RESUMO
The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.
Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Humanos , Unidades de Terapia Intensiva , Cuidados CríticosRESUMO
Infiltration of a vesicant medication, defined as extravasation, may result in significant patient injuries. The first step in preventing extravasation is the identification and recognition of vesicant medications and solutions. Because there is no list of noncytotoxic vesicants as established by a professional organization, the Infusion Nurses Society, as the global authority in infusion nursing, identified the need to address this gap. A task force was formed for the purpose of creating an evidence-based list of noncytotoxic vesicant medications and solutions.
Assuntos
Enfermagem Baseada em Evidências , Irritantes/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos , Humanos , Segurança do Paciente , SoluçõesRESUMO
The implementation of the Medicare Prospective Payment System (MPPS) has placed pressure on healthcare organizations to decrease patient length of stay without adversely affecting outcomes. This article discusses the impact of the MPPS on clinicians who provide infusion therapy, and examines methods for containing costs related to infusion care such as advanced planning and accurate vascular access device selection.
Assuntos
Infusões Intravenosas/economia , Medicare/economia , Sistema de Pagamento Prospectivo/economia , Benchmarking/organização & administração , Competência Clínica/economia , Competência Clínica/normas , Controle de Custos , Efeitos Psicossociais da Doença , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Grupos Diagnósticos Relacionados/economia , Falha de Equipamento/economia , Humanos , Controle de Infecções/economia , Controle de Infecções/normas , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/enfermagem , Tempo de Internação/economia , Papel do Profissional de Enfermagem , Planejamento de Assistência ao Paciente/organização & administração , Flebotomia/economia , Flebotomia/enfermagem , Flebotomia/normas , Guias de Prática Clínica como Assunto , Gestão da Qualidade Total/organização & administração , Estados UnidosRESUMO
Covenant Healthcare System is a 500-bed facility in Saginaw, Michigan. A peripherally inserted central catheter (PICC) program was instituted there in 1990 when it was St. Lukes Hospital. Over the course of 17 years, 30 nurses had been trained to place PICCs in their spare time. A "PICC, stick, and run team" was established in 1998 but was unsuccessful. After a merger with Saginaw General Hospital, Covenant Healthcare created two full-time vascular access specialty positions. This nursing-based PICC program with full-time staffing has revitalized vascular access at Covenant Healthcare System. Currently, PICCs are placed proactively at the beginning of hospital stays. Peripheral catheter restarts have been replaced with reliable PICC access sites. Delayed discharge for PICC insertion is no longer an issue.