'Pinholes in my arms': the vicious cycle of vascular access.

BACKGROUND: Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). AIMS: To explore how patients make sense of living with a CVAD. METHODS: This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. FINDINGS: Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. CONCLUSION: Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.

Health professionals' lack of knowledge of central venous access devices: the impact on patients.

BACKGROUND: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. AIM: the study objective was to uncover the global, cross-disease experience of patients with CVADs. METHOD: an online survey was sent to an international sample of people living with CVADs. FINDINGS: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. CONCLUSION: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.

Medical device classification: focus on vascular access.

Developments in the medical device industry are driven by a rapidly changing healthcare arena in combination with advances in technological fields such as materials science, bio-engineering and electronics. Subsequently, it is now estimated that over 500 000 different types of medical devices are produced globally. This article aims to give a simple explanation of device classification as it relates to vascular access devices. It aims to provide the reader with information to increase their knowledge and understanding of this topic.

Needle-free devices: keeping the system closed.

Health professionals are under increasing pressure to reduce costs while ensuring patient safety. As the number of vascular access devices (VADs) used in health care continues to increase, there is a need to reduce the complications of infection and occlusion associated with them. Needle-free devices (NFDs), also known as needleless connectors, have been available since the early 1990s and the type and variety of these devices has continued to develop. As well as the original aim of NFDs to maintain a closed system and to reduce the risk of needlestick injuries and blood spillage, NFDs are now designed with the aim of improving clinical outcomes by reducing the common complications of infection and catheter occlusion. As there are a number of NFDs available with specific designs, it is imperative that health professionals have an understanding of the different types and functions. This article provides an explanation of NFD design and functions and guidance and information about their benefits, as well as advice on preventing complications associated with their use.

A blended learning approach to teaching CVAD care and maintenance.

Nurses working within both acute and primary care settings are required to care for and maintain central venous access devices (CVADs). To support these nurses in practice, a higher education institution and local health board developed and delivered CVAD workshops, which were supported by a workbook and competency portfolio. Following positive evaluation of the workshops, an electronic learning (e-learning) package was also introduced to further support this clinical skill in practice. To ascertain whether this blended learning approach to teaching CVAD care and maintenance prepared nurses for practice, the learning package was evaluated through the use of electronic questionnaires. Results highlighted that the introduction of the e-learning package supported nurses' practice, and increased their confidence around correct clinical procedures.

Innovation in training for totally implanted port insertion.

This article discusses the use of fresh frozen cadavers as an innovative way to teach the procedure of totally implanted port insertion. In an attempt to increase the number of competent medical and nursing practitioners able to insert these devices, workshops have been devised and delivered at a university clinical anatomy skills centre. This method of teaching has had positive feedback from practitioners.

Innovation in training for totally implanted port insertion.

This article discusses the use of fresh frozen cadavers as an innovative way to teach the procedure of totally implanted port insertion. In an attempt to increase the number of competent medical and nursing practitioners able to insert these devices, workshops have been devised and delivered at a university clinical anatomy skills centre. This method of teaching has had positive feedback from practitioners.

Implementing a new teaching and learning strategy for CVAD care.

BACKGROUND: Central venous access devices (CVADs) are now a fundamental part of contemporary healthcare. Despite having many advantages, there are also complications associated with them. Evidence suggests that educating and training health professionals who maintain CVADs is essential for preventing such complications, however, the most effective approach for this training has not been evaluated. AIM: The aim of this study was to determine whether the introduction of an innovative educational intervention within a higher education institution (HEI) improved the confidence and knowledge of registered nurses dealing with CVADs. METHODS: A survey design consisting of a self-completion questionnaire and open-ended questions was used. RESULTS: This study demonstrated that nurses felt more confident following participation in the training. In addition, nurses discussed the advantages of training outside of the clinical setting as it provided them with a safe place to practise and gave them time to learn without interruption. The findings from this study suggest that the HEIs can provide an effective and safe environment for registered nurses to build confidence and knowledge in CVAD management.

Getting the most from ultrasound guidance for CVC insertion.

Ultrasound is an imaging technique that uses ultra-high frequency sound waves. The interaction of the sound waves with body tissue enables an image to be produced. Following guidance from the National Institute for Health and Care Excellence (NICE) (2002), the use of two-dimensional ultrasound imaging for central venous catheter (CVC) insertion has increased. Ultrasound provides the nurse with visualisation of the target vein as well as any other surrounding structures. It also demonstrates any variation in anatomy that the patient may have. Increased first-time puncture rates and decreased complications are among the benefits of ultrasound use for CVC placement described in the literature. However, NICE (2002) guidance recommended that education and training be sought by those using this technology. The aim of this article, therefore, is to provide useful information regarding ultrasound-guided venous access and to describe some techniques to improve image quality.

The experiences of nurses who insert central venous access devices.

