SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion.

PURPOSE: The aim of this randomized controlled trial was to evaluate the effectiveness of a cognitive-behavioral SuperKid intervention, in reducing fear and pain among children undergoing intravenous insertion in outpatient services. DESIGN AND METHODS: This study was designed as a randomized controlled trial, with 96 children aged 5-7 years. SuperKid intervention employed cognitive-behavioral techniques, implemented through a set of prepared cards. Fear was assessed using the Child Fear Scale, while pain status was measured using the Wong Baker Face Pain Scale. Scoring was performed by the mother, child, and researcher. Time series tests were conducted using the Wilks Lambda test. RESULTS: Most children in both the experimental and control groups reported fear regarding hospital procedures, particularly those involving pain and separation from their mothers. However, children in the experimental group who underwent the SuperKid intervention during and after IV insertion procedure experienced significantly less fear and pain than those in the control group. CONCLUSIONS: SuperKid intervention was found to be effective in reducing the procedural fear and pain of children undergoing intravenous insertion in outpatient services. The utilization of cognitive-behavioral techniques through a set of prepared cards provides an accessible and engaging means of alleviating negative emotional experiences among children undergoing medical/nursing procedures. PRACTICE IMPLICATIONS: SuperKid intervention can potentially improve children's attitudes toward medical care and make future procedures easier for them. Healthcare providers could consider incorporating cognitive-behavioral interventions, such as the SuperKid intervention, into their clinical practice to reduce the fear and pain experienced by children during medical/nursing procedures.

Reducing blood sample hemolysis in the emergency department using S-Monovette® in aspiration mode.

Background: Blood sample hemolysis continues to be a significant problem in clinical practice. In vitro hemolysis rates up to 77% have been reported in literature. The use of manual aspiration techniques for blood sampling has previously been shown to reduce the burden of erythrocyte injury in the pre-analytical phase compared to the vacuum collection technique. This study compares the hemolysis rates between two blood sampling methods: 5.0 ml BD Vacutainer® SST™ (BDV) and 4.9 ml S-Monovette® serum gel tubes in aspiration mode (SMA). Methods: This was a prospective randomised controlled study conducted in an Emergency department (ED). A convenience sample of 191 adult patients, aged 18-90 years old, presenting at the ED and requiring blood samples for serum electrolyte was included in the study. Paired blood samples were obtained through an intravenous cannula from each patient with randomised order of blood draw using SMA or BDV. Patient data was obtained and hemolysis index (HI), serum lactate dehydrogenase (LDH), and serum potassium (K) levels measured. Results: The adjusted mean HI (35.2 vs 21.5 mg/dL, p < 0.001), serum K (4.38 vs 4.16 mmol/L, p < 0.001) and LDH levels (259.6 vs 228.4 U/L, p < 0.001) were significantly higher in blood samples taken using BDV compared to SMA. The frequency of severely hemolyzed (>150 mg/dL) samples was also higher in blood collected using BDV (16.2%) compared to SMA (0%). Conclusions: The burden of hemolysis in blood samples taken from IV cannulae can be effectively reduced with the use of manual aspiration using the S-Monovette® blood collection system as compared to BD-Vacutainer.

Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study.

BACKGROUND: Peripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia. METHODS AND SETTING: An institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed. RESULTS: The incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63-6.27), admission unit (AHR = 1.88, 95%CI: 1.07-4.02), sickness (AHR = 0.24, 95% CI: 1.31-4.66), medication type (AHR = 2.04, 95%CI: 1.13-3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02-0.99), clinical experience (AHR = 0.52, CI:0.26-0.84), and flushing (AHR = 0.71, 95%CI: 0.34-0.98) were potential predictors of PIVC complication. CONCLUSION: Knowing the predictor factors helps clinicians to provide effective care and to detect complications early.

Short peripheral intravenous cannula and straight-tip guide wire in ultrasound-guided neonatal central venous catheterization.

