Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*

Alexandrou, Evan; Spencer, Timothy R; Frost, Steven A.; Mifflin, Nicholas; Davidson, Patricia M.; Hillman, Ken

doi:10.1097/ccm.0b013e3182a667f0

Cited by 79 publications

(63 citation statements)

References 31 publications

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“…CVAD insertion complications occur in 0.4–4.5% of procedures, in comparison to post-insertion complications, which can occur in up to 25% of the device life [5, 204–206]. CVADs are designed for prolonged use compared to peripheral intravenous catheters, and more evidence for post-insertion care is needed to avoid unnecessary complications and the need for catheter replacement.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trials in central vascular access devices: A scoping review

et al. 2017

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BackgroundRandomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities.MethodA scoping review (January 2006–December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form.ResultsIn total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections.ConclusionMore high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trials in central vascular access devices: A scoping review

et al. 2017

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“…A well-trained nursing team, as well as comprehensive and detailed education, would ensure PICC being used with slight complication [17]; however, because of the little evidence regarding radiation impact on PICC, the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) suggested that interval placement of PICCs with each chemotherapy treatment may be the most appropriate strategy [14]. Such strategy needs repeated intravenous punctures that increase a patient’s cost and pain and may result in higher complication rates [18]. …”

Section: Discussionmentioning

confidence: 99%

Effects of Ionizing Radiation on Physical Properties of Peripherally Inserted Central Catheter

Zhang

et al. 2016

PLoS ONE

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Peripherally inserted central catheter (PICC) has been widely used to treat cancer patients. It is unknown whether or not it can be applied safely during radiotherapy. The study aimed to investigate the direct effects of gamma radiation on physical properties of PICC. A total of 60 catheters were included in this study. Thirty PICCs were exposed to a radiation field, and another 30 PICCs received radiation in a 3-cm homogeneity water equivalent phantom and then were irradiated. Each group was divided into three subgroups: 10 PICCs were given conventional fractionation, 2 Gy per fraction, 5 fractions per week; 10 PICCs were continuously given hypofractionation, 10 Gy per fraction, for 6 weeks; and 10 PICCs were given mock radiation as controls. The physical properties of these catheters were analyzed after radiation. None of the PICCs leaked under 300-kPa airflow pressure lasting 15 seconds. Fracture force values and liquid velocity values of all PICCs were within the normal range. The liquid velocity values of the control groups were higher than the two groups that received radiation (P < 0.05), and there was no difference between the two irradiation groups (P > 0.05). There were no statistical differences among the conventional fractionation group, hypofractionation group, and control group when compared to the fracture force values in two parts (P > 0.05). The physical property of PICC is quite stable with a clinically relevant dose of gamma radiation. It is likely that PICC can be used safely in patients receiving radiotherapy, although further in vivo and clinical studies are required.

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“…[27][28][29] The secondary outcomes were CVAD complications after successful CVAD insertion. These were as follows: (1) CVAD-associated BSI: minimum definition of a laboratory-confirmed BSI that is not secondary to an infection at another body site, with a CVAD in place for .2 days 20 ; (2) CVAD-associated thrombosis: development of thrombosed vessel (partial or complete) at the CVAD site diagnosed via ultrasound 30 ; (3) occlusion or blockage: as defined by study investigators, including partial and full blockage of the CVAD lumen or lumens, irrespective of occlusion treatment 30 ; (4) dislodgement or migration: as defined by study investigators, including partial, complete, and accidental removal resulting in the CVAD tip no longer being placed in the inferior or superior vena cava 5 ; (5) breakage or rupture: as defined by study investigators, including a visible split in CVAD material diagnosed by leakage or radiographic evidence of extravasation from a portion of the CVAD into tissue 13 ; and (6) local infection and phlebitis: as defined by the study investigators, including exit, entrance, and tunnel infections and phlebitis. 5 …”

Section: Outcome Measuresmentioning

confidence: 99%

“…10 Their insertion can result in complications including pneumothorax, arterial puncture, hemorrhage, and cardiac rhythm dysfunction, 11 with overall CVAD insertion-related complications reported in 7% to 18% of CVAD insertions. 12,13 The more CVADs a child has had, the more complex the procedure becomes, as CVAD failures can result in venous damage and insufficiency. 12 Even after successful CVAD insertion, many mechanisms may result in CVAD failure or complications, many of which are considered preventable.…”

mentioning

confidence: 99%

Complications of Central Venous Access Devices: A Systematic Review

et al. 2015

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CONTEXT: The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.OBJECTIVE: To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.DATA SOURCES: Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.STUDY SELECTION: Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. CONCLUSIONS: CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.

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Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*

Cited by 79 publications

References 31 publications

Randomized controlled trials in central vascular access devices: A scoping review

Randomized controlled trials in central vascular access devices: A scoping review

Effects of Ionizing Radiation on Physical Properties of Peripherally Inserted Central Catheter

Complications of Central Venous Access Devices: A Systematic Review

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