Objective: The aim of this study was to conduct a narrative synthesis of randomized trials to evaluate the evidence on the effectiveness of antibiotics and antiseptics in preventing central line-associated bloodstream infection (CLABSI) in intensive care unit patients. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, and Scopus databases were searched for randomized controlled trials published from 2012 to March 2024. The methodological quality of the included studies was independently evaluated by 2 reviewers using the Critical Appraisal Skills Programme Spanish [Español] appraisal tool. Following data extraction, a narrative synthesis was performed to integrate and interpret the findings across studies. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO). Results: Nineteen randomized trials were appraised using the Critical Appraisal Skills Programme Spanish [Español] tool, of which 13 high-quality studies (score ≥6) were included in the review. These trials assessed antiseptic (alcohol, chlorhexidine), antibiotic (rifampin), or combined interventions versus standard care. Antiseptic and antibiotic-impregnated catheters and alcohol caps were associated with reduced CLABSI rates, hospital stay, and costs, while evidence for alcohol lock therapy was inconclusive. Conclusion: This review supports the use of antiseptic and antibiotic-coated catheters as promising measures to prevent CLABSI in critically ill patients. However, caution is warranted with alcohol lock therapy due to limited and conflicting evidence.
Objective: This study aimed to evaluate patients’ knowledge of using the Visual Infusion Phlebitis (VIP) score for self-monitoring of peripheral intravenous catheters (PIVCs) during hospitalization. Methods: A descriptive comparative pilot study was conducted on 64 inpatients aged ≥18 years by using a structured Patient Knowledge Evaluation Questionnaire (PKEQ) on days 1, 2, and 3 of hospitalization. Patients received education on using the VIP score after admission. Patient knowledge levels, phlebitis scores, and major adverse events were compared between younger participants aged ≥18 years to <70 years and older participants aged >70 years. Results: Results were statistically significant for patient knowledge of using the VIP score on day 1 ( P < .015) and day 2 ( P < .037) after PIVC insertion but not for day 3. Patients’ accuracy of scoring was comparable with nurses’ scores. Major in-hospital adverse events were not statistically different. Patients of all ages ≥18 years to >70 years applied their knowledge of the VIP score for accurate assessment and monitoring of their PIVCs for visual signs of phlebitis. Conclusion: These findings could guide innovative clinical practice developments in safe PIVC care by promoting patient education on using the VIP score for early visual detection of PIVC-related complications.
OBJECTIVE:This study was the first to assess inpatient use of ClearGuardTM HD antimicrobial barrier caps for the reduction of hemodialysis catheter-related central line-associated bloodstream infections (CLABSI) compared to the use of Tego™️ needlefree connectors with Curos™️ caps. METHODS:Retrospective observational data were used to evaluate the effect of ClearGuard on the CLABSI rate and standardized infection ratio (SIR) compared to the baseline rate and ratio. Financial analysis was conducted to measure return on investment. RESULTS:Compared to the baseline period, data from the implementation period showed a long-term CLABSI reduction from 1.91/month/site (95% CI: [0.91-4.00]) to 0.71/month/site (95% CI: [0.33-1.53]), a 63% reduction (95% CI: [46%-74%]) in CLABSIs (P < .00005). The overall SIR was reduced by 57%, from a baseline of 0.721 to 0.310. The annual cost savings were estimated at $1.6 million. CONCLUSION:The findings from the ClearGuard study and ongoing use across hospitals indicate a clinically significant reduction in hemodialysis catheter-related CLABSI events and associated costs.
Objective: The objective of this study was to describe the Biodesign methodology and its application in developing and evaluating a new medical device to reduce short peripheral intravenous catheter dislodgement. Methods: First, the Stanford Biodesign method, a systematic process for designing new medical technologies, was presented in six detailed steps. Second, examples from a recently published randomized clinical trial were used to illustrate how Biodesign can be applied to identify unmet needs in vascular access, generate concepts, and validate a solution. Results: The resulting product from the Biodesign process was a type of force-activated separation device (FASD). The trial of the FASD demonstrated a 73% relative risk reduction in short peripheral intravenous catheter dislodgement in the intervention group compared with the control, with no device-related adverse events. Other complication rates remained unchanged. Conclusions: The Biodesign methodology offers a systematic approach to innovation in infusion therapy. The FASD case illustrates how need-driven design and evidence generation can produce clinically meaningful solutions.
