Compliance with central venous catheter infection prevention practices after intervention with simulation.

OBJECTIVES: to assess the effect of an educational intervention based on clinical simulation on nursing professionals' compliance with practices to prevent peripherally inserted central venous catheter-associated primary bloodstream infections in a Neonatal Intensive Care Unit. METHODS: a quasi-experimental study, with preand post-intervention assessment with a single group. The population consisted of 41 nursing professionals, with 31 observations being made before and after the intervention. Analyzes were performed using descriptive statistics and the McNemar non-parametric test. A significance level of 5% was adopted. RESULTS: after the intervention, there was an increase in compliance with prevention practices of surgical antisepsis and professional hand hygiene, skin antisepsis with chlorhexidine, waiting for the time of the effect of alcoholic chlorhexidine and compliance with the sterile technique. CONCLUSIONS: the educational intervention showed an effect on increasing compliance with catheter-associated infection prevention practices.

Construção e validação de curso online para enfermeiros sobre cateteres venosos centrais em crianças no domicílio / Construcción y validación de un curso en línea para enfermeros sobre catéteres venosos centrales en niños en el hogar / Construction and validity of an online course for nurses on central venous catheters in children at home

Resumo Objetivo construir um curso online e autoinstrucional para enfermeiros que realizam assistência às crianças em uso de cateter venoso central no domicílio e validar o conteúdo do curso por especialistas. Método estudo metodológico, alicerçado no Design Instrucional pelo modelo ADDIE, desenvolvido em duas etapas entre setembro de 2019 e maio de 2020: construção do curso; e validação do conteúdo por um comitê de oito especialistas, recrutados pelo método bola de neve por meio eletrônico. Utilizou-se o Instrumento de Validação de Conteúdo Educativo em Saúde, com ponto de corte ≥0,8 para a validação de conteúdo. Resultado s: elaboram-se 25 produtos tecnológicos para a produção final do curso: quatro planos de ação pedagógica, seis storyboards, nove recursos educativos em vídeo e 6 módulos do curso em formato Sharable Content Object Reference Model, aplicável em diferentes plataformas. Todos os módulos apresentaram Índice de Validade de Conteúdo ≥0,80 em todos os domínios e na avaliação global. Conclusão e implicações para a prática o conteúdo de todos os módulos foi validado pelos especialistas. O curso contribui para a prática assistencial, permitindo atualização com base em conteúdo atual e validado cientificamente. Ele pode ser utilizado em outras propostas pedagógicas, desde que atendidas as premissas da Licença Creative Commons 4.0 Internacional.

Resumen Objetivo construir un curso en línea y de auto instrucción para enfermeras que brindan atención a niños utilizando un catéter venoso central en el hogar y validar el contenido del curso por especialistas. Método estudio metodológico, basado en Diseño Instruccional por el modelo ADDIE, desarrollado en dos etapas entre septiembre de 2019 y mayo de 2020: construcción del curso; y validación del contenido por un comité de ocho especialistas, reclutados por el método bola de nieve, electrónicamente. Se utilizó el Instrumento de Validación de Contenidos Educativos en Salud y se adoptó el punto de corte ≥0.8 para la validación de contenidos. Resultados en siete meses, se elaboran 25 productos tecnológicos para la producción final del curso: cuatro planes de acción pedagógica, seis storyboards, nueve recursos educativos de video y 6 módulos del curso en formato Sharable Content Object Reference Model, aplicables en diferentes plataformas. Todos los módulos mostraron un Índice de Validez de Contenido ≥0,80 en todos los dominios y en la evaluación general. Conclusión e implicaciones para la práctica el contenido de los módulos ha sido respaldado por especialistas. El curso contribuye a la práctica del cuidado, permitiendo la actualización a partir de contenidos actualizados y científicamente validados. Puede ser utilizado en otras propuestas pedagógicas, siempre que se cumplan las premisas de la Licencia Creative Commons 4.0 Internacional.

