Abstract
We report the opinions of a panel of infection prevention experts convened during the 2012 World Congress on Vascular Access. The panel reviewed topics related to the use of peripheral venous catheters (PVCs), with a specific focus on infection prevention. The international panel members agreed that lack of clinical evidence and scientific research regarding PVC management is a major cause of significant variances in practice. The panel members outlined a number of strategies that promote infection prevention during PVC use. However, overall agreement on all issues was not reached. Reasons for nonresolution were differences in the organization of health care systems among countries, differences in availability of materials among countries, and difference in national or supranational regulations.
Abstract
A man aged 30 years with a brachiocephalic arteriovenous fistula in the left upper arm developed clinical complaints of a cold left hand due to a flow of 3,500 mL/min. A successful banding procedure was performed. Nineteen months later, a stenosis at the banding site resulted in reduced flow and insufficient dialysis. Several percutaneous transluminal angioplasty procedures with different diameters were performed. A satisfactory result was achieved using a 6-mm high-pressure balloon.
Abstract
Purpose: Vein port systems are often used for infusion therapy. Safe access of these devices is necessary to ensure optimal device performance and the minimization of possible complications. We assessed the utility of YouTube for learning vein port access technique.
Materials and methods: The YouTube video database was searched for video files demonstrating vein port access technique. A scoring tool was developed to acquire objective data about the adherence of the operator to accepted access technique.
Results: Fifty-one YouTube videos were assessed for their value for learning vein port access technique. Using a scoring tool with a maximum score of 36, the scores for the 51 videos ranged from 7 to 32 (mean score =18.7). The best scores were for videos recorded as instructional videos by nurses and patients, with scores ranging from 17 to 32 (mean score =24.0).
Conclusions: There was considerable variability in the utility and value of the videos reviewed. Some videos were very informative and instructional, some were very uninformative, and some conveyed incorrect information that could lead to device failure and undue complications related to inappropriate port access technique. Health care providers, patients, and other caregivers should be very skeptical of the value of YouTube videos demonstrating medical techniques and should only accept the information provided if it is from a reputable source, which can often be very difficult to ascertain.
Abstract
Background: Although arteriovenous fistulae are the gold standard for vascular access, many patients do not have veins that are suitable for arteriovenous fistulae. These patients require arteriovenous grafts (AVGs). There have been no long-term trials designed to analyze the complication and patency rates of heparin-bonded versus conventional upper extremity AVGs. We aimed to compare patency and complication rates of upper extremity conventional versus heparin-bonded AVGs.
Methods: A retrospective chart review from 2008 through 2012 was conducted. Institutional review board approval was obtained. Patients with an upper extremity conventional or heparin-bonded AVG were included. Exclusion criteria included use of therapeutic anticoagulation and forearm loop grafts. Complication rates, reinterventions, and primary and secondary patency rates were compared using logistic regression analysis.
Results: The cohort consisted of 93 patients. Conventional and heparin-bonded grafts were compared and there was no statistically significant difference between the median time to use (29 vs 32 days; P =.440) or primary patency (P =.673). The duration of time elapsed until intervention was a median of 69 days (mean ±standard error =94.7 ± 10.4 days). Demographic characteristics of patients did not differ between the graft types (61% women; P =0.342). No statistically significant differences were seen between comorbidities in the 2 groups and body mass index did not differ (P =.986).
Conclusions: There is no improved primary patency, secondary patency, or difference in complication rates between patients who received conventional versus heparin-bonded AVGs.
Abstract
Background: In response to Medicare reimbursement changes related to central line-associated blood stream infection (CLABSI) effective January 2011, a long-term acute care hospital implemented quality improvement measures to reduce these health care-associated infections. Improvements included alcohol-impregnated port protectors, chlorhexidine gluconate barrier dressings, and didactic/hands on training for care and maintenance. During 2010 the peripherally inserted central line (PICC) team at a neighboring Magnet hospital was asked to partner and develop strategies to further decrease CLABSI.
Methods: The PICC team evaluated the effects of an antimicrobial PICC device in an effort to further reduce the incidence of CLABSI. Upon initiation of the evaluation phase, a database was created to track infection/thrombus rate, insertion-related complications, dwell time, diagnosis, tip location, infusate, vein used, and catheter size. Data collection and reporting was managed by the PICC team.
Results: Across a 2-year period (July 2011–July 2013), 100 devices were inserted with a total of 1,705 line days without any reported CLABSI. The majority of patients received a 4.5F single lumen device (59%). Dwell time ranged from 1 to 57 days with an average of 17 days. To date, no CLABSIs related to this device have been reported at the long-term acute care hospital.
