Peripheral Venous Catheter Insertion Research Articles

Appropriateness and Complications of Peripheral Venous Catheters Placed in an Emergency Department

BackgroundThe insertion of peripheral venous catheters (PVCs) is the invasive procedure most frequently performed in hospitals, and it could be associated with complications. The appropriateness of PVC placement, however, has not been carefully analyzed. ObjectivesWe conducted a study to assess the rate of PVC placement in our Emergency Department (ED), their use, their immediate or potential usefulness, and their complications. MethodsIn this descriptive prospective study, we recorded every PVC placed in our ED during 1 week and assessed its appropriateness in terms of its use and potential usefulness. We then followed the patients transferred to medical wards to determine the duration of PVC maintenance and any complications. ResultsPVCs (n = 210) were placed for 34% (n = 207) of the 605 patients admitted to the ED during the study period. Of these PVCs, 27% (n = 52) were not used and 43% (n = 91) were considered ineffective. Follow-up covered 92 patients with PVCs transferred to medical wards. We recorded seven episodes of phlebitis (8%) and no infections, local or systemic. The mean duration of PVS maintenance in the medical wards was 40 h from insertion. Of the PVCs with complications, 43% were ineffective. The mean duration of maintenance of the PVCs that led to complications was 80 h, compared with 35 h for those without complications (p < 0.02). ConclusionIn accordance with the literature, half of the PVCs inserted in our ED were ineffective; half the PVCs causing complications were avoidable.

Experiences of peripheral IV insertion in hospital: a qualitative study.

Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure; however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients' experiences of PVC insertion. Some 10 participants were purposively sampled for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter; technique of device insertion; competence of the inserter; and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences; siting the PVC in locations other than the antecubital fossa and hand; ensuring experienced and confident inserters are available to insert PVCs.

Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review.

Short-term peripheral venous catheters (PVCs) are commonly used in healthcare settings. To determine the magnitude of bloodstream infections (BSIs) related to their use, PubMed, article bibliographies, and the authors' library were searched for pertinent articles. The incidence of PVC-related BSIs was 0.18% among 85063 PVCs. Short-term PVCs accounted for a mean of 6.3% and 23% of nosocomial BSIs and nosocomial catheter-related BSIs, respectively. Prolonged dwell time and catheter insertion under emergent conditions increased risk of PVC-related bloodstream infection (PVCR-BSI). If approximately 200 million PVCs are successfully inserted into adult patients each year in the United States, there may be many PVCR-BSIs occurring yearly. Clinicians should obtain blood cultures in patients with evidence of PVC infection and systemic symptomatology such as fever, carefully inspect the PVC insertion site in bacteremic or fungemic patients, and remove PVCs associated with localized infection with or without associated BSI.

Assessing nursing students' knowledge and skills in performing venepuncture and inserting peripheral venous catheters.

Venepuncture and the insertion of peripheral venous catheters are common tasks in health care, and training in these procedures is included in nursing programmes. Evidence of nursing students' knowledge and skills in these procedures is limited. The main aim of this study was to assess nursing students' knowledge and skills when performing venepuncture and inserting peripheral venous catheters. Potential associations between level of knowledge and skills, self-training, self-efficacy, and demographic characteristics were also investigated. The assessment was performed by lecturers at a university college in Sweden using the two previously tested instruments "Assess Venepuncture" and "Assess Peripheral Venous Catheter Insertion". Between 81% and 100% of steps were carried out correctly by the students. The step with the highest rating was "Uses gloves", and lowest rating was 'Informs the patients about the possibility of obtaining local anaesthesia'. Significant correlations between degree of self-training and correct performance were found in the group of students who registered their self-training. No associations between demographic characteristics and correct performances were found. Assessing that students have achieved adequate levels of knowledge and skills in these procedures at different levels of the nursing education is of importance to prevent complications and support patient safety.

