Central venous access devices (CVADs) are an essential component of contemporary medical care, allowing for incompatible medications to be administered simultaneously and reduce the need for peripheral vascular access, particularly for critically ill or oncology patients.1 However, CVADs can entail significant risk. Bloodstream infection is the most detrimental consequence of inadequate CVAD management, presenting a significant burden to the patient, staff and economy of a hospital, especial...

Peripheral intravenous cannulation (PIVC) is commonplace in the neonatal setting, particularly in premature and critically unwell neonates who are unable to regulate homeostatic balance.1 Cannulation of a neonate can be difficult, given the significantly smaller venous anatomy and compromised skin integrity which can lead to localised toxicity and inflammation.2 Failure rates can be high, with 95% of PIVCs being removed due to complications including occlusion, leaking and extravasation inju...

Of the 11 million Australians accessing care in a hospital each year, an estimated 7.7 million will receive a peripheral intravenous catheter (PIVC), also called a cannula, meaning this procedure is commonplace, particularly in the emergency department.(1) Although this is such a common procedure, first-attempt failure rates are high, with an estimated 40% failure rate in adults and 65% in the paediatric population.(1) All clinicians who are cannulation competent must be abl...

Did you know that certain catheter-to-vein (CVR) ratios can have twice the risk of thrombosis in patients with cancer? Dr Rebecca Sharp from the University of South Australia (UniSA) and Australian Vascular Access Society has published a study in BMJ Open that analysed the outcomes of more than 2400 patients from 4 hospitals in Australia and New Zealand who received a peripherally inserted central catheter (PICC). The study found that up to 6% of patients with cancer who had received chemo...

Being aware of appropriate securement techniques is essential when caring for a vascular access device (VAD). Whether arterial or venous, when a VAD dislodges, it becomes useless, which can lead to delayed treatment and prolonged hospital admission.1 As such, clinicians need to understand the importance of securement techniques that can prevent dislodgement and the subsequent possible complications.2 Suture-less securement devices are commonplace in hospital settings, seen most commonly i...

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The emergency department is a fast-paced, hectic and often unpredictable environment. In the 2019-2020 financial year, Australian EDs treated 8,236,159 patients, reviewing an average of 22,600 patients per day (1). Often working under duress and having to make clinical decisions within a very narrow timeframe, ED clinicians must quickly identify what a critically unwell patient needs in order to be stabilised (2,3). Achieving vascular access usually means urgent insertion of a peripheral ...

Drawing blood from a cannula is a routine practice in some clinical environments. But is this best practice or will the blood become too haemolysed to provide accurate results? Drawing blood from a peripheral intravenous catheter/cannula (PIVC) is a routine practice in clinical environments such as the emergency department, rationalised as one less invasive test that a patient is subjected to. A PIVC should never be inserted just to draw blood or 'just in case' it's needed late...

Those who know me understand how passionate I am about PIVC care! In this Osler podcast, Dr Todd Fraser and I discuss best practice of PIVC insertion and maintenance, with essential tips for infection prevention and good cannula assessment and management. If you like this podcast, I encourage you to check out the Osler website and download the free My Osler app. They have lots of excellent education podcasts and learning modules for all kinds of healthcare professionals.&nbsp...

Are you a medical student, junior doctor, paramedic or advanced practice nurse wanting to brush up on your medical knowledge? Osler is a platform designed to support medical students and junior doctors transition to life on the wards, as well as any healthcare clinicians who strive for excellence by ensuring they are best prepared to care for their patients. Whether you're starting out as a student, or an expert in your field, whether you're a nurse, a doctor, allied health or p...