Vascular access in neonatal care settings: selecting the appropriate device

Hugill, Kevin

doi:10.12968/bjon.2016.25.3.171

Cited by 12 publications

(15 citation statements)

References 51 publications

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“…The selection of suitable veins is performed using the near infrared (NIR) technology for vein visualization, with the saphenous and antecubital veins generally being avoided for peripheral IV cannulation. In this facility's practice, the choice of appropriate venous access device is based on the duration of required therapies; fluid characteristics [pH (5)(6)(7)(8)(9) and osmolarity]; patient characteristics, including body weight; and a known history of difficult intravenous access. The design of the venous access device selection flowchart is based on the current infusion standards of practice (27,31) and local contexts such as product compatibility, hospital purchasing decisions, and practitioner consensus.…”

Section: Methodsmentioning

confidence: 99%

“…Evidence-based VAD insertion and maintenance strategies including appropriate skin/insertion site antisepsis and dressings have been developed to reduce the preventable causes of VAD failure and complications; however, evidence in the neonatal population is limited ( 7 , 8 ). Approaches to VAD selection, insertion, and maintenance in neonates frequently vary among caregivers, with practice often based on traditional practices, anecdotal evidence, or practices recommended for adults and adolescents ( 9 , 10 ). Undertaking clinical research can help in the identification of evidence-based practices that demonstrate effective methods for reducing preventable causes of patient harm or injury, as well as provide recommendations and guidelines for healthcare practitioners to focus on providing better and safer solutions and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes

et al. 2022

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BackgroundVenous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data.MethodsThis is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables.ResultsThe authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50–0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82–0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24–1.27) had a significant relationship with outcomes.ConclusionsFour subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes

et al. 2022

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“…[11,12] Approaches to VAD selection, insertion and maintenance in neonates frequently vary among caregivers, with practice often based on traditional practices, anecdotal evidence or practices recommended for adults and adolescents. [8, 13,14] Undertaking clinical research can help identify evidence-based practices that demonstrate effective methods for reducing preventable causes of patient harm or injury, providing recommendations and guidelines for healthcare practitioners to focus on providing better and safer solutions and outcomes.…”

Section: Introductionmentioning

confidence: 99%

The ABBA project (Assess Better Before Access): a retrospective, cross-sectional study of neonatal intravascular device outcomes

Rens

Bayoumi

Hoogen

et al. 2022

Preprint

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Background: Vascular access devices (VADs) play a vital role within the neonatal intensive care unit (NICU). However, VAD-use is not without significant risks, with complications such as infection, thrombosis, device occlusion and infiltration/extravasation frequently contributing to device-related failures and increase the risk of significant patient harm or injury. Methods: A retrospective, cross-sectional, single-center study in a large 112-bed NICU in Qatar that routinely collected intravenous device data from January 2016 to December 2018 was evaluated. The outcome of interest was to identify and evaluate the relationships between unmodifiable and potentially modifiable factors and Assess the situation and patients Better Before initiating vascular Access (ABBA), potentially reducing unwarranted complication rates leading to therapy failure within the neonatal setting.Results: During the study period, 23858 VADs were inserted. Of these, 89.3% were peripheral intravenous catheters (PIVCs). Infants who received a peripheral device were slightly older, with a median age of 8 (5) days, when compared to all infants receiving a central device, with a median age of 6 (4) days. Univariate logistic regression analyses identified 10 variables demonstrating significant relationships to device-related outcomes.Conclusions: Four subgroups of VAD were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, peripherally inserted central catheters and umbilical venous catheters). Central vascular access (peripherally inserted central catheters and umbilical venous catheters) had the least reported complications. Future research toward improving patient and intravenous therapy-related outcomes plays an important role. It requires a focus on innovations and clinical advancements in the world of neonatology and vascular access devices.

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“…Choices in VADs, insertion methods, and management are considered complex and multifaceted, and multiple interdisciplinary clinicians are frequently involved in their care. Evidence-based insertion and maintenance strategies, such as maximum sterile barriers and the use of chlorhexidine gluconate for skin disinfection, are frequently utilized steps to prevent infectious complications7 and have been developed to reduce the preventable causes of VAD failure and complications, however not always applicable in a neonatal population 10–15. Dedicated catheter insertion kits and dressing packs for care and maintenance were previously introduced at the facility, along with daily monitoring for device requirement/need, site assessment, and standardized documentation of all related cares and procedures.…”

mentioning

confidence: 99%

“…Evidence-based insertion and maintenance strategies, such as maximum sterile barriers and the use of chlorhexidine gluconate for skin disinfection, are frequently utilized steps to prevent infectious complications 7 and have been developed to reduce the preventable causes of VAD failure and complications, however not always applicable in a neonatal population. [10][11][12][13][14][15] Dedicated catheter insertion kits and dressing packs for care and maintenance were previously introduced at the facility, along with daily monitoring for device requirement/need, site assessment, and standardized documentation of all related cares and procedures.Catheter securement issues have serious consequences, and the interaction of patient, practice, and Cyanoacrylate Securement in Neonatal PICC Use…”

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confidence: 99%

Cyanoacrylate Securement in Neonatal PICC Use

Rens

Nimeri

Spencer

et al. 2021

Advances in Neonatal Care

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Background: Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant. Purpose: This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments. Method and Setting: This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. Results: The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type. Implications for Practice and Research: In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.

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Vascular access in neonatal care settings: selecting the appropriate device

Cited by 12 publications

References 51 publications

The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes

The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes

The ABBA project (Assess Better Before Access): a retrospective, cross-sectional study of neonatal intravascular device outcomes

Cyanoacrylate Securement in Neonatal PICC Use

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