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Optical Infiltration Detection Through an Occlusive Dressing
this allows for continual assessment and provides opportunity for learning needs. Conclusions: At the time this paper was written the new component has found significant cases to learn and improve from.
Optical Infiltration Detection Through an Occlusive Dressing Jason Naramore, Garret Bonnema, Gregory Schears Infiltration is a common cause of IV failure. A device using visible and near-infrared light to sense changes in the optical properties of subcutaneous tissue consistent with IV infiltrations has been developed in order to aid in the early detection of infiltrations to help minimize patient harm. The placement of the device over an occlusive dressing allows the sensor to be positioned closer to the catheter tip for better detection sensitivity and so it can be used on existing IVs. An IRB-approved study measured the sensitivity of the device for detecting early stage infiltrations when placed either over or under an occlusive dressing. Twenty-four healthy adult volunteers received two peripheral IVs in either the back of the hand or the forearm. Subjects were randomly assigned either a textured or smooth occlusive dressing and the device was placed over the dressing. The catheter was placed immediately adjacent to the wall of a typical vein used for PIV therapy with the sensor placed next to the catheter. Each site was infiltrated with 10 mL of isotonic saline solution at 60 mL/hr. The device monitored the site and issued notifications if an infiltration was detected. The device issued a red notification in 23 of the 24 test sites (sensor was placed over the occlusive dressing). This corresponds to a sensitivity of 95.8% with a 95% confidence interval (78.9% to 99.9% range). These results compare to a sensitivity of 100% with a 95% confidence interval (85.75% to 100% range) for the control sites (sensor was placed under the occlusive dressing). This study used subcutaneous injection of isotonic saline as an experimental model of infiltration. The sensor placement over a dressing is limited to the optically clear areas of the dressing (no white mesh borders), due to the optical sensing technique used by the device. There is not a statistically significant sensitivity difference of the device when placed over or under the occlusive dressing.
Our Experience with Subcutaneously Anchored Sutureless Devices in Pediatric Patients Mauro Pittiruti, Davide Celentano Purpose: Subcutaneously anchored sutureless devices (SAS) (i.e. Securacath, Interrad Medical) have been recently introduced in our hospital for securement of central lines in neonates and children. Methods: We have used SAS for securement of tunneled central lines (both CICCs and PICCs) in neonates and children requiring a central venous access for at least 10 days.
All catheters were inserted according to our insertion bundle for pediatric central lines (ultrasound guidance, modified Seldinger technique by micro-introducer, tip location by intracavitary ECG, cyanoacrylate glue for the closure of the puncture site and for the sealing of the exit site, transparent dressing). SAS was removed at the time of catheter removal. Results: 65 central lines (3-4Fr power injectable polyurethane catheters: 38 CICC + 27 PICC) were secured with SAS in 60 patients (age range 25 days to 12 years). All SAS were easy to place and duration of the line (equal to the duration of the SAS) ranged from 5 day to 7 months (median 3 weeks). We had only one accidental removal (associated with skin erosion related to the SAS). SAS removal e performed by splitting in two halves with scissors - did not require sedation or local anesthesia and was easy and uneventful in all cases. Limitations: A randomized controlled study is warranted. Conclusions: SAS was effective in preventing dislocation in 98% of patients. Complications at insertion, during maintenance and at removal were negligible.
Pilot of New Peripheral IV Blood Collection Device for Critical Care Difficult Access Patients Marya Chaisson, Frederick Browne Background: Reducing CLABSI rates is a high priority in the critical care setting, which cares for our sickest patients. Removing central lines and limiting the number of times they are accessed are proven strategies for reducing infection. However, in these same patients, line draws offer a crucial alternative to venipuncture for frequent blood collections. Purpose/Project: We piloted a recently FDA cleared blood collection device that attaches to a standard PIV and inserts a flexible cannula through it into the vein lumen for blood aspiration. The pilot assessed potential benefits of the device, including improved patient experience, reducing reliance on central line draws and standardization of phlebotomy practice. In addition we measured nurse provider satisfaction and perceived utility of this technology. Results: We found that the device and peripheral IV collections were a benefit to nurses and patients. Though use of the device was at nurse discretion, nurses chose it as a first option over 90% of the time. In total, over 75% of the unit blood collections were performed using these devices. Nurses rated the likelihood that the device would reduce overall reliance on central line draws as a 4 out of 5. The most common limitation noted was hesitance to use the device with superficially placed or poorly secured PIVs. Most importantly we saw significant benefit to patients and family members from reduced reliance on venipuncture as well as marked patient preference for blood collections using the pilot device. Implications: This pilot has demonstrated that the ability to perform reliable blood collections via the peripheral IV is preferred by nurses and patients, and has the potential to affect patient safety through reduction in central line accesses.
