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Peripheral Vascular Catheter Research: A Scoping Review
60 day periods. We paralleled the rates of DVT’s from 60 days before the length change and 60 days during. Results: It was noted that there was a decrease in overall diagnosed DVT’s after the PICC team started inserting Midlines less then 20cm. Implications: In can be implied from this review that Midlines inserted at a length of less than 20cm are safer, noting a decrease of DVT complication. Limitations: This study did not include the primary purpose of insertion, type of therapy indicated, or the duration of catheter placement. Conclusion: The results at the time of this report are promising and indicate further research. If the overall DVT rate is decreased by adopting this practice, it deems necessary to have further assessment. If this practice exhibits lower overall DVT rates, if should become the standard of practice.
Nurse-based Insertion of PICC-ports Mauro Pittiruti, Andrea Muasarò, Alessandro Emoli Purpose: Brachial ports (or ‘PICC-ports’) are becoming increasingly popular in Europe: they have the same indications as a chest port (i.e.: prolonged, episodic use of the central line, less than once a week), but they may be preferred in some clinical situations (planned irradiation of the chest area, planned reconstruction using pectoralis flap, supine position risky or impossible, radiodermitis or other local alterations of the chest skin, preference of the patient, etc.). We report our experience of 115 PICC ports inserted by specifically trained nurses in our Institution. Methods: We used only PICC-ports connected to 4-5Fr polyurethane catheters and inserted with aseptic precautions (dedicated ambient, hand hygiene, maximal barriers, 2% chlorhexidine), ultrasound-guided puncture and cannulation of appropriate deep vein at upper arm and tip location by intracavitary ECG. Results: There was no insertion-related complication, no infection, 3 episodes of catheter related thrombosis, 3 unscheduled removals of the port due to patient’s discomfort and/or local pain. In most cases patient’s compliance was very good, both during the insertion (no anxiety, no pain, no need for sedation) and during chemotherapy (no pain at Huber placement, no discomfort during treatment). Conclusions: Appropriate strategies were adopted for minimizing mechanical problems of the reservoir (choice of a small reservoir, minimal tunnel, reservoir placed above the biceps muscle and not secured with stitches), minimizing the risk of venous thrombosis (choice of a vein of proper caliber, venipuncture by ultrasound guidance and microintroducer technique, real time verification of tip location by intracavitary ECG) and achieving an optimal cosmetic result (small reservoir, vein ‘high’ in the upper arm, closure of the skin with glue). In selected patients, PICC ports are a safe and cost-effective alternative option to chest ports.
Peripheral Vascular Catheter Research: A Scoping Review Gillian Ray-Barruel, Mari Takashima, Samantha Keogh, Claire Rickard Purpose/Design: The rate of complications and failure of peripheral vascular devices remains high, suggesting that more
research is needed. We conducted a scoping review to identify which peripheral vascular device topics have been the focus of research, and to identify areas needing more research. Methods: We searched Pubmed, Cochrane Central Register of Controlled Trials, and CINAHL between 1 January 2005 and 30 June 2015 for randomized controlled trials involving peripheral vascular catheters. Results: The final review included 128 randomized controlled trials (94 peripheral intravenous catheters, 2 midline catheters, and 32 arterial catheters). Catheter insertion strategies and analgesia methods have been comprehensively studied. However, we found a lack of research addressing post-insertion care and maintenance, including dressings and securement, flushing practices and infection prevention strategies, such as skin preparation and hub decontamination. Limitations: As this was a scoping review, the focus was to identify the breadth of research topics that have been undertaken rather than the quality of the findings. Conclusions: There is insufficient evidence to guide practice in many areas of peripheral vascular device care. This is likely to be contributing to the high catheter failure rates reported in the literature. More randomized controlled trials investigating strategies for reducing catheter failure and preventing infection are needed. This scoping review will enable clinicians and researchers to identify the gaps in evidence and prioritize areas needing further research.
Right Line, First Time; Assisting Staff Nurses to Make the Right Decisions for Their Patients Earlier in the Treatment Process Lu Ellen Lawson Background: Staff nurses could not verbalize key factors to use in determining appropriate vascular access device selection for their patients. Many patients received multiple peripheral IVs or other inappropriate line before the Vascular Access Team was consulted to determine best access. Purpose: To educate bedside nurses to facilitate patients receiving the appropriate vascular device earlier in their treatment preventing unnecessary discomfort or injury. Project: A poster was designed using the following information: d pH scale showing common household items on one side with comparative medications on the other side of the scale d a decision tree using type of medication, vascular integrity of the patient and duration of treatment with appropriate options for vascular access d different lines rated from least risk to highest risk d vascular blood flow of veins of the hand, forearm, upper arm, axillary, subclavian and superior vena cava PowerPoint presentation prepared to detail this information and presented to nursing leaders, nurse managers, clinical unit leaders and unit-based shared governance committees. Posters printed and distributed to all nursing units. Each unit received a minimum of 2 posters to be posted in areas that would benefit staff the most. Outcomes: Staff can verbalize key factors in determining appropriate VAD for their patients and Vascular Access Team consults are initiated sooner in the patient’s treatment.
