Peripheral Venous Cannulation Research Articles

External vs Internal Focus of Attention in Procedural Skills Learning: A Randomized Study.

The Optimizing Performance Through Intrinsic Motivation and Attention for Learning theory postulates that directing attention to the intended movement effect or outcome (external focus) is more effective than directing attention to the internal body motion or body part (internal focus). This study compared external vs internal focus of attention as novice students learned ultrasound-guided peripheral cannulation. The authors hypothesized that conditions promoting an external (vs internal) focus of attention would result in better performance on immediate and delayed (retention) testing. The authors conducted a randomized, experimental study from October 2022 to February 2023 comparing external and internal focus using ultrasound-guided peripheral venous cannulation followed by practice using an ultrasound training block. Undergraduate health science students performed 4 practice trials with instructions to focus on the needle tip (external focus) or their hands (internal focus), followed by an immediate assessment and a retention assessment 2 weeks later. The primary outcome was time to successful cannulation. Results were compared using Kaplan-Meier curves and parametric survival analysis regression (accelerated failure time) models. Seventy participants completed the immediate assessment. The external focus group completed successful cannulation a mean of 2.33 times faster (95% CI = 1.47, 3.67; P < .001) than those in the internal focus group (median time, 12.0 vs 29.5 seconds). Results also favored the external focus group during practice, with the external focus group successfully completing the task a mean of 1.83 times faster (95% CI = 1.04, 3.21; P = .04) than the internal focus group. In the retention assessment, the external focus group successfully completed the task a mean of 2.37 times faster (95% CI = 1.19, 4.74; P = .02) than the internal focus group. External focus of attention compared with internal focus of attention improves medical motor skill learning in novice learners.

Low fidelity simulation versus standardized patient for teaching peripheral venous cannulation for nursing students: A crossover randomized trial

BackgroundThe placement of a peripheral venous cannulation is a procedure that all healthcare providers must be able to perform. AimThis study compared two simulation techniques of a peripheral venous cannulation (VC): low fidelity simulation (LFS) versus standardized patient (SP) in terms of efficiency. MethodsThis crossover randomized trial compared LFS to SP in VC placement for 2nd year nursing students from the Honoris United Universities. Each student performed the VC on both the manikin's arm and the SP in random order. The main outcome measure was successful of VC after the second attempt. The secondary outcome measures were time to successful of VC, number of attempts, adherence to asepsis (Registered protocol number: PACTR202111766112898). ResultsOne hundred sixty learners were needed (α = β = 5%, 20% difference between the two techniques and 53% for SC). We enrolled 172 students. No statistical difference was found concerning the main outcome measure: 135 (78.5%) versus 138 (80.2%) for respectively LFS versus SP (p:0.689), nor for the secondary outcome measures. Six out of nine non-technical skills variables had a statistically significant difference in favor of SP. ConclusionNo statistical difference was found concerning the main and secondary outcome measures. RegistrationRegistered protocol number: Pan African Clinical Trials register (PACTR202111766112898)—Date of first recruitment on February 2, 2022.

Assessment of the Peripheral Venous Cannulation in a Teaching Hospital: A Prospective Study

ABSTRACT Introduction: In today’s healthcare environment, peripheral venous cannulations are frequently performed procedures. Bloodstream infections could occur as a result of the intrusive operation. Peripheral venous cannulas should be inserted and managed according to specific rules. This study compared these standards to the peripheral venous cannulation procedure and results at a teaching hospital institution. Materials and Methods: This study investigated the procedure and results of peripheral venous cannulation in a teaching center using a prospectively completed audit loop study. The “Royal College of Nursing’s criteria for infusion therapy” is one such set of recommendations. After the first phase of the observations, the audit was conducted. Later, after 4 months based on the recommendations, the personnel received training on a variety of cannulation-related topics and the second set of observations for the cannulations was performed. Both observations were made and compared for significance that was considered at. 05 using the ANOVA. Results: During the first phase of the research, 212 cannulations were made, and 314 were made for the second phase to be audited. In the reaudit compared with the initial audit, there was a statistically substantial surge in documentation, cannula cleansing, glove use, suitable site selection, and hand cleanliness, according to comparative exploration. Moreover, there was a statistically substantial decline in recannulations. Conclusion: Even though peripheral intravenous cannulation is a straightforward process, if done incorrectly, it might have serious side effects. Such techniques’ auditing reveals performance flaws. Reaudit results reveal a noticeable increase in performance and outcome following proper personnel retraining.

