Managing CVADs in 2020.

Gemma Oliver Macmillan Head of Nursing, Cancer, Clinical Haematology and Haemophilia, East Kent Hospitals University NHS Foundation Trust.

Optimising patient safety when using elastomeric pumps to administer outpatient parenteral antibiotic therapy.

Outpatient parenteral antibiotic therapy (OPAT) is a growing area of practice that has numerous benefits for both patients and the healthcare system. In order for OPAT services to be successful, strategies need to be in place to maximise efficiency while providing safe, high-quality care. The use of elastomeric pumps to deliver intravenous (IV) antibiotics can have many benefits for OPAT services; they are cost-effective, easy to use and allow the patient to be fully ambulant. However, plans need to be put in place to make sure their use is safe and effective. This article discusses the use of elastomeric pumps by a UK-based OPAT team and the governance processes the team put in place to optimise patient safety when using elastomeric pumps to deliver IV antibiotics. Furthermore, with experience of using elastomeric pumps for more than 4 years the OPAT team was asked to evaluate an elastomeric pump new to the UK market: the Accufuser pump (Vygon (UK) Limited). By collecting data on its use it was found to be safe and easy to use. The team felt that the Accufuser pump ran to time in 96% of completed evaluations and considered it to be clinically acceptable in all responses.

ECG-based PICC tip verification system: an evaluation 5 years on.

In 2011, the vascular access team at East Kent Hospitals University NHS Foundation Trust safely and successfully incorporated the use of electrocardiogram (ECG) guidance technology for verification of peripherally inserted central catheters (PICC) tip placement into their practice. This study, 5 years on, compared the strengths and limitations of using this ECG method with the previous gold-standard of post-procedural chest X-ray. The study was undertaken using an embedded case study approach, and the cost, accuracy and efficiency of both systems were evaluated and compared. Using ECG to confirm PICC tip position was found to be cheaper, quicker and more accurate than post-procedural chest X-ray.

ECG or X-ray as the 'gold standard' for establishing PICC-tip location?

Recently there has been an increase in evidence that the tip position of a peripherally inserted central catheter (PICC) needs to be accurately placed in the lower third of the superior vena cava at the junction with the right atrium in order to minimise potential complications ( Royal College of Nursing, 2010 ; Infusion Nurses Society, 2011 ). The current 'gold standard' practice of performing a chest X-ray post-insertion of PICC can be fraught with complications with regard to accurately placing the PICC in this position. The purpose of this evaluation is to discuss how using an electrocardiogram-guided PICC placement system may be a preferable method with which to accurately measure the exact position of the PICC within the venous system.

Evaluation of an electrocardiograph-based PICC tip verification system.

Performing a chest x-ray after insertion of a peripherally inserted central catheter (PICC) is recognised as the gold standard for checking that the tip of the catheter is correctly positioned in the lower third of the superior vena cava at the right atrial junction; however, numerous problems are associated with this practice. A recent technological advancement has been developed that utilises changes in a patient's electrocardiograph (ECG) recorded from the tip of the PICC as a more reliable method. This evaluation discusses how a vascular access team in a large acute NHS Trust safely and successfully incorporated the use of ECG guidance technology for verification of PICC tip placement into their practice.