Short Peripheral Catheters Research Articles

Deployment of a Time of Catheters: Experience Report

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Peripheral Vascular Catheter Research: A Scoping Review

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Using High Flow Flushing Technique (HFFT) as Initial Intervention for Malpositioned Peripherally Inserted Central Catheters (PICC's) in the Adult Population

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Vascular Access Strategies in Intensive Care Units: Antimicrobial + Power Injectable Devices

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Protecting the Vessels- Options for the Cystic Fibrosis Patient

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Training and Implementation of PICC Team of the Hospital sãrio Libanãas - 2011

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Achieving Hemostasis Post Insertion of a Peripherally Inserted Central Catheter

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Quantitative T2 mapping for detection and quantification of thrombophlebitis in a rabbit model

Short peripheral catheter thrombophlebitis (SPCT), a sterile inflammation of the vein wall, is the most common complication associated with short peripheral catheters (SPCs) and affects up to 80% of hospitalized patients receiving IV therapy. Extensive research efforts have been devoted for improvement and optimization of the catheter material, but means for examination of any novel design are limited, inaccurate and require costly comprehensive pre-clinical and clinical trials. Therefore, there is a conclusive need for a reliable quantitative method for evaluation of SPCT, in particular for research purposes examining the thrombophlebitis-related symptoms of any novel catheter design. In this study, we developed for the first time a quantitative MRI based tool for evaluation of SPCT. The extent and severity of SPCT caused by two different commercially available SPCs with known predisposition for thrombophlebitis, were studied in a rabbit model. MRI analysis was consistent with the standardized pathology evaluation and showed remarkable difference in the percent of edema between the experimental groups. These differences were in line with previous studies and provide evidence that this type of analysis may be useful for future assessment of SPCT in vivo. As a non-invasive method, it may constitute a cost effective solution for examination of new catheters and other medical devices, thereby reducing the need for animal sacrifice.

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

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

Modelling catheter–vein biomechanical interactions during an intravenous procedure

A reliable intravenous (IV) access into the upper extremity veins requires the insertion of a temporary short peripheral catheter (SPC). This so common procedure is, however, associated with a risk of developing short peripheral catheter thrombophlebitis (SPCT) which causes distress and potentially prolongs patient hospitalization. We have developed and studied a biomechanical SPC–vein computational model during an IV procedure, and explored the biomechanical effects of repeated IV episodes on onset and reoccurrences of SPCT. The model was used to determine the effects of different insertion techniques as well as inter-patient biological variability on the catheter–vein wall contact pressures and wall deformations. We found that the maximal pressure exerted upon the vein wall was inhomogeneously distributed, and that the bending region was exposed to significantly greater pressures and deformations. The maximal exerted contact pressure on the inner vein's wall was 2938 Pa. The maximal extent of the SPC penetration into the vein wall reached 3.6 μm, which corresponds to approximately 100% of the average height of the inner layer, suggesting local squashing of endothelial cells at the contact site. The modelling describes a potential biomechanical damage pathway that can explain the reoccurrence of SPCT.

Flebitis asociada con accesos venosos periféricos en niños: revisión sistemática de la literatura

Objective: To carry out a systematic review of the literature on the occurrence of phlebitis related to short peripheral venous catheters in children. Methodology: We searched PubMed, Scopus and Scielo databases using venous catheter, infection, phlebitis and synonyms as free terms, no language restriction, in the last 10 years (since the CDC made its recommendations). Results: From an initial total of 1486 references, 9 measured the frequency of phlebitis and its relationship to the time of catheter placement. These studies were performed on heterogeneous

Intermittently delivered IV medication and pH: reevaluating the evidence.

The Infusion Nurses Society's Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor. In this narrative literature review, historical and current research was appraised and synthesized for pH of intermittently delivered intravenous medications and the development of infusion thrombophlebitis. On the basis of this review, the authors conclude and assert that pH alone is not an evidence-based indication for central line placement.

