Midline Catheters: Could They Replace a Central Vascular Access Device?

In the past 30 years, midline catheter use has grown rapidly. For several reasons, many providers and facilities are attempting to reduce the number of central venous catheters and subsequent central line-associated bloodstream infections (CLABSIs) by using midline catheters. Vessel preservation requires attention to all vascular access device (VAD)-associated complications and not only central line bloodstream infection. There is still much confusion about the appropriate tip location and the characteristics of fluids and medications that can safely be infused through a midline catheter residing in a peripheral vein. The Infusion Therapy Standards of Practice (the Standards) focuses on assessment of characteristics of infusion therapies that must be considered for VAD selection as an evidence-based list of fluids and medications for infusion through peripheral veins has yet to be established. This review of midline catheter studies evaluates the evidence regarding the substitution of a midline catheter for a central venous catheter. Many issues need to be addressed, such as studies that include an outcome list that mixes defined clinical complications (eg, thrombosis) with signs and symptoms of complications (eg, leaking). Another issue is basing a major change of clinical practice on retrospective chart reviews. Although a midline catheter may be appropriate for some patients, additional studies of a higher level of evidence are needed before this major practice change should occur.

WoCoVA consensus on the clinical use of in-line filtration during intravenous infusions: Current evidence and recommendations for future research.

The need for filtering intravenous infusions has long been recognized in the field of venous access, though hard scientific evidence about the actual indications for in-line filters has been scarce. In the last few years, several papers and a few clinical studies have raised again this issue, suggesting that the time has come for a proper definition of the type of filtration, of its potential benefit, and of its proper indications in clinical practice. The WoCoVA Foundation, whose goal is to increase the global awareness on the risk of intravenous access and on patients' safety, developed the project of a consensus on intravenous filtration. A panel of experts in different aspects of intravenous infusion was chosen to express the current state of knowledge about filtration and to indicate the direction of future research in this field. The present document reports the final conclusions of the panel.

Stopcocks for Infusion Therapy: Evidence and Experience.

Stopcocks have been used for decades to deliver infusion therapy in patients of all ages and in all health care settings. During the past 20 years, a growing number of studies have validated concern about the risk of the open lumen allowing intraluminal contamination. Additional studies highlight fluid flow dynamics associated with stopcocks. This integrative literature review and clinician practice survey analyzes the published evidence and reports of actual practices with stopcocks, and raises issues about practice changes that could reduce these risks.

Needleless connectors for IV catheters.

OVERVIEW: Needleless devices for connecting IV catheters, administration sets, and syringes were introduced in the early 1990s for the purpose of reducing the risk of needlestick injuries among health care providers. Although needleless connectors serve that purpose, their use has been associated with an increase in such complications as catheter-related bloodstream infection and catheter lumen occlusion. Complications may be related to design characteristics, user knowledge deficits, poor practices, or some combination thereof. The author describes the connectors in current use, how they differ in design and function, the potential complications associated with various models and practices, and the nursing interventions that can reduce the risk of these complications.

Short peripheral intravenous catheters and infections.

The rate of infections associated with short peripheral intravenous catheters is thought to be very low, even rare. Approximately 330 million peripheral catheters are sold annually in the United States. Although the rate may be low, the actual number of infections could be relatively high, with most going undetected because of short dwell times and early patient discharges. A recent estimate reported as many as 10000 Staphylococcus aureus bacteremias from peripheral catheters annually in the United States. This integrative literature review identified soft tissue, bone, and bloodstream infections. Analysis of 45 studies revealed significant knowledge gaps and inadequate clinical practices associated with one of the most common devices used in all health care settings.

Needlestick injuries, short peripheral catheters, and health care worker risks.

Percutaneous exposure (PCE) and mucocutaneous exposure (MCE) to blood and blood-containing body fluids pose risks to health care workers worldwide. Although PCEs have been greatly reduced in the United States, they have not been eliminated and continue to be a significant problem worldwide. MCE seems to be a much smaller problem than PCE; however, the data are limited and confusing. Venipuncture procedures can easily be associated with PCE, but there are no published reports of MCE occurring during insertion, use, and removal of peripheral catheters. This integrative, systematic literature review identifies the risks associated with venipuncture and the insertion of short peripheral catheters.

Development of an infusion alliance.

Infusion therapy is one of the most invasive, complex, and pervasive therapies in the current health care system, yet there is very little investment in organizational knowledge management and intellectual human capital required to maintain patient safety. Catheter complications, fluid and medication errors, inadequate nutritional support, and transfusion of incompatible blood products manifest evidence of the ongoing problem. The number of infusion therapy teams has greatly decreased because of questionable cost-cutting strategies; however, it is clear from identified trends in health care that infusion teams and the concept of an infusion alliance has a distinct place within a modern health care organization.

Needleless connectors: a primer on terminology.

Within the past 20 years there has been an explosion of devices designed to allow connection of multiple intravenous sets and catheter hubs without the use of needles. Currently, the number of devices, their internal and external designs, and their functions can be quite confusing. There is a lack of clear definitions and terminology universally accepted by all professionals involved, leading to additional confusion. The purpose of this article is to provide an overview of the many types of technological designs, clarify the characteristics, and recommend clear and concise definitions.

Infiltration and extravasation: update on prevention and management.

Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.