This study focuses on the effects of infusion nurse specialists on the culture of an institution as it relates to infusion therapy practice. During the 18-month study, data were gathered on the outcomes of the proactive approach instituted by the infusion specialists. Outcomes assessed included phlebitis prevalence, peripherally inserted catheter placements, patient satisfaction scores, and ratio of catheters being placed by interventional radiology to the bedside placements. The study discusses the methods used by the infusion team in an attempt to change the approach to infusion therapy.

Maintaining and restoring patency in midline catheters has been a significant issue in the hospitalized patient requiring a multitude of infusates and frequent blood specimen collection. Currently, clinicians may not use this device as often as clinically indicated because they lack an approved intervention to treat thrombotic occlusions. The purpose of this research was to show evidence that alteplase, a US Food and Drug Administration–approved thrombolytic for central vascular access devices, is a safe and effective thrombolytic for midline catheters. A prospective open label study of 497 midline catheters was conducted from July 2018 to December 2018. Of those studied, 112 devices were treated with 1 mg of alteplase, and 109 had patency restored with 1 dose. None of the 112 patients had a major adverse event, and only 1 minor event was recorded and was resolved without removal of the midline catheter. Treating occluded central vascular access devices with 2 mg of alteplase has been safe and effective since 2001. With this research, safety and efficacy appears to be established for 1 mg of alteplase, repeat times 1 mg if necessary, in midline catheters. With the option to treat patients with occluded midline catheters rather than replace, clinicians can reduce cost, increase patient satisfaction, and preserve vein health.

Vascular access specialists are brought into many difficult situations that stretch their ability to provide appropriate care to patients who have complicated medical and personal histories. In the following case, a hospital was challenged to provide appropriate care while remaining responsible and compassionate throughout the duration of infusate delivery.

No abstract

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.