A safe and effective winged peripheral intravenous cannula for use in clinical practice.

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.

Advanced nursing practice: a review of scopes of practice in cancer care.

The establishment of advanced nurse practitioners (ANPs) has expanded considerably in recent years and shown to result in substantial contributions to numerous fields of health care. Due to advancements in treatments and innovations in medicine, patients with cancer are living longer, requiring a multifactorial holistic approach in which ANPs, due to their skills and knowledge, can be best utilised, as they are able to provide the expert care required at various stages of the patient journey. This article explores scopes of practice from ANPs working with oncology patients in a tertiary cancer centre, making explicit their roles, in addition to highlighting experienced challenges and future directions of care.

Solving the problem of IV dislodgement.

Most patients in hospital will have some form of intravenous (IV) catheter in situ at some time to facilitate the administration of IV therapy. Accidental dislodgement, although widespread, is often unrecognised as a contributor to IV catheter failure. Dislodgement usually contributes to the delay in the administration of treatment, time-consuming IV restarts and a potential need for more invasive procedures. Dislodgement has serious implications, with costs to both patient and healthcare costs. Historically, prevention of IV catheter dislodgement has focused on the use of the correct securement methods and technique; however, these fail in many occasions, for example, where patients are confused or during bed transfers. In the recent years, new breakaway connector systems, such as ReLink, have been designed, which allow the tubing to become disconnected when undue pressure or pull is placed on it. This is done by a safety release valve that breaks apart, sealing off both ends of the tubing in an aseptic manner, while shutting off medication flow and preserving IV catheter integrity. Awareness raising and education focusing on accidental IV catheter dislodgement and the different ways to reduce its incidence in clinical practice would improve patient safety and potentially have significant healthcare savings.

The state of vascular access teams: Results of a European survey.

BACKGROUND: Many European health institutions have appointed multidisciplinary teams for the general management of vascular access to help improve efficiency, patient safety and reduce costs. Vascular access teams (VATs), or infusion teams, are specifically trained groups of healthcare professionals who assess, place, manage and monitor various outcomes and aspects of vascular access care. OBJECTIVE: To assess the current landscape of vascular access management as a discipline across Europe. METHODS: A Faculty of European VAT leads and experts developed a survey of 20 questions which was disseminated across several European countries. Questions focused on respondent and institution profile, vascular access device selection and placement, monitoring and reporting of complications, and access to training and education. The 1449 respondents included physicians, nurses, anaesthetists, radiologists and surgeons from public and private institutions ranging in size. RESULTS: Availability of dedicated VATs vary by country, institution size, and institution type. Institutions with a VAT are more likely to utilise a tool (eg, algorithm or guideline) to determine the appropriate vascular access device (55% vs 38%, P < .0002) and to have feedback on systematic monitoring of complications (40% vs 28%, P = .015). Respondents from institutions with a VAT are more likely to have received training on vascular access management (79% vs 53%, P < .0001) and indicated that the VAT was a source of support when difficulties arise. CONCLUSION: The survey results highlight some of the potential benefits of implementing a dedicated VAT including the use of a broader range of vascular access devices, increased awareness of the presence of vascular access policies, increased the likelihood of recent vascular access training, and increased rates of systematic monitoring of associated complications. The study reveals potential areas for further focus in the field of vascular access care, specifically examining the direct impact of vascular access teams.

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams.

BACKGROUND: Vascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications. PURPOSE: A faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals. METHODS: Interview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline®-cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program. RESULTS: While VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised. CONCLUSIONS: The implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in- and outpatient services, beneficial to both patients and institutions.

Clinical experiences of using ports and non-coring needles.

The following case studies describe the use of the Smith Medical implanted ports and Gripper huber needles. Smiths Medical produces a range of implanted ports that include the Port-A-Cath and P.A.S. Port Power P.A.C. systems. The ports are easy to implant, maintain and remove. They are lightweight and have features that are designed to reduce complication rates, including a highly compressed septum to increase needle retention, a titanium chamber with a gouge-resistant floor, a bevelled chamber for optimal rinsing, a round shape to avoid overturning and the Ultralock connection. They are available in various configurations, with single and dual lumens. There is also a needle for power-injection of contrast media for certain types of diagnostic imaging scans (Smith Medical 18). The Gripper Plus needle is designed with an emphasis on safety, effectiveness and patient comfort. These non-coring needles have a bevelled tip that sits flush with the back of the port without impeding the flow of fluid; this also prevents holes forming in the septum (Barton et al, 2018). The needle is available in different gauges and lengths, which can be tailored to reflect individual patient needs and the amount of adipose tissue present. It is essential to select the correct size, which will reduce the risk of dislodgement. The Gripper needles are compatible with paclitaxel and lipid solutions, and are recommended by the National Institute for Occupational Safety and Health (NIOSH) (1999). They are compatible with both the Port-a-Cath and P.A.S. Port Power P.A.C. systems, and can be ordered from the same manufacturer, which has the potential to make ordering, training and support more efficient.