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Reflecting on the nursing contribution to vascular access
British Journal of Nursing
Abstract
Intravenous (IV) therapy and care has become indispensable in today's modern healthcare environment. However, in a striking reversal of fortune, it has been suggested that the provision of IV services is often taken for granted and underpinned by routine and habit (Lundgren and Ek, 1996; Creamer, 2000). In an attempt to promote reflection within the profession, this article asks key questions about ownership and responsibility, level of ability, appropriateness of device selection, documentation and evaluation of IV care. The aim of this reflective exercise is to forge a stronger relationship between nursing practice and IV care, the ultimate outcome being the development of safe, corroborated, effective and reliable IV nursing care.
... Most doctors assume the currently used technique is safe and therefore continue to use it, tolerating the frustration of failure and the sadness of causing distressing to patients. 9 Some doctors learn to accept failure while others blame the vein, but few think to assess their own technique or that of others. Most related studies have looked into issues such as cannula-associated infections, pain relief or needlestick injuries, 10 rather than insertion techniques or the number of attempts needed to cannulate a vein. ...
... However, nurses and paramedics may lack the skill or experience to cannulate in complex cases. 9 There is also some concern that allowing other staff to carry out cannulation could, over time, deskill doctors, possibly resulting in inadequate care in difficult cases. ...
Insertion of intravenous cannulae is probably the most commonly performed invasive medical procedure. Failed attempts cause stress to patients and embarrassment to the provider and make subsequent attempts increasingly difficult. Making several attempts increases costs and the risk of introducing infection into the patient. Discarded used needles also pose a risk of needlestick injury to staff, increasing their chances of contracting HIV and other bloodborne infections. For the past 10 years Dr. Kadiyali Srivatsa has been developing a solution-U-Cannula™. Using the device makes it easy to insert a cannula at the first attempt. It also has an important additional benefit of eliminating cannula breakage and needlestick injuries, as the needle tip is safely encased within the needle guard after use.
... Most doctors assume the currently used technique is safe and therefore continue to use it, tolerating the frustration of failure and the sadness of causing distressing to patients. 9 Some doctors learn to accept failure while others blame the vein, but few think to assess their own technique or that of others. Most related studies have looked into issues such as cannula-associated infections, pain relief or needlestick injuries, 10 rather than insertion techniques or the number of attempts needed to cannulate a vein. ...
... However, nurses and paramedics may lack the skill or experience to cannulate in complex cases. 9 There is also some concern that allowing other staff to carry out cannulation could, over time, deskill doctors, possibly resulting in inadequate care in difficult cases. ...
Insertion of intravenous cannulae is probably the most commonly performed invasive medical procedure. Failed attempts cause stress to patients and embarrassment to the provider and make subsequent attempts increasingly difficult. Making several attempts increases costs and the risk of introducing infection into the patient. Discarded used needles also pose a risk of needlestick injury to staff, increasing their chances of contracting HIV and other bloodborne infections. For the past 10 years Dr. Kadiyali Srivatsa has been developing a solution-U-Cannula™. Using the device makes it easy to insert a cannula at the first attempt. It also has an important additional benefit of eliminating cannula breakage and needlestick injuries, as the needle tip is safely encased within the needle guard after use.
... The debate regarding nurses performing tasks traditionally carried out by doctors is controversial, with some commentators arguing that it represents neither expansion nor extension of their scope of practice, but rather change of it (Sheperd, 1993). A debate on who is most appropriate to perform IV cannulation has been raised in nursing literature (Jackson, 2003). Nurses performing traditional medical tasks can ensure continuity of holistic care, and the associated autonomy can create personal and professional satisfaction (Workman, 2000). ...
... A time frame for elective replacement hours is debatable, and published literature provides differing opinions. IV cannulas require regular monitoring and 48 hours may be the optimum time for removal (Jackson, 2003). A recent study from India agrees with Jackson and found that thrombophlebitis peaked on day 3 of cannula stay; the authors suggest that elective replacement should be at 48 hours ( Nishanth et al, 2009). ...
