Changing concepts in long-term central venous access: Catheter selection and cost savings

Horattas, Mark C.; J, Trupiano; Hopkins, Steven P.; Pasini, Debbie; Martino, Carl; Murty, A. S. N.

doi:10.1067/mic.2001.111536

Cited by 88 publications

(58 citation statements)

References 15 publications

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“…CVC-associated complications are well documented, with higher rates of bloodstream infection in femoral placement sites than in other sites. 20 Similar to the findings in previous studies, 21 costs per vascular access device were about 10% to 15% lower for PICCs than for CVCs; the overall reductions in costs per case and morbidity were greater when the reduction in bloodstream infections was considered.…”

supporting

confidence: 78%

Use of Peripherally Inserted Central Catheters As an Alternative to Central Catheters in Neurocritical Care Units

DeLemos

Abi-Nader

Akins

2011

Critical Care Nurse

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Background Patients in neurological critical care units often have lengthy stays that require extended vascular access and invasive hemodynamic monitoring. The traditional approach for these patients has relied heavily on central venous and pulmonary artery catheters. The aim of this study was to evaluate peripherally inserted central catheters as an alternative to central venous catheters in neurocritical care settings. Methods Data on 35 patients who had peripherally inserted central catheters rather than central venous or pulmonary artery catheters for intravascular access and monitoring were collected from a prospective registry of neurological critical care admissions. These data were cross-referenced with information from hospital-based data registries for peripherally inserted central catheters and subarachnoid hemorrhage. Results Complete data were available on 33 patients with Hunt-Hess grade IV–V aneurysmal subarachnoid hemorrhage. Catheters remained in place a total of 649 days (mean, 19 days; range, 4–64 days). One patient (3%) had deep vein thrombosis in an upper extremity. In 2 patients, central venous pressure measured with a peripherally inserted catheter was higher than pressure measured concurrently with a central venous catheter. None of the 33 patients had a central catheter bloodstream infection or persistent insertion-related complications. Conclusions Use of peripherally inserted central catheters rather than central venous catheters or pulmonary artery catheters in the neurocritical care unit reduced procedural and infection risk without compromising patient management.

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supporting

confidence: 78%

Use of Peripherally Inserted Central Catheters As an Alternative to Central Catheters in Neurocritical Care Units

DeLemos

Abi-Nader

Akins

2011

Critical Care Nurse

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“…The search covered two main areas of research: firstly, patient and clinical staff attitudes to RCTs and secondly, patient and clinical staff attitudes to venous access devices. Many qualitative studies have explored the views of cancer patients to the process of RCTs, exploring informed consent (12,13), understanding of equipoise (14), randomisation (15), recruitment (13,14,16) and participation in trial design (17). Despite this, recent research reveals health professionals' discomfort at approaching patients to discuss participation in an RCT at an already stressful period for the patient (17).…”

Section: Methodsmentioning

confidence: 99%

Exploring Attitudes towards a Randomised Controlled Trial of Venous access Devices – a Nested Pre-trial Qualitative Study

et al. 2015

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Purpose: This pre-trial qualitative research study was carried out to explore patient and clinical staff attitudes to central venous access devices (CVADs). In addition, views about participation in a randomised controlled trial (RCT) were explored with the aim of maximising recruitment to an imminent RCT of three CVADs. Methods: Three patient focus groups (each comprising three patients) and 23 interviews with clinical staff were conducted. Interviews and focus group discussions were digitally recorded, transcribed verbatim, anonymised, uploaded to the QSR NVivo10 qualitative software programme and thematically analysed. Results: Analysis of focus group interviews revealed the added challenges that a CVAD poses to patients with cancer. Four key themes emerged: continuity of daily life, pain and discomfort, stigma (a mark of disgrace associated with certain conditions) and self-preservation. The findings show the impact of a CVAD on patients' ability to manage their condition. Clinical staff interviews highlighted several potential barriers to recruitment; a lack of equipoise (genuine clinical uncertainty as to which intervention is the most beneficial), concerns about the logistics of device insertion and a perceived requirement for education and training. Conclusions: This qualitative study raises awareness of key areas of concern to patients who need a CVAD for chemotherapy delivery. It was identified that there is a need for clearer patient information around CVADs. Additionally it allows investigators to identify barriers to recruitment in a timely manner in order to minimise the potential for conflict between the roles of carer and researcher and consequently, maximise recruitment to the RCT. Keywords: Cancer, Health professionals' attitudes, Patient attitudes, Qualitative research, Randomised controlled trials, Venous access devices. BackgroundThis paper presents the results of a nested pre-trial qualitative research study carried out to inform a randomised controlled trial (RCT) of central venous access devices (CVADs). Qualitative and quantitative research are the two main research paradigms; whilst quantitative research tends to use numerical data, qualitative research uses language data either in the written or oral form (1). The value of utilising a mixture of quantitative and qualitative methods in developing and evaluating complex interventions is highlighted in recent Medical Research Council Guidance (2) and funders increasingly expect to see a qualitative research component incorporated in a study design. A nested qualitative study in a larger RCT serves to provide in-depth, explanatory

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“…PICC use has increased worldwide due to costeffective nurse insertion teams, increased patient satisfaction and to facilitate out of hospital care (Horattas et al, 2001;Sharp et al, 2014). However, the use of these devices has seen a concurrent rise in thrombus rates.…”

Section: Introductionmentioning

confidence: 99%

The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): A prospective cohort study

Sharp

Cummings

Fielder

et al. 2015

International Journal of Nursing Studies

143

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Changing concepts in long-term central venous access: Catheter selection and cost savings

Cited by 88 publications

References 15 publications

Use of Peripherally Inserted Central Catheters As an Alternative to Central Catheters in Neurocritical Care Units

Use of Peripherally Inserted Central Catheters As an Alternative to Central Catheters in Neurocritical Care Units

Exploring Attitudes towards a Randomised Controlled Trial of Venous access Devices – a Nested Pre-trial Qualitative Study

The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): A prospective cohort study

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