2016
j
Vol 21 No 4
j
JAVA
j
265
Nurse-based Insertion of PICC-ports Mauro Pittiruti, Andrea Muasarò, Alessandro Emoli Purpose: Brachial ports (or ‘PICC-ports’) are becoming increasingly popular in Europe: they have the same indications as a chest port (i.e.: prolonged, episodic use of the central line, less than once a week), but they may be preferred in some clinical situations (planned irradiation of the chest area, planned reconstruction using pectoralis flap, supine position risky or impossible, radiodermitis or other local alterations of the chest skin, preference of the patient, etc.). We report our experience of 115 PICC ports inserted by specifically trained nurses in our Institution. Methods: We used only PICC-ports connected to 4-5Fr polyurethane catheters and inserted with aseptic precautions (dedicated ambient, hand hygiene, maximal barriers, 2% chlorhexidine), ultrasound-guided puncture and cannulation of appropriate deep vein at upper arm and tip location by intracavitary ECG. Results: There was no insertion-related complication, no infection, 3 episodes of catheter related thrombosis, 3 unscheduled removals of the port due to patient’s discomfort and/or local pain. In most cases patient’s compliance was very good, both during the insertion (no anxiety, no pain, no need for sedation) and during chemotherapy (no pain at Huber placement, no discomfort during treatment). Conclusions: Appropriate strategies were adopted for minimizing mechanical problems of the reservoir (choice of a small reservoir, minimal tunnel, reservoir placed above the biceps muscle and not secured with stitches), minimizing the risk of venous thrombosis (choice of a vein of proper caliber, venipuncture by ultrasound guidance and microintroducer technique, real time verification of tip location by intracavitary ECG) and achieving an optimal cosmetic result (small reservoir, vein ‘high’ in the upper arm, closure of the skin with glue). In selected patients, PICC ports are a safe and cost-effective alternative option to chest ports.
Peripheral Vascular Catheter Research: A Scoping Review Gillian Ray-Barruel, Mari Takashima, Samantha Keogh, Claire Rickard Purpose/Design: The rate of complications and failure of peripheral vascular devices remains high, suggesting that more
research is needed. We conducted a scoping review to identify which peripheral vascular device topics have been the focus of research, and to identify areas needing more research. Methods: We searched Pubmed, Cochrane Central Register of Controlled Trials, and CINAHL between 1 January 2005 and 30 June 2015 for randomized controlled trials involving peripheral vascular catheters. Results: The final review included 128 randomized controlled trials (94 peripheral intravenous catheters, 2 midline catheters, and 32 arterial catheters). Catheter insertion strategies and analgesia methods have been comprehensively studied. However, we found a lack of research addressing post-insertion care and maintenance, including dressings and securement, flushing practices and infection prevention strategies, such as skin preparation and hub decontamination. Limitations: As this was a scoping review, the focus was to identify the breadth of research topics that have been undertaken rather than the quality of the findings. Conclusions: There is insufficient evidence to guide practice in many areas of peripheral vascular device care. This is likely to be contributing to the high catheter failure rates reported in the literature. More randomized controlled trials investigating strategies for reducing catheter failure and preventing infection are needed. This scoping review will enable clinicians and researchers to identify the gaps in evidence and prioritize areas needing further research.
Right Line, First Time; Assisting Staff Nurses to Make the Right Decisions for Their Patients Earlier in the Treatment Process Lu Ellen Lawson Background: Staff nurses could not verbalize key factors to use in determining appropriate vascular access device selection for their patients. Many patients received multiple peripheral IVs or other inappropriate line before the Vascular Access Team was consulted to determine best access. Purpose: To educate bedside nurses to facilitate patients receiving the appropriate vascular device earlier in their treatment preventing unnecessary discomfort or injury. Project: A poster was designed using the following information: d pH scale showing common household items on one side with comparative medications on the other side of the scale d a decision tree using type of medication, vascular integrity of the patient and duration of treatment with appropriate options for vascular access d different lines rated from least risk to highest risk d vascular blood flow of veins of the hand, forearm, upper arm, axillary, subclavian and superior vena cava PowerPoint presentation prepared to detail this information and presented to nursing leaders, nurse managers, clinical unit leaders and unit-based shared governance committees. Posters printed and distributed to all nursing units. Each unit received a minimum of 2 posters to be posted in areas that would benefit staff the most. Outcomes: Staff can verbalize key factors in determining appropriate VAD for their patients and Vascular Access Team consults are initiated sooner in the patient’s treatment.
2016
j
Vol 21 No 4
j
JAVA
j
265