Abstract Objective to construct an online, self-instructional course for nurses who provide care to children using a central venous catheter at home and validate the course content by experts. Method this is a methodological study, based on Instructional Design using the ADDIE model, developed in two stages between September 2019 and May 2020: course construction; and content validity by a committee of eight experts, recruited by the snowball method through electronic. The Educational Content Validation Instrument in Health was used, with a cut-off point ≥0.8 for content validity. Results twenty-five technological products are created for the course's final production: four pedagogical action plans, six storyboards, nine educational video resources and 6 course modules in Sharable Content Object Reference Model format, applicable on different platforms. All modules presented a Content Validity Index ≥0.80 in all domains and in the overall assessment. Conclusion and implications for practice the content of all modules has been validated by experts. The course contributes to care practice, allowing updating based on current and scientifically validated content. It can be used in other pedagogical proposals, as long as the Creative Commons Attribution 4.0 International License premises are met.

Cateter venoso central de curta permanência: produção de vídeos educativos para a equipe de enfermagem / Catéter venoso central de corta duración: producción de vídeos educativos para el equipo de enfermería / Short-term central venous catheter: Production of educational videos for the Nursing team

RESUMO Objetivo construir e validar roteiros e storyboards para a produção de vídeos educativos, em formato digital, sobre os cuidados e manutenção do cateter venoso central em pacientes adultos. Método estudo metodológico, descritivo, sobre construção e validação dos roteiros e storyboards para a produção de vídeos educativos, ocorrido em duas etapas metodológicas: de pré-produção e de produção. A etapa de pré-produção baseou-se em três fases: construção dos roteiros dos vídeos, elaboração dos storyboards e validação por peritos. A validação dos roteiros e storyboards foi realizada por nove juízes especialistas na temática e dois técnicos especialistas em vídeo. Calculou-se o Índice de Validação de Conteúdo (IVC), considerando-se como aceitável o índice mínimo de 0,80 para cada item dos instrumentos. Resultados produziram-se três vídeos educativos com as seguintes temáticas: cobertura, manutenção e troca e remoção do cateter venoso central. A respeito da validação pelos juízes especialistas na temática e pelos técnicos especialistas em vídeo, todos os itens avaliados resultaram na concordância em IVC de 100,0. Conclusão e implicações para a prática os vídeos educativos foram produzidos, validados e adequados para serem disponibilizados. A participação dos juízes na validação desse material foi fundamental para garantir a relevância teórica e prática do resultado.

RESUMEN Objetivo construir y validar guiones y storyboards para la producción de videos educativos, en formato digital, sobre el cuidado y mantenimiento del catéter venoso central en pacientes adultos. Método estudio metodológico y descriptivo sobre la construcción y validación de guiones y storyboards para la producción de vídeos educativos que se produjo en dos etapas metodológicas: preproducción y producción. La etapa de preproducción se basó en tres fases: construcción de los guiones de los vídeos, elaboración de storyboards y validación por parte de expertos. La validación de los guiones y storyboards fue realizada por 9 jueces especialistas en el tema y 2 técnicos expertos en video. Se calculó el Índice de Validación de Contenido (IVC), considerando como aceptable el índice mínimo de 0,80 para cada ítem de los instrumentos. Resultados se crearon tres vídeos educativos con los siguientes temas: cobertura, mantenimiento e intercambio y retirada del catéter venoso central. A partir de la valoración por parte de los jueces especialistas en el tema y de los técnicos especialistas en vídeo, todos los elementos evaluados resultaron en una concordancia en el IVC de 100,0. Conclusión e implicaciones para la práctica los videos educativos fueron construidos, validados y adecuados para ser puestos a disposición. La participación de los jueces en la validación de este material fue esencial para asegurar la relevancia teórica y práctica del resultado.

ABSTRACT Objective to prepare and validate scripts and storyboards for the production of educational videos, in digital format, about the care and maintenance of the central venous catheters in adult patients. Method a methodological and descriptive study about the elaboration and validation of scripts and storyboards for the production of educational videos that was conducted in two methodological stages: pre-production and production. The pre-production stage was based on three phases: preparation of the video scripts, elaboration of the storyboards, and validation by experts. Validation of the scripts and storyboards was in charge of 9 specialist judges in the subject matter and 2 technical experts in video; the Content Validation Index (CVI) was calculated considering as acceptable a minimum index of 0.80 for each item of the instruments. Results three educational videos were created with the following themes: dressing, maintenance and exchange and removal of the central venous catheter. Concerning the validation by expert judges in the subject matter and expert video technicians, all items evaluated resulted in agreement with a CVI of 100.0. Conclusion and implications for the practice the educational videos were elaborated, validated and suitable to be made available; the judges' participation in the validation of this material was essential to ensure the theoretical and practical relevance of the result.

