The Use of Educational Technology in Undergraduate and Postgraduate Nursing and Midwifery Education: A Scoping Review.

Technology has become integral to our personal and professional lives. Its use is increasing in healthcare, both in clinical and educational settings, with healthcare institutions and regulatory bodies recognizing that technology is ever-present. The aim of this scoping review was to examine and quantify the current evidence concerning the use of educational technologies in undergraduate and postgraduate nursing and midwifery education. This review was guided by the JBI methodology for scoping reviews. A tailored search strategy was developed with a research librarian and a number of databases were searched. A total of 19 638 literature sources were screened by three reviewers. Literature published from January 2016 to December 2020 was included and limited to the English language. The reporting of the review process is guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews checklist. This review provides an overview of the current use of educational technologies within nursing and midwifery education; it provides a list of the technologies used, the research methodologies and designs undertaken, and the educational theories, models or frameworks considered. The review highlights the wide range of technologies in use and the paucity of studies that are guided by an educational theory, model or framework.

Vascular access device type for systemic anti-cancer therapies: a scoping review protocol.

INTRODUCTION: Vascular access devices (VADs) are the most common invasive procedure performed in acute medicine and cancer patients undergo multiple invasive vascular access procedures. Our aim is to identify the type of evidence available regarding the best choice of VAD for cancer patients undergoing systemic anti-cancer therapy (SACT). In this article, the authors frame the scoping review protocol used, which will systematically report all published and unpublished literature around the use of VADs for the infusion of SACT in oncology. INCLUSION CRITERIA: For studies to be included, they must focus on people or populations aged 18 years or older and report on vascular access in cancer patients. The concept is the variety of VAD use in cancer and reported insertion and post-insertion complications. The context surrounds the intravenous treatment of SACT whether in a cancer centre or non-cancer setting. METHODS: The JBI scoping review methodology framework will guide the conduct of this scoping review. Electronic databases (CINAHL, Cochrane, Medline and Embase) will be searched. Grey literature sources and the reference lists of key studies will be reviewed to identify those appropriate for inclusion. No date limits will be used in the searches and studies will be limited to the English language. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion, and a third reviewer will arbitrate disagreements. All bibliographic data, study characteristics and indicators will be collected and charted using a data extraction tool.

Strategies to improve retention in randomised trials.

BACKGROUND: Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated. OBJECTIVES: To quantify the effect of strategies to improve retention of participants in randomised trials and to investigate if the effect varied by trial setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, PsycINFO, CINAHL, Web of Science Core Collection (SCI-expanded, SSCI, CPSI-S, CPCI-SSH and ESCI) either directly with a specified search strategy or indirectly through the ORRCA database. We also searched the SWAT repository to identify ongoing or recently completed retention trials. We did our most recent searches in January 2020. SELECTION CRITERIA: We included eligible randomised or quasi-randomised trials of evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS: We extracted data on: the retention strategy being evaluated; location of study; host trial setting; method of randomisation; numbers and proportions in each intervention and comparator group. We used a risk difference (RD) and 95% confidence interval (CI) to estimate the effectiveness of the strategies to improve retention. We assessed heterogeneity between trials. We applied GRADE to determine the certainty of the evidence within each comparison. MAIN RESULTS: We identified 70 eligible papers that reported data from 81 retention trials. We included 69 studies with more than 100,000 participants in the final meta-analyses, of which 67 studies evaluated interventions aimed at trial participants and two evaluated interventions aimed at trial staff involved in retention. All studies were in health care and most aimed to improve postal questionnaire response. Interventions were categorised into broad comparison groups: Data collection; Participants; Sites and site staff; Central study management; and Study design. These intervention groups consisted of 52 comparisons, none of which were supported by high-certainty evidence as determined by GRADE assessment. There were four comparisons presenting moderate-certainty evidence, three supporting retention (self-sampling kits, monetary reward together with reminder or prenotification and giving a pen at recruitment) and one reducing retention (inclusion of a diary with usual follow-up compared to usual follow-up alone). Of the remaining studies, 20 presented GRADE low-certainty evidence and 28 presented very low-certainty evidence. Our findings do provide a priority list for future replication studies, especially with regard to comparisons that currently rely on a single study. AUTHORS' CONCLUSIONS: Most of the interventions we identified aimed to improve retention in the form of postal questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. None of the comparisons are supported by high-certainty evidence. Comparisons in the review where the evidence certainty could be improved with the addition of well-done studies should be the focus for future evaluations.

Vascular access specialist teams for device insertion and prevention of failure.