2016
j
Vol 21 No 4
j
JAVA
j
255
Optical Infiltration Detection Through an Occlusive Dressing Jason Naramore, Garret Bonnema, Gregory Schears Infiltration is a common cause of IV failure. A device using visible and near-infrared light to sense changes in the optical properties of subcutaneous tissue consistent with IV infiltrations has been developed in order to aid in the early detection of infiltrations to help minimize patient harm. The placement of the device over an occlusive dressing allows the sensor to be positioned closer to the catheter tip for better detection sensitivity and so it can be used on existing IVs. An IRB-approved study measured the sensitivity of the device for detecting early stage infiltrations when placed either over or under an occlusive dressing. Twenty-four healthy adult volunteers received two peripheral IVs in either the back of the hand or the forearm. Subjects were randomly assigned either a textured or smooth occlusive dressing and the device was placed over the dressing. The catheter was placed immediately adjacent to the wall of a typical vein used for PIV therapy with the sensor placed next to the catheter. Each site was infiltrated with 10 mL of isotonic saline solution at 60 mL/hr. The device monitored the site and issued notifications if an infiltration was detected. The device issued a red notification in 23 of the 24 test sites (sensor was placed over the occlusive dressing). This corresponds to a sensitivity of 95.8% with a 95% confidence interval (78.9% to 99.9% range). These results compare to a sensitivity of 100% with a 95% confidence interval (85.75% to 100% range) for the control sites (sensor was placed under the occlusive dressing). This study used subcutaneous injection of isotonic saline as an experimental model of infiltration. The sensor placement over a dressing is limited to the optically clear areas of the dressing (no white mesh borders), due to the optical sensing technique used by the device. There is not a statistically significant sensitivity difference of the device when placed over or under the occlusive dressing.
Our Experience with Subcutaneously Anchored Sutureless Devices in Pediatric Patients Mauro Pittiruti, Davide Celentano Purpose: Subcutaneously anchored sutureless devices (SAS) (i.e. Securacath, Interrad Medical) have been recently introduced in our hospital for securement of central lines in neonates and children. Methods: We have used SAS for securement of tunneled central lines (both CICCs and PICCs) in neonates and children requiring a central venous access for at least 10 days.
All catheters were inserted according to our insertion bundle for pediatric central lines (ultrasound guidance, modified Seldinger technique by micro-introducer, tip location by intracavitary ECG, cyanoacrylate glue for the closure of the puncture site and for the sealing of the exit site, transparent dressing). SAS was removed at the time of catheter removal. Results: 65 central lines (3-4Fr power injectable polyurethane catheters: 38 CICC + 27 PICC) were secured with SAS in 60 patients (age range 25 days to 12 years). All SAS were easy to place and duration of the line (equal to the duration of the SAS) ranged from 5 day to 7 months (median 3 weeks). We had only one accidental removal (associated with skin erosion related to the SAS). SAS removal e performed by splitting in two halves with scissors - did not require sedation or local anesthesia and was easy and uneventful in all cases. Limitations: A randomized controlled study is warranted. Conclusions: SAS was effective in preventing dislocation in 98% of patients. Complications at insertion, during maintenance and at removal were negligible.
Pilot of New Peripheral IV Blood Collection Device for Critical Care Difficult Access Patients Marya Chaisson, Frederick Browne Background: Reducing CLABSI rates is a high priority in the critical care setting, which cares for our sickest patients. Removing central lines and limiting the number of times they are accessed are proven strategies for reducing infection. However, in these same patients, line draws offer a crucial alternative to venipuncture for frequent blood collections. Purpose/Project: We piloted a recently FDA cleared blood collection device that attaches to a standard PIV and inserts a flexible cannula through it into the vein lumen for blood aspiration. The pilot assessed potential benefits of the device, including improved patient experience, reducing reliance on central line draws and standardization of phlebotomy practice. In addition we measured nurse provider satisfaction and perceived utility of this technology. Results: We found that the device and peripheral IV collections were a benefit to nurses and patients. Though use of the device was at nurse discretion, nurses chose it as a first option over 90% of the time. In total, over 75% of the unit blood collections were performed using these devices. Nurses rated the likelihood that the device would reduce overall reliance on central line draws as a 4 out of 5. The most common limitation noted was hesitance to use the device with superficially placed or poorly secured PIVs. Most importantly we saw significant benefit to patients and family members from reduced reliance on venipuncture as well as marked patient preference for blood collections using the pilot device. Implications: This pilot has demonstrated that the ability to perform reliable blood collections via the peripheral IV is preferred by nurses and patients, and has the potential to affect patient safety through reduction in central line accesses.
2016
j
Vol 21 No 4
j
JAVA
j
255