The Use of Intraosseous Infusion in the Early Resuscitation of Patients With Extremely Severe Burns.

According to research, shock, the most common complication of extremely severe burns, is also the leading cause of mortality among patients with such burns. The case fatality rate reaches 83.45% when the total burn area exceeds 90%. The American Heart Association in 2020 recommended the intraosseous (IO) access after the peripheral access and prior to the central venous access when venous cannulation is either difficult or delayed. The use and experience with intraosseous infusion in extremely severe burns are still limited. We report efficacy and safety results from 19 burn patients treated with IO infusion between June 2020 and December 2022. In these patients, the mean injury time of burns was 1.55 ± 1.10 hours, the mean burn surface area was 86.24% ± 11.33%, the mean catheterization time was 49.68 ± 10.11 seconds, and the mean emergency retention time was 2.75 ± 1.74 hours, the mean actual fluid supplement amount was 5,533.68 ± 3,077.19 mL, the mean hourly urine volume of the patient was 93.31 ± 60.94 mL, the mean emergency detention time was 4.16 ± 2.97 hours, and the mean duration of hospitalization was 34.50 ± 25.38 days. The results demonstrated a clinically meaningful improvement and higher response rate vs peripheral venous cannulation and an acceptable safety profile in those patients.

Abstract 15087: First Clinical Trial in China to Evaluate the Efficacy and Safety of Moyoassist® Extra-VAD System

Cardiogenic shock(CS)is associated with significant morbidity and mortality. For patients unresponsive to medicinal treatment, an alternative is a mechanical circulatory support (MCS) system. In China, common treatments using short-term MCS include IABP and VA-ECMO, both methods found their limitations. Therefore, a better strategy must be proposed to improve prognosis in CS patients, such as extracorporeal VAD (Extra VAD). Here, we reported 40 patients' data collected from a prospective, multicenter, single group clinical trial conducted from July 2021 to Feb 2023, which aims to evaluate the efficacy and safety of MoyoAssist® Extra-VAD system. MoyoAssist® is developed based on fully magnetically levitated pump technology to temporarily support the left, right, or biventricular circulation of patients with acute heart failure and cardiogenic shock of all causes. Patients were recruited for various indications, with PCCS (50%) and BTT (32.5%) being the top two causes. A combination of median sternotomy (22.5%), peripheral venous cannulation (52.5%) and mini-incision (25%) were employed to implant the device. Especially, jugular vein cannulation was a pioneering approach proposed to enable patients’ early ambulation and recovery. MoyoAssist® Extra-VAD has demonstrated stable and sufficient circulation support without severe device associated adverse events. The mean support duration was 7d16hrs, and overall survival rate at 30-day follow up was 62.5%. Hemodynamics indicated improvement with increased MAP and reduced CVP in all sub-groups. Lactate has shown a significant decrease in the PCCS-survival group (3.95 vs. 1.05, p&lt;0.05), indicating improved reperfusion of organ tissues. While AST has shown a significant drop in the BTT-survival group (67.10 vs. 56.17, p&lt;0.05), indicating improved liver function. During the support, 3 patients with peripheral cannulation and 2 patients with mini-incision were able to ambulate early. The types of complication seen were similar to those reported with CentriMag, but the rates of bleeding (15%) and hemolysis (0%) were much lower. In conclusion, MoyoAssist® Extra-VAD has demonstrated its safety and efficacy for short-to-mid-term support of patients with acute heart failure and cardiogenic shock.

Efficacy of Infrared Vein Visualization versus Standard Technique for Peripheral Venous Cannulation in Infant and Toddler Populations: A Randomized Study.

Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations. Following Institutional Review Board (IRB) approval and written informed consent, children were randomly assigned to either a standard cannulation technique group or an IR vein visualization device group for venous cannulation. The primary outcome variable was the success rate of IV cannulation, and the secondary variables were the total number of attempts and the time to successful cannulation. No difference was noted between either group for first-attempt success rate (standard versus IR: 61.25% vs. 54.4%; p = 0.4) or time to establish IV cannulation (standard versus IR: median [interquartile range], 40 s [24-120] vs. 53 s [26-106]; p = 0.55). The anesthesiologist's grading of the anticipated difficulty of IV cannulation was a significant predictor of cannulation success (p = 0.0016). Our study demonstrated no significant benefit in utilizing the IR vein visualization device in terms of the overall success rate, number of attempts, and time to establish successful IV cannulation when compared to the standard technique. However, in difficult IV access situations, this device proved to be a valuable rescue adjunct.

Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study.

Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections. To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA). Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up. A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up. The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.

How does ultrasound guidance compare with landmark method for adults undergoing peripheral venous cannulation?

How does ultrasound guidance compare with landmark method for adults undergoing peripheral venous cannulation?

P47 MITRAL VALVE RE–REPAIR THROUGH A RIGHT MINITHORACOTOMY

Abstract Objective Recurrent mitral valve regurgitation after prior repair is usually treated with re–repair or replacement through a median sternotomy. We report our small initial experience with mitral valve re–repair through a repeated minimally invasive approach. Methods From July 2018 to November 2021, 10 patients (median age 52 years IQR 49–68; male 90%) underwent isolated mitral valve re–repair with a right mini–thoracotomy approach with peripheral arterial and venous cannulation. Median Euroscore II was 2.05 (IQR 2.03–2.54). Results The median time from the original operation to redo surgery was 4.7 (3.5–8.1) years. Median cardiopulmonary bypass and cross–clamp times were 128 (IQR 109–134) and 99.5 (IQR 81–112) minutes, respectively. Failure of previous mitral valve repair was mainly due to Gore–Tex chordal rupture (3 patients), annular detachment (3 patients), native chordal rupture (2 patients), and posterior leaflet prolapse (2 patients). Concerning the surgical terchnique, a complete mitral valve ring Corcym Memo 3D or 4D was used in 8 patients while additional repair techniques were needed 5 patients (PTFE neochords implantation, cleft or commissure closure). No conversion to full sternotomy and no reoperation for bleeding was necessary. Median ICU and hospital stay were 2.0 (IQR 2.0–2.0) and 7.5 (7.0–9.0) days respectively. Median follow up time was 3.5 (2.8–3.9) years. Neither deaths nor major postoperative complications occurred in the follow–up period. Conclusions In our experience, mitral valve re–repair can be an attractive option for patients with failure of previous mitral valve surgery and can be safely performed through a minimally invasive approach with good outcomes. Main advantages seem to be the avoidance of extensive surgical dissection, optimal valve exposure, and low risk of surgical complications.

Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery.

We aimed to evaluate the effects of internal jugular vein (IJV) catheterization on intracranial pressure (ICP) and postoperative delirium (POD) during robot-assisted laparoscopic surgery by measuring the optic nerve sheath diameter (ONSD). Data from a prospective single-center cohort study, conducted from October 2021 to February 2022, were used. Forty out of 80 patients scheduled for laparoscopic radical hysterectomy or prostatectomy were assigned to the group receiving IJV catheterization (Group I), and the other 40 only received peripheral venous cannulation (Group C) according to clinical need of patients. Ultrasonography of ONSDs, the proportion of regurgitation time in a cardiac cycle, and hemodynamic parameters were measured at four time points: immediately after induction of anesthesia in the supine position (T0), 30 min (T1), 60 min (T2) after orienting to the Trendelenburg position, and before returning to the supine position at the end of surgery (T3). Time to eye opening and emergence stay, POD, and QoR-15 were compared. The ONSDs increase gradually as the surgery progressed. Group I showed a higher value of ONSD at T1 (4.72 ± 0.29 mm vs. 4.5 ± 0.33 mm, p = 0.0057) and T3 (5.65 ± 0.33 mm vs. 5.26 ± 0.31 mm, p < 0.0001). The proportions of the regurgitation time of IJVV were greater in Group I than those in Group C at T1 (14.95, 8.5%-18.9% vs. 9.6%, 0%-17.2%, p < 0.0001) and T3 (14.3, 10.6%-18.5% vs. 10.4%, 0%-16.5%, p = 0.0003). Group I had a delayed time to eye opening (10.7 ± 1.72 min vs. 13.3 ± 2.35 min, p < 0.0001) and emergence stay (32.2 ± 5.62 min vs. 39.9 ± 6.7 min, p < 0.0001). There were no significant differences in POD and QoR-15 between the two groups on day three. IJV cannulation may not be the preferred approach in robot-assisted laparoscopic surgery as it was risk factor for IJVV regurgitation, ICP elevation, emergence delayed.

