Reducing Risks and Improving Vascular Access Outcomes

Morrell, Elizabeth

doi:10.1097/nan.0000000000000377

Cited by 26 publications

(16 citation statements)

References 28 publications

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“…This finding is lower than most studies conducted in Portugal, with complications rates varying between 50% and 62.1% [33,34,39,53], although none of the studies was conducted in an oncology setting. Several risk factors can be attributed to the existing complication rate in this specific cohort, namely patient age, gender, immune system suppression or high body mass index [5,54,55]. However, nurses' practices potentially explain some of the found complications, since poor patient involvement, adherence to aseptic technique, catheter stabilization and dressing integrity, and catheter flushing can lead to high incidence rates of infiltration and phlebitis.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study

Santos-Costa

Paiva-Santos

Sousa

et al. 2022

JPM

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A significant number of adult oncology patients require at least one peripheral intravenous catheter to fulfill their therapeutic plan. Recent evidence indicates that catheter failure rates are high in this cohort, impacting care outcomes and patient experience during cancer treatment. This reality represents a challenge to nurses worldwide since in most international settings they are responsible for delivering quality care during the insertion and maintenance of such devices. This study aims to explore current nursing practices regarding the insertion, maintenance, and surveillance of peripheral intravenous catheters in oncology patients. A two-phase mix-method study was conducted with the nursing team from the surgical ward of a large oncology hospital in Portugal. In phase one (observational prospective study), nurses’ practices during catheter insertion and maintenance were observed by the research team and recorded using standardized instruments and validated scales. In phase two, three online focus groups were conducted with the nursing team to present the results observed in phase one and explore their perceptions of current practices. All ethical principles were assured throughout the study. Significant divergent practices were observed and identified by the nurses, especially concerning patient involvement, nurses’ adherence to the aseptic, non-touch technique, catheter stabilization and dressing, and catheter flushing and locking. Such practices may partially explain the high complication rate found (26%) and substantiate the need for future intervention in this field.

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Section: Discussionmentioning

confidence: 99%

Nurses’ Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study

Santos-Costa

Paiva-Santos

Sousa

et al. 2022

JPM

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“…Midline catheter failures can lead to increases in vein trauma, staff time, length of stay, and overall costs of health care 18. Delays in treatment from interruption of the prescribed therapy can decrease infusate effectiveness, lower patient satisfaction, and lead to poor outcomes 17–20. This study investigated the role of catheter material as a factor influencing the probability of completing the prescribed therapy.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition

Bunch

2022

Journal of Infusion Nursing

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Vascular access specialists are responsible for assessing the patient in their unique situation and determining the correct vascular access device to complete the therapeutic goal without complication or failure. This retrospective cohort study compared the failure rates of a variety of polyurethane (PU) midline catheters and a midline catheter constructed of an emerging hydrophilic biomaterial (HBM). A total of 205 patients received a midline catheter and were situationally randomized by the facility where they received it. Patients who had received a midline catheter between March 2021 and May 2021 were assessed for catheter-related failures leading to increased staff time, delays in treatment, or replacement with a new vascular access device to complete the therapy. There were 101 patients in the PU cohort and 104 patients in the HBM cohort. Comparing overall failure rates between the groups revealed a 23.8% failure rate in the PU control group and only a 3.8% failure rate in the HBM group. This suggests that a midline catheter constructed of HBM biomaterial is associated with significantly lower rates of failure, thereby improving patient experience and health care economics.

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“…A mean of 1.17 attempts per catheter were needed to achieve insertion, somewhat lower than the figures reported in other studies (Deutsch et al, 2014; Lisova et al, 2018; Scoppettuolo et al, 2016; Spiegel et al, 2020). This result is promising since, in clinical practice, it is extremely important to achieve successful catheter placement with as few attempts as possible and thereby minimize patient suffering (Morrell, 2020). Specifically, Bortolussi et al (2015) observed low levels of pain and distress during catheterisation with PICCs and midlines, implying that the insertion of these devices with a high first attempt success rate significantly improves the overall quality of life of these patients.…”

Section: Discussionmentioning

confidence: 99%

Experience in the use of midclavicular catheters: An inception cohort study

Tomás-López

Cristóbal-Domínguez

Báez-Gurruchaga

et al. 2021

Journal of Clinical Nursing

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Aims and objectives:To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal.Background: Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length.Design: Inception cohort study. Methods:We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days.Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed.Results: Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days.The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure.Conclusions: Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal.Relevance to clinical practice.

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Reducing Risks and Improving Vascular Access Outcomes

Cited by 26 publications

References 28 publications

Nurses’ Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study

Nurses’ Practices in the Peripheral Intravenous Catheterization of Adult Oncology Patients: A Mix-Method Study

A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition

Experience in the use of midclavicular catheters: An inception cohort study

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