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Introduction Peripheral intravenous catheters (PIVCs) are frequently used in hospitals. However, PIVC complications are common, with failures leading to treatment delays, additional procedures, patient pain and discomfort, increased clinician workload and substantially increased healthcare costs. Recent evidence suggests integrated PIVC systems may...

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... study is a two-arm (table 1), multicentre RCT of supe- riority design comparing two PIVC systems to prevent PIVC complications and failure. In addition, covariates associated with catheter failure including patient vari- ables and catheter variables will be evaluated. ...

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... Since establishing venous access occurs while the patient is awake, and usually precedes administration of any anesthetic agents, PVC placement can be an uncomfortable and painful procedure. Repeated and unsuccessful attempts to place a PVC can be stressful for both patient and clinician, causing localized pain and swelling, creating a portal of entry for micro-organisms, and forcing clinicians to seek alternative sites, where cannulation may be more difficult or dangerous [5][6][7]. Therefore, a successful PVC placement in the first attempt is always desirable. Reports indicate that up to a quarter of adult patients, and half of pediatric patients experience a firstattempt cannulation failure [8][9][10]. ...
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Background: A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. Methods: An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. Results: Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of "good" or "very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal-prior or during the catheterization attempt-was associated with an increased risk of cannulation failure (7.909, CI 5.989-10.443, P < .001 and 23.023, CI 10.372-51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347-2.967, P = .001). Conclusions: First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure. Trial registration: ClinicalTrials.gov, Identifier: NCT02213965 , Date: 12/08/2014.
... Despite a reduction in the mechanical stimuli that contributed to catheter failure, complications related to chemical irritation from pharmaceuticals could not be avoided. An effective method to prevent pharmaceutical chemical stimulation, especially from drugs administered at high concentrations, has not been established (16)(17)(18). High concentrations of drugs are administered via central veins with abundant blood flow. Moreover, the administration of drugs at an osmotic pressure more than twice as that of physiological saline increases the risk of catheter failure and ulceration, even in the dosage range permitted for administration into the peripheral veins (19). ...
Article
This study aimed to determine whether the placement of a peripheral intravenous catheter (PIVC) in the cephalic vein of the forearm could prevent PIVC failure in patients receiving hyperosmotic drugs through the peripheral vein. This retrospective cohort study included patients aged ≥ 20 years who had received infusion therapy via a PIVC in our institution between July and November 2017. Patients were divided into groups according to PIVC insertion into the cephalic, basilic, and medial veins. PIVCs used to administer drugs with osmotic pressure ratios > 2.0 were included. The primary outcome was survival time to catheter failure. Catheter failure was defined as accidental and unplanned catheter removal. We set the cephalic vein and other veins, including the medial and basilic veins, in the forearm as cohort groups. We used the Kaplan-Meier survival curves to compare the time until catheter failure in the cohort groups. The Cox proportional hazard models were fitted, and the hazard ratios were calculated. A total of 46 catheters with hyperosmotic agents were included in the analysis. Catheter failure was observed in 25 (54.3%) cases. Time to catheter failure in patients receiving high-dose drugs via the cephalic vein was significantly longer than that in the other two groups (p < 0.01). Thus, the cephalic vein, which has a high blood flow, is the ideal site of PIVC insertion in patients receiving high drug concentrations to prevent catheter failure.
... Integrated peripheral venous catheters reduce pressures on the vein and movement of the catheter body against the inner wall of the vein, which occurs when nurses manipulate the catheter, or when additional fluid tubing or direct injections are made through the dedicated port. 27 Decreasing pressure on the vein and catheter movements is key to reducing irritation of the tunica intima of the vessels, which in turn can reduce infiltration, occlusion, or phlebitis. Flushing the catheter before and after drug administration contributes to maintaining the catheter patency in several ways: reduction of contact between incompatible drugs or fluids, limitation of the risk of thrombosis and phlebitis, and reduction of fibrin accumulation in the internal lumen of the catheter, reducing the risk of thrombosis, and bacterial colonisation. ...
Article
Background Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure. Methods We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143. Findings 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02–0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6–69·4] h vs 30·0 [16·6–52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group. Interpretation For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time. Funding Becton Dickinson.
... Integrated peripheral venous catheters reduce pressures on the vein and movement of the catheter body against the inner wall of the vein, which occurs when nurses manipulate the catheter, or when additional fluid tubing or direct injections are made through the dedicated port. 27 Decreasing pressure on the vein and catheter movements is key to reducing irritation of the tunica intima of the vessels, which in turn can reduce infiltration, occlusion, or phlebitis. Flushing the catheter before and after drug administration contributes to maintaining the catheter patency in several ways: reduction of contact between incompatible drugs or fluids, limitation of the risk of thrombosis and phlebitis, and reduction of fibrin accumulation in the internal lumen of the catheter, reducing the risk of thrombosis, and bacterial colonisation. ...
