Implications for maintaining vascular access device patency and performance: Application of science to practice

Abstract

Introduction:Vascular access devices are commonly inserted devices that facilitate the administration of fluids and drugs, as well as blood sampling. Despite their common use in clinical settings, these devices are prone to occlusion and failure, requiring replacement and exposing the patient to ongoing discomfort/pain, local vessel inflammation and risk of infection. A range of insertion and maintenance strategies are employed to optimize device performance; however, the evidence base for many of these mechanisms is limited and the mechanisms contributing to the failure of these devices are largely unknown.Aims/objectives:(1) To revisit existing understanding of blood, vessel physiology and biological fluid dynamics; (2) develop an understanding of the implications that different clinical practices have on vessel health, and (3) apply these understandings to vascular access device research and practice.Method:Narrative review of biomedical and bioengineering studies related to vascular access practice.Results/outcomes:Current vascular access device insertion and maintenance practice and policy are variable with limited clinical evidence to support the theoretical assumptions underpinning these regimens. This review demonstrates the physiological response to vascular access device insertion, flushing and infusion on the vein, blood components and blood flow. These appear to be associated with changes in intravascular fluid dynamics. Variable forces are at play that impact blood componentry and the endothelium. These may explain the mechanisms contributing to vascular access failure.Conclusion:This review provides an update to our current knowledge and understanding of vascular physiology and the hemodynamic response, challenging some previously held assumptions regarding vascular access device maintenance, which require further investigation.

Effect of Clinical Nursing Pathway Intervention Based on Evidence-Based Medicine on Venous Thrombosis in Long-Term Bedridden Patients

“…The incidence of adverse events in the control group was 61.2%, which was higher than 21.2% in the observation group. The conclusion showed that the clinical nursing path based on evidence-based medicine plays a better role in preventing venous thrombosis and adverse complications in long-term bedridden patients compared with the conventional nursing model [ 29 ]. Compared with the conventional nursing mode, personalized health education for patients could better improve the compliance of patients.…”

Evaluation of the Duration of Peripheral Venous Catheter in Vein in Hospitalized Children

“…Despite their common use in clinical settings, these devices are prone to occlusion and failure, requiring replacement and exposing the patient to ongoing discomfort/ pain, local vessel inflammation and risk of infection. [1][2][3]23] In order to prevent these complications, observation of the catheter area by nurses is very important, especially in irritant drug infusions. [20] However, it was seen that studies conducted on catheter vein duration and frequency of interventions especially in children are in a limited number in the literature.…”

“…It is an important issue for healthcare professionals to take measures against repeated invasive procedures and to increase such studies. [12,18,23] Jeong et al (2017) determined that the mean PIVC dwell time was 55.62±27 hours, mostly at 24-72 hours intervals, in 1596 pediatric patients. [20] In another study conducted on children who were between the ages 3-18, it was found that the mean duration of catheterization was 83.53 hours.…”

“…in the case of failure in fluid/drug flow given from the catheter (obstruction and catheter dislocation) to reduce the number of catheter interventions in children and to increase the duration of the catheter in veins before treatment end. [2,17,18,23,28] A study aimed at examining the effectiveness of IV House UltraDressing for protecting PIVCs in pediatric patients was conducted. This randomized controlled trial comprised 60 pediatric patients (aged 2-24 months): 30 in the experimental group and 30 in the control group.…”

A simulation study of high-flow versus normal-flow three-way stopcock for rapid fluid administration in emergency situations: A randomised crossover design

“…We should keep in mind that higher frequency and volume of flushing has been observed to have more peripheral IV complications, such as vessel damage, infection, and thrombosis. 19,20 Highpressure and high-volume injections should only be undertaken in emergency situations where there is no other alternative.…”