Recommendations for Improving Safety Practices With Short Peripheral Catheters

The short peripheral catheter (SPC) is the most common vascular access device used in the health care arena. That use is growing every year with approximately 330 million short peripheral catheters sold in the United States in 2012. The projected growth in the US population, along with an aging population and rising morbidity rates, will contribute to an increased need for vascular access devices and infusion therapy. 1,2

Biomechanical aspects of catheter-related thrombophlebitis

Short peripheral catheters (SPCs) are the most common intravenous devices used in medical practice. Short peripheral catheter thrombophlebitis (SPCT) is the most frequent complication associated with SPCs, causing discomfort and usually leading to removal of the catheter and insertion of a new one at a different site. The aim of this research was to explore whether biomechanical factors, in addition to biochemical factors, also play a role in the formation of thrombophlebitis. Hence, two of the biomechanical aspects of SPCT were investigated: the physical pressure load exerted by the SPC on the endothelial monolayer, and disturbances in the flow patterns due to the SPC. Endothelial activation was studied by subjecting human umbilical vein endothelial cells (HUVEC) to a weight load of SPC pieces and measuring the release profile of von-Willebrand Factor (vWF) over time, using ELISA. vWF release was chosen as the measure for endothelial activation since it was the major component of the Weibel-Palade Bodies (WPBs), which underwent exocytosis by endothelial cells during activation. Flow patterns were analyzed on a 3D computational fluid dynamics (CFD) model of a brachiocephalic vein with SPC. vWF release profiles were significantly higher in the HUVECs subjected to the load, indicating HUVEC activation. CFD simulations demonstrated a decrease in flow velocities along the catheter body, between the catheter and the vein, due to an enlarged boundary layer. Results indicate that the contact region between the SPC body and the vein wall can be partially responsible for SPCT development, and inflammatory and coagulatory processes initiated by stimulated endothelial cells may be amplified due to disturbed blood flow.

Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental cohort study

Data concerning the effectiveness of strategies implemented to reduce short peripheral vein catheter (PVC)-related adverse events are scarce. A quasiexperimental study (2004-2011) was conducted to evaluate an intervention to reduce peripheral vein phlebitis (PVP) and PVC-related bloodstream infections (BSIs). Bundle intervention consisted of health care worker education and training, withdrawal of unnecessary catheters, exchange catheter policy, withdrawal of catheters at early stages of PVP, use of scales as a measuring tool, and repeated period-prevalence surveillance of PVC adverse events on wards. A Poisson exponentially weighted moving average control chart was used to assess time series analysis. One thousand six hundred thirty-one patients with 2,325 short catheters inserted were prospectively followed. PVP decreased by 48% (12.1% [95% confidence interval (CI): 10.7-13.2] during the intervention period versus 23.3% [95% CI: 16.4-30.1] in preintervention period; P < .05), and no reduction of PVP measured as 1,000 catheter-days was noted (48.6 [95% CI: 46.1-51.2] vs 37.9 [95% CI: 24.5-51.4], P > .05). A significant incidence reduction in PVC-related BSIs and health care-acquired Staphylococcus aureus BSIs was also achieved. A comprehensive multifaceted hospital approach was successful in reducing PVC-related adverse effects. Poisson exponentially weighted moving average control chart fits well as time series using Poisson data when very few events are present.

Recommendations for Frequency of Assessment of the Short Peripheral Catheter Site

Gorski, Lisa A. MS, RN, CRNI®, HHCNS-BC, FAAN; Committee Chair; Hallock, Dora MSN, RN, OCN®, CRNI®, CHPN; Kuehn, Susan C. BSN, RN, NNP-BC; Morris, Phyllis MSN, RN, CRNI®; Russell, Jean M. BSN, RN, CRNI®; Skala, Lisa C. BSN, MSN, RN, CRNI®, VA-BC Author Information

Short Peripheral Intravenous Catheters and Infections

The rate of infections associated with short peripheral intravenous catheters is thought to be very low, even rare. Approximately 330 million peripheral catheters are sold annually in the United States. Although the rate may be low, the actual number of infections could be relatively high, with most going undetected because of short dwell times and early patient discharges. A recent estimate reported as many as 10000 Staphylococcus aureus bacteremias from peripheral catheters annually in the United States. This integrative literature review identified soft tissue, bone, and bloodstream infections. Analysis of 45 studies revealed significant knowledge gaps and inadequate clinical practices associated with one of the most common devices used in all health care settings.