Peripheral intravenous cannulation (PIVC) is a potentially painful and distressing procedure for patients, and is traditionally carried out by medical personnel. A university hospital in Ireland was chosen to initiate a pilot intravenous (IV) cannulation team, to ascertain whether this procedure could be performed effectively by a team of nurses. The team was introduced to support the implementation of the European working time directive (EWTD). A team of four registered general nurses, led by a senior phlebotomist, provided PIVC. Request books were placed on each ward and data was recorded before and after each insertion. A constantly increasing percentage of first-time cannulation success is displayed from the first five months of the study. In-depth analysis on an orthopaedic ward reveal a preference for distal site insertion and routine change at 72 hours. IV teams performing IV cannulation can effectively reduce insertion rate attempts, and potentially offer a solution to the manpower issues arising as a result of implementation of the EWTD.
... Cannula-related bloodstream infections (CRBSI) are a known side effect of phlebitis. Jackson's Visual Infusion Phlebitis Scoring System [causing complications] was used to assess the presence and severity of phlebitis [6]. Phlebitis can have unfavorable effects on patients, such as increased hospital stays and medical expenses [5]. ...
Peripheral venous catheters (PVCs) are frequently used in clinical practice. Nonetheless, individuals who receive intravenous injections frequently have varying degrees of phlebitis. According to pertinent research, the catheter gauge, insertion site, and length of catheterization are strongly correlated with the incidence of phlebitis. However, no meta-analysis on the combined incidence of phlebitis and its contributing factors has been conducted. Thus, the purpose of this meta-analysis was to close the previously identified gaps.
A literature survey was conducted using electronic databases (CINAHL, Embassy, Google Scholar, and PubMed), and 4 studies were included they used peripheral intravenous catheters for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain the overall and subgroup phlebitis incidence rates and odds ratio for phlebitis incidence.
The incidence of phlebitis was 41 per 100 catheters (95% CI 0.22–0.60). There were 1584 patients in the included studies to know the incidence of phlebitis. In the subgroup analysis, the incidence of phlebitis in neonatal and infant patients was 30% (95% CI 0.25–0.34), in pediatrics patients was 34% (95% CI 0.29–0.38), and in adult patients was 50% (95% CI 0.11–0.89) respectively. Joint involvement in the PIVC (AOR: 2.44, 95% CI 1.67, 3.2), longer catheter dwell time (AOR = 3.96, 95% CI 1.59–7.33), and drug and blood administration in one vein (AOR = 1.91, 95% CI 1.67–2.15) were the most common factors associated with the incidence of phlebitis in Ethiopia.
This meta-analysis indicates that PIVC-induced phlebitis is highly prevalent in Ethiopia. This meta-analysis identified significant risk factors for the development of phlebitis including medications and blood administered in a single vein, longer cannula dwelling times, and joint involvement in peripheral intravenous cannula insertion. Using the right interventions can lower the chance of developing phlebitis.
... 1 Si bien la utilización de accesos vasculares y la administración de terapia de infusión tiene beneficios no está exenta de complicaciones, lo que se traduce en un impacto negativo tanto para el paciente como para la institución de salud. 2 Desde antes del año 2000 en Estados Unidos comienza el desarrollo de los equipos de accesos vasculares. En el trabajo de Hunter publicado en el año 2003, las tareas estarían centradas en instalación catéteres centrales de inserción periférica y ser facilitadores en el manejo de catéteres periféricos, línea media y centrales, lo que contribuiría a la mejora de la atención y satisfacción del paciente. ...