BACKGROUND: Most people admitted to hospitals worldwide require a vascular access device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes. OBJECTIVES: To compare the use of the vascular access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, device failure, and cost-effectiveness. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018. SELECTION CRITERIA: We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management. MAIN RESULTS: We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication. AUTHORS' CONCLUSIONS: This systematic review failed to locate relevant published RCTs to support or refute the assertion that vascular access specialist teams are superior to the generalist model. A vascular access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of vascular access devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for vascular access devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a vascular access specialist team approach for vascular access device insertion and care for the prevention of failure.

Vessel Health and Preservation: a model and clinical pathway for using vascular access devices.

Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ranging from hospitals to clinics and home care. Clinical pathways are processes used by healthcare providers to integrate and illustrate the best evidence and approach to care for a specific area of practice. The Vessel Health and Preservation (VHP) model is a framework and pathway process, consisting of four quadrants, to guide initiation and management of treatment requiring intravenous access. The pathway is designed to promote preservation of the vasculature of patients from admission through discharge with a focus on acute care. This article describes the model and pathway process. Moving through the quadrants of assessment/selection, insertion, management and evaluation of outcomes the clinician receives vascular access education to establish an understanding of the key principles and is then better able to provide care to the patient. Research on the VHP model has found that patients, clinicians and healthcare facilities benefit from the evidence integrated within the VHP model for improved outcomes, greater success with insertion, time saved through improved efficiency, risk reduced through appropriate device discontinuation, and greater patient satisfaction.

"iM Ready to Learn": Undergraduate Nursing Students Knowledge, Preferences, and Practice of Mobile Technology and Social Media.

The purpose of this study was to identify in what way social media and mobile technology assist with learning and education of the undergraduate nurse. The study involved undergraduate nursing students across three campuses from the University of Notre Dame Australia. Participants were invited to complete an online questionnaire that related to their current knowledge, preferences, and practice with mobile technology and social media within their undergraduate nursing degree. A quantitative descriptive survey design was adapted from an initial pilot survey by the authors. A total of 386 nursing students (23.47% of the total enrolment) completed the online survey. Overall, results suggested that students are more supportive of social media and mobile technology in principle than in practice. Students who frequently use mobile technologies prefer to print out, highlight, and annotate the lecture material. Findings suggest that nursing students currently use mobile technology and social media and are keen to engage in ongoing learning and collaboration using these resources. Therefore, nursing academia should encourage the appropriate use of mobile technology and social media within the undergraduate curriculum so that responsible use of such technologies positively affects the future nursing workforce.

Evaluating Nursing Students' Venipuncture and Peripheral Intravenous Cannulation Knowledge, Attitude, and Performance: A Two-Phase Evaluation Study.

Peripheral intravenous cannulation and venipuncture are among the most common invasive procedures in health care and are not without risks or complications. The aim of this study was to evaluate the current training provided to nursing and midwifery undergraduate students. Student knowledge, attitude, practice, and performance regarding these procedural skills were assessed. A knowledge, attitude, and practices survey was disseminated to final year nursing and midwifery students as the first phase of this study. For the second phase of the study, nursing students were video recorded and then observed performing the skill of peripheral intravenous cannulation in a simulated environment. Thirty-eight nursing and midwifery students completed the survey, and 66 nursing students participated in the observation study. Descriptive statistics were performed. The mean knowledge score was 7.2 out of 15.0, (standard deviation [SD] = 2.4), and the mean attitude score was 10.20 out of 18.00 (SD = 4.79). Qualitative data from the survey were categorized to demonstrate specific areas of focus for improving the training. The mean performance score was 16.20 out of 28.00 (SD = 2.98). This study provides valuable input to developing and enhancing evidence-based curricula. It can help educators and supervisors, in both academic and clinical settings, identify areas where clinical performance and education could be enhanced.

A scoping review of Clinical Studies, Hospital Group Reports and National Strategic Documents on vascular access devices in cancer patients.

