Short Peripheral Catheters Research Articles

Exploring the causes of peripheral intravenous catheter failure based on shape of catheters removed from various insertion sites.

The risk of peripheral intravenous catheter failure varies according to the insertion site. This study examined catheter shape just after removal to evaluate the causes of catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the catheter insertion site before catheter removal and clinical images of the removed catheters. We analyzed 184 catheters from 142 participants. There were no significant differences in the catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the catheter was present in 9.2% of cases; the median bend angle at the catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of catheters inserted in the upper arm was significantly greater than of catheters in the forearm (p = 0.013). Catheter curvature was related to catheter failure (14.8% of failed catheters had curvature; p = 0.035) and occlusion (35.3% of occluded catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed catheters than for surviving catheters. To prevent catheter failure, especially occlusion resulting from catheter curvature, a catheter should be inserted at an appropriate insertion site far from the antecubital fossa.

Maintaining Short Peripheral Catheter Patency: A Comparison of Saline Lock Versus Continuous Infusion in the Acute Care Setting.

Sparse evidence exists about how short peripheral catheter (SPC) duration is affected by the presence of a saline lock versus continually infusing fluids. Often the choice to lock an SPC with saline is based on provider preference, rather than available evidence or patient-centered factors. This study compared the duration of 85 SPCs: locked with saline versus continuously running fluids. A secondary analysis considered the influence of a number of intermittent medications and flushes. Although the saline-locked group had a slightly longer duration time, it was not statistically significant. Factors such as desire to ambulate or nighttime saline flushes merit consideration in SPC care decisions and standardized nurse-driven protocols.

Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide.

Peripheral intravenous catheter (PIVC) use in health care is common worldwide. Failure of PIVCs is also common, resulting in premature removal and replacement. To investigate the characteristics, management practices, and outcomes of PIVCs internationally. Cross-sectional study. Hospitalized patients from rural, regional, and metropolitan areas internationally. Hospital, device, and inserter characteristics were collected along with assessment of the catheter insertion site. PIVC use in different geographic regions was compared. We reviewed 40,620 PIVCs in 51 countries. PIVCs were used primarily for intravenous medication (n = 28,571, 70%) and predominantly inserted in general wards (n = 22,167, 55%). Two-thirds of all devices were placed in non-recommended sites such as the hand, wrist, or antecubital veins. Nurses inserted most PIVCs (n = 28,575, 71%); although there was wide regional variation (26% to 97%). The prevalence of iIn this study, we found that many PIVCs were placed in areas of flexion, were symptomatic or idle, had suboptimal dressings, or lacked adequate documentation. This suggests inconsistency between recommended management guidelines for PIVCs and current practice.dle PIVCs was 14% (n = 5,796). Overall, 10% (n = 4,204) of PIVCs were painful to the patient or otherwise symptomatic of phlebitis; a further 10% (n = 3,879) had signs of PIVC malfunction; and 21% of PIVC dressings were suboptimal (n = 8,507). Over one-third of PIVCs (n = 14,787, 36%) had no documented daily site assessment and half (n = 19,768, 49%) had no documented date and time of insertion. In this study, we found that many PIVCs were placed in areas of flexion, were symptomatic or idle, had suboptimal dressings, or lacked adequate documentation. This suggests inconsistency between recommended management guidelines for PIVCs and current practice.

Routine Versus Clinically Indicated Short Peripheral Catheter Replacement: An Evidence-based Practice Project.

Despite current, high-quality, level 1 evidence that supports clinically indicated short peripheral catheter (SPC) replacement, the current practice in the health care system studied was to change SPCs routinely every 96 hours. A before-and-after design was used to evaluate the impact of SPC replacement when clinically indicated. Following the practice change, there were no SPC-related infections, monthly phlebitis rates ranged from 1.9% to 3.5%, and SPC use decreased by 14.2%, resulting in estimated cost savings of $2100 and 70 hours of nursing time saved. The translation of evidence on timing of SPC replacement into practice was a success.

A Randomized Controlled Study to Evaluate the Effectiveness of 2 Treatment Methods in Reducing Incidence of Short Peripheral Catheter-Related Phlebitis

Short peripheral catheter (SPC)-related phlebitis can lead to bloodstream infections and affect patients' quality of life. A randomized trial was carried out to evaluate the effectiveness of 2 treatment methods in reducing the incidence of SPC-related phlebitis. The 2 treatment methods differed in terms of the cleansing solution used before insertion and dressing material used after removal. The results demonstrated that the type of cleansing solution and postremoval dressing material did not make a difference in the incidence of phlebitis. Strict adherence to aseptic techniques and prompt removal of the SPC remained the cornerstone in the prevention of phlebitis.