La conformación de equipos de acceso vascular en el mundo ha estado acompañada de múltiples beneficios reportados, tanto para las personas portadoras de dispositivos vasculares como para las organizaciones de salud, demostrado en la implementación de algoritmos de decisión para la selección del dispositivos vasculares, mayor satisfacción usuaria, menos dolor durante el procedimiento de instalación, disminución de complicaciones asociadas al acceso vascular, fortalecimiento de la monitorización y seguimiento de eventos adversos asociado al uso de catéteres venosos y ahorro económicos para los establecimientos hospitalarios. En Chile, existen diferentes intentos de conformación o modelos iniciales de equipos de acceso vascular sin reporte de estas. El objetivo general de este articulo es describir en forma general los recursos para implementar una unidad de acceso vascular en hospitales públicos, a través de la revisión de literatura disponible en diferentes bases de datos durante enero-julio 2023, con el propósito de ofrecer una guía inicial para la implementación de unidades de acceso vascular en nuestro país. La conformación de estas unidades ha sido heterogénea y diversa, sin embargo, caracterizada con un propósito común de fortalecer la seguridad del paciente a través de prácticas basadas en evidencia para la instalación y mantención de dispositivos vasculares. Uno de los aspectos clave es la necesidad de contar con un equipo de enfermería especializado, con los recursos materiales y físicos necesarios, tiempo de dedicación exclusiva de los integrantes del equipo, indicadores sensibles de la unidad y anclado como una unidad estratégica para las instituciones de salud.
... A discussão dos resultados é sustentada pelos objetivos previamente delineados para esta investigação, sendo este capítulo elaborado e estruturado de forma crítica e reflexiva de forma a serem debatidos os dados recolhidos, tendo em conta a metodologia já descrita. Parafraseando Jackson (2003) O estudo da ocorrência de flebites associada à introdução de CVP é uma temática que há décadas tem questionado e preocupado a comunidade científica. As primeiras referências à utilização de instrumentos de avaliação do local de inserção do CVP para a prevenção de flebi tes foi elaborada por Maddox et al. (1983). ...
... In the authors' hospital, the visual infusion phlebitis (VIP) score (Jackson, 2003) and a care bundle are routinely used to standardise PVC care. Action taken depends on the VIP score. ...
Replacing peripheral vascular catheters when clinically indicated rather
than routinely has multiple benefits for patients and practitioners.
Managing vascular catheters based on clinical indication provides early
opportunities for intervention, or catheter removal or replacement. Where
clinically indicated, peripheral vascular catheters can be used for a long
time, and this is aided by decision-making tools such as the visual infusion
phlebitis score and care bundles. Fewer cannulations result in less pain,
better patient comfort and a lower risk of infection. For each cannulation
avoided, about 20 minutes can be saved for other care activities. Replacing
peripheral vascular catheters according to clinical indication can improve
patient safety and optimise resource use.
By extending the duration of PVC use beyond 72 hours avoided a significant
number of unnecessary cannulations. If they had continued with catheter replacement at 72 hours, 728 peripheral catheters would have been placed on patients they assessed. However, only 327 PVCs were used. The clinically indicated replacement strategy
facilitated safe, continued use of peripheral catheters that were assessed as healthy, which in turn avoided 401 cannulations.
Given the estimated cost of €15 (about £13.90) per cannulation, this simple, evidence-based intervention could save the hospital €123 750 (about £114 500) a year. Nationally, with 1.7 million inpatient and day case discharges (HPSC, 2017), on a conservative estimate of 25% of patients requiring PVC for delivery of healthcare and 55% of these not receiving a replacement catheter with clinically indicated replacement, implementing this policy could save around €3.5 million (about £3.24 million) annually to the Health Service Executive (Ireland).
... In the authors' hospital, the visual infusion phlebitis (VIP) score (Jackson, 2003) and a care bundle are routinely used to standardise PVC care. Action taken depends on the VIP score. ...
Replacing peripheral vascular catheters when clinically indicated rather than routinely has multiple benefits for patients and practitioners. Managing vascular catheters based on clinical indication provides early opportunities for intervention, or catheter removal or replacement. Where clinically indicated, peripheral vascular catheters can be used for a long time, and this is aided by decision-making tools such as the visual infusion phlebitis score and care bundles. Fewer cannulations result in less pain, better patient comfort and a lower risk of infection. For each cannulation avoided, about 20 minutes can be saved for other care activities. Replacing peripheral vascular catheters according to clinical indication can improve patient safety and optimise resource use.
... Cholera is known to be a disease that causes symptoms such as diarrhea and vomit, thus, there is the need to maintain the hydric balance. William Brooke O'Shaughnessy deduced this hypothesis in 1832 and together with Thomas Latta -his student -they successfully injected (continuously) a saline solution in the basilic vein of a cholera patient, whom survived the disease (Jackson, 2003,Peterfreund, Philip, 2013,Rivera et al., 2005. ...
