The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study.

BACKGROUND: Placement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes. METHODS: This study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable. RESULTS: Between January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001). CONCLUSIONS: Black females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.

Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation.

BACKGROUND: Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop. METHODS: A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop. RESULTS: A total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop. CONCLUSIONS: Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.

Evaluation of extended-length cannula inserted using ultrasound guidance in patients with difficult IV access.

Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways.

Incidence of peripheral intravenous catheter phlebitis and its associated factors among patients admitted to University of Gondar hospital, Northwest Ethiopia: a prospective, observational study.

BACKGROUND: Phlebitis, inflammation of tunica intima of venous wall, occurred in 13-56% of hospitalized patients. It is characterized by pain, erythema, swelling, palpable venous cord, and pussy discharge at catheter site. Cannula-related blood stream infection (CRBSI) is recognized complication of phlebitis. Adverse outcomes of phlebitis embrace patient discomfort, longer hospital stay and higher health care cost. This study aimed to determine the incidence and associated factors of peripheral vein phlebitis among hospitalized patients. METHODS: A hospital-based prospective, observational study was conducted between April 1 and August 31, 2020 at University of Gondar hospital, Northwest Ethiopia. A consecutive sampling method was used to recruit 384 patients. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients' records. Presence and severity of phlebitis was identified by Jackson's Visual Infusion Phlebitis (VIP) Scoring System. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with occurrence of phlebitis. P-value < 0.05 was used to declare significant association. RESULT: A total of 384 study subjects were included in the study. The mean age of study subjects was 46 years, with a range of 19 to 96 years. The incidence of phlebitis was 70% among study subjects. Mid-stage (grade 3) and advanced-stage (grade 4) phlebitis were noticed in 136/268 (51%) and 89/268 (33%) respectively. Odds of developing phlebitis were twofold higher in patients with catheter-in situ > 96 h (AOR = 2.261, 95% CI 1.087-4.702, P-value = 0.029) as compared to those with catheter dwell time < 72 h. Female patients were 70% (AOR = 0.293, 95% CI 0.031-0.626, P-value = 0.002) lower than male patients with risk of developing phlebitis. Patients who use infusates were 53% (AOR = 0.472, 95% CI 0.280-0.796, P-value = 0.005) less likely to develop phlebitis as compared to those who didn't use infusates. CONCLUSION: The cannula must be reviewed on daily basis, and it should be removed if it stayed later than 96 h.

Does non-invasive blood pressure measurement increase the complications and decrease indwelling time of peripheral intravenous catheters: A cohort study.

AIMS AND OBJECTIVES: To explore the efficacy of non-invasive blood pressure monitors on reducing clinical complications of peripheral intravenous catheters in renal transplant recipients. BACKGROUND: A peripheral intravenous catheter is a regular route of medication administration, but the incidence of complications such as infiltration, occlusion and phlebitis perpetuates in the clinical setting. DESIGN: This was a cohort study. METHODS: Patients were placed naturally into observation group or control group according to whether or not the two procedures (non-invasive blood pressure monitoring and peripheral intravenous catheters indwelling) were on the same arm. Univariate test and Cox regression model were used to estimate relative risk factors. The STROBE checklist was used to guide the submission. RESULTS: We identified 177 kidney recipient patients during the perioperative period with 440 peripheral intravenous catheters. There were incidences of 112 (25.5%) phlebitis, 137 (31.1%) occlusion and 150 (31.8%) infiltration. There was no significant difference between incidence of phlebitis, occlusion and infiltration between the observation group and the control group (p > .05). The observation group peripheral intravenous catheters indwelling time was 97.03 ± 6.76 hr, while it was 89.22 ± 9.55 hr for the control group. However, this difference was not significant between the two groups (p > .05). Cox risk regression showed that only a high BMI was a risk factor for peripheral intravenous catheters indwelling time. CONCLUSION: Non-invasive blood pressure monitoring did not increase complications or shorten PIVCs indwelling time among renal transplant recipients. BMI represented an independent risk factor for the peripheral intravenous catheters indwelling time. RELEVANCE TO CLINICAL PRACTICE: It is not a prohibition to take non-invasive blood pressure measurement when having a peripheral intravenous catheter, especially in some special circumstances in the clinical practice or when good prevention procedures are implemented.

Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis.

BACKGROUND: Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. METHODS: We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. RESULTS: We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031-0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018-0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038-0.30, p = 0.024). CONCLUSION: There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. Further studies are needed to confirm our observations.

Ultrasound-detected venous changes associated with peripheral intravenous placement in children.