BACKGROUND: Inserting a J-tip guide-wire into a vein's lumen is often difficult when using the Seldinger or modified Seldinger technique for central venous catheterization (CVC) in newborns. This study was designed to compare the efficacy and safety of guide-wire insertion using the combination of a short peripheral intravenous cannula with a straight-tip guide-wire vs. a needle with a J-tip guide-wire for ultrasound-guided (USG) cannulation of the internal jugular vein (IJV) in newborns using an in-plane technique. METHODS: One hundred and thirty newborn patients (weight, 1.4-5.2 kg) scheduled for selective or emergency surgery, were randomly assigned to either the needle group (combined with a J-tip guide-wire) or cannula group (combined with a straight-tip guide-wire). The primary outcome was the rate of successful guide-wire insertion on the first attempt. The puncture attempts, catheter placement attempts, and mechanical complications were also compared between the groups. RESULTS: The rate of successful guide-wire insertion on the first attempt was higher in the cannula group (97%) than in the needle group (76%) (p < 0.05, χ2 = 11.233). Moreover, fewer insertion attempts were needed in the cannula group (1.0 ± 0.2) than in the needle group (1.7 ± 1.1) (p < 0.05, 95% CI [0.449, 1.028]). The time to successful guide-wire insertion was shorter in the cannula group (63 ± 32 s) than in the needle group (92±50 s) (p < 0.05, 95% CI [14.024, 43.063]). No differences were found about other catheterization parameters and complications between the groups. CONCLUSION: The short peripheral cannula combined with a straight-tip guide-wire was superior to the needle combined with a J-tip guide-wire for USG newborn IJV catheterization in terms of successful guide-wire insertion on the first attempt and overall number of insertion attempts.

Quantifying exposure to chlorhexidine from decontamination of peripheral intravenous injection ports.

BACKGROUND: Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits. OBJECTIVE: To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning. METHODS: Twenty benchtop PIVC set-ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set-up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography-electrospray tandem mass spectrometry for entrained chlorhexidine. RESULTS: Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One-way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p < .00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p < .01). CONCLUSIONS: Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk-benefit assessments for its use in PIVC maintenance antisepsis policies and protocols.

Is the Use of Pre-existing Peripheral Intravenous Cannula as an Alternative to Venipuncture for Blood Sampling Being Implemented?

Background: Blood tests are usually obtained by venipuncture which is an insertion of a needle into a vein. Since blood collection is frequently ordered, it contributes to the increased workload on healthcare professionals. Thus, utilization of previously inserted peripheral intravenous lines for blood collection is proposed to decrease the work burden. Objective: The aim of the study was to make assessment of the awareness and practice of emergency medicine and intensive care unit staff regarding blood sampling via pre-existing peripheral line. Methods: This is a cross-sectional study used a web-based and self-administered questionnaire. It distributed among emergency department and intensive care unit staff between November 2021 and February 2022. Results: A total of 95 healthcare providers participated in the study. Most respondents were nurses (n=49, 51.5%) with 58.5% assigned to the intensive care unit. The overall mean awareness score was 1.74 out of 4 points with standard deviation of 1.29. Poor awareness was found among (n=65, 68.4%) and the remaining (n=30, 31.6%) had good awareness. Positive significant association has been observed between the level of awareness and practice (p=0.015). no significant difference was found between the emergency department and intensive care unit staff in terms of awareness level and practice. Conclusion: Findings from the current study showed variation in participants' views, hence, nurses and other health care providers are left to use their personal preferences in deciding patient care. This highlights the need for establishing institutional policies regarding blood sampling via a pre-existing peripheral intravenous line.

Forearmed is forewarned: A prospective intervention observational time-series study of patient empowerment for ultrasound-guided peripheral intravenous access.

