Abstract

Aim: To examine the phenomenon of catheter-related thrombosis by describing the pathophysiology of thrombosis and reviewing the evidence relating to the incidence, morbidity and the use of ultrasound-guided placement on the reduction in occurrence.

Background: The use of peripherally inserted central catheters (PICCs) as a means to deliver essential therapy for patients is common practice within the field of Oncology. The functional capacity of these devices has to be balanced with the potential for the development of complications such as thrombosis which may lead to debilitating physical or psychological effects.

Methods: Papers of all methodological design were included in the English language from 1980–2009. A review of the literature included papers associated with; the incidence of PICC-related upper extremity deep vein thrombosis (UEDVT), the morbidity and mortality associated with central venous catheter-related UEDVT and the use of ultrasound guidance to place PICCs.

Results: The literature demonstrates that catheter-related thrombosis is not an uncommon event especially when cancer patients are under investigation. The evidence relating to the use of ultrasound-guided placement as a means to reduce the incidence of thrombosis specifically in PICCs is small in respect to the number of papers but demonstrates a clear reduction in occurrence.

Conclusion: The development of co-morbidities of thrombosis such as pulmonary embolus or post-thrombotic syndrome exacerbates the disease process and is demonstrated to result in the deterioration of health and untimely death. The use of ultrasound devices to place PICCs needs to be considered in the clinical environment based on early indication from the literature that placement in the upper arm leads to a reduction in the incidence of catheter-related thrombosis.

Abstract

Aim and objectives: The aim of this paper was to review published manuscripts on the use of midline catheters, the implications of study findings and recommendations for clinical practice in the acute care setting.

Design: Modified integrative literature review

Methods: Using key MeSH terms, we searched the electronic databases: CINAHL, Medline, and Embase. The Cochrane and Joanna Briggs databases, Google Search Engine and the reference lists of published materials were also searched. Studies were included if they were in the English language and reported the use of midline catheters in adult acute care populations. Manuscripts that described midlines made of aquavene were excluded

Results: Two hundred and thirty two (232) papers were identified using the search strategy. From these identified papers, thirty (30) were included in the final review. Thematic analysis identified three major themes. These included: (i) advantages of using midline catheters (ii) disadvantages of using midline catheters (iii) insertion and management issues.

Conclusion: Midline catheters have both positive and negative implications for clinical practice. They can be used for extended periods of intravenous therapy without requiring repeated cannulations but are not without risk. Midline catheters have been associated with mechanical and chemical phlebitis along with intravascular thrombosis. As such they are not suitable across the entire adult acute population. Midline catheters reduce the number of repeated cannulations which reduces patient discomfort, increases patient satisfaction and also contributes to organisational efficiency.

Abstract

Purpose: To assess the knowledge gap of healthcare workers about practice with needleless connectors.

Background: Catheter-related bloodstream infection (CR-BSI) and lumen occlusion can be directly related to practices of cleaning needleless connectors, IV administration set management, and flushing and clamping methods.

Review of Relevant Literature: Five publications report outbreaks of CR-BSI from hospitals in the US and Australia. A significant increase in CR-BSI rates after an organizational change of products was observed. No randomized controlled trials are available from the USA comparing types or designs of needleless connectors.

Device instructions state some devices can be locked with normal saline. Two randomized clinical trials assessed outcomes with catheter lock solution. Both reported higher rates of occlusion with the use of normal saline only and one documented a higher rate of CR-BSI.

Methods: An invitation to participate in a survey with 22 questions was sent electronically to approximately 4000 healthcare workers with a response from 554 in clinical practice.

Results: The specific type of needleless connector being used was unknown by 25% and correct clamping sequence was chosen by 52.8% of respondents. The majority, 94.3% reported that they always clean these devices before each use, however there are differences in technique.

Conclusions: There is a significant gap of knowledge about the specific needleless connectors being used, the most appropriate cleaning, flushing, and clamping sequence for the specific device.

Implications for Practice: Staff education should focus on the connections between needleless connectors, CR-BSI and lumen occlusion. Frequent product training on needleless connectors, the specific type in use and correct techniques are necessary.