Needlestick Injuries, Short Peripheral Catheters, and Health Care Worker Risks

Percutaneous exposure (PCE) and mucocutaneous exposure (MCE) to blood and blood-containing body fluids pose risks to health care workers worldwide. Although PCEs have been greatly reduced in the United States, they have not been eliminated and continue to be a significant problem worldwide. MCE seems to be a much smaller problem than PCE; however, the data are limited and confusing. Venipuncture procedures can easily be associated with PCE, but there are no published reports of MCE occurring during insertion, use, and removal of peripheral catheters. This integrative, systematic literature review identifies the risks associated with venipuncture and the insertion of short peripheral catheters.

Techniques for Hyaluronidase-Facilitated Subcutaneous Fluid Administration With Recombinant Human Hyaluronidase

Recombinant human hyaluronidase facilitates subcutaneous (SC) fluid delivery, but little is known about how various access sets influence ease of administration, technical challenges (TCs), or adverse events. This randomized, open-label, parallel-group trial was performed to assess the impact of catheter size (20- and 24-gauge short peripheral intravenous catheter, 27-gauge SC button), catheter material (Teflon, polyurethane), and securement method (transparent semipermeable membrane dressing [TSM], double chevron with cloth or plastic tape) on hyaluronidase-facilitated SC fluid delivery. Healthy volunteers (N = 100) were randomized to 1 of 9 access groups using a factorial design. To minimize variability, treatment was performed at a single center and standardized to 150 units of SC recombinant human hyaluronidase (HYLENEX, Baxter Healthcare Corporation) followed by 1000 mL of lactated Ringer's solution. The first attempt at needle insertion succeeded in 98% of subjects; the median time for first catheter placement was less than 1 minute. The median infusion time was 6.8 hours. Overall, the incidence of TCs observed (catheter kinking, dislodgment, or pullout or infusion pump alarm) was low and comparable across groups (16.7%-27.3%); however, catheter kinking, dislodgment, and pullout occurred only in groups using double- chevron securement. Infusion-site reactions (pain, 20%-75%; erythema, 17%-36%; swelling, 0%-33%) were the most common adverse events. Pain was less frequent in groups using the 27-gauge SC button (27%) or the 24-gauge catheter (20%-36%) than with the 20-gauge catheter (50%-75%). Hyaluronidase-facilitated SC fluid administration with recombinant human hyaluronidase was generally well tolerated and successfully implemented using a range of access sets. Technical challenges were not common but were further minimized with TSM securement. Infusion-site pain was mostly mild and least common with 24-gauge or smaller catheter/needles.

New Product Decisions - The Process and Outcome for a Community health system

PurposeTo compare patient outcomes and evaluate safety features and costs associated with a new catheter system and securement dressing. BackgroundThe need to improve dwell times for short peripheral catheters and reduce complication rates, along with improvements in clinical practice in radiology and enhanced staff safety were driving factors leading to a change in peripheral catheters and securement systems. Review of Relevant LiteratureSeveral reports of catheter stabilization devices have shown improved clinical outcomes with their use. Currently available studies on this new catheter system include one small evaluation and a randomized trial comparing a traditional round hub catheter coupled with a supplemental securement device and the new catheter system with an integrated stabilization platform combined with a securement dressing. Passive safety mechanisms on peripheral catheters may produce fewer needlestick injuries than mechanisms requiring the user to activate the device. MethodsAfter a learning period, the following seven months were designated the intervention period. Outcome data from the same seven-month period of the preceding year were used for comparison. The data were divided into scheduled and unscheduled restarts. Data from two hospitals are reported separately and in combination. Data from the two periods were analyzed for equivalence or noninferiority. ResultsClinical outcomes for both periods are virtually equivalent, demonstrating that one system is not inferior to the other regarding catheter complications. However the catheter system with the integrated stabilization platform was less costly and safer due to a passive safety mechanism. Problems with high pressure injection in the radiology department were also solved with the new catheter system. ConclusionsWhile any product change can be a challenging experience, we accomplished these changes in an orderly manner without negative impact on patient outcomes and reducing costs. Improvements in radiology were also attributed to these changes, along with enhanced staff safety. Implications for PracticeThe catheter designed with an integrated stabilization platform, apre-attached extension set, and apassive safety mechanism produced benefits for radiology staff without negatively affecting patient outcomes in other clinical areas. These product changes were implemented in an organized manner and involved all stakeholders in the process.