Cyanoacrylate tissue adhesive: a new tool for the vascular access toolbox.

Health professionals are responsible for preventing and minimising complications related to vascular access devices. This is important from the perspectives of both the patient and the health economy. Practitioners have many tools at their disposal and evidence is available to assist in using these tools to enhance best practice. A relatively new tool has been acknowledged as having a role in vascular access as well as previously recognised roles in other areas of healthcare. Cyanoacrylate tissue adhesive has been approved for use with vascular access devices and the benefits of this aid to device securement are now being recognised.

Patients' experiences of the PICC insertion procedure.

Peripherally inserted central catheters (PICCs) are a type of central venous access device used to deliver a variety of intravenous therapies, including chemotherapy. PICCs may be placed by interventional radiologists, anaesthetists or, as is increasingly common, by specialist nurses in the hospital setting. However, little is known about how patients feel regarding the PICC insertion procedure. The aim of this study was to interview patients who had undergone a recent PICC insertion in the chemotherapy day unit to identify their experiences. On analysis of the qualitative data obtained from the semi-structured interview, five themes emerged: the context of cancer; expectations; levels of pain and anxiety; coping strategies; and explanation. The findings of this study support some previously described elements of procedural experiences; however, new understanding has provided implications for practice in the areas of expectations, allaying anxiety levels, supporting individual coping strategies and providing explanation. The major limitation of the study was the homogenous sample of oncology patients with a clear link between the patient experience of the PICC insertion and the context of cancer. The main recommendation for further research would be to repeat this study with a broader patient population.

Plane and practice parallels: our journey to AVA 2013.

It was an unremarkable start to our trip to Nashville for the 27th annual meeting of the Association of Vascular Access (AVA). Poster (check), presentation (check), meeting point at the airport (check), luggage within weight limit (check), hand luggage minus sharp items and liquids (check).

European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project.

Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.

Termination of pregnancy services: experiences of gynaecological nurses.

AIM: This paper is a report of a study to identify the experience of gynaecological nurses involved with termination of pregnancy. BACKGROUND: Staff involved with termination of pregnancy have been found to experience both positive and negative views. Varying processes and experiences for staff have been identified, from termination of pregnancy work being emotionally draining and stressful to there being a process of care that evolves with greater experience. METHODS: A purposive sample of seven gynaecological nurses currently working in a termination of pregnancy service was recruited. Data were collected between October 2007 and January 2008 using interviews and standardized questionnaires. Transcripts of the interviews were analysed using Interpretive Phenomenological Analysis. RESULTS: Eight superordinate themes emerged from the analysis: (1) Unconditional acceptance and understanding of termination of pregnancy, (2) Strategies for managing the demands and challenges, (3) What we do for patients and job satisfaction, (4) Challenges to unconditional acceptance, (5) Juggling the contrasting needs and demands of patients, (6) The most demanding aspects of the role, (7) The significance of personal experience and (8) The service context. Some of the experiences were interpreted as ways in which nurses justified their role. The themes were understood in terms of a balance between strains, coping and contextual influences. CONCLUSION: Providing a recognized supportive supervisory environment might allow for the acknowledgement of the unique challenges staff in termination of pregnancy services face, and might enhance a sense of validation within the organization and hence staff wellbeing.

Development of an ultrasound-guided PICC insertion service.

Use of the peripherally inserted central catheter (PICC) has gained popularity over the past 30 years in the USA and over the past 15 years in the UK. The PICC was initially used for specific purposes, such as the delivery of parenteral nutrition and chemotherapy, but its use has expanded both within the acute hospital and community settings. This article describes an ultrasound-guided PICC insertion service that has been set up in a district general hospital to expand the service within the oncology department and to begin a service for non-oncology patients. As expected, patients who have benefited from the development of this service include those requiring parenteral nutrition, chemotherapy and intravenous therapy in the community. However, retrospective audit has shown that the largest group of patients to benefit from the ultrasound-guided PICC insertion service was those with difficult venous access for a variety of reasons. Some of these reasons are discussed, along with an overview of the benefits the service has provided to other groups of patients, and associated benefits to the hospital trust.