Totally Endoscopic Constrictive Pericarditis Treatment: A Case Series.

Minimally invasive cardiac surgery has increased in popularity to reduce the morbidity associated with open heart surgery. In this article, a totally endoscopic case series is presented in which anterior pericardiectomy is performed by peripheral femoral arterial and venous cannulation. Right periareoal incision and right submammary incision were used for male and female patients, respectively, to access the heart by the fourth intercostal space.

COMPARISON OF THE EFFICACY OF INSERTING MIDLINE CATHETERS BY EXPERIENCED AND INEXPERIENCED NURSES: A RETROSPECTIVE OBSERVATIONAL STUDY

Aim: The purpose of this retrospective observational study was to compare peripheral venous cannulation performed under ultrasound guidance by expe-rienced and inexperienced nurses. Material and Methods: The observational study was retrospective. Analysis was done of eighty-seven charts of successful ultrasound-guided cannulations performed by experienced and inexperienced operators over a 5-month period. Results: In the experienced group, an average of 1.31 puncture attempts were performed (median=1), and in the inexperienced group that number was 1.42 (median=1). One attempt was enough for 76.6% (n=36) and 72.5% (n=29) of cannulations, respectively. Experienced nurses needed statistically signif i cantly less time to successfully puncture a vessel (p=0.003). Conclusions: Implementing the procedure of inserting midline catheters under ultrasound guidance should be based on properly conducted training and supervised clinical experience. Performing an adequate number of cannulations during training reduced the time required for the procedure and decreased the number of failures. Completing 20 to 50 cannulations during the course makes it possible to achieve a high success rate of vascular access insertion with a minimum number of attempts.

Retained peripherally inserted central catheter guidewire with vegetation.