INTRODUCTION: The extent of vascular/venous access device (VAD) research output from the Island of Ireland is unknown. The identification of the papers available is important to create a future research agenda. OBJECTIVES: The main objective of this study is to answer three questions: What is the number and descriptive quality of reported Vascular Access Device literature from the Island of Ireland? Is the reporting of Catheter Related Infection rates for cancer patients common in Irish Hospital Groups, National Cancer Reports and Publication Outputs? What are the implications for future research in this area? METHODS: We used a scoping review and searched selected databases, grey literature and hospital regulatory bodies websites following the Joanna Briggs Institute Guidelines 2017. A data charting form was developed based on a template from the Joanna Briggs Institute and this was used to extract data from the included reports. RESULTS: A total of 660 reports were screened. Sixty-one full text articles were reviewed from which 20 reports were included for data extraction. Of the reports included the following designs were used: nine retrospective study designs, four guidelines, two prospective study designs, two literature reviews and one of the following; survey, case study and cross sectional analysis designs. We did not identify any randomised controlled trials, systematic reviews, meta-analysis, meta-synthesis and scoping reviews. Five studies included catheter related infection rates. Gaps in the research include the collection of data sets and the need to establish a VAD registry; develop core outcomes for VADs; assessment and evaluation of VAD care bundles among cancer patients; and, the inclusion of public and patient involvement in future VAD research. CONCLUSION: The reporting of VAD outcomes in published literature regarding cancer patients receiving treatment in Ireland is inconsistent and varied with no interventional studies addressing vascular access complications in cancer care.

Vascular access in critically ill patients with COVID-19: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to examine the extent of vascular access research undertaken on the critically ill COVID-19 population. INTRODUCTION: Two fundamental supportive invasive interventions in the critical care environment are mechanical ventilation and intravenous therapy. Ventilation research has dominated the literature since the pandemic began; however, there has been little research on vascular access devices, despite these interventions existing almost codependently. The systematic proning of this cohort of patients increases the risk of dressing infiltration and infection. Vascular access devices, and the coagulopathic manifestations of COVID-19, place these patients at heightened risk of complications. Vascular access device insertion, care, and maintenance in the critically ill COVID-19 population must be understood to investigate whether this population is at increased risk of vascular access device complications and vessel health compromise. INCLUSION CRITERIA: All study designs will be eligible for inclusion in this review. The intensive care unit will be the main focus of the review. Results will be limited to adults with disease progression severe enough to require admission to critical care. METHODS: A search of Embase, MEDLINE (Ovid), Web of Science, and PubMed will be conducted. Clinical trial data will also be sought. As recommended by JBI, a 3-step search process will be followed. Data will be extracted using a data extraction instrument based on a template from JBI. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the results will be presented in a PRISMA flow diagram. Publication dates will be filtered from 2019 to the present; only English-language results will be included.

The use of educational technology in teaching and assessing clinical psychomotor skills in nursing and midwifery education: A state-of-the-art literature review.

BACKGROUND: An integral part of both undergraduate and postgraduate nursing and midwifery programmes, is the teaching and assessment of clinical psychomotor skills. In order to provide safe care, there is an expectation that technical nursing procedures are performed competently and effectively. Due to limited opportunities to practice clinical skills there is a challenge to advance and implement innovative teaching approaches. Technological advances provide us with alternative options, outside of the traditional teaching approaches, to teach these skills. OBJECTIVE: The aim of this state-of-the-art review was to examine and provide an overview of the current use of educational technologies in nursing and midwifery education in teaching clinical psychomotor skills. METHODS: A-state-of -the-art literature review was carried out, as this type of evidence synthesis design reveals the current knowledge on a topic and identifies gaps for future research. We used a focused search strategy with the expertise of a research librarian. Data extraction included research designs and educational theories guiding the included studies along with the type of technologies studied. A descriptive summary of each study's findings in relation to the educational outcomes was performed. FINDINGS: Sixty studies were sourced which met this reviews' eligibility criteria. Technologies in which most research was carried out included; simulation, video and virtual reality. The most common research design noted included randomized or quasi-experimental studies. The vast majority of studies (n = 47) did not elaborate whether educational theories guided them, while of the remaining thirteen studies, eleven theoretical frameworks were reported. CONCLUSION: Technology use in nursing and midwifery educational research surrounding psychomotor skills education is present. The educational outcomes reported by the majority of studies on the use of educational technology in teaching and/or assessing clinical psychomotor skills are encouraging. Additionally, the majority of studies noted that students evaluated the technology positively and were satisfied with its use in their education. Future research may include evaluating the technologies in both undergraduate and postgraduate populations. Finally, opportunities exist to expand the evaluation of student learning or assessment of these skills using technologies from the educational environment to the clinical environment. REGISTRATION: Not registered.

Quality of life in Hidradenitis Suppurativa (Acne Inversa): A scoping review.