The superficial veins of the forearm are prone to possess different patterns of anastomosis. This is highly significant, as venipunctures in the upper limb are among the most performed procedures in the world and they often rely on the veins of the cubital fossa. In addition, the relationship of these veins to the cutaneous nerves are also prone to vary and are often uncertain. These veins are also manipulated in the creation of arteriovenous fistula for dialisis, which remains as the best choice of treatment for renal failure patients. Such fistulas are often performed on the wrist or the cubital fossa, with the cephalic vein or basilic vein. It is known that anatomical variations of the vessels and nerves on the cubital fossa may induce the professionals to error, and one of the most common complications of venipuncture are accidental nerve puncture, which can lead to paresthesia and pain. We aim to perform a comprehensive review of the venous arrangements of the cubital fossa and their clinical aspects, as well as of veni-puncture from a historical perspective and of the complications of venipuncture and arterio-venous fistula from an anatomical point of view, with the purpose of compiling available data and help healthcare professionals to reduce puncture errors or arteriovenous fistula complications and improve patient care.
... Nurses must be aware of their own limitations in relation to experience and skill (Nursing and Midwifery Council 2004). There may be times when the nurse should decline to attempt cannulation if patient history or assessment suggests that cannulation is too complex (6) Phlebitis occurring early (<_48 hours="hours" is="is" often="often" due="due" to="to" traumatic="traumatic" insertion="insertion" which="which" damage="damage" veins="veins" associated="associated" with="with" inadequately="inadequately" prepared="prepared" skin="skin" and="and" drying="drying" time="time" not="not" observed.="observed." replacing="replacing" cannula="cannula" in="in" _72="_72" may="may" be="be" beneficial="beneficial" some="some" hospitals="hospitals" but="but" we="we" feel="feel" this="this" will="will" necessary="necessary" if="if" the="the" introduced="introduced" first="first" attempt="attempt" very="very" strict="strict" a="a" septic="septic" technique.="technique." ...
We use cookies to improve our service and to tailor our content and advertising to you. More info! "Close You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our cookies policy Close Intended for healthcare professionals Research Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial BMJ 2008; 337 doi: https://doi. Since 1989, we have been warning cannula manufacturers about the danger of multiple attempts and its association with spreading hospital infections. The incidence of Staphylococcus aureus infections acquired in hospitals has risen in tandem with increased use of cannulation since the Braunule (cannula) was introduced in 1962 (1). When working as a Registrar in Neonatal units, we noticed babies who were difficult to introduce cannula were getting MRSA infections. To over come this problem, we studied the technique and developed a spring loaded-device to help us introduce the cannula with ease. Our hypothesis was tested and the results were published in Anastasia Analgesia (2) Cannula manufacturers were enthusiastic and so asked senior consultants if they find cannula introduction technique difficult. Based on their response, they were not keen to bring in changes because they were told our technique will de-skill doctors and the seniors felt they did not have any problem. Intravenous cannulation-as well as the word 'Venflon'-is hated by all, especially patients and house officers. The former dislike it because it is painful, whereas the latter are repulsed more by the fact that
... However, the difference in oxygen saturation between the two groups was not significant [8]. Furthermore, another study also disagrees with the results of the current study, and that study identified no differences between groups for pre-procedural or procedural mean of pulse rate or oxygen saturation (p > 0.05) [15]. Most of children had mild discomfort in the age group of 24 -35 months with a significant association between level of pain and child's age in the intervention group. ...
Background and objective: Relief of pain is a basic need and right of all children; effective pain management requires health professionals to be able to apply a number of interventions to achieve optimal results. The current study aimed to discover the effects of distraction therapy on children’s pain perception during peripheral venous cannulation.