Peripheral venous catheter insertion simulation training: A randomized controlled trial comparing performance after instructor-led teaching versus peer-assisted learning

IntroductionPeripheral venous catheter insertion is a procedural skill that every medical student should master. Training is often limited to a small number of students and is poorly evaluated. The objective of this study was to evaluate the performance of peer-assisted learning in comparison to instructor-led teaching for peripheral venous catheter insertion training. MethodsStudents were randomized to the control group attending a traditional instructor-led training session (slideshow and demonstration by an anesthetist instructor, followed by training on a procedural simulator) or to the test group attending a peer-assisted training session (slideshow and demonstration video-recorded by the same instructor, followed by training on a procedural simulator). The primary endpoint was the performance of peripheral venous catheter insertion, assessed on procedural simulator one week later by blinded experts using a standardized 20-item grid. Students self-evaluated their confidence levels using a numeric 10-point scale. ResultsEighty-six students were included, 73 of whom attended the assessment session. The median performance score was 12/20 [8–15] in the instructor-led teaching group versus 13/20 [11–15] in the peer-assisted learning group (P=0.430). Confidence levels improved significantly after the assessment session and were significantly higher in the peer-assisted learning group (7.6/10 [7.0–8.0] versus 7.0/10 [5.0–8.0], P=0.026). ConclusionPeer-assisted learning is effective for peripheral venous catheter insertion training and can be as effective as instructor-led teaching. Given the large number of students to train, this finding is important for optimizing the cost-effectiveness of peripheral venous catheter insertion training.

Optimising peripheral venous catheter usage in the general inpatient ward: a prospective observational study.

To evaluate current practices in managing peripheral venous catheters through catheter lifespan, reasons for removal and identifying potential predictors of catheter complications. Peripheral venous catheter insertion is a common minimally invasive procedure performed during patient admission. Current routine replacement of catheters may not be required in the light of recent evidence. A prospective observational study was carried out in April 2013. One hundred patients were selected by systematic sampling. Ward nurses with support from three research nurses collected data for two weeks, ceasing earlier if patient no longer required venous catheters, was discharged, passed on or was transferred to a nongeneral ward setting. Analysis for potential predictors was carried out using random-effects model. A total of 218 catheters were sampled, with a median catheter lifespan of 2·0days. Half the catheters were removed because of complications with only 13 catheter removals due to phlebitis (grade 1+) in the first three days. Percentage of catheters removed due to complications also decreased as indwelling time increased. Twenty-three catheters (8·3%) could also have been saved as they were rendered 'not required/discharge' on day 1. Only insertion on the outer forearm was found to be associated with the likelihood of developing venous catheter complications. Phlebitis rates in our setting are comparable to other published studies with all phlebitis cases occurring before the third day. The median catheter lifespan of two days is shorter than routine three-day replacement, which warrants an urgent review of current insertion and maintenance practices in our local setting. Changing practice from routine replacement to clinically indicated has benefits to nurses and patients in terms of manpower time and costs. However, an effort to maximise peripheral catheter lifespan is necessary through daily vigilant catheter care and regular audits of practices.

Non-dominant hand quicker to insert peripheral venous catheters under echographic guidance: A randomised trial

BackgroundUltrasound guidance for venous catheter placement requires the use of both hands. An accurate and stable ultrasound image is fundamental for obtaining good quality images, consequently permitting accurate needle placement. We hypothesized that the dominant hand could be used to perform echography, leaving the non-dominant hand available for peripheral venous catheter (PVC) insertion. MethodsProspective, open-label, randomized, crossover study. Group 1 inserted the PVC with the dominant hand, and held the probe with the non-dominant hand in a first series of 20 insertions, and vice versa in a second series of 20 insertions performed 11days later. Group 2 punctured with the non-dominant hand in Series 1 and vice versa in series 2. The study population comprised female student nurses (aged 20–30years) who had learned neither ultrasound techniques nor catheter insertion. The primary endpoint was time to successful puncture. We recorded age, sex, video game use, and the laterality of hands, feet and eyes. ResultsOne left-handed and nine right-handed nurses were randomized to each group. Puncture by the non-dominant hand was significantly quicker in both series (P<0.001). There was no difference between groups for time to successful puncture with the dominant hand; however a significant difference was found for the non-dominant hand (P<0.01). According to multivariate analysis, the time to successful puncture was significantly lower when the non-dominant hand was used to puncture (adjusted difference 5.6s, P<0.0001). ConclusionUsing the dominant hand to hold the ultrasound probe and the non-dominant hand to puncture and insert the catheter achieves successful insertion in a significantly shorter time.