HIGHLIGHTS: Ultrasound shows several venous changes in pediatric PIV-containing veins. Changes were visualized by ultrasound in the absence of physical exam findings. Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure. BACKGROUND: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. METHODS: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. RESULTS: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). CONCLUSION: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.

Younger age and in situ duration of peripheral intravenous catheters were risk factors for extravasation in a retrospective paediatric study.

AIM: Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS: This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed. RESULTS: We analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ duration of PIVCs were associated risk factors (p < 0.001). CONCLUSION: Extravasation was frequent and neonates were particularly at risk. Younger age and longer in situ PIVC duration were independent risk factors for extravasation.

Introduction of color-flow injection test to confirm intravascular location of peripherally placed intravenous catheters.

BACKGROUND: The incidence of infiltration and extravasation when using peripheral intravenous catheters is high in pediatric patients. Due to the lack of a gold standard test to confirm intravascular location of a peripherally placed intravenous catheter, we introduce a novel method, the color-flow injection test to assess the intravascular location of these catheters. For the color-flow injection test, 1 mL of normal saline was injected within 2 seconds in the distal intravenous catheter and changes in color-flow via ultrasonography were observed at the proximal draining veins. The primary objective of the study was to demonstrate feasibility of the color-flow injection test. METHODS: A prospective study was conducted on children <18 years old undergoing general anesthesia. All peripheral intravenous catheters were subject to the color-flow injection test and standard confirmation tests. RESULTS: Out of the 100 patients enrolled, 22 patients came to the operating room with preexisting peripheral intravenous catheters. Intraoperatively, 105 attempts were made on 78 patients of which 27 catheters were considered as infiltrated during their placement. A final set of 100 catheters were considered for intraoperative usage after they had passed at least one of the standard confirmatory tests. For the color-flow injection test, the ideal sites for ultrasound evaluation of proximal draining veins were the axillary veins and femoral veins. The color-flow injection test was positive in 93 of the 100 catheters with color-flow changes noticed in the proximal veins during the saline injection. Of the 100 catheters, infiltration around seven catheter sites were observed within 2 hours of intraoperative usage and the color-flow injection test was negative in these seven catheters. The color-flow injection test was also negative in the 27 catheters that had infiltrated during their placement. The color-flow injection test was sensitive at 100% [95% confidence interval (CI)=95-100] and specific at 100% (95% CI=56-100) to indicate intravascular location. CONCLUSION: We were able to confirm intravascular location of peripheral intravenous catheters using the color-flow injection test in pediatric patients. The test can lead to early recognition of malfunctioning peripheral intravenous catheters and decrease rate of infiltration-extravasation injuries associated with their use.

Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults: A nonblinded, cluster-randomized trial in China.

AIM: The purpose of this study was to investigate the safety of clinically indicated peripheral intravenous catheters (PIVC) replacement intervals. BACKGROUND: Peripheral intravenous catheters are used internationally, including in China where PIVCs are routinely replaced every 72 to 96 hours. Despite some recent international evidence showing such routine replacement is unnecessary, developing countries such as China have no supporting data. METHOD: This cluster-randomized trial was conducted between December 2 and December 31, 2013, in 10 internal medicine wards and 10 surgery wards at a tertiary referral teaching hospital in Xiamen, China. Patients were randomly divided into an experimental group (PIVCs were replaced only when clinical indications appeared) and a control group (PIVCs were routinely changed every 72-96 hours). Per-protocol analysis and intention-to-treat analysis were used to analyse the data. Primary end point was the incidence of phlebitis. RESULTS: This study analysed the data of 1198 patients (553 patients in the experimental group and 645 patients in the control group). There were no catheter-related bloodstream infections or local infections in the 2 groups. The 2 groups showed no statistically significant differences in the incidence of phlebitis, catheter occlusion, infiltration, and accidental removal. CONCLUSIONS: Clinically indicated PIVC replacement is feasible, and it may reduce nursing staff workload and patient discomfort.

Integrated short peripheral intravenous cannulas and risk of catheter failure: A systematic review and meta-analysis.