This study was conducted to determine the relationship between the peripheral intravenous catheter biomaterial type and the incidence of phlebitis. This prospective cohort study aims to determine the effect of ethylene tetrafluoroethylene (ETFE) and polypropylene (PP) biomaterials on the incidence of phlebitis. The study was conducted in the internal medicine ward of 1 of the hospitals in Makassar City, Indonesia. Phlebitis was assessed using the Visual Infusion Phlebitis scale based on the Maddox scale. Data were analyzed using SPSS software version 23. A total of 30 samples were included in this study, each consisting of 15 samples in the ETFE and PP biomaterial groups. The analysis showed a significant difference in the duration of catheter use until the occurrence of phlebitis between the 2 groups (P = .05). However, there were significant differences in the scale of phlebitis (P = .01) and bacterial count (P = .002), where PP biomaterial showed a higher rate of phlebitis occurrence and bacterial colonization than ETFE. These findings suggest that PP biomaterials are more prone to cause phlebitis than ETFE. Therefore, nurses are advised to be more selective in choosing the peripheral intravenous catheter biomaterial type to minimize the risk of phlebitis complications in patients.
OBJECTIVE:The aim of this study was to determine the effect of jet lidocaine on pain and anxiety during peripheral venous access. METHODS:A comprehensive literature search was conducted in PubMed, Web of Science, EBSCOhost, Google Scholar, and the YÖK Thesis Center without year limitation. Five randomized controlled trials that met the inclusion criteria were included in the analysis. Data extraction and methodological quality assessment were performed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools, and study selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The findings were synthesized using meta-analysis and narrative synthesis. RESULTS:The pooled analysis demonstrated that jet lidocaine significantly reduced anxiety related to peripheral venous access (standardized mean difference: -1.031; 95% confidence interval: -1.653 to -0.409; Z = -3.249; P = .001; I2 = 89.98%). However, its effect on pain was not statistically significant (standardized mean difference: -0.817; 95% confidence interval: -1.817 to 0.182; Z = -1.602; P = .109; I2 = 96.57%). CONCLUSION:Jet lidocaine may be an effective option for reducing anxiety during peripheral venous access; however, its effect on pain was not statistically significant. Further high-quality randomized controlled trials with standardized protocols and larger sample sizes are needed to clarify its analgesic effectiveness and clinical outcomes.
This scoping review aimed to describe and analyze educational methodologies used for teaching peripheral venipuncture to nursing students. The study was conducted according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR. Primary studies that addressed educational methodologies used for teaching peripheral venipuncture were included. The research question was as follows: "What are the educational methodologies used for teaching nursing students about peripheral venipuncture?" The searches were carried out in the MEDLINE, SciELO, LILACS, BDENF, Embase, Scopus, and ScienceDirect databases. The results were evaluated through the synthesis of the selected articles. Thirty-seven studies were included, and the most frequent methodologies were clinical simulation with manikins, educational hypermedia, instructional videos, digital games, interactive software, and virtual reality. Simulation was noted for enhancing technical performance, while digital resources promoted engagement, self-confidence, and autonomous learning. The most common study designs were experimental, descriptive, and methodological, with the use of validated instruments to assess knowledge, skills, and student perception. The mapped educational methodologies facilitate the teaching of peripheral venipuncture, contributing to the development of technical competencies and safety in practice. The adoption of hybrid approaches, integrating digital technologies with supervised practice, is recommended to strengthen nursing education in peripheral venipuncture.
OBJECTIVE:This study compared the clinical characteristics of catheter-related thrombosis (CRT) associated with internal jugular and subclavian vein-implanted ports. METHODS:This retrospective study enrolled patients who were newly implanted with a vascular access port between January and December 2022. Relevant patient and clinical information, including demographic data, catheter details, and CRT results, were mainly obtained from the hospital's electronic medical record database. Follow-up was conducted until the time of the patient's first occurrence of thrombus at the infusion port or the last vascular color Doppler ultrasound available for patients without thrombus up to the study deadline (December 2024). RESULTS:Among 647 patients who underwent B-ultrasound examinations due to different reasons, such as discomfort symptoms, catheter dysfunction, and pre-extubation thrombus screening, 277 patients (42.8%) experienced CRT, and the median time to thrombosis was 14 (12, 16) months. It was most frequently located at the entrance of the catheterized vein (36.6%). Breast cancer and internal jugular vein catheterization were risk factors for CRT. After pairwise comparisons, there was a significant difference in the median time (4 [2, 7] vs 5 [3, 10] months) between the early onset thrombus (hypoechoic), and older thrombi (hyperechoic signal) (adjusted P = .021). CONCLUSION:For cancer patients who undergo ultrasound examinations for various reasons, the risk of CRT is relatively high. More attention should be paid to patients with breast cancer and with internal jugular vein implantation around 14 months after catheterization.