Upper extremity deep vein thrombosis - The venous thromboembolism Cinderella?

When referring to venous thromboembolism (VTE), one tends to think of lower limb deep vein thrombosis (DVT) and pulmonary embolism (PE). A rarer and poorly understood form of DVT occurs in the upper extremity (UEDVT). With UEDVT being a cause of significant morbidity and mortality and its prevalence said to be increasing at a concerning rate, should the scientific community be paying more attention to the VTE Cinderella? Historically rare with an annual incidence of 2 per 100,000 persons, the medical inpatients and thrombosis study reports UEDVT to now complicate approximately 14 per 100,000 hospital admissions. Whether this is a true representation of the changing epidemiology of UEDVT is unclear due to the study’s low statistical power. What we can be certain of, however, is that secondary UEDVT is becoming increasingly prevalent, which cannot be ignored. UEDVT is classified as primary (namely idiopathic, Paget-Schroetter syndrome or thoracic outlet obstruction secondary to a first rib) or, more frequently, secondary to central and peripheral venous catheter insertion, pacemaker insertion or malignancy. Anatomically, UEDVT most commonly involves the subclavian (18–67%) or axillary (5–25%) vein. Unlike previously reported, UEDVT is far from being a benign self-limiting condition. Post-thrombotic syndrome (PTS) complicates up to 44% of UEDVT, with patients suffering ipsilateral upper limb swelling, pain and, in severe cases, ulceration. Symptomatic PE occurs in up to 33% of patients, and UEDVT recurs in as many as 8% of patients per year. Despite the reduction in patients’ quality of life through loss of work productivity and symptom chronicity, UEDVT has generated relatively little research attention. Reference to UEDVT is sparse in current VTE guidelines. Likewise, a pre-test clinical probability algorithm combining symptoms, diagnostic biochemical markers and imaging is lacking. The National Institute of Health and Care Excellence makes no reference to UEDVT in their VTE guidelines and quality standards. The British Journal of Haematology (BJH) and the American College of Chest Physicians (ACCP) however have. This in part may reflect the lack of robust evidence in the form of randomised controlled trials to base recommendations upon. Although, surely any attempt to standardise clinical practice and promote patient safety is better than none? The ACCP advocate the use of compression ultrasound for the initial investigation of UEDVT. In cases where a high index of clinical suspicion for UEDVT remains despite a negative ultrasound scan, contrast venography is recommended. The BJH, on the other hand, states no preference regarding which of the two imaging modalities is used. This is despite compression ultrasound and contrast venography differing in terms of patient safety and accessibility, with the former being non-invasive and inexpensive. The discrepancy in recommendation may reflect the contrasting level of supporting evidence used, with the BJH ascribing it as level 1B evidence compared to 2C evidence used by the ACCP. Given that both guidelines were published in the same year, one would assume that both societies had access to the same available data. We are therefore left with the uncertainty of whether the difference in specificity and sensitivity of compression ultrasound and venography is of any clinical significance in diagnosing UEDVT. The paucity of high-quality randomised controlled trials also hinders the management of UEDVT. Anticoagulation, whether it is heparin of a non-specified form or fondaparinux, followed by warfarin, is the preferred treatment. Duration of anticoagulation is arbitrary with the BJH stating no optimal duration, and the ACCP stating it to be aetiology dependent (continuation of anticoagulation for as long as the central venous catheter remains in situ, otherwise

Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study

Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.

Epidemiology of painful procedures performed in neonates: A systematic review of observational studies.

Procedural pain in neonates has been a concern in the last two decades. The purpose of this review was to provide a critical appraisal and a synthesis of the published epidemiological studies about procedural pain in neonates admitted to intensive care units. The aims were to determine the frequency of painful procedures and pain management interventions as well as to identify their predictors. Academic Search, CINAHL, LILACS, Medic Latina, MEDLINE and SciELO databases were searched for observational studies on procedural pain in neonates admitted to intensive care units. Studies in which neonatal data could not be extracted from the paediatric population were excluded. Eighteen studies were included in the review. Six studies with the same study duration, the first 14days of the neonate life or admission in the unit of care, identified 6832 to 42,413 invasive procedures, with an average of 7.5-17.3 per neonate per day. The most frequent procedures were heel lance, suctioning, venepuncture and insertion of peripheral venous catheter. Pharmacological and nonpharmacological approaches were inconsistently applied. Predictors of the frequency of procedures and analgesic use included the neonate's clinical condition, day of unit stay, type of procedure, parental presence and pain assessment. The existence of pain protocols was not a predictor of analgesia. Painful procedures were performed frequently and often with inadequate pain management. Unlike neonate clinical factors, organizational factors may be modified to promote a context of care more favourable to pain management.