Background: Hidradenitis Suppurativa (HS) is a chronic, relapsing, inflammatory skin condition which is physically, psychologically and socially disabling and often affects a patient's quality of life (QOL). There are numerous QOL tools used in dermatology. However, assessment of QOL in patients with HS is difficult due to the inability of generic QOL tools to specifically capture QOL in patients with HS. Numerous HS-specific QOL tools have been developed in recent years. It is important to identify evidence on full psychometric evaluation of these tools. Objectives: There has been a gradual increase in the use of generic and disease-specific QOL tools in the last few decades. The aim of this scoping review (SR) is to evaluate the most widely used generic QOL tools and HS-specific QOL tools to identify the psychometric evaluation of such tools. Methods: Design: An SR guided by Joanna Briggs Institute manual and Arskey O'Malley framework guidelines. Data extraction included the studies available on full psychometric evaluation of the most widely used dermatology generic QOL tools in HS and HS-specific QOL tools. Results: Ten papers were included in the review, eight papers demonstrated HS-specific QOL assessment tools. The psychometric properties of these tools were underpinned by reliability, validity and sensitivity measurement. Six disease-specific tools were identified in this SR. However, they all lack full psychometric evaluation. Conclusion: This review indicates that an extensive research in the field of QOL tools for HS is much needed. It is crucial to develop user-friendly and validate disease-specific tools to measure the real impact of disease on patients QOL. QOL instruments can evaluate the impact on life of an HS patient, thus helping improve intervention and management of disease. There is a necessity for more research into existing HS-specific QOL tools and they should be widely tested and fully validated.

Effectiveness of structured self-evaluation of video recorded performance on peripheral intravenous catheter insertion: a randomised control trial study protocol.

BACKGROUND: Clinical psychomotor skills training is a core component of undergraduate nursing education. Performing technical skills competently involves the use of cognitive and motor function. The training of these technical skills is typically carried out in clinical simulation laboratories. Peripheral intravenous catheter/cannula insertion is an example of a technical skill. It is the most common invasive procedure performed in the healthcare environment. Owing to unacceptable clinical risk and complications to patients, it is imperative that practitioners performing these skills are trained effectively to provide patients with best practice and high-quality care. Technologies identified as innovative teaching methods to help train students in this skill and in the skill of venepuncture include virtual reality, hypermedia and simulators. However, little high-quality evidence exists to confirm such educational approaches are effective. METHODS/DESIGN: This study is a single-centre, non-blinded, two-group, pre-test and post-test randomised control trial. The randomised control trial will investigate whether a formal structured self-evaluation of videoed performance (experimental group) has an impact on nursing students' peripheral intravenous cannulation knowledge, performance and confidence. The control group will also be videoed performing the skill but they will not view or self-evaluate their videoed performance. The peripheral intravenous cannulation procedures will be carried out in a clinical simulation laboratory using a task trainer. The data collection tools will be completed online using survey forms. Students will be randomised into the experimental group or into the control group using simple random sampling. The primary outcome measures the nursing students' knowledge level of the skill of peripheral intravenous cannulation insertion. Secondary outcomes evaluate procedural competence and self-reported confidence and practices in the clinical environment. DISCUSSION: This randomised control trial will investigate whether this pedagogical approach, using video modelling and self-evaluation, will positively influence students' knowledge, confidence and performance in the skill of peripheral intravenous cannulation. Evaluating such teaching strategies using stringent methodologies may be impactful in influencing the training provided to healthcare practitioners. TRIAL REGISTRATION: The randomised control trial detailed in this article is an educational research study and so does not fall under the ICMJE definition of a clinical trial as "any research project that prospectively assigns people or a group of people to an intervention, with or without concurrent comparison or control groups, to study the relationship between a health-related intervention and a health outcome".

The burden of peripheral intravenous catheters in older hospital inpatients: A national cross-sectional study part of the ONE MILLION GLOBAL PERIPHERAL INTRAVENOUS CATHETERS COLLABORATION.

OBJECTIVES: To investigate the burden of peripheral intravenous catheters (PIVCs) in older hospitalised patients. METHODS: A cross-sectional prospective observational study (2014/2015) to describe the characteristics, indications and outcomes of PIVCs among patients aged ≥65 from 65 Australian hospitals. RESULTS: Amongst 2179 individual PIVCs (in 2041 patients, mean age 77.6 years, 45% female, 58% in NSW), 43% were inserted by doctors and 74% used that day, meaning 25% were 'idle'. Overall, 18% (393/2179) exhibited signs of PIVC-related complications. Most commonly exhibited PIVC-related complications were tenderness (4.1%) and local redness (1.8%). Nearly one in three (29.1%) dressings was soiled, loosened or had come off, and only 36.8% had the time and date documented on the dressing. Both infusing IV medications (aOR 1.74, 95% CI 1.28-2.38, p < 0.001) and inserting the PIVC in a non-upper limb vein (aOR 3.40 compared to forearm [reference site], 95% CI 1.62-7.17, p < 0.001) were independently associated with PIVC failure. Phlebitis was exhibited in 7% (154) of the patients. Only infusing intravenous medications increased the likelihood of developing symptoms of phlebitis (aOR 1.61, 95% CI 1.01-2.57, p = 0.05). Increasing age was inversely associated with symptoms of phlebitis. Among the 1575 patients (79%) who rated their PIVC experience using the Likert scale 0-10 (where 10 = 'best possible'), the median score was 8 (IQR 6-10). Age in highest quartile (>84 years) was independently associated with lower likelihood of a high score (aOR 0.71, 95% CI 0.54-0.94, p = 0.02). CONCLUSIONS: Given 1 in 5 PIVCs were identified with having complications, further research should focus on optimising PIVC use in older patients.

Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial.

BACKGROUND: One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. OBJECTIVES: We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. DESIGNS, SETTINGS AND PARTICIPANTS: A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for >24 h were studied. MAIN OUTCOME MEASURES: The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction. RESULTS: Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs. INTERVENTION: Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different. CONCLUSIONS: PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.

Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation.

BACKGROUND: Around 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international consensus on relevance and feasibility of clinical practice guideline recommendations to reduce PIVC failure. METHODS: e-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals. FINDINGS: Over 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3). CONCLUSION: We provide an international consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.

Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study.

OBJECTIVES: Rates of unused ('idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. DESIGN: A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. SETTING: Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. PARTICIPANTS: Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. RESULTS: From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. CONCLUSION: The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.

Design, development and preliminary assessment in a porcine model of a novel peripheral intravenous catheter aimed at reducing early failure rates.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet despite best efforts by end-users, PIVCs experience unacceptably high early failure rates. We aimed to design a new PIVC that reduces the early failure rate of in-dwelling PIVCs and we conducted preliminary tests to assess its efficacy and safety in a porcine model of intravenous access. METHODS: We used computer-aided design and simulation to create a PIVC with a ramped tip geometry, which directs the infused fluid away from the vein wall; we called the design the FloRamp™. We created FloRamp prototypes (test device) and tested them against a market-leading device (BD Insyte™; control device) in a highly-controlled setting with five insertion sites per device in four pigs. We measured resistance to infusion and visual infusion phlebitis (VIP) every 6 h and terminated the experiment at 48 h. Veins were harvested for histology and seven pathological markers were assessed. RESULTS: Computer simulations showed that the optimum FloRamp tip reduced maximum endothelial shear stress by 60%, from 12.7 Pa to 5.1 Pa, compared to a typical PIVC tip and improved the infusion dynamics of saline in the blood stream. In the animal study, we found that 2/5 of the control devices were occluded after 24 h, whereas all test devices remained patent and functional. The FloRamp created less resistance to infusion (0.73 ± 0.81 vs 0.47 ± 0.50, p = 0.06) and lower VIP scores (0.60 ± 0.93 vs 0.31 ± 0.70, p = 0.09) than the control device, although neither findings were significantly different. Histopathology revealed that 5/7 of the assessed markers were lower in veins with the FloRamp. CONCLUSIONS: Herein we report preliminary assessment of a novel PIVC design, which could be advantageous in clinical settings through decreased device occlusion and reduced early failure rates.

Interns' attitudes to IV cannulation: a KAP study.

UNLABELLED: One of the most common procedures for junior medical doctors is peripheral intravenous cannulation (PIVC). Considering this, an understanding of the peripheral intravenous cannulation procedure is paramount. AIM: The objective of this study was to identify the level of understanding of interns regarding intravenous cannulation. METHOD: An anonymized structured questionnaire using a knowledge attitude and practices (KAP) format was distributed to 60 interns affiliated to a university college hospital in Ireland. FINDINGS: This study suggests that interns are poorly prepared for one of the most common clinical skills they will perform. They showed poor understanding of whether peripheral cannulation is a clean or aseptic technique, and lacked knowledge of the potential side effects of peripheral cannulation and IV therapy. RECOMMENDATIONS: A structured learning module on peripheral intravenous cannulation is required. A rigid, evidence-based, Objective Structured Clinical Examination (OSCE) on peripheral cannulation is recommended. The reduction of junior doctors' weekly working hours to 48 under the European Working Time Directive offers the potential for nurses to take ownership of IV cannulation. This will allow junior doctors to focus on other clinical skills and assessments, which can only be to the advantage of the patient.

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices.

BACKGROUND: Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. METHODS: This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February-18 March 2017 and 5 January-4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. RESULTS: A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7-3.3). CONCLUSION: One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

A pilot intravenous cannulation team: an Irish perspective.

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.