Infection free midline catheter implementation at a community hospital (2 years)

DeVries, Michelle; Lee, Janice; Hoffman, Lisa

doi:10.1016/j.ajic.2019.03.001

Cited by 61 publications

(74 citation statements)

References 14 publications

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“…Symptoms of leaking, pain, and swelling are not complications in and of themselves, as is typically reported in the literature 31 , 32 , 40 , 41 ; they are signs of vessel damage and thrombosis, as evidenced by histopathological examination. Unlike with use of short peripheral i.v.…”

Section: Discussionmentioning

confidence: 66%

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Ryder¹,

Gunther

Nishikawa³

et al. 2020

American Journal of Health-System Pharmacy

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Purpose Infusate osmolarity, pH, and cytotoxicity were investigated as risk factors for midline catheter failure. Methods An experimental, randomized, controlled, blinded trial was conducted using an ovine model. Two 10-cm, 18-gauge single-lumen midline catheters were inserted into the cephalic veins of sheep. The animals were divided into 6 study arms and were administered solutions of vancomycin 4 mg/mL (a low-cytotoxicity infusate) or 10 mg/mL (a high-cytotoxicity infusate), doxycycline 1 mg/mL (an acidic infusate), or acyclovir 3.5 mg/mL (an alkaline infusate) and 0.9% sodium chloride injection; or 1 of 2 premixed Clinimix (amino acids in dextrose; Baxter International) products with respective osmolarities of 675 mOsm/L (a low-osmolarity infusate) and 930 mOsm/L (a mid-osmolarity infusate). Contralateral legs were infused with 0.9% sodium chloride injection for control purposes. Catheter failure was evaluated by assessment of adverse clinical symptoms (swelling, pain, leakage, and occlusion). A quantitative vessel injury score (VIS) was calculated by grading 4 histopathological features: inflammation, mural thrombus, necrosis, and perivascular reaction. Results Among 20 sheep included in the study, the overall catheter failure rate was 95% for test catheters (median time to failure, 7.5 days; range, 3–14 days), while 60% of the control catheters failed before or concurrently (median time to failure, 7 days; range, 4.5–14 days). Four of the 6 study arms (all but the Clinimix 675-mOsm/L and acyclovir 3.5-mg/mL arms) demonstrated an increase in mean VIS of ≥77% in test vs control legs (P ≤ 0.034). Both pain and swelling occurred at higher rates in test vs control legs: 65% vs 10% and 70% vs 50%, respectively. The mean difference in rates of occlusive pericatheter mural thrombus between the test and control arms was statistically significant for the vancomycin 10-mg/mL (P = 0.0476), Clinimix 930-mOsm/L (P = 0.0406), and doxycycline 1-mg/mL (P = 0.032) arms. Conclusion Administration of infusates of varied pH, osmolarity, and cytotoxicity via midline catheter resulted in severe vascular injury and premature catheter failure; therefore, the tested infusates should not be infused via midline catheters.

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Section: Discussionmentioning

confidence: 66%

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Ryder¹,

Gunther

Nishikawa³

et al. 2020

American Journal of Health-System Pharmacy

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“…For hospitalized children and adolescents, PIVCs and midline catheters were reported as appropriate for short-term peripherally compatible therapies in multiple studies because of their low risk of catheter-related infections and thrombosis in comparison to PICCs. 14,43,94,100,127,143 However, in one study, the authors suggested that these devices are associated with increased risk of occlusion with extended dwell times. 127 PICCs were reported to have high insertion success rates 84 and low failure rates in children and adolescents, 6,59 although one study reported severe complications in 40.1% of failed PICCs, associated with increasing patient age.…”

Section: Figurementioning

confidence: 99%

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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“…Since publication, MAGIC has been implemented in many hospitals worldwide but particularly in the United States, with evidence suggesting significant reductions in inappropriate VAD use, patient harm, and costs. [9][10][11] Similar evidence-based VAD appropriateness criteria have not been developed for pediatrics. Therefore, we sought to develop the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC), a pediatric-focused version of its adult counterpart, using the RAND Corporation and University of California, Los Angeles (RAND/ UCLA) Appropriateness Method 12 to address this knowledge gap.…”

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confidence: 99%

The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC

et al. 2020

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OBJECTIVES: Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts.

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Infection free midline catheter implementation at a community hospital (2 years)

Cited by 61 publications

References 14 publications

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC

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