Management of central catheters in newborns and children hospitalized in intensive care units / Manejo de catéteres centrales en recién nacidos y niños hospitalizados en unidades de cuidados intensivos / Manejo de cateteres centrais em recém-nascidos e crianças internadas em unidades de terapia intensiva

Objective: to identify the care strategies adopted by nursing professionals in the handling of central catheters in children and newborns hospitalized in an Intensive Care Unit. Method: descriptive research, with quantitative approach, of the non-participant systematic observation type, in a tertiary public hospital in Rio de Janeiro. A structured checklist was applied to the professionals who assisted this clientele. The data were submitted to simple descriptive analysis and organized in graphs. Results: 80 observations were obtained, separated into three stages: moments of hand hygiene; manipulation of the deep catheter; equipment and connectors. Conclusion: the nursing team has satisfactory support to items considered essential in the care and prevention of bloodstream infections related to central catheters in children and newborns hospitalized in the Intensive Care Unit.

Objetivo: identificar las estrategias de cuidado adoptadas por los profesionales de enfermería en el manejo de catéteres centrales en niños y recién nacidos hospitalizados en una Unidad de Cuidados Intensivos. Método: investigación descriptiva, con enfoque cuantitativo, del tipo observación sistemática no participante, en un hospital público terciario de Río de Janeiro. Se aplicó una lista de verificación estructurada a los profesionales que asistieron a esta clientela. Los datos fueron sometidos a un análisis descriptivo simple y organizados en gráficos. Resultados: se obtuvieron 80 observaciones, separadas en tres etapas: momentos de higiene de manos; manipulación del catéter profundo; equipos y conectores. Conclusión: el equipo de enfermería cuenta con un apoyo satisfactorio a los ítems considerados esenciales en el cuidado y prevención de infecciones del torrente sanguíneo relacionadas con catéteres centrales en niños y recién nacidos hospitalizados en la Unidad de Cuidados Intensivos.

Objetivo: identificar as estratégias de cuidado adotadas pelos profissionais de enfermagem no manuseio dos cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva. Método: pesquisa descritiva, com abordagem quantitativa, do tipo observação sistemática não participante, em um hospital público terciário do Rio de Janeiro. Foi aplicado um check-list estruturado aos profissionais que assistiram essa clientela. Os dados foram submetidos a análise descritiva simples e organizados em gráficos. Resultados: obteve-se 80 observações, separadas em três etapas: momentos da higienização das mãos; manipulação do cateter profundo; equipos e conectores. Conclusão: a equipe de enfermagem possui uma adesão satisfatória aos itens considerados essenciais no cuidado e na prevenção de infecções da corrente sanguínea relacionados a cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva.

Safety and feasibility of 3-month interval access and flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments.

ABSTRACT: Patients with colorectal cancer (CRC) treated with curative intent surgery undergo continuous fluorouracil (5-FU) infusion-based chemotherapy using totally implantable central venous port system (TICVPS) in cases with high risk of recurrence. Approximately 30% of patients relapse after therapy completion, especially within 2 years. Hence, many patients with high risk CRC keep the TICVPS for 6 to 24 months after treatment with regular intervals of TICVPS flushing. However, little is known about the proper interval duration of the port. The aim of this study is to investigate whether a 3 months extended interval is safe and if port maintenance is feasible.A retrospective cohort was compiled of patients with CRC who underwent curative intent surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. The primary end point was TICVPS maintenance rate, including maintenance of TICVPS for at least 6 months, planned TICVPS removal after 6 months, and regaining the use of TICVPS at the time of recurrence.A total of 214 patients with CRC underwent curative intent treatments during the study period. Among them, 60 patients were excluded, including 6 patients for early recurrence within 3 months and 54 patients with violation of flushing interval. Finally, 154 patients were analyzed. Mean flushing interval was 98.4 days (95% confidence interval [CI], 96.2-100.6; range, 60-120). In December 2018, 35 patients kept the TICVPS, 92 patients had planned removal, 25 patients reused the TICVPS, and 2 patients had to unexpectedly remove the TICVPS due to site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8% (152/154). Thirty-eight patients relapsed, and 30 patients were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) reused the maintained TICVPS without a reinsertion procedures.Our study demonstrated that 3-month interval access and flushing is safe and feasible for maintaining TICVPS during surveillance of patients with CRC. An extended interval up to 3 months can be considered because it is compatible with CRC surveillance visit schedules.