BACKGROUND: Short peripheral catheters (SPCs) are used to provide intravenous therapies in hospitalized patients. Recently, the category of SPC has become more complex, with the introduction in clinical practice of "integrated" SPCs (ISPCs), renewed regarding the material (polyurethane rather than polytetrafluoroethylene) and design (large wing; pre-assembled extension; preassembled needle-free connector (NFC)). METHODS: This systematic review and meta-analysis aimed to analyze randomized controlled trials (RCTs) and quasi-randomized studies in hospitalized patients, analyzing the risk of overall catheter failure as well as the risk of each type of complication (occlusion, infiltration, thrombophlebitis, and dislodgement) for ISPCs compared to non-integrated SPCs. These systematic review and meta-analysis were registered on PROSPERO (CRD42022322970). DATA SOURCES: We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical Trials register from April to November 2022. RESULTS: INCLUDED STUDIES: The research identified 1260 articles. After the abstract review, 13 studies were included for full manuscript review and, after that, six papers (4727 patients) were included in the meta-analysis. DESCRIPTION OF THE EFFECT: We found a significantly reduced risk of catheter failure (pooling all complications) for ISPCs compared to SPCs (p = 0.002 RR 0.65; 95% CI 0.63-0.9). A significant reduction in the risks of occlusion (p = 0.007 RR 0.72; 95% CI 0.56-0.92) was observed. As regards the risk of infiltration, thrombophlebitis, and dislodgement, the analysis showed a trend in favor of ISPCs, though not statistically significant (respectively p = 0.2 RR 0.84; 95% CI 0.64-1.1; p = 0.25 RR 0.91; 95% CI 0.78-1.07; p = 0.06 RR 0.72; 95% CI 0.52-1.01). CONCLUSIONS: ISPCs significantly reduce the risks of catheter failure (overall complications) and occlusion. More RCTs are needed to understand if the preassembled ISPC is better than the composted closed system (non-integrated SPC + extension line + NFC).

Heparin versus normal saline for the care of peripheral intravenous catheters in children: A meta-analysis.

AIM: To conduct a meta-analysis to evaluate the role of heparin versus normal saline lock in the care of peripheral intravenous catheters. DESIGN: A meta-analysis. METHODS: This meta-analysis searched nine databases for randomized controlled trials (RCTs) on heparin versus normal saline for the care of peripheral intravenous catheters in children up to April 5, 2023. The quality of included RCTs was evaluated using the risk of bias tool of Cochrane library. RevMan5.3 software was used for data analysis. RESULTS: Ten RCTs with a total of 1255 children were involved. Meta-analysis indicated that heparin lock reduced the incidence of blockage of peripheral intravenous catheter [OR = 2.01, 95% CI (1.42,2.84), p < 0.001], prolonged the duration of peripheral intravenous catheter indwelling[MD = -0.43, 95% CI (-0.75, -0.11), p = 0.008]. There were no statistical differences in the incidence of phlebitis [OR = 1.02, 95% CI (0.59, 1.74), p = 0.95 W]. PUBLIC CONTRIBUTION: Heparin may have more benefits in the nursing care of peripheral intravenous catheters compared with normal saline.

The effect of rose oil aromatherapy and hand-holding on pain due to peripheral intravenous catheter insertion.

INTRODUCTION: The study aimed to evaluate the effectiveness of rose oil (Rosa Damascene Mill.) aromatherapy and hand-holding in reducing pain associated with peripheral intravenous catheter insertion. METHODS: A comparative mixed-method design. A total of 126 patients were included in the study. For the study's quantitative data, sociodemographic characteristics of the patients and the Patient Interview Form for the qualitative data of the Numeric Rating Scale were used. In all patients included in the study, PIVC insertion was performed a single time by the same nurse using a standard procedure. Chi-square and Bonferroni tests were used for comparative statistics. RESULTS: No statistically significant difference between the groups regarding age, gender, marital status, BMI, and education level (p>0.05). Pain scores: it was 2.40±1.78 in the rose oil group, 3.53±1.98 in the hand-holding group, and 4.88±1.56 in the control group. The difference between the groups regarding pain scores is statistically significant (p=0.001). CONCLUSIONS: The study determined that rose oil aromatherapy and hand-holding interventions reduce pain during PIVC. However, rose oil aromatherapy was more effective on pain than the hand-holding intervention. (Clinical Trial ID: NCT05425849).

Peripheral intravenous therapy infiltration and extravasation (PIVIE) risks in 11 006 paediatric surgery inpatients in China: a retrospective observational study.