OBJECTIVE: Ultrasound (US) is a valuable adjunct to improve the success rates of difficult peripheral intravenous cannula (PIVC) insertions but is usually clinician initiated. The present study assessed for any change in clinician practice resulting from interventions aimed at empowering patients to advocate for early use of US if they self-identified as having difficult PIVC access. METHODS: This was a prospective observational time-series study using a rapid quality improvement (RQI) framework. Three ED waiting room intervention strategies (printed media, video and wristband) were tested over three 2-week periods at a large teaching hospital. The impact of each intervention was assessed at eight time points during each intervention and compared to a pre-intervention baseline period using trend and time-series analysis. RESULTS: A total of 1611 PIVC insertions were surveyed over 42 time points. The proportion of US-guided PIVC insertions was highest during Intervention 3 (wristbands; 5.5%) but all proportions remained below baseline (6.5%). Trend analysis identified an increasing frequency of US use during Intervention 1 (printed media, P = 0.01). However, no statistically significant trends were observed within the periods. CONCLUSIONS: This is the first prospective study to assess the effect of various interventions to empower patients to self-identify as having difficult PIVC access and advocate for the use of US-guidance. The present study was indeterminate: no intervention tested in the present study noticeably influenced clinical practice, potentially attributable to the study design and confounding factors. This innovative study serves as a pilot for future research into patient empowerment, which is currently lacking in the literature.

Lifespan and Associated Factors of Peripheral Intravenous Cannula Among Hospitalized Children in Public Hospitals of the Gurage Zone, Ethiopia, 2021.

Background: Peripheral intravenous cannulas are routinely used in hospital-admitted children requiring intravenous therapy. The majority of peripheral IVC lines are removed before completion of therapy due to cannula complications in children. Peripheral intravenous cannula securing is a painful procedure for children, so recognizing the variables associated with the peripheral intravenous cannula lifespan would help decrease the complications and increase the duration of cannula patency. Objective: The main aim of this study was to determine the lifespan and associated factors of peripheral intravenous cannula among hospitalized children in Gurage zone public hospitals, Ethiopia, 2021. Methods: We conducted an institution-based cross-sectional study design among 422 admitted children in public hospitals of the Gurage zone using a systematic random sampling technique. We collected data from interviews of parents using structured questionnaires and direct observations using checklists. The data was coded and entered into EPI-DATA version 3.1 and exported to SPSS version 25 for analysis. Bivariable and multivariable analysis was used by using a binary logistic regression model. Finally, the variables with a p-value of <0.05 with a 95% confidence interval (CI) from the multivariable analysis were considered statistically significant. Results: One hundred and sixty-six children (41.4%) had a short cannula lifespan (below 30 h). Multivariable logistic regression analysis showed that neonatal intensive care unit (NICU) [AOR = 4.975; 95% CI (2.811-8.805)], reason for removal (complication) [AOR = 3.277; 95% CI (1.924-5.583)], fluid [AOR = 2.285; 95% CI (1.274-4.100)], and blood transfusion [AOR = 2.407; 95% CI (1.005-5.572)] were the statistically significant variables associated with the lifespan of a peripheral intravenous cannula. Conclusion and Recommendation: The proportion of the short lifespan of the peripheral intravenous cannula was higher in hospitalized children and health care providers better to use low concentration electrolytes, low osmotic pressure, and weak alkalinity fluid. The cannula access might be the responsibility of the health-trained staff, and conserving immediate removal upon the presence of a signal that indicates a complication.

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key.

OBJECTIVE: To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics. METHODS: Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia. RESULTS: Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February-April 2020) involving 21 stakeholders culminating in the co-production of the "DIVA Key". The DIVA Key was evaluated between May-December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63-0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2-27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8-10]; 8 [8-10 respectively). CONCLUSION: The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.

Safety and efficacy of peripheral versus centrally administered vasopressor infusion: A single-centre retrospective observational study.