Effect of the PIVO Device on the Procedure of Phlebotomy from Peripheral IV Catheters.

Short peripheral catheters (SPC) are an existing conduit into many patients' veins and line draws from SPC are a desired method of routine blood collection especially in difficult venous access patients. The PIVO device facilitates blood collection through SPC and is being used clinically in a number of hospitals. This study aimed to determine the appropriate wait time following a flush and the minimum waste volume required to obtain an undiluted blood sample when using the PIVO device and how that differed from current guidelines from SPC line draws. A clinical study was conducted examining the analyte results of samples drawn with PIVO through a SPC at varying wait times following a saline flush. Both an initial waste volume and a postwaste sample were compared to a venipuncture control. The resulting samples showed no saline dilution as measured by sodium and creatinine results at all studied wait times. These findings suggest that blood collections using the PIVO device can produce a clinically valid sample with a 30-second wait following a SPC flush and no waste volume prior to sample collection.

Characteristics of Observations and Procedures Followed by Expert Nurses for the Selection of the Intravenous Insertion Site for a Short Peripheral Catheter

Characteristics of Observations and Procedures Followed by Expert Nurses for the Selection of the Intravenous Insertion Site for a Short Peripheral Catheter

Project HANDS: A Bundled Approach to Increase Short Peripheral Catheter Dwell Time.

Increasing short peripheral catheter (SPC) dwell time is becoming common practice. A number of variables lead to unscheduled restarts and significant complications with SPCs. Preventing complications is important to patient outcomes as dwell time increases. This quality improvement project compared the use of a manufactured securement device versus tape and transparent occlusive dressing while instituting a standardized insertion and care bundle with a 96-hour dwell time. Major findings included no statistically significant difference in restart rates in SPCs secured with a device compared with those secured with tape and transparent occlusive dressing (P = .06). These results differ from other published studies and may be due to the traditional nature of the hospital's infusion team and patients' average length of stay.

Is Thrombus With Subcutaneous Edema Detected by Ultrasonography Related to Short Peripheral Catheter Failure? A Prospective Observational Study

Short peripheral catheter (SPC) failure is an important clinical problem. The purpose of this study was to clarify the relationship between SPC failure and etiologies such as thrombus, subcutaneous edema, and catheter dislodgment using ultrasonography and to explore the risk factors associated with the etiologies. Two hundred catheters that were in use for infusion, excluding chemotherapy, were observed. Risk factors were examined by logistic regression analysis. Sixty catheters were removed as the result of SPC failure. Frequency of thrombus with subcutaneous edema in SPC failure cases was significantly greater than in those cases where therapy was completed without complications (P < .01). Multivariate analysis demonstrated that 2 or more insertion attempts were significantly associated with thrombus with subcutaneous edema. Results suggest that subsurface skin assessment for catheterization could prevent SPC failure.

A Simulation-Based Blended Curriculum for Short Peripheral Intravenous Catheter Insertion: An Industry-Practice Collaboration.

Despite peripheral intravenous catheter (PIVC) insertion being a commonly performed skill, practicing nurses may receive little substantive education, training, or opportunities to practice this skill at a competent level. This article describes a collaboration between private industry and a hospital to modify, implement, and evaluate a simulation-based blended PIVC insertion continuing education program for staff nurses. Included is an overview of the practical and theoretical rationale for the initial development of the curriculum to address an identified PIVC insertion education gap, the collaborative modification and implementation of the program, and an evaluation of the program. The curriculum combined self-paced e-learning and classroom-based deliberate practice with simulation tools of varying fidelity in a peer-to-peer learning environment. Given the mutual challenges of resource allocation in industry training and clinical nursing education departments, interprofessional partnerships may be an effective option for sharing instructional knowledge and resources to promote innovation and improve patient care. J Contin Educ Nurs. 2017;48(9):397-406.

Removal of Peripheral Intravenous Catheters Due to Catheter Failures Among Adult Patients.

This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.

Extending Short Peripheral Catheter Dwell Time: A Best Practice Discussion.

