Abstract

Objectives: The risk nurses face related to exposure to blood borne pathogens associated with IV therapy are daily challenges. Providing a product with the least risk of exposure is the responsibility of the healthcare organization. Where the two meet creates an environment that fosters a safe work environment and raises the awareness that safety is everyone's job.

Project: Following identification of exposure rates from IV catheter stylets the Carilion Clinic undertook a project to improve the practices and provide a higher level of safety for its staff.

Results: Following staff evaluation and selection of a new IV catheter, the exposure rate related to contaminated IV catheter stylets dropped from 13 in 2005 to 2 in 2007. Numerous other practices and products related to IV therapy were reviewed and improved upon following the catheter conversion as well.

Conclusion and Implications for Practice: A higher level of safety can be achieved when nurses are involved in the selection of a product, staff education, and support from leadership.

Abstract

Two preliminary studies were conducted to determine feasibility of using the electrocardiography (EKG) method to determine terminal tip location when inserting a peripherally inserted central catheter (PICC). This method uses the guidewire inside the catheter (or a column of saline contained in the catheter) as an intracavitary electrode. The EKG monitor is then connected to the intracavitary electrode. The reading on the EKG monitor reflects the closeness of the intracavitary electrode (the catheter tip) to the superior vena cava (SVC). The studies revealed that the EKG method was extremely precise; all tips placed using the EKG method and confirmed using x-ray were located in the superior vena cava. In conclusion, the EKG method has clear advantages in terms of accuracy, cost-effectiveness, and feasibility in conditions where x-ray control may be difficult or expensive to obtain. The method is quite simple, easy to learn and to teach, non-invasive, easy to reproduce, safe, and apt to minimize malpositions due to failure of entering the SVC.

Abstract

Background, Method and Purpose: The use of peripherally inserted central catheters (PICCs) in the UK has been steadily increasing since they were first introduced in 1995. Ultrasound-guided upper arm placement - which has become prevalent in the USA over the last few years - is gradually attracting interest amongst PICC placers in the UK. The literature shows that upper arm placement improves insertion success rate (Hockley, Hamilton, Young, Chapman, Taylor, Creed et al, 2007; Hunter, 2007; Krstenic, Brealey, Gaikwad & Maraveyas, 2008) and patient satisfaction (Polak, Anderson, Hagspiel, & Mungovan, 1998; Sansivero, 2000; McMahon, 2002). Following a switch to upper arm placement at her institution, the author examined audit data from before and after the change in practice to see if there were other measurable clinical improvements.

Results: Comparison of data from a four-year period shows that upper arm placement in our patient population increased insertion success rate and line longevity, while reducing exit site infection, thrombosis and catheter migration.

Implications for Practice: This data shows that ultrasound-guided upper-arm placement improves patient outcomes. PICC placers still using the more traditional antecubital approach should consider a change in practice.

Abstract

Nurses commonly face challenges placing peripheral intravenous (IV) lines in adults and children, a situation described as difficult venous access (DVA). Multiple venipuncture attempts can heighten patient anxiety and suffering, delay vital treatment, and increase costs. Numerous factors such as small, fragile or hidden veins can predispose patients to DVA, and collapsed veins due to dehydration are especially problematic. Several techniques can improve venous prominence, but when IV access cannot be achieved promptly, other routes of administration can be valuable. For rehydration fluids and certain drugs, subcutaneous administration may be a safe and effective alternative, providing cost and ease-of-use advantages.