Peripheral venous catheter in cardiology: root cause analysis of an adverse event during patient transport in radiology

The insertion of peripheral venous catheter (PVC) is a basic and trivialized act of nursing with significant associated infection risks. There are few publications about PVC complications compared to those of central lines and the root causes of such events are not well known. In 2014, a survey was conducted to measure the frequency of complications associated with PVC insertions and manipulations.

Reducing the Incidence of Phlebitis Related to Intravenous Injection in Pediatric Patients

Peripheral venous catheter (PVC) is commonly used to provide nutrition and medicine to pediatric inpatients. Phlebitis is a common side effect of PVC insertion. Over 90% of pediatric patients in the paedi-atric medical ward at the Chang Gung Memorial Hospital (CGMH) receive PVC insertion, with an incident rate of phlebitis of 5.07%. Common cause factors of phlebitis are: insufficient sterilization time, inappropriate methods used to fix the PVC, the use of fixtures that loosen easily, high re-fix rates, and inadequate wound care after catheter removal. The purpose of this project was to reduce the incidence rate of PVC-insertion-related phlebitis in children from 5.07% to 2.5%. A one-week clinical observation identified the re-inserting / re-fixing of existing PVCs as the principal cause of phlebitis in the CGMH paediatric ward. Therefore, the researchers modified the catheter care bundle based on a review of the literature and the suggestions of clinical pediatric experts. Modifications included applying 2% chlorhexidine to sterilize the insertion site; using a new, non-woven fabric splint to fix the PVC site; providing cartoon-themed waterproof dressings for the first bath after the removal of the PVC; and setting standard operating procedures (SOPs) for PVC insertion and catheter removal. After applying these modifications, the incident rate of phlebitis in children with PVC insertions decreased from 5.07% to 2.08%. The application of 2% chlorhexidine reduces the waiting time for sterilization; the purpose-designed splint strengthens the fixation of the PVC; and the development of the SOPs for PVC insertion and post-removal catheter care reduces the risk of phlebitis. The combination of these strategies effectively reduces the incidence of phlebitis and improves the nursing care quality.

Sodium hypochlorite in antisepsis of children’s and new-born babies’ skin prior to insertion of peripheral venous catheter

Antisepsis of the skin of children to whom a peripheral venous catheter (PVC) is to be attached is an important factor in reducing catheter related infections. No data are available on the effectiveness of sodium hypochlorite. Explorative study of children and new-born babies treated in hospital to ascertain bacterial contamination levels of PVC tips as surrogate infection indicator. In a sample of 51 children and 52 new-born babies, catheter tips were found contaminated for 7.8% of the children and 3.8% of the new-born babies. The positive results of this pilot study suggest that serious consideration should be given to assessing Amukine Med 0.05% for use with PVCs.

Use of sodium hypochlorite for skin antisepsis before inserting a peripheral venous catheter: a pilot study.

Although it can be prevented, catheter-related bacteremia is common and dangerous. The antiseptics most widely used during insertion of peripheral venous catheters (PVCs) include povidone iodine, alcohol, and chlorhexidine. Another widely used antiseptic is a solution of 0.057 g sodium hypochlorite. This pilot study explored the contamination rate of the PVC tip inserted after skin decontamination with sodium hypochlorite. Culture analysis of the tips of the PVCs inserted into the 42 participants showed 7 (16.7%) colonized catheters. The results of this pilot study suggest taking into serious consideration the assessment of this antiseptic in randomized experimental studies.

Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies

There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010. In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.

Improving patient safety during insertion of peripheral venous catheters: an observational intervention study.

Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test). Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after). Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68.6% when three of five steps were done; p<0.001). The intervention was described as helpful by 46.8% of the participants, as neutral by 46.8%, and as disruptive by 6.4%.Conclusions: A multimodal strategy to improve both compliance with safety steps for peripheral venous catheter insertion and performance of an optimum procedure was effective and was regarded helpful by healthcare workers.

Development of Instruments for Assessment of Knowledge and Skills in Performing Venepuncture and Inserting Peripheral Venous Catheters

Performing venepuncture is one of the most routinely performed invasive procedures in nursing care. The aim of this study was to develop instruments for the assessment of nursing students' knowledge and skills when performing venepuncture and inserting a peripheral venous catheter. Two instruments were developed using the following steps. 1) Assessment items of importance for the procedures (venepuncture 48 items and peripheral venous catheter 51 items) were collected from focus groups including nurses, lecturers and patients. 2) The number of items was reduced using a method based on the Delphi method. Experts (n=51) reviewed the instruments in two rounds. The revised versions included 31 items for venepuncture and 33 items for peripheral venous catheter insertion. 3) Usability tests were conducted by nurses who tested the instruments to confirm that items were possible to assess. 4) Inter-rater reliability was assessed by twelve lecturers who in pairs, but independently of each other, used the instruments to assess 50 nursing students. Proportion of agreement and Cohen's kappa coefficient were calculated for each item to determine inter-rater reliability. Among the tested items for both instruments, the median proportion of agreement was 1 (range 0.66-1) and the median kappa was 0.52 (range 0.22-1). The instruments developed for assessing nursing students' knowledge and skills of venepuncture and peripheral venous catheter insertion showed satisfactory inter-rater reliability.

Accuracy in documentation of peripheral venous catheters in paediatric care: an intervention study in electronic patient records

The aim of this study is to compare the accuracy and completeness in the recording of peripheral venous catheters before and after implementing a template in the electronic patient record in paediatric care. As a basis for quality improvement and research purposes and to ensure patient safety, accurate clinical data need to be easily accessible in patient records. Several studies have concluded that the relation between performed care and what is documented in patient records is poor. Before and after study. The study took place at a large paediatric university hospital in Sweden. Inclusion criteria were patients who were admitted to one of the included wards, had one or several peripheral venous catheters and were available at the ward at the time for data collection. Data were collected by observations and record audits before and then four and 10 months after the introduction of a template for recording peripheral venous catheters in a structured and standardised way. A significant increase in peripheral venous catheters with complete recording was observed after as compared with before the intervention. The percentage of peripheral venous catheters with recording of any kind was relatively stable (85-93%). The overall recording of peripheral venous catheters insertion did not improve, but there was an increase in the recording of side and size after the intervention. One of the 22 complications observed before the intervention was documented and none of the complications (n = 17 and n = 9) after. The electronic patient record did not provide accurate data on peripheral venous catheters in paediatric care neither before nor after the intervention. Further efforts to increase the documentation of catheter-related complications are needed. Integrated decision support systems in electronic patient records that remind nurses to inspect peripheral venous catheters regularly could be one solution.

Comparison of alcohol, povidone-iodine and octenidine dihydrochloride as skin disinfectants to reduce bacterial count prior to peripheral venous catheter insertions in newborn infants

AbstractBackground Vascular access may increase the risk of bloodstream infections, especially in newborn infants with weak immune systems and requiring invasive supportive care. Skin disinfection prior to peripheral venous catheter insertion lowers the risk of infection. However, antiseptics chosen for this task should be effective and safe for newborn infants.Objective To compare the effectiveness of 70% alcohol (BD alcohol swabs ®), 10% povidone-iodine (Pharma-RSUPNCM), and octenidine (Octenisept ®) as antiseptics for reducing skin bacteria for pre-invasive procedures in neonates.Methods Infants aged less than 28 days, regardless of gestational age, at the Neonatal Unit of Cipto Mangunkusumo Hospital (RSUPNCM) were included in our study. Infants were divided into three groups, each tested with different skin antiseptics (alcohol, povidone-iodine or octenidine). Skin swabs were performed before and after application of skin antiseptic, followed by inoculation onto blood agar plates. Colony-forming units were counted after 18 hours of incubation at 37ºC.Results Ninety subjects were divided into 3 groups of 30, each group using either 70% alcohol swabs, 10% povidone-iodine, or octenidine as skin antiseptic. Skin swabs were taken before and after antiseptic application and drying, as well as 5 minutes after application. The mean reductions in CFU/cm2 (%) after antiseptic application (and fully dried) were 97.54% for povidone-iodine, 97.52% for octenidine, and 89.07% for alcohol. There were no significant differences in mean CFU reductions among the three antiseptics groups (P=0.299). Furthermore, 5 minutes after application, there were still no significant differences in the three antiseptic groups (P=0.289).Conclusions Although octenidine showed a significant bacterial count reduction after application, it was not significantly different from those of alcohol or povidone-iodine. [Paediatr Indones. 2011;51:277-81].