BACKGROUND: Shock affects one-third of patients admitted to intensive care and is associated with increased mortality. Vasopressor medications are used to maintain blood pressure in shock. Central venous catheters are associated with serious complications and pose logistical difficulties for insertion. Delivery of vasopressors via peripheral intravenous cannula may be a safe alternative. METHODS: This is a retrospective cohort study comparing safety profile and outcomes of vasopressor delivery via peripheral and central routes in critically ill patients over a 12-month period in a mixed medical-surgical intensive care unit. Demographics, clinical characteristics, treatments, and safety outcome data were extracted from medical records. Patients were classified into three groups: vasopressor infusions via peripheral intravenous cannula, combined peripheral intravenous cannula followed by central venous catheter, and central venous catheter only. Groups were compared using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. The impact of duration of vasopressor infusion on complication rates was assessed using logistic regression. RESULTS: We identified 212 patients who received vasopressor infusion, 39 received via peripheral only (Group 1), 155 via peripheral followed by central (Group 2), and 18 via central only (Group 3). There were some baseline differences between groups. Group 1 had the lowest median Acute Physiology and Chronic Health Evaluation III score (64, interquartile range = 44-77), and Group 3, the highest (86, interquartile range = 57-101). Duration of vasopressor infusion was shortest in Group 1 and longer in Groups 2 and 3. There were no major complications; however, minor complications such as leakage, extravasation, and erythema occurred in 41% of Group 1 and 28% of Group 2 patients. Duration of peripheral vasopressor infusion was not associated with an increased risk of complications. CONCLUSIONS: Administration of vasopressor infusions for short duration in critically ill patients via a peripheral venous cannula may be feasible, with low rates of complications, and offers a safe alternative to central venous access.

Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis.

Rhino-orbital mucormycosis has seen a huge resurgence in patients post COVID-19 infection. In patients with minimal orbital disease and especially with preserved vision, retrobulbar injections of amphotericin B can be of great help in controlling the disease. Instead of giving daily injections of amphotericin B using needles every time, we used an 18-gauge intravenous (IV) cannula with injection port and suture holes to deliver the amphotericin into the orbital space for a period of 5 days. Patients were more compliant and less distressed with this method compared with being given an injection with a needle daily. We got a good response in terms of orbital disease regression with this method. In our review of the literature, we did not come across any such case of amphotericin B injection using an IV cannula. Injection of amphotericin B into the orbit using an IV cannula is a viable and easy treatment option for cases of rhino-orbital mucormycosis.

A Foreign Body in the Cephalic Vein: Broken Piece of Intravenous Cannula.

Peripheral intravenous cannulation is a routine in the medical field with the rarity of complications in expert hands. However, at times, complications arise including the fracture of the cannula inside the vein, which is a rare but potentially serious complication with the possibility of pulmonary embolism. We have reported a case of a broken piece of a cannula in the cephalic vein removed with the help of a Fogarty catheter with the emphasis on preoperative imaging studies to localize it and use of a tourniquet to avoid distal migration during retrieval. There are varied reports about the conservative vs operative approaches for foreign bodies in vasculature. It should be removed in the first place where expertise allow so that the rare but potentially serious complications can be avoided.

Impact of structured simulation-based and on-job training program on nurses' competency in pediatric peripheral intravenous cannulation: Children's hospital experience.

BACKGROUND: Peripheral intravenous cannulation (PIVC) is a frequent invasive, painful procedure in children. Nursing education and competency are of great importance to decrease complications. OBJECTIVES: to evaluate the impact of structured simulation-based PIVC training and on-job assessment program on nurses' knowledge, attitudes, and performance. DESIGN: Settings/participants: A prospective, structured, competency improvement training, assessment, feedback, and reassessment conducted on 150 pediatric nurses. They provided nursing care for in-patients at the newly open Children's hospital, Ain Shams University. METHODS: PIVC insertion skills and care knowledge, structured simulation-based mannequin training arm venipuncture model and on-job assessment were conducted. In the preparatory phase, 15 nurses were interviewed to develop the assessment tools. Knowledge and attitudes were assessed quantitatively using a validated self-administered questionnaire. Structured simulation-based training, and on-job skill assessment were performed using validated observer checklist. Assessment performed at enrollment (baseline), immediate post training, and reassessment 2-months after the training, using same tools. RESULTS: Knowledge, performance, and attitudes were significantly improved for the 150 trained nurses. There was improvement in immediate post training assessment than the reassessment after 2-months, compared to baseline for total knowledge score; peripheral cannula insertion score; hand washing before aseptic procedure; skin antisepsis at puncture site; no puncture site palpation after disinfection; apply sterile dressing to puncture site, p = 0.00, respectively. There was improvement in the reassessment after 2-months than post training assessment, compared to baseline for the total attitude score, p = 0.02; peripheral cannula care, p = 0.00; aseptic technique, p = 0.00; wearing protective gloves, p = 0.01; total practice score, p = 0.00. Years of experience, last 6-months training course, practice level, educational level, age, and attitude influence overall performance. CONCLUSIONS: Structured simulation-based training and on-job skill assessment are effective for improvement of PIVC insertion and care. Continuous education, feedback, assessment/reassessment, and monitoring should be recommended to retain the gained improvement in attitudes, knowledge, and skills. Changing workplace structure and improve work environment should be studied as factors that might affect learning.