Article
Introduction Deux milliards de cathéters veineux périphériques courts sont vendus dans le monde chaque année. La procédure optimale de désinfection cutanée et les types de cathéters à privilégier ne sont pas clairement établis. L’objectif de cette étude était de démontrer la supériorité : –de 2 % de chlorhexidine-alcoolique (CHG) sur 5 % de povidone–iodée–alcoolique (PVI) dans la prévention des complications infectieuses (colonisation et infections locales ou bactériémiques) ; –d’une combinaison de dispositifs innovants par rapport aux dispositifs standards pour prolonger le temps écoulé entre l’insertion du cathéter et son retrait pour complication. Matériels et méthodes Entre le 7 janvier 2019 et le 6 septembre 2019, nous avons randomisé 1000 adultes (âge ≥ 18 ans) via un générateur de nombres aléatoires en ligne sécurisé, en quatre groupes de traitement (selon la préparation cutanée, CHG vs PVI, et le type de matériel employé, standard vs innovant). Dans le groupe « matériel standard », des cathéters ouverts ont été utilisés et perfusés en continue pour empêcher l’occlusion du cathéter jusqu’à son retrait. Dans le groupe « matériel innovant », des cathéters intégrés fermés ont été utilisés ; l’administration des médicaments était réalisé à travers une valve bidirectionnelle neutre, après retrait d’un capuchon antiseptique ; un rinçage pulsée était réalisé avant et après chaque administration de médicament. Résultats Le risque de complications infectieuses était moindre avec la CHG (4 vs 72 événements dans le groupe PVI : HR : 0,05 ; IC95 % [0,02 à 0,15] ; p < 0,0001). Comparés aux patients du groupe standard, les patients assignés au groupe innovation avaient un taux moindre d’échec du cathéter (34,8 % vs 47,5 % ; différence de risque absolue : −12,7 % [−18,7 % à −6,6 %] ; p < 0,0001) et un délai plus long entre l’insertion et l’échec du cathéter (HR : 1,67 [1,35 à 2,00] ; p < 0,0001). Des réactions cutanées mineures sont survenues dans respectivement 1,8 % et 1,4 % des patients des groupes CHG et PVI, sans différence statistiquement significative. Conclusion Pour l’antisepsie cutanée, la CHG offre une meilleure protection contre les complications infectieuses liées au cathéter veineux périphérique que la PVI. L’utilisation de matériels innovants en combinaison a permis d’allonger le temps entre l’insertion et l’échec du cathéter.
... Multiple IV insertion attempts can drive up cost and resource utilization at hospitals. 17 Complications resulting from catheter use can compromise patient care, as they may cause cancellation or delay of procedures, necessitate catheter replacement, or interrupt drug administration. 18 Therefore, complications present a substantial burden to the health care system and patients in terms of consumption of health care resources and decreased patient quality of life. ...
... 18 Therefore, complications present a substantial burden to the health care system and patients in terms of consumption of health care resources and decreased patient quality of life. 17,18 This economic burden can be in the form of direct costs (eg, increased hospital stay, drug treatment, or medical and surgical procedures) or indirect costs (eg, lost patient income or demands on caregiver time). Multiple studies have demonstrated that catheter-related complications such as CR-BSI lead to increased cost, including costs associated with increased patient hospital stay. ...
Article
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Short peripheral catheter (SPC) insertion is a common invasive procedure performed in hospitalized patients. Variations in this fundamental nursing skill exist among nurses, with significant impacts on budgets, patient satisfaction, and worker safety-key concerns for nurse leaders. A performance improvement project focused on vascular access management was undertaken, with the goal to improve SPC practice and associated outcomes. Assessment of current SPC policies, practices, products, and outcomes identified areas of potential improvement. A performance improvement program was undertaken, and its effects on clinical, safety, and economic outcomes were assessed at 5 hospitals in 1 health care system. Clinical, safety, and economic outcomes improved, as demonstrated by longer average catheter dwell times, increased first-insertion success, improved patient satisfaction, reduced blood exposure, and annual cost savings. A vascular access management program can support leaders in achieving consistent guideline adherent practice among nurses while reducing cost and increasing patient and nurse satisfaction.
... Bundle items such as hand hygiene, chlorhexidine skin prep, disinfection of needleless connectors, PIVC site checks, PIVC dressing checks, daily review of PIVC need, and documentation of insertion and removal are all recommended in guidelines and clinical standards [12e14,16]. Other items included in bundles such as integrated closed catheters have demonstrated a relative risk reduction in BSI [69], but more research is underway [70], and these devices are not yet referenced in existing guidelines, so their inclusion in a bundle appears somewhat premature. ...