Sir, Central venous cannulation is often a necessity for patients in intensive care units or in patients with difficult peripheral access. Loss of the guidewire is a serious and potentially life-threatening complication with reports of fatalities in up to 20% of cases, when the complete guide wire is lost.[1] A 2-year 3-month-old female child presented to our institute with chief complaints of poor weight gain, abdominal discomfort, and decrease in appetite. Chest X-ray of the patient showed a radio-dense wire extending into inferior vena cava (IVC) and right atrium [Figure 1]. Patient had a history of hospital admission at the age of 8 months for jaundice. Peripherally inserted central catheter (PICC) was inserted at that hospital in right femoral vein due to difficult peripheral venous cannulation. PICC line was kept for 12 days and later it was removed. Later on, patient presented to our institute with above mentioned complaints. Computerised tomography (CT) scan showed evidence of a linear radio-dense wire extending from infrarenal IVC into the right ventricle. Its tip was seen in the superior vena cava suggestive of foreign material [Figure 1b]. Transthoracic echocardiography showed a hyperechoic mobile structure of size 20 × 10 mm (possibly a vegetation) in the right atrium having attachment to the superior vena cava and IVC with to-and-fro movement across tricuspid valve and near total occlusion of IVC by hyperechoic structure till mid abdomen level [Video 1]. Moderate to severe tricuspid regurgitation (TR) was seen on transthoracic echocardiography. Surgical removal of PICC guidewire was planned. Complete blood count, serum electrolytes, coagulation profile, liver, and kidney function tests were done preoperatively. Preoperative electrocardiogram showed sinus tachycardia and nonspecific ST-T wave changes. The open surgical repair was planned under hypothermic cardiopulmonary bypassFigure 1: (a) Chest X-.Ray PA view showing a radio dense wire extending into inferior vena cava and right atrium. (b) Computerised tomography scan showing evidence of a linear Ra: Right atrium dense wire extending from infrarenal IVC, extending into right ventricle and the tip is seen in superior vena cava suggesting foreign material. (c) Guidewire with vegetation. (d) Right atrium opened with blocked IVC. IVC: Inferior vena cava {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0bc3rv32"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Patient was induced with general anaesthesia and endotracheal intubation carried out after injecting fentanyl 5 mg/kg, midazolam 0.1 mg/kg, and vecuronium 0.1 mg/kg. Five lead electrocardiogram, invasive arterial blood pressure, central venous pressure, temperature, end tidal carbon dioxide, pulse oximetry, and urine output were monitored intraoperatively. Cardiopulmonary bypass (CPB) was established after cannulating ascending aorta and right atrium. Total circulatory arrest was initiated. Right atrium was opened and removal of guidewire with vegetation from right atrial wall and tricuspid valve leaflet were done [Figure 1c and 1d]. Tricuspid valve was checked for tricuspid regurgitation and anteroseptal commissuroplasty was done. Post repair, moderate to severe tricuspid regurgitation was present. CPB was instituted again, and tricuspid valve was repaired. After complete rewarming, patient was weaned off CPB uneventfully. 180 ml of packed red blood cells was transfused intraoperatively. Total duration of surgery was four hours. Patient was shifted to paediatric intensive care unit and was extubated on second postoperative day. Complications pertaining to the retained guide wire include complete loss of wire, injury to the vessel from the wire, fracture of the wire, and bleeding.[1–5] Patients undergoing foreign body removal pose a challenge for the anaesthesiologist as there can be risk of arrhythmia, bleeding causing haemodynamic instability, prolonged aortic cross clamp time, and postbypass myocardial dysfunction. Percutaneous retrieval was not possible in this case due to the extent of guide wire with associated vegetation and risk of its embolisation. Therefore, decision was made for surgical plan to remove guide wire under cardiopulmonary bypass. This case highlights the importance of formulating a plan for the anaesthetic management of patients undergoing guidewire removal and preparedness for postoperative management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A comparative study of 10% lidocaine spray versus eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA) to attenuate pain of peripheral venous cannulation in children: A prospective randomized control trial at a tertiary care centre.

Eutectic mixture of local anesthetics (EMLA) (2.5% lidocaine and 2.5% prilocaine) cream is the commonly used topical anesthetic for painful intradermal procedures. Topical 10% lidocaine spray has successfully been used to anesthetize mucosal surfaces. Owing to its skin penetrative properties, this study was conducted to compare dermal analgesia between 10% lidocaine spray and EMLA cream for intravenous (IV) cannulation in children. In this prospective single-blind randomized study, ninety-nine Paediatric patients were assigned into Group A (number(n) =51) with Lignocaine 10% spray applied 10 minutes and Group B (n = 48) EMLA cream applied 1 hour prior to cannulation. Vital signs were recorded before, during, and after the procedure. The primary objective of the study was assessment of severity of pain during IV cannulation using 10 cm visual analogue scale (VAS). Secondary objectives such as ease of cannulation and adverse effects were also noted. All cannulations were performed in the first attempt with no adverse effects in both lidocaine group and EMLA group. The median (interquartile range) VAS score was 2 cm (1 to 3) in both the groups with a P value of 0.58. Topical 10% lidocaine spray applied ten minutes before venous cannulation is as effective as EMLA cream applied an hour before cannulation in children in providing dermal analgesia for intravenous cannulation with an added advantage of rapid onset of action in the former group.

Ultrasound guidance versus landmark method for peripheral venous cannulation in adults.

Ultrasound guidance versus landmark method for peripheral venous cannulation in adults.

Seek and you shall find—retrieval of a retained fractured intravenous cannula by Z-plasty incision: a case report

Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.

