Abstract

Background: Bachelor of Science in Nursing students get minimal exposure or experience in the assessment and care of vascular access devices (VADs) let alone the placement of such devices. Students in our university nursing program receive no structured experience. Students learn how to assess and care for VADs in the clinical setting while working with clinical faculty and staff nurse mentors.

Purpose: The purpose of this pilot program was to increase the awareness and understanding of VADs for third-year nursing students to enhance their comfort level in assessing and caring for these devices.

Methods: Thirty-two third-year nursing students, in groups of 8, participated in this pilot program in addition to their usual academic and clinical assignments. The 4 structured components of this program included a didactic session to share basic VAD information, simulation laboratory time to practice peripheral intravenous line insertion, a 4-hour one-to-one shadowing experience with a vascular access service team registered nurse providing patient care, and a wrap-up session by the vascular access service team educational nurse coordinator to provide debriefing and additional information.

Conclusions: Students who participated in this pilot program expressed an increased level of comfort regarding VADs. They came away with knowledge that other nursing students in the program do not receive during their academic and clinical time.

Abstract

Sludge is defined as a slushy mass, deposit, or sediment. In vascular access ports (VAPs), it appears to be the buildup of clotted blood, blood components, drug and mineral precipitates or residues, and lipids that adhere to or reside in the internal path of the reservoir. Several studies note the presence of sludge as a risk factor for increased incidence of VAP-related bloodstream infections as well as higher occlusion rates. Overall, the occurrence of sludge in implanted vascular ports may increase patient-associated risks and costs to health care providers by as much as $40,000 per incident. Understanding the significance of these associated risks and costs may lead to solutions that save health care facilities money; better serve health care providers; and ultimately, improve patient outcomes.

Abstract

Background: A number of mechanical complications can occur during the insertion of a central venous catheter (CVC), including breakage or loss of the wire and unrecognized failure to remove the wire. Complications related to retention of a guidewire can be serious or fatal.

Methods: Incident reports on retained CVC guidewires entered into the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization (PSO) database (Chicago, IL) over a 5-year period were reviewed to improve our understanding of their circumstances, causes, and related patient outcomes.

Findings: A total of 42 events that involved retention of a whole guidewire or a fragment of a wire were found in the UHC Safety Intelligence PSO database from 2008 through 2012. Although one-third of these events were discovered during or at the end of the CVC insertion procedure, retained CVC guidewires were commonly discovered days to years after the procedure and on imaging tests performed for unrelated reasons or during other subsequent care. Managers who reviewed the events commonly recommended education and training to prevent retained CVC guidewires, but factors contributing to these events such as distractions and emergency situations also suggest the need for a device design that prevents the occurrence.

Conclusions: Efforts to prevent the loss of CVC guidewires should include clinician education and the development of a device design that prevents inadvertent guidewire loss and alerts clinicians when the end of the guidewire is near.

Abstract

Objective: To compare the incidence of nonelective removal of single-lumen silicone and dual-lumen polyurethane percutaneously inserted central catheters (PICCs).

Study Design: A prospective cohort study was conducted with neonates in whom 247 PICC lines had been successfully inserted. Patients were assigned to either the single-lumen silicone group or the dual-lumen polyurethane group and nonelective removal incidence was compared using a logistic regression model.

Results: Incidence of nonelective removal in dual-lumen polyurethane PICCs (n =91) was 48.3% versus 34% in single-lumen silicone PICCs (n =156). Thus, dual-lumen polyurethane catheters had a significantly increased chance of nonelective removal compared with single-lumen silicone PICCs (P =.004). The most usual complication in dual-lumen polyurethane PICCs was suspected catheter-related bloodstream infection; in single-lumen silicone PICCs it was external rupture.

Conclusions: Dual-lumen polyurethane PICCs are associated with higher rates of nonelective removal and complications such as suspected catheter-related bloodstream infection. Cautious nursing care is necessary to prevent complications.

Abstract

Understanding proper chamber flushing volume for each port manufacturer and port chamber shape is of value to both clinicians and patients. Failing to follow adequate flushing volumes may lead to sludge buildup and further complications. By sampling the chamber flushing volume of ports of various shapes from different manufacturers, we were able to assess cumulative volume flushing rates using a mixture approximating the viscosity of blood. The data collected highlight the relationship between chamber shape, flushing volume, and flow rate and why it is important that manufacturers recommend adequate flushing volumes specific to each port.