practice session using the phantom models. Statistically significant improvements were found in participants' confidence (p < 0.001; 95% CI: 5.287, 9.499; d = 1.31), perceived competence (p < 0.001; 95% CI: 1.231, 2.742; d = 1.20), knowledge (p < 0.001; 95% CI: 1.079, 2.163; d = 1.47), and skills (p < 0.001; 95% CI: 2.499; 5.501; d = 1.29). Participants improved in maintaining needle visualization (p < 0.001; 95% CI: 0.272, 0.9; d = 0.79) and decreasing their cannulation attempts (0.045; 95% CI: 0.013, 1.022; d = 0.48). Participants with no and novice experience saw statistically significant improvement across all categories (p < 0.02) compared to those with intermediate, advanced, or expert experience with ultrasound. 96.5% of participants could perform ultrasound-guided peripheral IV cannulation independently or with indirect supervision following the intervention. At $36.52 per model, the self-assembled ultrasound phantom models provided a cost-effective and sustainable solution to teaching ultrasound-guided peripheral IV cannulations. Education and simulation for ultrasound-guided peripheral vascular access may benefit individuals with no or novice ultrasound experience.

Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician.

Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.

A standardized educational program to improve peripheral vascular access outcomes in the emergency department: A quasi-experimental pre-post trial.

Difficult intravenous access (DIVA) patients are known to have disproportionately poorer vascular access outcomes. The impact of education and training on vascular access outcomes in this vulnerable population is unclear. We aim to demonstrate the success of a program (Operation (O) STICK) on improving vascular access outcomes in DIVA patients. This was a quasi-experimental pre-post interventional study conducted at a tertiary care emergency department (ED) with 120,000 annual visits and 1100 hospital beds. Adult patients requiring an ultrasound-guided (US) peripheral intravenous catheter (PIVC) in the ED were eligible participants. Traditional (palpation method) insertions were excluded. Using multivariable linear regression and inverse probability weighted (IPW) linear regression, the standard group inclusive of PIVCs inserted by staff without formalized OSTICK training were compared to the interventional group inclusive of PIVCs inserted by staff with training and competency in the OSTICK training model. Data were collected over two time intervals: 4/1/21-9/30/21 (pre; non-OSTICK) and 10/1/22-3/31/23 (post; OSTICK). 2375 DIVA patients included 1035 (43.6%) non-OSTICK and 1340 (56.4%) OSTICK PIVCs. Overall, OSTICK PIVCs had a higher proportion of upper arm or forearm placements (94.6% vs 57.4%; p < 0.001), 20 gauge catheters (97.1% vs 92.3%; p < 0.001), and left-sided placements (54.4% vs 43.5%; p < 0.001). 62.7% of OSTICK PIVCs were placed by ED technicians, compared to 25.5% in the non-OSTICK group (p < 0.001). OSTICK PIVCs were placed on the first attempt 86.2% of the time and by the second attempt 95.4% of the time. In a subanalysis of 1343 hospitalized patients (689 (51.3%) OSTICK vs 654 (48.7%) non-OSTICK), OSTICK PIVCs survived for a median of 92% of the patient's hospital length of stay, compared to non-OSTICK PIVCs at 74% (p < 0.001). Formalized vascular access training in the ED leads to improved adherence to best practices for PIVC insertion, high success of cannulation with minimal attempts, and improved PIVC functionality during hospitalization for DIVA patients. Importantly, these outcomes are sustainable as they were captured 12 months after implementation of the program.

Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study.

The Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care. This study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022. We performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year. A total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma. IO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible.

Influence of the Seldinger technique on the dwell time and failure rates of ultrasound-guided peripheral cannulas: A prospective observational study

Ultrasound is commonly used to assist with peripheral vascular access and there is growing evidence that there is an advantage to using guidewires to aid insertion. This prospective observational study compares outcomes in ultrasound-guided peripheral cannulation using either standard catheter-over-needle devices or a single lumen arterial catheter inserted using the Seldinger technique. Analysis of results demonstrated a clear advantage in terms of device survival to completion of therapy in the guidewire group.

National practice of Nursing professionals in the insertion of peripheral vascular access devices.

to identify and compare the practice of Nursing professionals regarding the insertion of peripheral vascular access devices, according to professional category. descriptive sectional study carried out between July 2021 and May 2022 with 2,584 Nursing professionals, using a questionnaire validated by three judges with expertise in intravenous therapy, containing variables related to catheterization and the vascular access device. Descriptive and inferential analysis was carried out. most professionals do not prepare the patient or perform some essential care before attempting peripheral intravenous catheterization. Regarding the preferred catheterization site, hands, arm and forearm stand out. There is no control over the tourniquet time, and the patient is punctured more than three times. The most used device materials are polyurethane and Teflon ® , more than one criterion is adopted for device selection, and Micropore ® type adhesive tape was the covering most cited by Nursing professionals. The identification of catheterization was not adequate. Nursing technicians and assistants are the professionals who least comply with what is recommended in recognized guidelines. Nurses' practice also presents deviations from scientific evidence.

Peripheral vascular access devices for hospitalized older adults: A scoping review protocol

Background: Insertion of peripheral vascular access devices (PVADs) is the most commonly performed invasive medical procedure worldwide. Peripheral vascular access devices pose a significant risk of complications, especially in older adults, who experience age-related changes in skin, connective tissue, and veins. Adults older than 65 years old have the highest rate of hospital admissions, and a higher prevalence of co-morbid conditions than do younger adults. Despite the risks, PVADs in this population have not been well-explored. Aim: To identify the available evidence on PVADs in older adult populations, including patient experience. This scoping review protocol will function as a framework for a review, using a systematic process of published and grey literature. The population is adults 65 years of age and over. Methods: The Johanna Briggs Institute methodology, built on the Arksey and O’Malley framework, will guide this scoping review. A search of electronic medical databases will be conducted. Grey literature searches will supplement the electronic database searches. A data extraction tool will be employed for screening and data extraction. The PRISMA-ScR flow chart will be used to present the methodological process, and the extracted data will be tabulated with a narrative summary. Conclusion: This scoping review protocol provides the framework that underpins the scoping review, which will explore the existing evidence to inform future research.