OBJECTIVE: To determine the risk factors associated with peripheral intravenous therapy infiltration and extravasation (PIVIE) in paediatric surgery inpatients. METHODS: This retrospective observational study was conducted at a tertiary general hospital in Sichuan, China. Logistic regression was employed to identify independent risk factors predictive of PIVIE. Kaplan-Meier survival analysis was undertaken to determine the relationship between the occurrence of PIVIE and the duration of that event (survival time). RESULTS: This study included 11 006 paediatric surgery inpatients and 19 771 peripheral intravenous catheters (PIVCs). The incidence of PIVIE was 16.93% (3347 of 19 771). The following were significant predictors of PIVIE: sex (odds ratio [OR] 0.834; 95% confidence interval [CI] 0.772, 0.900); age (OR 0.945; 95% CI, 0.934, 0.956); disease classification (OR 0.962, 95% CI 0.950, 0.976); puncture site (OR 1.061; 95% CI 1.044, 1.078); and indwelling time (OR 1.257; 95% CI 1.215, 1.300). CONCLUSIONS: Sex, age, type of disease, puncture site and indwelling time were risk factors for PIVIE. The puncture site should be effectively assessed and accurately selected. Informed judgements should be based on the child's sex, age and medical condition, so that the appropriate preventive measures to minimize the risk of PIVIE can be implemented.

Awareness of peripheral IV catheters among nurses, physicians, and trainees: A prospective cohort study.

BACKGROUND: Peripheral intravenous catheters (PIVs) are the most frequently used invasive device in hospitalized patients. These devices are not benign and are associated with complications. However, clinician awareness of them is variable and poorly understood. METHODS: We conducted a prospective, multicenter, observational point prevalence study to assess awareness of PIV presence among clinicians caring for hospitalized patients in 4 hospitals between May 2018 and February 2019 located in Michigan, USA. We first assessed patients for the presence of a PIV then interviewed their providers. Differences in awareness by provider type were assessed via χ² tests; P < .05 was considered statistically significant. Analyses were performed on Stata MP v16. RESULTS: A total of 1,385 patients and 4,003 providers were interviewed. Nurses had the greatest awareness of overall PIV presence, 98.6%, while attendings were correct 88.1% of the time. Nurses were more likely to correctly assess PIV presence and exact location than physicians (67.7% vs <30% for all others). Awareness of PIV presence did not significantly vary in patients on contact precautions or those receiving infusions. CONCLUSIONS: Given the ubiquity of PIVs and known complications, methods to increase awareness to ensure appropriate care and removal are necessary.

Comparative intervention assessing a catheter stabilization device on peripheral intravenous line loss.

BACKGROUND: Short peripheral intravenous catheters are the most common invasive procedure used to deliver medications, blood products, and fluids to patients, and failure has the potential to impact the quality of care. METHODS: This study compared IVs stabilized with current transparent film dressing to those using an engineered stabilization device. The first phase of the study evaluated documentation; data from patient records were found less than optimal but most complete for securement and removal, the two fields most critical to the study. The second phase measured IV dwell time, restart rates, and time between IV loss and restarts. RESULTS: Although there were no statistically significant differences in restarts, the IV dwell time was longer when the engineered device was in place, helping to extend the life of the IV and prevent interruption of care. In the absence of data on the cost of infections and other complications, the use of an engineered device increased the cost of IV starts. CONCLUSIONS: Adding an engineered stabilization device increases the cost of peripheral IV starts, but contributes to reducing IV restarts and preventing IV complications due to destabilized IVs. Although there were no statistically significant differences in restarts, the IV dwell time was longer when the device was in place, helping to extend the life of the IV and prevent interruption of care. Complete and accurate documentation and improved quality depended upon the ability to abstract unit-level data, which is vital for capturing the appropriate healthcare indicators. Clinical nurses must be involved in the decision-making regarding health records and operability at the unit level.

The safety of clinically indicated replacement or routine replacement of peripheral intravenous catheters: A randomized controlled study.

OBJECTIVE: The primary purpose of this study was to explore the safety of peripheral intravenous catheter (PIVC) replacement every 96 h compared to that of clinically indicated catheter removal. METHODS: A prospective, single-blind, randomized controlled trial was conducted. A random number table method was used. Six hundred patients treated with PIVC intravenous infusion in 10 nursing units of a hospital from September to October 2019 were selected. Sixty were collected from each nursing unit, including 30 in the clinically indicated replacement group and 30 in the routine replacement group. The incidence of phlebitis, catheter-related infection (CRI), occlusion, infiltration, and any form of infusion therapy failure were compared between the two groups. SPSS 23.0 software was used. RESULTS: The dwelling times of PIVC in the clinically indicated replacement group and routine replacement group were significantly different (hours) (83.62 ± 50.08, 69.75 ± 25.54, t = 3.021, p = 0.003). The incidence of any form of infusion therapy failure (RR = 4.448, 95% CI: 3.158-6.265, p < 0.001), phlebitis (RR = 2.416, 95% CI: 1.595-3.660, p < 0.001), occlusion (RR = 6.610, 95% CI: 3.062-14.268, p < 0.001), infiltration (RR = 2.607, 95% CI: 1.130-6.016, p = 0.020), accidental dislodgement (RR = 2.027, 95% CI: 1.868-2.200, p = 0.013), and pain at the insertion site (RR = 2.521, 95% CI: 1.742-3.649, p < 0.001) was higher in the clinically indicated replacement group than that in the routine replacement group. The overall survival curve of PIVC was drawn with Kaplan-Meier survival analysis. The median survival time of intravenous infusion was 59.58 h; the cumulative survival rates of 48 h, 72 h, and 96 h were 77.00%, 51.33%, and 20.33%, respectively. CONCLUSION: Replacement of PIVC every 96 h is safer than clinically indicated.