Methods: A quasi-experimental study was carried out at emergency unit of Raparin Paediatric Teaching Hospital in Erbil city, Iraq. Data collection occurred from Feb 22, 2016 to May 25, 2016. A non-probability purposive sample of 120 children who were undergoing peripheral venous cannulation are recruited for the study. Data was collected through a questionnaire format and a standard observational checklist Assessments of the face, legs, activity including crying, and the console ability (FLACC) pain rating scale were used to assess the pain perception of child. A cartoon and animation video films were used by the researcher, as distraction therapy for the intervention group, while the control group received traditional routine care by the nurses. The statistical package for social science (SPSS, Version 22) was used for data processing and statistical analysis such as frequency, percentage, mean, SD, F-test, paired t-test, chi-square and Fisher exact test.
Results: The study found that the majority of children in the intervention group experienced mild discomfort and pain while the majority of children in the control group experienced severe pain or discomfort or both. The results revealed that there were very highly significant differences in the levels of pain perception between intervention and control groups.
Conclusion: Application of distraction therapy could have a positive effectiveness for relieving pain among preschool age children during peripheral venous cannulation.
... Occorre quindi pianificare e attuare programmi di controllo a diversi livelli (nazionale, regionale, locale). L'adozio- ne di protocolli e procedure codificate (bundle), scritti secondo criteri di evidenza scientifica, permette di regolare e standar- dizzare le attività efficaci in grado di ridurre il rischio di infezio- ni, in primo luogo, e di indurre cambiamenti comportamentali di medici e infermieri nella gestione di dispositivi intravasali (2). ...
In recent years, the need for the vascular access surveillance has been growing steadily. In our dialysis department, a dedicated multidisciplinary team is active since 10 years. The Team is composed of 2 nephrologists and 5 nurses who take care of AV related surgery, AV management in the dialysis rooms, infection control, nurses education and audit. Having an AV Team allowed to monitor and efficiently control the infection rate (0.65/1000 CVC days) and contained the AV management related costs while improving patients’ quality of life. Furthermore, it has been a reason for continuous professional growth. The article describes the major organization and structural and professional characteristics of our AV Team setting.
... Entre as principais condutas para a realização de punção venosa para administração do tratamento quimioterápico, é preconizada a escolha de veia periférica no membro superior, evitando-se punção de membros edemaciados, com lesões, com distúrbios motores ou sensoriais ou recentemente puncionados. 2 Quanto ao dispositivo, são indicados os flexíveis, como o jelco e Saf-T-Intima®, e, para a fixação, indicam-se materiais que não prejudiquem a visibilidade da área puncionada 4,8,9,14,15 . Outros fatores que devem ser considerados durante a infusão de agentes quimioterápicos são a certificação do correto posicionamento do dispositivo e do retorno venoso antes de aplicar a droga; manter a área puncionada sob observação constante durante o período da infusão; instruir o paciente a relatar imediatamente qualquer anormalidade, como dor, queimação, formigamento ou prurido; e documentar, nos prontuários do paciente todas as condutas e orientações realizadas antes, durante e após a infusão dos quimioterápicos 4,8,9,14,15 . ...
This descriptive and exploratory study aimed to evaluate the venous network of women with cervical uterine cancer, at the beginning and at the end of the chemotherapy treatment; to analyze the occurrence of phlebitis caused by the drugs used in protocols of neoadjuvant and adjuvant chemotherapy and to relate the types of vein with the most used devices, length of stay and complications. An instrument was used to evaluate the venous network for upper limbs. Participants were twenty women who received care at a teaching hospital in the interior of the state of Sao Paulo. The evaluation of the venous network presented little changes and hematoma was the most frequent complication (60%). The results point out aspects of the nursing practice, related to the administration of chemotherapeutic agents, and highlight the need to develop and implement care protocols.
... Carlquist (1981) commented that there is a reduction in complaints from patients and their satisfaction increases if they are seen by an expert. Weaknesses Most of the data and literature was from the USA and there were few nurse-led IV teams in the United Kingdom (UK) ( Jackson, 2003 ). Performing tasks in isolation does not appear to offer holistic care to patients and this is a medical model of care. ...
Health professionals wishing to expand the service that they offer to their patients must present their employers with a convincing cost-effective and evidence-based rationale for doing so. This article outlines the development of a business case to expand the intravenous therapy service in an English National Health Service trust.