National practice of Nursing professionals in the insertion of peripheral vascular access devices

Objetivo: identificar e comparar a prática dos profissionais de Enfermagem quanto à inserção de dispositivos de acesso vascular periféricos, de acordo com a categoria profissional. Método: estudo seccional descritivo realizado no período entre julho de 2021 e maio de 2022 com 2.584 profissionais de Enfermagem, por meio de questionário validado por três juízes com expertise em terapia intravenosa, contendo variáveis relacionadas à cateterização e ao dispositivo de acesso vascular. Foi realizada análise descritiva e inferencial. Resultados: a maioria dos profissionais não prepara o paciente nem realiza alguns cuidados essenciais antes da tentativa de cateterização intravenosa periférica. Quanto ao local preferencial de cateterização, destacam-se as mãos, o braço e o antebraço. Não há controle do tempo de garroteamento e o paciente é puncionado mais de três vezes. Os materiais dos dispositivos mais utilizados são poliuretano e Teflon ® , é adotado mais de um critério para a seleção do dispositivo, e a fita adesiva do tipo Micropore ® foi a cobertura mais citada pelos profissionais de Enfermagem. A identificação da cateterização não foi adequada. Conclusão: técnicos e auxiliares de enfermagem são os profissionais que menos atendem ao que está preconizado nas diretrizes reconhecidas. A prática dos enfermeiros também apresenta desvios em relação às evidências científicas.

National practice of Nursing professionals in the insertion of peripheral vascular access devices

Objetivo: identificar y comparar la práctica de los profesionales de Enfermería respecto a la inserción de dispositivos de acceso vascular periférico, según categoría profesional. Método: estudio descriptivo seccional realizado entre julio de 2021 y mayo de 2022 con 2.584 profesionales de Enfermería, mediante cuestionario validado por tres jueces con experiencia en terapia intravenosa, que contiene variables relacionadas al cateterismo y al dispositivo de acceso vascular. Se realizó análisis descriptivo e inferencial. Resultados: la mayoría de los profesionales no prepara al paciente ni realizan algunos cuidados esenciales antes de intentar el cateterismo intravenoso periférico. En cuanto al sitio preferencial para el cateterismo, destacan las manos, el brazo y el antebrazo. No hay control sobre el tiempo del torniquete, y el paciente es punzado más de tres veces. Los materiales del dispositivo más utilizados son el poliuretano y el Teflón ® , se adopta más de un criterio para la selección del dispositivo, y la cinta adhesiva tipo Micropore ® fue la cobertura más citada por los profesionales de Enfermería. La identificación del cateterismo no fue adecuada. Conclusión: los técnicos y auxiliares de enfermería son los profesionales que menos cumplen con lo recomendado en guías reconocidas. La práctica de los enfermeros también presenta desviaciones de la evidencia científica.

Ultrasound Guided Vascular Access Practical Issues (Pictorial Essay)

Ultrasound-guided vascular access is rapidly becoming a more critical topic as critical care medicine systems struggle with an increasing number of patients with vascular access problems. Depending on the situation up to 50% of the patients may have no peripheral vascular access sites or access is very difficult to obtain, which can lead to many complications such as bleeding, pneumothorax or prolonged procedure.

A single center retrospective study: Comparison between centrifugal separation plasma exchange with ACD-A and membrane separation plasma exchange with heparin on acute liver failure and acute on chronic liver failure.

The purpose of this retrospective study is to compare the efficacy and safety of the centrifugal separation therapeutic plasma exchange (TPE) using citrate anticoagulant (cTPEc) with membrane separation TPE using heparin anticoagulant (mTPEh) in liver failure patients. The patients treated by cTPEc were defined as cTPEc group and those treated by mTPEh were defined as mTPEh group, respectively. Clinical characteristics were compared between the two groups. Survival analyses of two groups and subgroups classified by the model for end-stage liver disease (MELD) score were performed by Kaplan-Meier method and were compared by the log-rank test. In this study, there were 51 patients in cTPEc group and 18 patients in mTPEh group, respectively. The overall 28-day survival rate was 76% (39/51) in cTPEc group and 61% (11/18) in mTPEh group (P > .05). The 90-day survival rate was 69% (35/51) in cTPEc group and 50% (9/18) in mTPEh group (P > .05). MELD score = 30 was the best cut-off value to predict the prognosis of patients with liver failure treated with TPE, in mTPEh group as well as cTPEc group. The median of total calcium/ionized calcium ratio (2.84, range from 2.20 to 3.71) after cTPEc was significantly higher than the ratio (1.97, range from 1.73 to 3.19) before cTPEc (P < .001). However, there was no significant difference between the mean concentrations of total calcium before cTPEc and at 48 h after cTPEc. Our study concludes that there was no statistically significant difference in survival rate and complications between cTPEc and mTPEh groups. The liver failure patients tolerated cTPEc treatment via peripheral vascular access with the prognosis similar to mTPEh. The prognosis in patients with MELD score < 30 was better than in patients with MELD score ≥ 30 in both groups. In this study, the patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) treated with cTPEc tolerated the TPE frequency of every other day without significant clinical adverse event of hypocalcemia with similar outcomes to the mTPEh treatment. For liver failure patients treated with cTPEc, close clinical observation and monitoring ionized calcium are necessary to ensure the patients' safety.