Pulmonary Embolization of Radiolucent Intravenous Cannula: Endovascular Retrieval.

Fracture and embolization of peripheral intravenous cannula is very rare. Although endovascular retrieval is the standard of care for most of the embolized intravascular devices, endovascular management of embolized peripheral intravenous cannula is technically difficult due to its radiolucent nature and it is not described previously in the literature. We describe the clinical presentation, imaging findings, and endovascular management in a middle aged male who had fractured peripheral intravenous cannula which was embolized into the pulmonary artery branch. Technical nuances associated with retrieval of this radiolucent little plastic tube have been discussed.

A missing piece: Fracture of peripheral intravenous cannula, a case report.

INTRODUCTION AND IMPORTANCE: Peripheral venous cannulation is the most common procedure, often performed by junior colleagues. Despite its benign nature, it is associated with extravascular infiltration, thrombophlebitis, hematoma, catheter-associated bloodstream infections, trauma to surrounding structures, including tendon and nerve injures, hematoma formation and air embolism. Fracture of a peripheral intravenous cannula in situ is a rare, potentially serious complication that is underreported. More importantly, the etiology and prevention of this complication are not widely known by those performing cannulation. This case report will increase awareness and knowledge on intravenous peripheral cannula fracture to improve peripheral intravenous cannulation safety. CASE PRESENTATION: In this case report, we describe a fracture of a size 18 G plastic peripheral intravenous cannula (Neovac-Neomedic) in situ in a 76-year-old hypertensive male managed at Aga Khan Hospital Dar es salaam, Tanzania. The cannula's fracture was noticed 24 h later during the cannula's removal, where a fragment of the cannula was noted, and a palpable cord-like structure was appreciated along the cubital fossa. Ultrasound was done to localize the distal segment, confirming a cannula fracture with the distal fragment's retention. Surgical exploration under local anesthetic was necessary, retrieving the fragment. There were no intra-operatively or post-operative complications encountered. Proximal migration of the segment risks the chances of developing sepsis, dysrhythmia, and myocardial infarction, but this did not occur in our case. CLINICAL DISCUSSION: Reinsertion of the guide needle into the plastic sheath in situ most probably caused the fracture. Additional healthcare costs are incurred for investigation, admission, and surgical procedures. The patient experience may be affected by this complication. CONCLUSION: Understanding the guide needle's reinsertion may result in cannula fracture, allows safer cannulation practices by the clinician and adequate counseling of the patient before the procedure.

CT-guided retrieval of a fractured intravenous cannula in a toddler: A case report.

INTRODUCTION: Fractured cannula is a complication of peripheral intravenous cannula (PIVC) insertion. It is a rare but potentially fatal complication. We present a case of iatrogenic fracture of a PIVC in a toddler. CASE REPORT: An acutely ill 30-month-old boy presented at the emergency room and a PIVC insertion was attempted several times using the same cannula which fractured in the process. While the main part of the device was recovered, about 7 mm of the cannula was retained in the tissues and was not palpable. Computed tomography was used to locate the foreign body which was surgically removed under general anesthesia. DISCUSSION: A fractured and retained PIVC, especially when it is not palpable clinically, is an emergency due to possible embolization and the consequent potentially fatal outcome. This case underscores strict adherence to standard guidelines in prevention and the importance of computed tomography in the management of this condition.