Rapid Superficial Vein Assessment (RaSuVA): A pre-procedural systematic evaluation of superficial veins to optimize venous catheterization in neonates.

BACKGROUND: Placement of peripheral intra-venous cannulas and epicutaneo-caval catheters is routinely performed in in Neonatal Intensive Care Unit (NICU), and both devices require visible superficial veins easy to cannulate. NICU patients are intrinsically characterized by poor and fragile vein asset, so that puncture and cannulation of superficial veins is often a challenge even for trained clinicians and cannulation frequently results in a stressful, painful, difficult procedure. METHODS AND RESULTS: Rapid Superficial Vein Assessment is meant to offer a systematic pre-procedural evaluation of all superficial veins of the newborn, so to allow a rational choice of the best insertion site, tailored on the single patient, and optimized for the specific type of venous access device. The superficial veins are examined systematically, both with and without NIR technology, exploring seven skin areas in the following order: (1) medial malleolus, (2) lateral malleolus, (3) retro-popliteal fossa, (4) back of the hand and wrist, (5) antecubital fossa, (6) anterior scalp surface, and (7) posterior scalp surface. CONCLUSIONS: The aim of the protocol is to increase the first attempt success rate and reduce the duration of the procedure, the number of attempts for single patient and possibly to limit complications, stress, and pain in neonates.

Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools.

Objectives: This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter (PIVC) insertion and care practices. Methods: The six-step forward and backward translation method was used to translate the adapted questionnaires. The English version questionnaires included the point prevalence audit checklist, the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire, plus a Patient/parent Experience Survey. Data collection was conducted in Indonesia between October 2019 and February 2020. In total, there were six translators (two for each instrument), nine-panel vascular access experts (three for each instrument), and 30 participants (ten for each instrument) of the target population involved in the translation and validation of the three instruments. Three-panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index and kappa index were calculated. Ten-panel members of the target population evaluated each questionnaire regarding feasibility, clarity, logical sequence, and formatting. Qualitative comments from the panel were also reviewed. Results: The translation process indicated relatively low discrepancies between translators except for semantic equivalence. There were nine, eight, and one semantic discrepancies found in the forward translation of the point prevalence audit checklist, nurse survey, and patient/parent experience survey. The semantic discrepancies were less prevalent in the backward translation, with only one, three, and two items reported during the process. The item validity index for all of the three instruments showed relatively high agreement between experts (I-CVI > 0.78, S-CVI/Ave >0.90, S-CVI/UA > 0.70, and kappa index >0.74). The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically. However, some re-formatting of the nurse survey and patient/parent experience survey were needed to avoid ambiguity and confusion for the participants. Conclusions: The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context. They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.

Effects of a Clinically Indicated Peripheral Intravenous Replacement on Indwelling Time and Complications of Peripheral Intravenous Catheters in Pediatric Patients: A Randomized Controlled Trial.

Peripheral intravenous catheters (PVCs) are common treatment modalities for pediatric patients, and may cause infection, infiltration, occlusion, and phlebitis. The purpose of this study was to evaluate the effect of a clinically indicated peripheral intravenous replacement (CIPIR) on PVC indwelling time and complication rates in pediatric patients. This study used a randomized, pre- and post-repeated measures design. A total of 283 participants were randomly assigned to an experimental group (n = 140) and a control group (n = 143). The experimental group received CIPIR and the control group received usual care with routine PVC replacement every three days. The insert sites of PVC were assessed every day until the signs of infiltration, occlusion, or phlebitis were presented. Patients in the experimental group had significantly longer PVC indwelling times compared to those in the control group (t = -18.447, p < 0.001). No significant differences were noted between groups in infiltration (χ2 = 2.193, p = 0.139), occlusion (χ2 = 0.498, p = 0.481), or phlebitis (χ2 = 3.865, p = 0.050). CIPIR can prolong the PVC indwelling time in pediatric patients with no increase in the rate of adverse events.