Peripheral intravenous catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic “pre-scan” for selecting a large-diameter vein before catheterization, a “post-scan” for confirming the catheter tip position after catheterization with ultrasonography, and the use of a flexible polyurethane catheter to reduce the mechanical irritation that contributes to the incidence of catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was catheter failure, which was defined as accidental and unplanned catheter removal. We used Kaplan-Meier survival curves to compare rates of time until catheter failure. We analysed 189 and 233 catheters in the intervention and control groups, respectively. In the control group, 68 catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for catheter failure was 0.60 (95% CI: 0.47–0.71). Care protocols, including assessment of vein diameter, vein depth, and catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce catheter failure incidence.

Up to 50% peripheral intravenous catheters (PIVs) are removed prematurely because of failures. Catheter failure (CF) leads to replacement and is a great concern for patients and medical staff. It is known that visualization of catheters and vessels with ultrasonography (US) during placement prevents CF. However, US is not a common technique for general nurses. In order to standardize US-assisted PIV placement techniques, an algorithm is needed. This study aimed to develop an algorithm using US-assisted PIV placement to reduce CF rate. Furthermore, to evaluate the effectiveness of the algorithm, CF rates were compared before and after intervention. A pretestposttest study was performed. The intervention was PIV placement by 23 nurses undergoing training sessions for the algorithm. Intention to treat, per protocol analyses were applied. Logistic regression analysis was used for factor analysis. The CF rate in the pre-intervention group 35.2% (19/54) did not significantly differ from post-intervention group 33.6% (48/143) (p = 0.831), yet significantly differ from complete algorithm-use group 8.7% (2/23; p = 0.017). In factor analysis, compliance to the algorithm was significantly correlated with CF (p = 0.032). The compliance rate was low 16.1% (23/143). Algorithm compliance reduced CF by confirming appropriate catheter tip position from the insertion to the securement phase. This algorithm effectively reduced CF, however, the compliance rate was unacceptable. In order to increase the compliance rate, modified algorithm and new visualizing technology is required.

Background: The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. Methods: Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein’s visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. Results: Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. Conclusions: Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

AimsFollowing chemotherapy, induration may occur. This study was conducted to survey induration incidence and risk factors, and investigation for actual condition of induration.MethodsA cohort study was conducted for survey of incidence and risk factors, and a cross‐sectional observation study was conducted to examine actual condition of induration. The sites of chemotherapy administration were recorded, and these were observed on the next treatment day. Clinical nurses judged the presence or absence of induration by palpation. The sites were observed using ultrasonography. To investigate the risk factors associated with the induration, logistic regression analysis was performed using independent variables based on univariate analysis or previous reports.ResultsIn total, 69 patients were analyzed. The induration incidence was 17.4%, and three abnormal conditions were confirmed: subcutaneous edema, thrombosis, and thickening of the vessel wall. Breast cancer, non‐vesicant drug, vein diameter, and fosaprepitant use were included in the logistic regression model. Breast cancer: odds ratio (OR) 9.25; 95 CI 1.91.–44.71; non‐vesicant drug: OR 1.37; 95 CI 0.13–14.95; vein diameter: OR 0.40; 95% CI 0.16–0.97; fosaprepitant use: OR 0.16; 95% CI, 0.18–10.32.ConclusionsThe induration incidence was 17.4%. Risk factors for induration following chemotherapy administration were breast cancer and smaller vein diameter. Abnormal cases of subcutaneous tissue were confirmed, including subcutaneous edema, thrombosis, and thickening of the vessel wall. Induration may be prevented by selecting larger diameter vessels using ultrasonography when catheterizing for chemotherapy.

Background: Peripheral intravenous catheter placement is frequently unsuccessful at the first attempt. One suggested risk factor is a small vein size, because of the consequences of mechanical forces generated by the needle tip. We developed short bevel needles with a very thin tip and evaluated their puncture performance in two in vitro models. Methods: Peripheral intravenous catheters with a new needle ground using the lancet method (experimental catheter (L)) or backcut method (experimental catheter (B)) were compared with a conventional peripheral intravenous catheter (Surshield Surflo®) in a penetration force test and a tube puncture test. Penetration forces were measured when peripheral intravenous catheters penetrated a polyethylene sheet. The tube puncture test was used to evaluate whether the peripheral intravenous catheters could puncture a polyvinyl chloride tube at two positions, at the center and at 0.5 mm from the center of the tube. Results: Mean penetration forces at the needle tip produced by experimental catheters (L) (0.05 N) and (B) (0.04 N) were significantly lower than those produced by the conventional catheter (0.09 N) (p < 0.01). At the catheter tip, mean forces produced by experimental catheter (B) and the conventional catheter were 0.16 N and 0.26 N, respectively (p < 0.05). In the tube puncture test, the frequency at which the conventional catheter punctured the center-shifted site on the tube at an angle of 20° and speed of 50 mm/min was low (40%). In contrast, experimental catheters (L) and (B) were 100% successful at puncturing both the center and center-shifted sites at 20°. Conclusion: Puncture performance was comparable between the lancet-ground and backcut-ground needles except for penetration forces at the catheter tip. The experimental catheters produced lower penetration forces and induced puncture without target displacement at smaller angles compared with the conventional catheter. Therefore, optimization of the needle can prevent vein deformation and movement, which may increase the first-attempt success rate.