... In 1832 Dr. Thomas Latta, a student of O'Shaughnessy's methods, performed the first IV procedure, giving a saline injection to a patient with 'blue' cholera. He witnessed a 'miracle' recovery from the dehydrated patient (17). He had feared he'd arrived too late to save the patient, who 'apparently had reached the last moments of her earthly existence and now nothing could injure her. ...
Reliable securement of peripheral venous cannulae (PVC) is an important factor in their maintenance. This audit in a district general hospital compares the occurrence of PVC restarts between a 3-month period in 2010 and the same 3 months in 2011. The only difference in the PVC care bundle between these dates was the implementation of an advanced securement dressing for cannulae in 2011. Results show a significant increase in cannulae attaining the maximum local protocol duration of 72 hours during 2011. Also, restarts owing to dressing influenced factors (dislodgement, infiltration and leakage) were significantly lower in 2011 when the new dressing was used. The total number of PVC restarts during the comparative audit periods was 9% lower in 2011 compared with 2010. This data suggests that better PVC securement is leading to an overall reduction in PVC insertions but further evidence is required to support this conclusion.
The aim of this article is to review the principles of infection control relating to intravenous (IV) therapy. IV therapy and peripheral IV cannulation are common procedures. Zingg and Pittet (2009) noted that as many as 80% of hospitalized patients will have a cannula in situ, and Hart (2008) suggested that patients who require IV therapy are often seriously ill and immunocompromised, thus are more susceptible to infection. The Department of Health (DH) (2007a) estimated that 6000 patients acquire a catheter-related bloodstream infection every year in the UK. Robust standards of practice are therefore paramount to ensure safe and competent practice, both in peripheral IV cannulation and IV care. Using the chain of infection as a framework to review practice will enable practitioners to ensure thorough standards of practice, and the Royal College of Nursing (RCN) (2005) stated that only trained and competent staff using strict aseptic techniques should be involved in IV or cannulae care. Furthermore, the Code (Nursing and Midwifery Council (NMC), (2008) stipulates all practitioners must deliver care based on the best available evidence and/or best practice, and that knowledge and skills for safe and effective practice must be kept up-to-date throughout each health professional's working life.
The purpose of this study was to describe saline-lock (SL) usage patterns of patients admitted with high-frequency medical diagnoses to a telemetry unit and to determine the acceptability of constructing a decision tree stratifying SL insertion decisions.
A quantitative, descriptive study using retrospective chart reviews was used.
The study was conducted within a 48-bed telemetry unit of a large, urban, teaching hospital.
The sample was composed of the medical records of patients admitted to the telemetry unit from April 2007 through June 2007. Charts were included in the sample if the patient was admitted to the telemetry unit with one of the 4 highest-frequency admitting diagnoses, specifically myocardial infarction, congestive heart failure, syncope, and chest pain.
Data were collected via patient chart review using an electronic database by a team of 4 registered nurses, including 1 clinical nurse specialist. Data collection steps included a verification process that involved a random audit of the most recently collected chart data.
More than one-third of SLs were not used, and more than half that were used were accessed for the nonurgent delivery of medications. Saline locks were most frequently used for urgent medication delivery when patients were admitted with a diagnosis of heart failure.
Findings suggest that most patients admitted to telemetry units do not require an immediate intravenous access for drug delivery.
Clinical nurse specialists should consider that an evidence-based algorithm for determining SL need may improve patient outcomes and reduce SL-associated complication and infection rates.
Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O'Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sources and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care and aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy is simple to use and provides a route for improving cannula-related documentation. A high standard of documentation will also assist audit, which is crucial to reducing PIC infection.
Inserting peripheral intravenous catheters is a clinical skill that is increasingly becoming part of nurses' remit because of a number of changes in the NHS, including a reduction in junior doctors' working hours and role development. To undertake this skill it is important that nurses receive the appropriate education and can provide evidence of training and competence. A hospital policy is essential to standardize practice and ensure an evidence base. However, all practitioners should be aware that it is their responsibility to maintain their practice and keep up to date. This article provides both the theoretical and practical knowledge to assist nurses who wish to include cannulation as part of their clinical remit.