Article
Objective: The objective of this review was to synthesize the best evidence for the effectiveness of interventions to reduce occupational stress and/or burnout in the emergency department. Introduction: The prevalence of occupational stress and burnout among busy emergency department staff requires urgent attention. This review summarizes the current evidence to provide recommendations on interventions to reduce occupational stress in the emergency department. Inclusion criteria: Studies reporting on all health personnel working in emergency departments were included in the review. Any individual-focused or organizational-directed intervention was considered. Both published and unpublished studies including experimental and quasi-experimental studies were considered for inclusion in the review. The outcomes of interest included occupational stress, burnout, compassion fatigue, anxiety, and depression. Methods: A three-step search strategy was utilized to search seven databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Scopus, PsycINFO, Web of Science) and five gray literature resources (MedNar, Google Scholar, ProQuest Dissertations and Theses, Conference Proceedings). The search was limited to papers published in English between January 1, 2008, and February 1, 2019. Titles and abstracts of the studies were screened. Two reviewers independently appraised the full text of selected studies and extracted data using standardized tools from JBI. Where possible, data were pooled in statistical meta-analysis. Effect sizes were expressed as standardized mean differences, and their 95% confidence intervals were calculated for analysis. Results: A total of 14 studies were included in the systematic review. Sample sizes of the included studies ranged from 14 to 392 participants. Of the included studies, four were randomized controlled trials and 10 were quasiexperimental studies. The overall quality of the included studies was compromised due to lack of true randomization, concealment, blinding, or the use of a single-group without a comparator. Educational-style interventions were investigated in six included studies and mindfulness-based interventions in four studies. The remaining four studies investigated organizational-directed interventions that incorporated a variety of strategies. The top three most commonly used tools were the Maslach Burnout Inventory, the Perceived Stress Scale, and the Professional Quality of Life Scale. The studies that investigated educational interventions reported a statistically significant reduction in both stress and/or burnout. Three of the four studies that investigated mindfulness-based interventions reported reduced stress levels. A fixed-effects meta-analysis of two of the studies demonstrated a non-significant difference in stress between groups receiving mindfulness-based interventions and those who did not (n¼58, SMD¼�0.32, 95% CI �0.84 to 0.20, P¼0.23; heterogeneity: x2¼0.01, P¼0.93, I2¼0%). Organizational-based interventions were found to reduce stress levels but increase burnout. Conclusions: Individual-focused interventions, including both educational interventions and mindfulness-based interventions, have the potential to reduce occupational stress and/or burnout for staff working in emergency departments. However, inconsistencies in reporting and outcome measurements impact certainty of results. More high-quality randomized controlled trials are recommended with larger sample sizes as well as measurement of longterm effects to improve knowledge in this field.
... for VAS-inserted catheters (8.8%) compared to those inserted by other health professionals (11.8%). 24 This study included 31,115 PIVCs, but did not identify the number of PIVCs inserted by the VAS team compared to other health professionals. ...
... Bundle items such as hand hygiene, chlorhexidine skin prep, disinfection of needleless connectors, PIVC site checks, PIVC dressing checks, daily review of PIVC need, and documentation of insertion and removal are all recommended in guidelines and clinical standards [12e14,16]. Other items included in bundles such as integrated closed catheters have demonstrated a relative risk reduction in BSI [69], but more research is underway [70], and these devices are not yet referenced in existing guidelines, so their inclusion in a bundle appears somewhat premature. ...
Article
Full-text available
Background: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods: In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results: Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. Conclusions: The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
... Bundle items such as hand hygiene, chlorhexidine skin prep, disinfection of needleless connectors, PIVC site checks, PIVC dressing checks, daily review of PIVC need, and documentation of insertion and removal are all recommended in guidelines and clinical standards [12e14,16]. Other items included in bundles such as integrated closed catheters have demonstrated a relative risk reduction in BSI [69], but more research is underway [70], and these devices are not yet referenced in existing guidelines, so their inclusion in a bundle appears somewhat premature. ...
Article
Full-text available
Background: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods: In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000eDecember 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results: Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2e7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between ‘low’ and ‘fair’. Conclusions: The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
Article
Background: Integrated peripheral intravenous catheters (PIVCs) demonstrate clinical efficacy, however, device complexity and design differences may be a potential barrier to implementation. Aims: To assess nurse acceptability of integrated PIVC systems. Methods: A cross-sectional survey was nested within a multicentre randomised controlled trial. One hundred nurses caring for patients with integrated and non-integrated PIVCs completed a 17-item survey about key differences between devices (eg function and appearance, perceived patient comfort and skin injuries). Findings: Most nurses reported the integrated PIVC wings prevented device movement (80%), achieved patient comfort in areas of flexion (78%), and no patients developed skin injuries (100%). Nurses rated the ease of accessing and overall confidence using the integrated PIVC as significantly higher than the non-integrated design (P<0.001). Conclusion: The integrated PIVC received positive feedback from nurses and had few barriers to implementation.