Improving Patient Outcomes through CQI: Vascular Access Planning

Barton, Amy J.; Danek, Gale; Johns, Paula; Coons, Mary

doi:10.1097/00001786-199812000-00010

Cited by 63 publications

(31 citation statements)

References 5 publications

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“…2 A third study conducted at a university teaching hospital reviewed vascular access by staff nurses from inpatient pediatric, medical, surgical, and intensive care units. 3 This study reported the mean number of attempts to obtain peripheral IV access as 2.2, with one in four patients experiencing treatment delays secondary to difficult access. 3 The difficult IV access (DIVA) score is the product of a recent study by Yen et al, 4 the goal of which was to identify factors that contribute to difficult IV catheter placement.…”

mentioning

confidence: 89%

“…3 This study reported the mean number of attempts to obtain peripheral IV access as 2.2, with one in four patients experiencing treatment delays secondary to difficult access. 3 The difficult IV access (DIVA) score is the product of a recent study by Yen et al, 4 the goal of which was to identify factors that contribute to difficult IV catheter placement. That study assessed 16 candidate variables, ultimately developing a four-variable proportionally weighted rule (Table 1).…”

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confidence: 89%

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Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children With Difficult Intravenous Access

Riker

Kennedy

Winfrey

et al. 2011

Academic Emergency Medicine

111

109

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Objectives: The difficult intravenous access (DIVA) score, a proportionally weighted four-variable (vein palpability, vein visibility, patient age, and history of prematurity) clinical rule, has been developed to predict failure of intravenous (IV) placement in children. This study sought to externally validate and refine the DIVA score.Methods: Patients undergoing peripheral IV placement by pediatric emergency department (ED) nurses were enrolled. The outcome of interest was defined as failure of cannulation on first attempt. Proposed refinement predictor variables include history of newborn intensive care unit (NICU) stay, operator experience characteristics (years since graduation, years of pediatric nursing experience, and IVs started per month), and skin shade. Adjusted multivariate models were constructed using logistic regression. Receiver operating characteristic (ROC) curves were constructed and areas under the curve (AUC) calculated for each model. Results:A total of 366 subjects were enrolled (mean age = 5.4 years, SD ± 5.6 years) and of them, 118 (32.2%) subjects failed the first IV attempt. The original four-variable model tested in this data set resulted in an AUC of 0.72 (95% confidence interval [CI] = 0.67 to 0.78). Patients with a DIVA score of 4 or greater had more than 50% likelihood of failed first IV attempt. A three-variable rule (vein palpability, vein visibility, and patient age) was evaluated and found to possess similar discriminating ability (AUC = 0.72, 95% CI = 0.67 to 0.78).Conclusions: This study validated the previously derived four-variable DIVA score. A simpler threevariable rule was as predictive of failed IV placement on first attempt as the four-variable rule. Validation in nonpediatric EDs is needed to thoroughly evaluate generalizability.

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confidence: 89%

mentioning

confidence: 89%

Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children With Difficult Intravenous Access

Riker

Kennedy

Winfrey

et al. 2011

Academic Emergency Medicine

111

109

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“…Multiple factors need to be weighed when considering use of a VAD, and the type of infusion system chosen must be individualized [26,65]. Issues to be considered include the patient's overall clinical status, age, and vein condition; the diagnosis; current vascular access; antimicrobials prescribed and their frequency of administration; need for a programmable infusion pump; and the anticipated duration of therapy [66].…”

Section: Antimicrobial Selection and Administrationmentioning

confidence: 99%

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Tice

Rehm

Dalovisio

et al. 2004

Journal of Infusion Nursing

124

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EXECUTIVE SUMMARYThese guidelines were formulated to assist physicians and other health care professionals with various aspects of the administration of outpatient parenteral antimicrobial therapy (OPAT). Although there are many reassuring retrospective studies on the efficacy and safety of OPAT, few prospective studies have been conducted to compare the risks and outcomes for patients who receive treatment as outpatients rather than as inpatients. Because truly evidence-based studies are lacking, the present guidelines are formulated from the collective experience of the committee members and advisors from related organizations.Important aspects of OPAT are described in the text and tables and include the following:1. The literature supports the effectiveness of OPAT for a wide variety of infections (table 1 and the Appendix).2. A thorough assessment of the patient's general medical condition, the infectious process, and the home situation is necessary before starting therapy (table 2) 3. Prescribing physicians should be aware of a number of aspects of OPAT which distinguish it from

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“…6 (B) Patients and their families still currently play a minor role in the selection of VAD at the onset of treatment, notwithstanding the evidence showing that patient involvement is associated with greater patient satisfaction, fewer delays in therapy related to loss of vascular access, fewer device complications, preservation of peripheral veins, less nursing time spent attempting to gain vascular access, shorter hospital stays, fewer emergency room visits, and decreased infusion therapy costs. 7 However, most patients who require intravenous therapy for longer than 1 week are not routinely assessed for intermediate dwelling VADs. In addition, patient satisfaction about long-term VADs has rarely been addressed.…”

Section: Introductionmentioning

confidence: 99%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

252

166

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Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

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Improving Patient Outcomes through CQI: Vascular Access Planning

Cited by 63 publications

References 5 publications

Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children With Difficult Intravenous Access

Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children With Difficult Intravenous Access

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

Vascular Access in Oncology Patients

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