Phlebitis due to the insertion of peripheral venous catheters: issues relevant to nursing care

ABSTRACTObjective: to contribute to the reflection on the mechanisms leading to phlebitis as a complication of intravenous therapy. Methodology: this is about an update paper, which presents the epidemiology, predisposing factors, preventive measures and evaluation methods of phlebitis due to insertion of peripheral venous catheter, in order to subsidize the nursing plan. Results: the phenomenon of phlebitis is quite prevalent in hospitalized patients, related to multiple factors such as hyperosmolarity and pH of the solution infused, type of device used venous and nursing care with regard to the procedure of venipuncture and venous access. It is important for nurses to learn the tools to diagnose phlebitis, identifying signs and symptoms of inflammation, thus being able to intervene according to the degree shown, preventing the occurrence of phlebosclerosis. Conclusion: knowing the types of phlebitis and, consequently, their risk factors helps the nurse to have a better basis for decision making regarding the construction of specific protocols aimed at preventing this complication. Descriptors: phlebitis; catheterization, peripheral; nursing care.RESUMOObjetivo: informar aos leitores sobre os mecanismos que conduzem à flebite enquanto complicação da terapia intravenosa. Metodologia: artigo de atualização, o qual apresenta os aspectos epidemiológicos, fatores predisponentes, medidas preventivas e métodos de avaliação da flebite decorrente de inserção de cateter venoso periférico, com vistas a subsidiar as condutas de enfermagem. Resultados: a flebite consiste em fenômeno bastante prevalente em pacientes hospitalizados, relacionado a múltiplos fatores, tais como hiperosmolaridade e ph da solução infundida, tipo de dispositivo venoso utilizado e o cuidado de enfermagem no que se refere ao procedimento de venopunção e manutenção do acesso venoso. É fundamental que o enfermeiro conheça os métodos disponíveis para diagnosticar a flebite, identificando sinais e sintomas flogísticos, podendo assim intervir de acordo com o grau evidenciado, prevenindo a ocorrência de fleboesclerose. Conclusão: conhecer os tipos de flebite e, consequentemente, seus fatores de risco contribui para que o enfermeiro tenha melhor embasamento para a tomada de decisão no que concerne à construção de protocolos específicos visando à prevenção desta complicação. Descritores: flebite; cateterismo venoso periférico; cuidados de enfermagem.RESUMENObjetivo: contribuir a la discusión de los mecanismos que conducen a la flebitis como complicación de la terapia intravenosa. Metodología: documento de actualización, que presenta la epidemiología, factores predisponentes, las medidas preventivas y métodos de evaluación de flebitis debido a la inserción de catéter venoso periférico, con el fin de subsidiar el plan de enfermería. Resultados: el fenómeno de la flebitis es muy frecuente en pacientes hospitalizados, relacionado con múltiples factores tales como hiperosmolaridad y el pH de la solución infundida, el tipo de dispositivo utilizado atención venosa y de enfermería en relación con el procedimiento de punción venosa y el acceso venoso. Es importante para las enfermeras aprender las herramientas para disgnosticar la flebitis, la identificación de signos y síntomas de inflmación, con lo que haya podido intervenir en función del grado se muestra, evitando la aparición de phlebosclerosis. Conclusión: conocer los tipos de flebitis y, en consecuencia, sus factores de riesgo ayuda a la enfermera para tener una mejor base para la toma de decisiones respecto a la construcción de protocolos específicos para prevenir esta complicación. Descriptores: flebitis; cateterismo periférico; atención de enfermería.