Objective:The objective of this study was to analyze current evidence-based pan-European standards of good clinical practice in the use of peripheral intravenous catheters (PIVCs) to determine if they meet clinicians' needs for unambiguous, standardized guidance for the prevention and management of PIVC-associated complications.Methods:Reference documents meeting agreed inclusion criteria were identified and analyzed. Documents were systematically searched for terms (selected based on expertise of the authors and supported by scientific literature) most likely to be associated with the prevention/management of complications associated with the use of PIVCs. A matrix was constructed to visualize the degree of consensus across guidelines regarding prevention and management terminology. Recommendations for optimizing clarity and standardization across Europe were proposed.Results:Few European reference documents included PIVCs within their scope, and few were subject to a quality review. Adherence to the established GRADE framework of rating supporting evidence was missing from all reference documents. There was ambiguous terminology across documents and many instances of omission of terms rated important by the authors for the prevention and management of complications.Conclusion:An English-language European guideline for the prevention of complications associated with PIVCs is needed, featuring consensus terminology and a standardized, systematic, and transparent method for grading evidence.
OBJECTIVE:The aim of the study was to compare catheter dislodgement rates between abdominal wall-tunneled femoral peripherally inserted central catheters (PICCs) and conventional upper arm PICCs in pediatric oncology patients. METHODS:A retrospective analysis included 355 pediatric oncology patients from Shandong Cancer Hospital (March 2022 to March 2025). Patients were divided into the Tunnel group (abdominal wall-tunneled femoral PICC, n = 145) and Conventional group (upper arm PICC, n = 210). The primary outcome was unplanned catheter dislodgement (external migration >3 cm or complete dislodgement). The Kaplan-Meier method estimated cumulative dislodgement rates; Cox regression identified influencing factors. RESULTS:The dislodgement rate was 12.41% in the Tunnel group vs 40.95% in the Conventional group (χ2 = 33.727, P < .001). The mean indwelling time was longer in the Tunnel group (181.50 ± 54.72 days vs 114.97 ± 55.84 days; t = -11.165, P < .001). Survival curves showed higher cumulative catheter survival in the Tunnel group (log-rank P < .001). CONCLUSION:Abdominal wall-tunneled femoral PICCs significantly reduce dislodgement risk and prolong indwelling time, providing a stable central venous access for pediatric oncology patients requiring long-term therapy.
BACKGROUND:Vascular access specialist teams (VASTs) are established worldwide to enhance the safety and efficiency of vascular access procedures. In Poland, nurse-led VASTs are a novel concept. OBJECTIVE:The aim of the study was to evaluate whether implementation of a nurse-led VAST improved the efficiency and safety of vascular access devices in a large academic hospital in Poland. METHODS:This retrospective analysis included long peripheral intravenous catheters inserted from 2021 to 2024 and midline catheters inserted from 2022 to 2024. Data were obtained from hospital records and the electronic medical record (EMR) after integration of VAST documentation in 2023. Outcomes included insertion time, number of attempts, dwell and withdrawal times, and reasons for removal. RESULTS:Over the study period, time to catheter insertion decreased (14.27 days in 2022 vs 4.34 days in 2024), the number of insertion attempts declined, dwell and withdrawal times increased, and the proportion of removals due to complications decreased from 38.37% to 22.92%. CONCLUSION:The implementation of a nurse-led VAST improved efficiency and safety of vascular access, demonstrating fewer insertion attempts, longer dwell times, and lower complication rates. These findings indicate that the VAST model can be successfully adapted in health care systems where nurse-led vascular access practice has not previously existed.
Peripherally inserted central catheters (PICCs) are vital for long-term intravenous therapy but increase the risk of venous thromboembolism (VTE), a process commonly explained through the conceptual framework of Virchow's Triad: stasis, endothelial injury, and hypercoagulability. The catheter-to-vein ratio (CVR), a key modifiable thrombosis risk factor that primarily influences stasis, lacks a universal definition, causing variability in measurement, thresholds, and clinical use. This study compares the diameter-based approach commonly cited in the literature with the area-based approach later adapted for clinical CVR tools, emphasizing that both gain from standard geometric relationships rather than distinct mathematical formulations. Through mathematical conversion, the analysis reveals that a 45% diameter-based CVR corresponds to approximately a 20% area-based CVR, underscoring substantial discrepancies when assuming equivalence. The study endorses a 20% area-based (45% diameter-based) CVR threshold for oncology patients and a 33% area-based (57% diameter-based) threshold for noncancer patients. A harmonized CVR reference is proposed to bridge the gap between methods. To enhance consistency and patient safety, the study advocates for a standardized CVR definition, consistent vein measurement techniques, and stricter control of confounders in future research. It further recommends developing a next-generation CVR calculator integrating hemodynamic and clotting risk factors to refine VTE risk assessment.