External validation of the DIVA and DIVA3 clinical predictive rules to identify difficult intravenous access in paediatric patients.

BACKGROUND: Intravenous (IV) peripheral access is often a difficult procedure in the paediatric ED, causing pain and significant distress. Clinical prediction tools including reproducible variables have been developed to help clinicians identify children at risk of difficult IV access, likely to need additional resources/interventions to maximise success at first attempt. We aimed to externally validate the Difficult IntraVenous Access (DIVA) and DIVA3 scores developed for this purpose. METHODS: Cross-sectional study of children undergoing IV cannulation by nurses in a tertiary-care paediatric ED. Data were collected at the time of the procedure in a clinical report form. RESULTS: Of 440 children included (56.8% males; median age 4.7 years (IQR 1.5-9.5)), 23.4% had a difficult IV access (defined as requiring >1 attempt). Diagnostic accuracy measures for a DIVA cut-off ≥4 and their 95% CIs were sensitivity 24.3% (16.4% to 33.7%), specificity 92.6% (89.2% to 95.1%), positive and negative predictive value 50.0% (35.3% to 64.5%) and 80.0% (75.7% to 83.9%), respectively. The same measures for the DIVA3 were 22.3% (14.7% to 31.6%), 93.5% (90.3% to 95.9%), 51.1% (35.8% to 66.3%) and 79.8% (75.4% to 83.6%). The area under the receiver operating characteristic curve was 0.652 (95% CI 0.591 to 0.712) for the DIVA and 0.649 (95% CI 0.589 to 0.709) for the DIVA3 score. In patients with DIVA and DIVA3 <4, nurses' prediction of greater difficulty in IV placement and moderate/severe dehydration were common independent predictors of difficult IV at multivariate analysis. Only nurses' prediction of greater difficulty in IV placement were associated with higher odds of difficult cannulation for both DIVA/DIVA3 scores ≥4. CONCLUSION: We externally validated the DIVA and DIVA3 showing a similar accuracy compared with the DIVA derivation cohort and between DIVA and DIVA3. We identified factors that can help refine further the risk of difficult IV access and support decision making on the best strategy to maximise the chances of cannulation success on first attempt.

A Review of Central Venous Access Using Ultrasound Guidance Technology.

More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.

Ultrasound-guidance of peripheral venous catheterization in apheresis minimizes the need for central venous catheters.

INTRODUCTION: Central venous catheters (CVC) can facilitate a reliable blood flow for apheresis procedures, but the placement is time-consuming and costly and the incidence of catheter-related complications is high. Ultrasound can aid nurses to insert peripheral venous catheters (PVC), which is safer for the patients. METHODS AND MATERIALS: We evaluated the use of CVC vs PVC for all apheresis procedures 3 years after the implementation of structured training of apheresis nurses to perform ultrasound-guided PVC. Ultrasound can visualize the needle tip and target vessel dynamically and guide peripheral venous catheterization with an increased success rate. Time consumption for PVC insertion was measured. RESULTS: In 10 months, we performed 1294 apheresis procedures on 227 patients, where 97.4% were performed with PVC. Hundred percent of extracorporeal photophoresis (off-line ECP) and peripheral blood stem cell collections on adults were performed with PVC. Patients who were treated with CVC (n = 8) were either children, had poor peripheral blood flow due to dehydration or admitted to an intensive care unit and had CVC for other reasons. Time consumption for PVC placement with ultrasound was 11 minutes on average. CONCLUSION: Training of apheresis nurses in ultrasound-guided peripheral venous catheterization can enable close to 100% of apheresis procedures to be performed by PVC.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence.

BACKGROUND: To evaluate novice and expert clinicians' procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. METHODS: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians' confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). RESULTS: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance (p < 0.001) and ultrasound skills (p < 0.001). CONCLUSION: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

Examination of nursing drug administration practices via central venous catheter: An observational study.

