Highlights R is a computer language for statistical data analysis. R statistical computer language is free and accessible to everyone. R can be used for your own statistical analysis. R can be used to check published data and analyze new data.
Peripheral intravenous catheter (PIVC) insertion is among the most common hospital procedures worldwide, yet first-attempt success rates remain inconsistent. Difficult intravenous access (DIVA), defined as two or more failed attempts combined with non-visible or non-palpable veins or a history of difficult access, is linked to treatment delays, vessel trauma, patient anxiety, and higher costs of care. Patients at greatest risk include those with obesity, chronic illness, prior DIVA, intravenous drug use, and advanced age. The impact of DIVA extends beyond procedural challenges. Repeated failures contribute to unnecessary central line use, increased supply consumption, and diminished patient trust, while also influencing hospital performance metrics tied to patient experience and reimbursement. Evidence supports early identification of at-risk patients and structured intervention as key to improving outcomes. Risk assessment tools, escalation pathways, and vein visualization technologies such as ultrasound and near-infrared imaging improve first attempt success and reduce complications. Longer PIVCs and midline catheters further support vessel preservation in appropriate patients. This position paper, endorsed by the Association for Vascular Access (AVA) outlines the scope and consequences of DIVA in hospitalized adult populations and proposes a comprehensive, evidence-based framework to support earlier recognition and more effective vascular access planning. Key strategies include use of validated risk assessment tools, structured escalation pathways, vein visualization technologies such as ultrasound, and device selection guided by vessel health and preservation principles. The paper also emphasizes the importance of patient-centered communication, clinician education and competency validation, and integration of documentation and clinical decision support tools within the electronic medical record. Together, these practices aim to improve first-attempt success, preserve vascular access sites, enhance patient experience, reduce complications, and promote more efficient use of healthcare resources. Implementing a standardized approach to DIVA supports both safer clinical care and better patient outcomes.
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The ulnar nerve is a motor-sensory nerve in the posteromedial brachium. Identifying the ulnar nerve is essential for ultrasound-guided access assessment. Upper-arm basilic vein access risks unintended ulnar nerve contact or injury.
Research Article| May 26 2020 The Use of Visualization Technology for the Insertion of Peripheral Intravenous Catheters Stephanie Pitts, MSN, RN, CPN, VA-BC™; Stephanie Pitts, MSN, RN, CPN, VA-BC™ Search for other works by this author on: This Site PubMed Google Scholar Matt Ostroff, ARNP-C, VA-BC™ Matt Ostroff, ARNP-C, VA-BC™ Search for other works by this author on: This Site PubMed Google Scholar Journal of the Association for Vascular Access (2019) 24 (3): 10–14. https://doi.org/10.2309/j.java.2019.003.007 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Stephanie Pitts, Matt Ostroff; The Use of Visualization Technology for the Insertion of Peripheral Intravenous Catheters. Journal of the Association for Vascular Access 1 September 2019; 24 (3): 10–14. doi: https://doi.org/10.2309/j.java.2019.003.007 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest Search It is estimated that over 350 million peripheral intravenous catheters (PIVCs) are inserted in the United States annually, making PIVC insertion the most commonly performed invasive procedure for patients.1–3 Peripheral intravenous catheters are often inserted for infusion of fluids, medications, administration of blood products, and the withdrawal of blood.4 Vascular access device selection is a collaborative effort with the health care team taking into consideration the patient's history, condition, and infusion needs.4 Venous vasculature is assessed through inspection, palpation, and visualization technology. The typical approach to prepare the vessel for PIVC insertion is the use of a tourniquet to enlarge the vessel, visual inspection, dangling the extremity, irritating the vessel (i.e., tapping), and heat.5 Vein visualization technology is designed to assess for vessel health and to detect the vessel pathway, identifying key anatomical... Copyright © 2019 Association for Vascular Access. All rights reserved.2019 You do not currently have access to this content.
Catheter-associated thrombosis (CAT) is a potential complication of vascular access devices, including peripherally inserted central catheters (PICCs), which can result in therapy interruption, increased cost of care, and patient consequences including phlebitis and pulmonary embolism. There are multiple modifiable (e.g., catheter size, insertion, and location confirmation methods) and nonmodifiable (e.g., cancer, history of thrombosis) risk factors for CAT. A multidisciplinary approach focused on quality improvement may help to lower risk. A retrospective study of patients with PICCs placed by vascular access nurses was conducted after a quality improvement initiative at a hospital within a 1200-bed health system in Philadelphia. A pre-post analysis was performed to compare the rates of CAT before and after a multiyear intervention targeting modifiable risk factors. An economic model calculated economic impact based on results of the observational audit. Across the health system, very low CAT rates (1.2%) were observed in the post-intervention period, compared with a pre-intervention rate of 4.6%. The greatest reduction was attributed to the elimination of 6-Fr PICCs as part of the intervention. For every 1000 PICC placements, the economic model predicted cost savings exceeding $1M USD (i.e., $1,399,644) due to avoided thrombosis. This retrospective study demonstrated that small improvements to controllable elements of catheter care in a broad patient population can result in significant reductions in the risk of CAT and associated costs. Further study is required to confirm benefits in larger populations, and to understand which modifications could result in the highest cost savings.
Venous valves are common structures that can obstruct catheter placement. Most people have valves in both subclavian veins near the venous confluence. 1,2 Resistance often occurs at the junction of the subclavian and internal jugular veins. Subclavian valves may deflect catheters, leading to malposition in the internal jugular. Recognizing valves can improve practice, patient outcomes, and device design.
Association is any relationship, and correlation is a linear relationship. Many measures of association and correlation exist; 9 are presented here. Measures of association and correlation are based on data types. Measures of association and correlation can be applied to improve patient care. Evidence-based vascular access can be enhanced through applying statistics.
Puncturing the bicep muscle when accessing the brachial veins is suboptimal. Use dynamic ultrasound techniques to avoid critical structures. Assess and select vessels thoroughly and strategically to minimize risk. Position the arm to optimize presentation of anatomy and minimize risk.
Handball exercise does not significantly impact AVF maturation. AVF can be successfully cannulated at 6 weeks if blood flow ≥ 500 ml/min & diameter ≥ 5 mm. Wall shear stress, blood flow, and fistula body diameter were key predictors of AVF maturation. No significant difference in AVF maturation rates between exercise and control groups. To compare arteriovenous fistula (AVF) maturation in soft handball exercise (Group I) versus no exercise (Group II). Stage 5 chronic kidney disease patients aged 18 to 60 years planned for AVF construction were randomized into soft handball exercise (Group I) versus no exercise (Group II) groups. Side-to-side AVF anastomosis was created after vascular mapping. Doppler parameters such as blood flow and wall shear stress (WSS) were assessed in the 2nd, 4th, 6th, and 12th weeks. Mature AVF was defined with blood flow ≥500 mL, fistula body diameter ≥5 mm, and the ability to use the fistula with 2 needles for 3 consecutive dialysis sessions at 6 weeks. A total of 103 patients were randomized into the handball exercise group (Group I, n = 50) and control group (Group II, n = 53). By 6 weeks, 77 (75%) patients achieved AVF maturation. However, no significant difference was found in maturation rates between the handball group (72%) and the control group (77%; P = 0.628), indicating no added benefit from handball exercise. Blood flow, fistula diameter, and WSS were significantly higher in matured AVFs than nonmatured ones ( P < 0.001), but these parameters did not differ between the intervention and control groups. In patients with newly created AVFs, handball exercise does not play any role in AVF maturation. Successful cannulation can be done at 6 weeks with a blood flow ≥500 mL and fistula body diameter ≥5 mm.
