Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.

Anxiety is a symptom complex with a differential diagnosis that has become increasingly specific in recent years. Elderly patients often present to their primary care physician with symptoms of anxiety rather than seek a mental health professional. Because presentation may be somewhat different in elderly patients than in young adults, careful consideration of the differential diagnosis is important to ensure the most effective treatment. Pharmacotherapy, behavioral therapy, and traditional psychotherapy are useful for these disorders.

Highlights Abstract Background: Central vascular access devices (CVADs) are essential for patient care in modern medicine. Providing access to the central circulation, CVADs allow fluids and medications to be infused rapidly and hemodiluted. The placement of a CVAD requires knowledge of vascular access devices, optimal site selection, infection prevention protocols, and expert techniques to limit potential adverse outcomes. Research has been focused on how to safely and effectively place CVADs, but little effort has been made to investigate the securement of the catheter once it is in place. Methods: This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered through PROSPERO. Two systematic searches of the literature were conducted, the first in January 2021 and the second in January 2022, by using multiple medical databases. Of the 1127 titles that met initial inclusion criteria 117 were selected for evaluation and then 39 for study. Results: Search results yielded various outcomes, making a direct comparison between studies challenging. However, it was clear that safety and efficacy were not applied to suture-based securement and have not been well researched despite its general use. Conclusions: Randomized controlled studies are needed to measure the relative safety and efficacy of different securement modalities, their impact on CVAD complications, and ultimately patient outcomes.