Abstract

Products and technologies that aid health care professionals in vascular access practice save staff time, and while promoting patient safety and prevention of infection can provide excellent opportunities for evaluations to support evidence-based practice. This was an industry sponsored, prospective, single site, controlled, randomized clinical evaluation pilot study of two catheter dressings, 3M^™ Tegaderm^™ Chlorhexidine Gluconate (CHG) IV Securement Dressing (CHG gel dressing) (3M Health Care, St. Paul, MN) and BIOPATCH^® Antimicrobial Dressing with Chlorhexidine Gluconate (BIOPATCH^® Protective Disk with CHG, Johnson & Johnson, Somerville, NJ). Twelve intravascular (IV) therapy health care professionals (Clinicians) were asked for their professional evaluations of the catheter dressings: the ease of application and performance factors featured in specific questions. Catheters were secured on 12 healthy volunteers to simulate inserted jugular catheters (IJ) and peripherally inserted central catheters (PICC) using StatLock^® PICC Plus and 3M^™ Steri-Strip^™. Each clinician applied and removed one CHG gel dressing and one CHG disk on one simulated PICC and one simulated IJ site, according to the manufacturers' instructions.

The clinicians concluded, based upon a 1 to 5 rating scale, that the CHG gel dressing is better in regard to ease of application, ease of applying correctly, ease of removal, ability to visualize the insertion site, ease of training another clinician to apply the dressing, and more intuitive application. Twelve out of 12 clinicians favored the CHG gel dressing over the CHG disk in overall performance.

Abstract

To conduct a systematic review that compares the effectiveness of nurses using 2-D ultrasound guided insertion of peripherally inserted central catheters (PICCs) with the landmark method in adult patients. Nine electronic databases were searched, the reference lists of studies were screened, the Internet was searched, and contact was made with experts. A quality assessment checklist was used to assess study validity. Dichotomous outcome data on the failure rate to insert PICCs were calculated as relative risk (RR) with 95% confidence intervals. Data were pooled using the Mantel-Haenszel fixed effects model. From 156 studies, four eligible non-randomised studies were identified. Three studies originated from the United States and RR of failure to insert PICCs was significantly lower in the ultrasound group: 0.26 (0.10 to 0.64), 0.47 (0.38 to 0.59) and 0.28 (0.20 to 0.41). One study from the United Kingdom did not find a statistically significant difference in failure to insert PICCs between landmark and ultrasound groups: single centre RR was 0.60 (0.23 to 1.57) and multi centre RR was 0.42 (0.16 to 1.09). The pooled RR for all studies was 0.40 (0.33 to 0.48) showing that ultrasound significantly reduces failure rates by 60%. The presence of bias is evident in all studies. There is evidence to support the use of 2-D ultrasound by nurses to insert PICC lines. Further more rigorous research is required, such as a multi-centre randomised controlled trial with economic evaluation, before the widespread uptake of this technology can be recommended.

Abstract

Purpose: To analyze patient outcomes and processes of insertion after the introduction of the peripherally inserted central catheter (PICC) in the University Medical Center Utrecht (UMC Utrecht) in the Netherlands.

Patients and method: A prospective analysis of PICC inserted in the UMC Utrecht looking at patient characteristics, dwell time and infections.

Results: A total number of 510 PICCs in 439 patients with 17655 catheter days were analyzed using ultrasound (US) and modified Seldinger technique (MST). Overall there were 2.35 catheter-related bloodstream infections (CRBSI) per 100 devices and 0.68 infections per 1000 catheter days. When used specifically for home infusion, the CRBSI rates were 1.09 per 100 devices and 0.23 per 1000 catheter days. One advanced nurse practitioner (ANP) inserted all PICCs. Although a full sterile barrier (no hat and gown) was not used during insertion, the infection rate in our study was lower compared to the 1.1 infection per 1000 catheter days reported in a meta-analyses on CRBSI (Maki, Kluger, & Crnich, 2006).

Conclusion: Through the use of modern techniques like US and MST and upper arm insertion of PICCs, the complication rate is lower compared to older techniques as shown in most prospective studies. Extended dwell time, as a positive outcome of using PICCs made more doctors decide to choose a PICC. Age of the patient did not influence dwell time or complications. Further research, preferably a randomized controlled trial, is needed to compare the subclavian catheter with the PICC as well as exploration of the effects of anticipatory choice for PICCs, specifically in immune compromised patients.

Abstract

Vascular access devices (VAD) represent high technology and are used frequently in infant, pediatric, adult, and geriatric populations for vascular infusion of chemotherapy, immunotherapy, blood products, biologic response modifiers, nutrition support, analgesics, ionotropics, antibiotics, and other medications, as well as for extraction of pleural fluid from patients with chronic effusions and for treatment with dialysis. Increasingly, these devices are migrating to the home setting as they are used in chronic care and as insurance requirements reduce access to prolonged hospital stays.

Surveillance of infections in high risk patients such as those with cancer, cardiac conditions, or post-trauma convalescence is essential to avoid adverse events and to offer early treatment. VAD site and blood stream infections are common VAD complications, occurring in up to 50% of home care patients, usually during days 4–25 after hospital discharge. Our literature search for reports of remote home monitoring for support of VAD patients and their caregivers found none.

The use of videoconferencing technology to assess VAD sites in the post-discharge environment would significantly enhance patient safety, facilitate continuity of care, and meet the Communicable Disease Center's stated need for the development of surveillance systems to monitor infections in home care settings. Low-cost Internet- or telephone-based videoconferencing technology that could be deployed easily and used during risk periods would be highly beneficial to patients and increase the cost-effective use of homecare nursing personnel.

We report criteria-based protocols for remote assessment of VAD status, for monitoring VAD care procedures employed in the home, and for conducting VAD-care teaching of patients and their caregivers. In addition, we report an initial evaluation of the ability to assess VAD status using low-end videoconferencing technologies.