AIM: To determine the compliance with nursing drug administration procedure steps associated with access to the central venous catheter for bolus infusion in intensive care units. METHODS: This observational study was conducted with 30 nurses working in an intensive care unit of a university hospital. The drug administrations practiced by nurses via central venous catheter were monitored simultaneously at 12:00 a.m., 02:00 p.m., and 06:00 p.m. by two observers. The data were collected using a data collection form and central venous catheter drug administration procedure steps. RESULTS: A total of 90 different drug administrations were observed in three different treatment hours from 30 nurses. The interobserver conformity was found to be moderate in two steps (kappa = 0.520-0.627, P = 0.01) and perfect in all other steps (kappa = 0.821-1.000, P = 0.000). According to the drug administration procedure steps via a central venous catheter, all nurses applied the following steps correctly during all treatment hours: drug card control, preparation of treatment materials, checking the patient's identity, and steps of drug treatment administration. The following tasks were frequently performed incorrectly or not at all: hand hygiene (before treatment 87.8%; after treatment 82.2%), scrubbing the three-way stopcock entrance with an alcohol swab (55.6%), waiting for the alcohol to dry (81.1%), and flushing the lumen with a compatible fluid (before treatment 84.4%: after treatment 75.6%). CONCLUSION: Observation of drug administration procedure steps via central venous catheter according to the treatment hours showed that the nurses performed many incomplete or inaccurate drug administration procedure steps and the mistakes increased toward the evening hours.

Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study.

This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.

Prevenção da infeção associada ao cateter venoso central na pessoa em situação crítica: intervenção de enfermagem especializada / Prevention of central venous catheter-associated infection in critically ill people: specialized nursing intervention

O presente relatório pretende demonstrar, de modo crítico e reflexivo, as atividades realizadas, bem como o percurso de aquisição de competências que visam a atribuição do grau de mestre em Enfermagem na área de especialização Pessoa em Situação Crítica. Os crescentes avanços na área da emergência oncológica, aliados ao desenvolvimento científico-tecnológico verificado, acarretam inúmeros desafios para o enfermeiro, nomeadamente situações de grande complexidade que exigem respostas eficazes, de forma global e holística, às necessidades da pessoa em situação crítica e sua família. A pessoa com doença hemato-oncológica apresenta uma vulnerabilidade e instabilidade física e emocional acrescidas, decorrentes da doença, complexidade de tratamentos e procedimentos invasivos, porque estão mais suscetíveis a processos infeciosos e desenvolvimento de sépsis, ameaçando a integridade de um ou mais órgãos vitais, tornam-se por isso pessoa em situação crítica. O cateter venoso central apresenta-se como ferramenta essencial na prestação de cuidados a esta pessoa, quer pela possibilidade de monitorização hemodinâmica, quer pela capacidade de administração rápida de terapêutica de life saving. Todavia a sua utilização não está isenta de riscos, nomeadamente, a exposição do doente a infeções nosocomiais da corrente sanguínea. Pretende salientar-se a intervenção especializada do enfermeiro como uma estratégia eficaz para prevenir a infeção associada ao cateter venoso central, naquela pessoa, associando a perspetiva transformativa de ambiente e a sua influência no desenvolvimento da pessoa e família (Teoria Ambientalista de Florence Nightingale), com a ação de cuidar enquanto elemento facilitador do processo de transição vivenciado pela pessoa em situação crítica e família no momento de instabilidade (Teoria das Transições de Afaf Meleis).

This report aims at presenting, in a critical and reflective manner, the conducted activities and the path followed to acquire competencies, which lead to the attribution of the master's degree in Nursing with a specialization in Critical Patients. The increasing advances in the area of oncological emergency, combined with scientific and technological developments, create numerous challenges for the nurse. These include situations of great complexity that require effective responses, both globally and holistically, to the needs of the critically ill individual and his/her family. Patients who suffer from hemato-oncological diseases present a greater vulnerability, as well as an increased physical and emotional instability. This is a consequence of the experienced condition, coupled with the complexity of invasive treatments and procedures. These patients are more susceptible to infections and to the development of sepsis, which might threaten the integrity of one or more vital organs, leading to critical situations. While providing care to such individuals, the central venous catheter is an essential tool, due to the possibility of hemodynamic monitoring and of rapidly administrating life-saving therapeutics. However, its use poses some risks, namely the patient's exposure to nosocomial infections affecting the bloodstream. The present work intends to emphasize the nurse's specialized intervention as an effective strategy to prevent infections associated with central venous catheters in these individuals. To achieve this, it combines two points of view: 1) a transformative perspective regarding the environment and its influence on the development of individuals and families (Florence Nightingale's Environmental Theory); 2) the provision of care seen as a facilitator of the transition process experienced by the critically ill patient and his/her family, during the period of instability (Afaf Meleis' Transitions Theory).

