No abstract

Purpose Infusate osmolarity, pH, and cytotoxicity were investigated as risk factors for midline catheter failure. Methods An experimental, randomized, controlled, blinded trial was conducted using an ovine model. Two 10-cm, 18-gauge single-lumen midline catheters were inserted into the cephalic veins of sheep. The animals were divided into 6 study arms and were administered solutions of vancomycin 4 mg/mL (a low-cytotoxicity infusate) or 10 mg/mL (a high-cytotoxicity infusate), doxycycline 1 mg/mL (an acidic infusate), or acyclovir 3.5 mg/mL (an alkaline infusate) and 0.9% sodium chloride injection; or 1 of 2 premixed Clinimix (amino acids in dextrose; Baxter International) products with respective osmolarities of 675 mOsm/L (a low-osmolarity infusate) and 930 mOsm/L (a mid-osmolarity infusate). Contralateral legs were infused with 0.9% sodium chloride injection for control purposes. Catheter failure was evaluated by assessment of adverse clinical symptoms (swelling, pain, leakage, and occlusion). A quantitative vessel injury score (VIS) was calculated by grading 4 histopathological features: inflammation, mural thrombus, necrosis, and perivascular reaction. Results Among 20 sheep included in the study, the overall catheter failure rate was 95% for test catheters (median time to failure, 7.5 days; range, 3–14 days), while 60% of the control catheters failed before or concurrently (median time to failure, 7 days; range, 4.5–14 days). Four of the 6 study arms (all but the Clinimix 675-mOsm/L and acyclovir 3.5-mg/mL arms) demonstrated an increase in mean VIS of ≥77% in test vs control legs (P ≤ 0.034). Both pain and swelling occurred at higher rates in test vs control legs: 65% vs 10% and 70% vs 50%, respectively. The mean difference in rates of occlusive pericatheter mural thrombus between the test and control arms was statistically significant for the vancomycin 10-mg/mL (P = 0.0476), Clinimix 930-mOsm/L (P = 0.0406), and doxycycline 1-mg/mL (P = 0.032) arms. Conclusion Administration of infusates of varied pH, osmolarity, and cytotoxicity via midline catheter resulted in severe vascular injury and premature catheter failure; therefore, the tested infusates should not be infused via midline catheters.

Many challenges face vascular access nurses as technology improves and patients require more numerous and lengthy intravenous therapies. Nurses began placing peripherally inserted central catheters (PICCs) at the patient bedside in an effort to defray costly interventional radiology procedures and provide for patient comfort. In recent years, the numbers of PICC procedures have increased, and the procedure itself has become more technologically advanced. With these advances have come new logistical, environmental, and ergonomic challenges. This article explores some of these challenges, offers an alternative model to bedside PICC insertions, and describes the process and results of implementing this model in the milieu of a university teaching hospital.

Purpose: The purpose of this study was to evaluate the effectiveness of clinical practice changes in an effort to reduce peripherally inserted central catheter thrombosis risk. Patients and Method: A retrospective analysis of adult patients in the acute care setting. Results: A total number of 1307 charts of patients who received PICCs were reviewed encompassing the months of January 2008, October 2008 and August 2010. During the period from January 2008 to October 2008, clinical practice changes were made to include the use of ultrasound guidance. Ensuring catheter tip termination in the superior vena cava with the addition of ultrasound technology as an insertion practice combined to decrease symptomatic PICC related deep vein thrombosis rates from 4.8 % to 2.9%. During the period from October 2008 to August 2010, an additional practice was introduced that involved measurement and documentation of vein diameters(without the use of a tourniquet) prior to all PICC insertion procedures. Deep vein thrombosis (DVT) rates dropped further from 2.9 % to 1.4 % during this period. Conclusion: Obtaining central tip location and using ultrasound guidance for PICC placement are effective in reducing PICC related DVT. Additionally, routine measurement of vein diameters in their native state and use of that information to ensure that the vessel diameter is at least twice the outer diameter of the catheter is an effective practice to reduce DVT rates and reduce thrombosis risk.

The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency.

The purpose of this interpretive phenomenological study was to determine what it means to patients to live with a peripherally inserted central catheter (PICC)-related deep vein thrombosis and to describe the influence of the experience on the individual's quality of life. The sample included 11 adult patients from an acute care setting who developed a PICC-related symptomatic thrombus between November 2014 and March 2016, using purposive sampling. Three distinct themes emerged from the data in this study: a loss of trust in health care providers, additional burdens to existing problems, and a yearning for understanding.

Decision-making for vascular access device selection is becoming increasingly complex as new technologies come to market and efforts to reduce central line-associated bloodstream infections increase. This retrospective review of 165 midline catheter outcomes was undertaken after a cluster of unexpected failures occurred in a large academic medical center in the southeastern United States. Mean dwell time for midline catheters was 8.5 days; 62.8% lasted to therapy completion, and complications occurred in 15.8%. A quality improvement initiative including implementation of a blood return algorithm and standard education for unit staff reduced infiltration and thrombosis complications.

The only method for obtaining reliable coagulation test results from central venous access devices is the flush then waste/discard method. This method has only been studied with peripherally inserted central catheters. Additional randomized, controlled trials with larger sample sizes are needed to determine the most appropriate method for drawing coagulation test results from central venous access devices.