This article describes a clinical audit of peripheral venous cannulae (PVC) undertaken by members of a national intravenous therapy forum. PVC care was reviewed using the RCN 'Standards for Infusion Therapy' and the Department of Healh's 'Winning Ways' report, action area 2 (DH, 2003; RCN, 2003) to define best practice. Data were collected by members of the forum and submitted for analysis by the members' coordinator. The findings of the audit highlighted several areas for improvement in PVC care. The most significant finding was poor documentation of the insertion of the cannula. An additional concern was that the person who performed the cannulation could not be identified for 236 (37.7%) of PVC audited. Draft recommendations with strategies for implementation have been proposed and feedback sought from participants with plans to re-audit in 2007.
In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling urethral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site <http://www. epic.tvu.ac.uk>. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice.
Relata las primeras investigaciones de caracter cientifico sobre el analisis y la terapia de fluidos del Colera. La escena es Bretana en el ano 1831, durante el brote de la segunda pandemia de Colera, extendida desde Asia por la actual Union Sovietica. Describe los analisis pioneros del Dr. O`Shaughnessy sobre las caracteristicas de la sangre deshidratada de los moribundos por el Colera, y sus propuestas de inyeccion de agua con adicion de cloro y sodio. Informa sobre las primeras experiencias exitosas del Dr. Latta al aplicar la terapia
The purpose of the study was to describe how nurses (n = 37) planned, took care of, and documented peripheral intravenous (vein) cannulae (PIV) and what controls their way of action. Knowledge, experience, and routine were said to govern the care and handling of PIV. The nurses' intention was that a PIV should be inserted for 1-3 days, but all of them were aware of PIV being inserted considerably longer, the reasons being forgetfulness, carelessness, mistake, no one to take responsibility, bad routines and stress. Patients who had received drugs or solutions daily were given less information and furthermore the same PIV-entry was used for drugs, solutions and blood. Only one nurse documented the insertion and the removal of a PIV. The nurses' personal comments were that the area was neglected and there were great variations in the care and handling of PIV. Their task is to systematically identify the patients' needs and risk factors, and to analyse, diagnose, plan, implement and evaluate the care given. Using a standardised guide could be a way to reduce the frequency of complications in the daily care of PIV.
The purpose of this study was to examine nursing issues in the care of patients with peripheral venous cannulas (PVCs) with particular focus on duration of cannulation in order to minimize risk of infection. A tentative practice model evolved from this study. The research approach used involved qualitative methods utilizing grounded theory. Data analysis produced one tentative core category, 'effectiveness'. This allowed for the development of a 12-dimensional model explaining the nursing function against four interrelated models: development; practice; organizational support; effectiveness. Related to these four models were key professional aspects of 'autonomy-control' and 'knowledge-practice'. Interpretative findings from the study were plotted against this model, giving a graphic representation and highlighting strengths and weaknesses of nursing practice. Aspects requiring improvement included: PVC care as a syllabus subject; nursing practice; autonomy and control issues; shared responsibility problems; documentation systems; goal setting; outcomes. The policy, nurses' knowledge of PVC care and identification of critical issues were considered satisfactory. The model incorporates 12 important dimensions associated with effective practice that can be applied to nursing at different levels - clinical practice, education, management - and to other disciplines, providing a framework for narrowing the theory-practice gap and improving patient care.
Infusion resource teams are comprised of nurses specially trained and experienced in infusion therapy. Our multidisciplinary team provides clinical, educational, and research support to a 1000-bed Canadian tertiary hospital. To characterize the infusion resource nurse service, 789 recorded consults for 250 patients during a 12-month period study were reviewed. Noncritical medicine and surgical wards accounted for a similar number of consults, with the highest volume (31% of total consults) being generated by the general and vascular surgery wards. Vein status was visible and either "fair" or "good" in approximately half of all consults, but 39% of consults were visible and "poor." Most consults (81% of total) resulted in the initiation of peripheral intravenous catheters into an area of nonflexion in an upper extremity and successful peripheral catheter initiations were accomplished in 96% of all cases. Our multidisciplinary infusion program approach to vascular access support appears to be a well-utilized and an effective resource for this hospital.