OBJECTIVE:Guidelines from the Oncology Nursing Society (ONS) and Infusion Nurses Society (INS) were reviewed to establish a flushing protocol. No consensus on implanted vascular access port (IVAP) flush frequency was recommended. Guidelines suggest extending up to 12 weeks may be safe based on functionality. However, limited research on the risks associated with stagnant reservoir contents leaves this practice under debate. METHODS:An oncology clinic studied IVAP flush practices during the COVID-19 pandemic when routine care was delayed. Concerns arose about biofilm, clots, or other harmful substances being flushed into patients. A new approach was developed to observe IVAP reservoir contents, allowing abnormal substances to be aspirated and discarded before flushing. RESULTS:In 150 patients observed from 5 to 17+ weeks, visible clots and altered reservoir contents were found in 52% of cases. CONCLUSION:Findings suggest that prolonged intervals between flushes may increase risks associated with stagnant IVAP contents. This research highlights the need for further studies to establish safe and evidence-based flush frequencies. The new observational method offers a proactive approach to identify and remove harmful substances, helping to mitigate risks when routine IVAP maintenance is delayed. Ensuring patient safety requires further investigation into the physiological impacts of extended flush intervals.
BACKGROUND:Predictors of difficult peripheral intravenous cannulation include nonvisible and non-palpable veins, history of difficult access, intravenous drug use, abnormal body mass index, vascular disease, and conditions such as wasting syndrome, diabetes, sickle cell disease, hemodialysis, chronic obstructive pulmonary disease, and upper limb alterations, including edema. This study evaluated the predictive accuracy of upper-limb edema in identifying difficult intravenous catheter placement. METHODS:A secondary analysis was conducted on data from a large prospective observational study investigating the prevalence of difficult intravenous access (DIVA), cannulation timing, and enhanced adult-DIVA (EA-DIVA) thresholds for ultrasound guidance at the emergency department of an urban general hospital. Logistic regression was used to identify predictors of ultrasound-guided cannulation. RESULTS:Significant predictors of DIVA included overweight (odds ratio [OR] = 3.934; 95% CI: 2.218-6.977), neurovascular diseases (OR = 3.106; 95% CI: 1.650-5.845), and upper-limb edema (OR = 3.026; 95% CI: 1.542-5.937). Other predictors were history of difficult cannulation (OR = 2.675), vascular depletion (OR = 2.669), abnormal vein evaluation (OR = 2.649), and abnormal skin assessment (OR = 1.841). CONCLUSION:Upper-limb edema emerged as a strong, independent predictor of DIVA not currently included in the EA-DIVA score. Its immediate clinical detectability suggests its potential as a binary screening criterion for direct referral to ultrasound-guided cannulation.
OBJECTIVE:To compare the efficacy, safety, and operational efficiency of the intermittent negative-pressure guidewire technique and the stay-locking technique in restoring the function of thrombotically occluded peripherally inserted central catheters (PICCs). METHODS:An in vitro thrombotically occluded PICC model was created using 110 catheters, with successful occlusion established in 90. The experimental group comprised 43 models treated with the intermittent negative-pressure guidewire technique, while the control group included 45 models treated using the stay-locking technique. Relevant procedural data were collected and analyzed statistically. RESULTS:The success rate was significantly higher in the experimental group (62.79%) compared with the control group (4.44%, P < .0001). There was no significant difference in the incidence of thrombus overflow at the catheter tip between groups (P = .704); however, the length of thrombus overflow was significantly greater in the control group (P = .001). Additionally, successful interventions were associated with significantly shorter operation times and significantly higher-pressure recovery rates (P < .0001 for both comparisons). CONCLUSION:In an in vitro model of thrombotically occluded PICCs, the intermittent negative-pressure guidewire technique demonstrated superior efficacy, including shorter operation time and higher success rates, compared with the stay-locking technique. The marked increase in the pressure recovery rate in successful cases indicates the technique's effectiveness in restoring catheter function.
Objective: The aim of the study was to evaluate the effectiveness of replacing the connector assembly in resolving occlusion of peripherally inserted central catheters (PICCs) during parenteral nutrition (PN) administration. Methods: This retrospective study reviewed data from 24 patients who received PN via 4Fr single-lumen silicone PICCs at a 2000-bed tertiary general hospital between 2018 and 2023. All patients experienced either partial or complete catheter occlusion following PN infusion. A novel procedure was adopted to replace the connector assembly, and the subsequent outcomes were observed. Results: The success rates of connector replacement were 87.5% and 50.0% on the first and second attempts, respectively, with restored catheter function. Repeated replacement, however, markedly reduced patency (from 87.5% to 0% after the third replacement) and progressively shortened the median functional indwelling time (from 44.5 to 36.5 days), indicating diminished overall durability and therapeutic efficacy. Conclusion: Connector assembly replacement is an effective, immediate, and economical method to resolve PICC occlusions caused by PN. This approach may offer a practical alternative to chemical catheter clearance, particularly for 4Fr single-lumen silicone catheters.