Nursing Interventions to Reduce Peripherally Inserted Central Catheter Occlusion for Cancer Patients: A Systematic Review of Literature.

BACKGROUND: Cancer patients are considered the most at risk of the consequences of catheter occlusion. Therefore, nursing interventions that can effectively reduce the occlusion of peripherally inserted central catheter (PICC) lines must be identified to ensure a smooth treatment. OBJECTIVE: This study aimed to evaluate nursing interventions to minimize PICC line occlusion and make recommended measures for preventing or decreasing occlusion and abnormal extubation. METHODS: Studies about PICC occlusion that were published up to January 2017 were searched and screened in PubMed, Web of Science, Science Direct (Elsevier), EMBASE, Cochrane Library, and Chinese databases CNKI and Wanfang. Two independent reviewers screened the literature in accordance with the inclusion and exclusion criteria, assessed the quality of the included studies, and extracted the data. Further meta-analysis was performed using RevMan 5.3. RESULTS: Thirteen trials were included. Meta-analysis revealed that education for nurses (relative risk, 0.31; 95% confidence interval, 0.19-0.51; P < .00001) was significantly associated with PICC occlusion, whereas PICC type (relative risk, 0.60; 95% confidence interval, 0.32-1.15; P = .12) was not significantly associated with PICC occlusion. The solution to washing pipes and the PICC insertion techniques were descriptively analyzed to reach statistical significance. CONCLUSION: This study determined the correlation of PICC occlusion with the nurses' knowledge and skills, PICC types, flushing liquid and methods, and insertion techniques. IMPLICATIONS FOR PRACTICE: The findings of this study can serve as a guide for clinical work and for developing targeted measures to reduce occlusion.

The case for using implanted ports.

Uses of central venous access devices (CVADs) include the administration of vital fluids and medications. Implanted ports are a type of CVAD that is used when long-term vascular access is required. The device is discreet and associated with a low risk of catheter-related bloodstream infection. This article describes the different types and components of ports and how to select them. It explains how to insert ports, and provides guidance on accessing and de-accessing them.

Best practice for using ports and non-coring needles.

Ports are predominately inserted into oncology patients, but their use is becoming increasingly popular for other indications, such as cystic fibrosis. These devices not only provide patients and health professionals with reliable vascular access, but also preserve vessel health for future use. This article explores the additional equipment required to be able to access ports. It reiterates the need for education on the use of these devices, as this will help increase their longevity.

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.

Lecture-based education versus simulation in educating student nurses about central line-associated bloodstream infection-prevention guidelines.

The Center for Disease Control and Prevention published central line-associated bloodstream infection-prevention guidelines to prevent complications and improve the quality of care; however, it is not known whether student nurses receive education about these guidelines or what is the best approach to this education. This study aimed to assess student nurses' knowledge of central line-associated bloodstream infection-prevention guidelines and to compare the effectiveness of simulation versus classroom lecturing in educating them with these prevention guidelines. It used a two-arm randomized controlled trial design with pre-post tests. It was conducted at two public universities in Jordan, with a total of 131 fourth-year student nurses as participants. The participants were randomly assigned to the experimental group (receiving classroom lectures) and the control group (receiving a simulation course). Pretest and posttest data were collected using a structured questionnaire of 23 items. The overall knowledge scores in the pretest were poor with no statistically significant difference between the two groups. In the posttest, both groups showed improvement in the majority of items. The participants in the classroom lectures group scored slightly higher in the majority of items in the posttest; however, there was no statistically significant difference in the overall scores t (129) = 1.03, P = (.57), (95% confidence interval = -1.9 to 4.3). Focusing on the elements related to clinical skills and decision-making would help to make lecture-based education an effective alternative to simulation, especially in universities and nursing schools with limited budgets.