Effectiveness of art-based distraction in reducing pain and anxiety of hospitalized children during cannulation procedure: A randomized controlled trial.

Peripheral venous cannulation (PIVC) is one of the most common needle procedures associated with the therapies of pediatric patients, which causes pain and anxiety in children. Trace Image and Coloring for Kids-Book (TICK-B) is one of the arts-based interventions to relieve pain and anxiety, but none of the existing studies use the TICK-B to decrease children's pain intensity and anxiety levels during PICV. This study aimed to investigate the effectiveness of the Trace Image and Coloring for Kids-Book (TICK-B) in decreasing children's pain and anxiety during PIVC. A parallel, randomized, double-blind controlled trial was used in this study. Children aged 6-12 years were randomly allocated to one of two groups: intervention or control. The intervention group (n = 48) received the TICK-B during the PIVC, compared to no intervention in the control group (n = 52). The children, their parents, and an observer nurse rated outcomes 1-2 min after completion of the procedure. The patients in both groups were similar in age, gender, duration of hospitalization, injections, mother's age, and education. Faces Pain Scale-Revised (FPS-R), Children's Fear Scale (CFS), and Visual Analog Scale (VAS) were used to measure pain and anxiety. Paired and independent t-tests were used for data analysis. Patients in the intervention group reported significantly reduced pain levels than those in the control group (p <0.001), as reported by children (3.08 vs. 7.06), parents (3.08 vs. 7.13), and the observer nurse (3.06 vs. 7.13), respectively. Anxiety levels were also significantly lower among patients in the intervention group than in the control group (p <0.001), as reported by children (0.88 vs. 3.17), parents (0.94 vs. 3.19), and the observer nurse (0.85 vs. 2.94), respectively. TICK-B is an effective technique for reducing children's pain and anxiety during PIVC. TICK-B is a simple, inexpensive, and effective technique that nurses can use to decrease the levels of pain and anxiety of pediatric patients during intravenous cannulation.

Cannulation: an update for dentists

Peripheral venous cannulation is a skill dentists may require in hospital jobs and sedation practice. This article provides a comprehensive overview of the technique, equipment, relative contraindications and potential complications. CPD/Clinical Relevance: To act as an update and refresher for the dental team on peripheral venous cannulation.

Difficult intravenous access in a paediatric intensive care unit

IntroductionMultiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). ObjectivesThe main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. MethodA cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. ResultsA total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. ConclusionsWe found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.

Efficacy of Eutectic Mixture of Local Anesthetic Cream and Vibrator Device in Pain Reduction during Peripheral Venous Cannulation in a Tertiary Care Center of Central Nepal

Background Venous cannulation is a commonly performed procedure which often leads to patient anxiety. Application of a vibrator device and or prior use of topical anesthetics are proven methods to decrease associated pain.&#x0D; Objective To compare the clinical efficacy of prior use of Eutectic Mixture of Local Anesthetic (EMLA) cream and vibrator device in pain reduction during peripheral venous cannulation.&#x0D; Method A true experimental study was conducted in November 2019 among 78 patients aged 20-60 years receiving peripheral cannulation at operation theatre. They were included using consecutive sampling and sorted to interventional and noninterventional group using simple random sampling lottery method. Participants in the non-interventional group received peripheral cannulation using routine technique whereas participants in the interventional group received topical Eutectic Mixture of Local Anesthetic cream or vibrator device prior to cannulation. Perceived post cannulation pain intensity was measured using numerical pain rating scale. Kruskal-Wallis test was used for data comparison.&#x0D; Result The mean age of the participants was 40.57 ± 12.5 years. The median pain score of Eutectic Mixture of Local Anesthetic cream, vibrator and no intervention was 3, 3 and 6 respectively. The reduction in median pain intensity was significantly greater with topical anesthetic cream and vibrator device when compared to the noninterventional group (p &lt; 0.05).&#x0D; Conclusion Prior interventions with Eutectic Mixture of Local Anesthetic or vibrator device are useful in reducing pain intensity during peripheral venous cannulation. Routine use of these in day to day practice could be a part of standard nursing care practice.