Complications involving short peripheral catheters (SPCs) can significantly affect health care costs, patient quality of life, morbidity, mortality, and treatment expense, especially when the hospital stay is lengthened. This article examines the relationship between SPC dwell time and the incidence of phlebitis and potential bacteremia. The literature is replete with most studies supporting SPCs remaining in situ until a clinical reason warrants catheter removal. Removing and not routinely restarting unneccessary intravenous catheters can help prevent catheter-related infections and other vascular complications and reduce cost.

Impact of Ultrasound on Short Peripheral Intravenous Catheter Placement on Vein Thrombosis Risk.

Approximately 90% of hospitalized patients have a short peripheral intravenous catheter (SPC) placed. Methods of inserting the catheter have evolved over time and now include the use of ultrasound (US)-guided procedures for placement. Little is known about the impact that US-guided procedures have on the vein. This study compared the rate of venous thrombosis in patients with and without US-guided catheter placement. This prospective, single-blind, observational study assessed for venous thrombosis in 153 veins from 135 patients. Veins were evaluated by a research nurse blinded to the method of placement between 48 and 72 hours after the SPC was placed. The Fisher exact test showed a significant difference between vessel compressibility and catheter insertion method (P = .0012). The proportion of noncompressible veins was significantly greater when US was used in comparison with freehand SPC insertion. The Mantel-Haenszel chi-square value of 10.34 (P = .0013) showed that US insertion technique is associated with a higher likelihood of noncompressible veins. This pilot study provides compelling evidence that the use of US to assist with catheter placement is associated with a higher rate of noncompressible veins at day 2 or 3. Further studies are needed with a larger sample to determine the generalizability of the results from this pilot study.

A Novel Needle-Free Blood Draw Device for Sample Collection From Short Peripheral Catheters.

A new US Food and Drug Administration-cleared needleless blood collection device (PIVO; Velano Vascular, San Francisco, CA) for short peripheral catheters was compared with conventional venipuncture for collecting blood samples for routine laboratory analysis from adult healthy volunteers. The PIVO device was comparable with venipuncture in terms of providing high-integrity samples (no hemolysis or clotting), equivalent laboratory values, and better patient experience as assessed by pain scores. Further studies to assess the overall utility of the PIVO device are warranted.

Impact of Ultrasound on Short Peripheral Intravenous Catheter Placement on Vein Thrombosis Risk.

Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy.

Mechanical Compression Effects on the Secretion of vWF and IL-8 by Cultured Human Vein Endothelium.

Short peripheral catheters are ubiquitous in today's healthcare environment enabling effective delivery of fluids and medications directly into a patient's vasculature. However, complications related to their use, such as short peripheral catheter thrombophlebitis (SPCT), affect up to 80% of hospitalized patients. While indwelling within the vein, the catheters exert prolonged constant pressure upon the endothelium which can trigger inflammation processes. We have developed and studied an in-vitro model of cultured endothelial cells subjected to mechanical compression of modular self-designed weights, and explored their inflammatory response by quantification of two key biomarkers- vWF and IL-8. Evaluation was performed by ELISA immunoassay and processing of vWF-labeled immunofluorescence images. We found that application of weights correspond to 272 Pa yielded increased release of vWF and IL-8 up to 150% and 250% respectively, comparing to the exertion of 136 Pa. Analyses of the immunofluorescence images revealed significantly longer and more extracellular vWF-strings as well as higher intensity stained-pixels in cells exposed to elevated pressures. The release of both factors found to be significantly dependent on the extent of the exerted pressure. The research shed a light on the relationship between induced mechanical compression and the pathogenesis of SPCT. Minimizing, let alone eliminating the contact between the catheter and the vein wall will mitigate the pressure acting on the endothelium, thereby reducing the secretion of inflammatory factors and lessen the incidence of SPCT.

Survey of Techniques to Induce Vasodilation Performed by Clinical Nurses During Short Peripheral Catheter Placement

Survey of Techniques to Induce Vasodilation Performed by Clinical Nurses During Short Peripheral Catheter Placement

Development and Testing of a Short Peripheral Intravenous Catheter Insertion Skills Checklist

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.

Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit

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.

The Expansion of a Nurse-led Peripherally Inserted Central Catheter (PICC) Team to a Vascular Resource Team to Insert Peripheral Intravenous Catheters

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.