Vascular Access: April edition out now

VASCULAR ACCESS, April edition of the peer-reviewed multidisciplinary official journal of the Australian Vascular Access Society (AVAS) is now available!

Table of contents

Woods C, Ray-Barruel G, Marsh N, Flynn J, Larsen E, Rickard CM. Registered nurses' experiences of using four methods of peripheral intravenous catheter dressings and securement during a randomised controlled trial. A survey. Vascular Access 2018;4(1)

Abstract:

Background: Peripheral intravenous catheters (PIVC) have undesirably high failure rates (2069%), despite billions used around the world annually. An assortment of dressing and securement methods has been designed to anchor these catheters and prevent PIVC complications or failure. However, there is inadequate evidence about optimal dressing and securement methods and how decisions for their use are made.

Objective: The study aim was to understand staff perceptions of four catheter dressing and securement methods tested in a randomised controlled trial (RCT), so as to provide context for the RCT findings.

Method: A printed survey was distributed among nurses involved with the trial at a large tertiary hospital in southeast Queensland, Australia.

Results: Of 150 surveys distributed, 109 (72.6%) surveys were completed and analysed. The majority of respondents came from the surgical department and had fewer than 5 years' clinical nursing experience (44%). Covering the insertion site was the most important factor identified by staff when choosing a PIVC dressing securement approach (61%), followed by stabilising the cannula (34%). Nurses reported that all four dressing and securement arms in the trial had satisfactory perceived performance and acceptability.
Conclusion: Available supplies of PIVC dressings and securements change regularly due to new products or suppliers, which affects clinical practice. The use of a staff survey was a useful way to drill down and gather feedback from the nurses about the performance and acceptability of all four dressing and securement arms in the trial. Active inclusion and involvement of the nursing staff is an important element in the desired endpoint of translation of research evidence into practice.

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Takashima M, Gavin NC, Larsen EN, Northfield S, Mihala G, Corley A, Ziegenfuss M, Rickard CM. Building a central vascular access device registry in an adult intensive care unit: feasibility study. Vascular Access 2018;4(1)

Abstract:

Introduction: Central venous access devices (CVAD) provide vascular access for the majority of intensive care patients. However, no comprehensive registry for CVAD insertion, complications and failure currently exists for research and quality assessment purposes in Australia. The primary aim of this study was to examine the feasibility of a CVAD registry to measure peripherally inserted central catheter (PICC) outcomes.

Methods: In this feasibility study, intensive care unit (ICU) patients undergoing PICC insertion within an Australian tertiary-referral hospital were included. Data was extracted from the electronic medical record (EMR) and post-ICU discharge from ward paper medical records until removal of PICC, patient transfer to another hospital/facility, or death. The primary outcome was registry feasibility according to published criteria for national clinical quality registries. Secondary outcomes included: PICC utilisation ratio; PICC numbers and days; details of patients and PICCs; reason for PICC removal; and PICC failure/1000 catheter days.

Results: Three out of seven feasibility criteria were not met: operational requirement, capturing necessary data, and infrastructure. Many patients were transferred to other wards, and the lack of an EMR in this setting meant 22% of PICCs were lost to follow-up due to unavailable records. However, for insertion-only data, six out of seven feasibility criteria were met, except for operational requirements, which could be solved by restructuring of the EMR.

Conclusion: A CVAD registry capturing data until PICC removal is only feasible if EMR is used throughout the hospital. The adoption of registry fields into the EMR will enable auto-population of a CVAD registry.

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Alexandrou E, Mifflin N, McManus C, Sou V, Frost SA. Extended dwell peripheral catheters in patients with difficult venous access: Comparison of a peripheral intravenous catheter and midline catheter. Vascular Access 2018;4(1)

Abstract:

Introduction: Extending the traditional dwell of peripheral venous catheters from routine replacement has been shown to be successful without increasing risk to patient safety. One group of patients that can benefit from extending catheter dwell are those with difficult venous access, who may endure multiple, painful cannulation attempts. We report our experience on the use of two peripheral devices for extended dwell in patients with difficult venous access.

Methods: The devices chosen and available to the Australian market during the study period were the 100 mm PowerGlide® midline catheter and the 48 mm Nexiva® catheter in both 18 and 20 gauges. Catheter selection was based on ultrasound assessment of vessel depth from skin and diameter. Patient information and catheter characteristics were collected and presented as numbers, ranges and proportions. Non-parametric tests were used to assess differences in catheter groups where appropriate.

Results: Between November 2015 and August 2016, 192 patients had extended dwell peripheral catheters inserted. PowerGlide® catheters were the primary devices placed (n=161, 84%) compared to Nexiva® catheters and the basilic vein was the vessel of choice (n=175, 90%). Primary reasons for device placement were difficult venous access requiring infusion therapy as well as antibiotic therapy. Median dwell of all devices was six days (IQR 311 days) and 68% of devices (n=131) were removed for cessation of intravenous therapy.

Conclusion: The majority of devices were placed on first attempt and a number were successfully managed for weeks until cessation of therapy. Rates of phlebitis were minimal, and no infections were reported.

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AVAS members can access the journal here.