There has been much role expansion in nursing in the last two decades, with advanced nurses now performing minimally invasive surgery such as central venous access device insertion. However, there is a lack of research exploring the perceptions of nurses performing these procedures. This study explored the lived experiences of nurses who perform minimally invasive surgery, namely central venous access device insertion. Three key themes emerged from this analysis:stress associated with the unpredictable nature of the procedure,coping with responsibility and a patient-focused approach. Although the practitioners experience a degree of stress in the role, they also experience job satisfaction and feel that their roles have a positive impact on the patients in their care. The study findings provide information to managers and nurses performing these roles, and suggest how stress and burnout can be prevented.

A guide to the use and care of vascular access devices in the palliative care setting.

There has been a steady increase in the number and range of vascular access devices used in all areas of health care. With this increase there comes a requirement that health professionals dealing with these devices be aware of the range available, indications for use, and the most up to date guidance on the care and maintenance procedures. Care of the device is paramount to preventing complications. This article provides an overview of the types of venous access devices that may be encountered when a patient is transferred to palliative care services, as well as of the procedures for routine maintenance.

Exploring how the development of a nurse-led vascular access service has benefited patients.

The management and care of patients in Greater Glasgow and Clyde needing long-term vascular access has changed markedly over the past six years. A nurse-led vascular access service has been introduced to reduce waiting times for patients requiring long-term venous access for treatments such as chemotherapy, long-term antibiotics, renal dialysis and feeding. Nurses in the service now insert tunnelled central venous catheters (TCVCs) and also educate and train other healthcare professionals. This service has led to a reduction in complications and provided a source of expert advice for both patients and healthcare professionals.

The care of vascular access devices in community care.

Infusion therapy is now an integral part of the majority of nurses' professional practice (RCN, 2006). Infusion therapy is no longer confined to secondary care, and home intravenous therapy is becoming more commonplace (Keyley, 2002). As nurses, we are responsible for maintaining our skills and knowledge in relation to all aspects of patient care (RCN, 2006). This article provides an overview of the types of vascular access devices used in primary care, and provides guidance and recommendations to ensure best practice. Although there are many complications associated with vascular access devices (Docherty, 2006) this article will focus on the prevention of infection and maintainace of catheter patency in vascular access devices. Infection is one of the most serious complications that can result from the presence and use of a central venous catheter (Humar et al. 2000), however careful management of these devices can minimize the complications associated with infusion therapy.

Anti-NMDAR Encephalitis.

Anti-N-methyl-D-aspartate receptor encephalitis is a newly described disease process. Patients are generally young females who present with psychiatric symptoms and progress to have seizures, abnormal movements, and. autonomic instability. Diagnosis is made based on serum and cerebrospinal fluid results, However, a characteristic EEG pattern described as extreme delta brush has been associated with this disorder making it especially relevant to neurodiagnostic technologists in practice today. Our case presentations follow two patients through the course of their illness and recovery.

Distinct properties and advantages of a novel peroxisome proliferator-activated protein [gamma] selective modulator.

Antidiabetic thiazolidinediones (TZDs) and non-TZD compounds have been shown to serve as agonists of the peroxisome proliferator-activated receptor gamma (PPARgamma). Here, we report the identification and characterization of a novel non-TZD selective PPARgamma modulator (nTZDpa). nTZDpa bound potently to PPARgamma with high selectivity vs. PPARalpha or PPARdelta. In cell-based assays for transcriptional activation, nTZDpa served as a selective, potent PPARgamma partial agonist and was able to antagonize the activity of PPARgamma full agonists. nTZDpa also displayed partial agonist effects when its ability to promote adipogenesis in 3T3-L1 cells was evaluated. Assessment of protein conformation using protease protection or solution nuclear magnetic resonance spectroscopy methods showed that nTZDpa produced altered PPARgamma conformational stability vs. full agonists, thereby establishing a physical basis for its observed partial agonism. DNA microarray analysis of RNA from 3T3-L1 adipocytes treated with nTZDpa or several structurally diverse PPARgamma full agonists demonstrated qualitative differences in the affected gene expression profile for nTZDpa. Chronic treatment of fat-fed, C57BL/6J mice with nTZDpa or a TZD full agonist ameliorated hyperglycemia and hyperinsulinemia. However, unlike the TZD, nTZDpa caused reductions in weight gain and adipose depot size. Feed efficiency was also substantially diminished. Unlike TZDs, nTZDpa did not cause cardiac hypertrophy in mice. When a panel of PPARgamma target genes was examined in white adipose tissue, nTZDpa produced a different in vivo expression pattern vs. the full agonist. These findings establish that novel selective PPARgamma modulators can produce altered receptor conformational stability leading to distinctive gene expression profiles, reduced adipogenic cellular effects, and potentially improved in vivo biological responses. Such compounds may lead to preferred therapies for diabetes, obesity, or metabolic syndrome.