Conclusions: Based on 100 insertions yielding no infections this new product appears to improve patient safety and quality of care. Relative to these results sole use of this product has become their institutional standard for long-term intravenous needs.
Novel Catheter Positioning System for Intravenous Central Lines: A Report of 1 Hospital's Experience
Abstract
Background: Malpositioned peripherally inserted central catheters (PICCs) can create serious complications. Confirmatory chest radiographs, the standard method for certifying proper central-catheter tip position, are sometimes imprecise and unreliable. James A. Haley Veterans' Hospital tested an advanced electronic positioning system for central lines that could hypothetically reduce malpositions. Little data has previously been published about this technology.
Methods: Before the positioning system could be approved for use at the hospital, efficacy data had to pass reviews by multiple individuals/entities. The hospital's PICC team initially conducted a 2-week trial of the vascular positioning system, using it on 28 patients. Permission was granted to continue using the new system and to request acquisition of the technology. Use of confirmatory radiographic images continued during this further evaluation.
Results: The overall malposition rate during the first 12 months of system use was reduced by about half—a statistically significant finding. The system could be used optimally with 594 of 834 placements (71.2%) at an accuracy rate of 98.5%. The system could be used suboptimally (eg, with patients who have pacemakers) for 240 of the 834 placements, at an accuracy rate of 84.6%. The overall malposition rate was 5.5%—about half the 10.8% rate seen during the 12-month period before system use.
Conclusions: The statistically significant results, from the largest data set reported at 1 site using the system, were judged sufficient to switch to using the system instead of confirmatory radiographic images when the system indicated correct PICC placement in the heart's cavoatrial junction. The malposition rate with the system continues to improve as the PICC team gains experience in using the system. Additional study is needed on this and other positioning systems.
Abstract
Background: Federal agencies such as the Centers for Disease Control and Prevention have mandated reduction of hospital-acquired infections and recommended the use of antimicrobial catheters in clinical settings where central line-associated bloodstream infection (CLABSI) rates have remained high. The Infusion Nurses Society also recommends antimicrobial catheters for specific patient populations. At a California hospital, evidence-based infection prevention strategies for CLABSI prevention had been in effect for several years, but the CLABSI rate remained at an unacceptable level. For this reason, the effect of an antimicrobial peripherally inserted central catheter (PICC) on the incidence of CLABSI was studied.
Methods: A quasiexperimental design was used with concurrent data collection on patients in an intervention group who received an antimicrobial PICC. Retrospective data were collected for patients in a nonintervention group who received nonantimicrobial PICCs the previous year.
Results: The 257 patients in the nonintervention group experienced 8 CLABSIs with an infection rate of 4.18/1,000 line days. The 260 subjects in the intervention group experienced 1 CLABSI with an infection rate of 0.47/1,000 line days. The decrease in the number of infections per 1,000 line days for the intervention group was statistically significant.
Conclusions: The use of an antimicrobial PICC in conjunction with current infection prevention practices resulted in a statistically significant decrease in infection rate, which supports the recommendation for continued use of antimicrobial catheters. Treatment cost savings, which overcame the higher initial cost for the devices, were found to be an additional benefit of using antimicrobial catheters.
Abstract
The use of peripherally inserted central catheters (PICCs) in hospitalized patients is already well established by studies and guidelines, and PICCs are widely used at our institution. However, few studies have been published examining patients using the device in day hospital systems; specifically, if the device brings about early dehospitalization, if it facilitates quick return to coexistence in society and to work, and how to plan medication administration through this system. Our general objective was to evaluate the advantages and disadvantages of the use of PICCs in patients undergoing prolonged intravenous treatment. We selected patients using PICCs in the day hospital at the Institute of Orthopedics and Traumatology at Clinics Hospital of the School of Medicine of the University of São Paulo, conducted a semistructured interview, and did an analysis of medical records. The most frequent diagnoses that led to use of a PICC were postoperative infection (53.84%) and osteomyelitis (23.07%). Teicoplanin was the most common drug prescribed, followed by vancomycin. Regarding the puncture site, the basilic vein prevailed with 69.23%. Most of the catheters (61.54%) remained in place from 60 to 150 days. The end of the drug therapy was the reason for removal in 66.4% of cases. Regarding pain assessment, 88.47% of patients declared they did not feel any pain or felt moderate pain during the PICC insertion procedure. Based on the data collected, it can be concluded that PICCs are reliable devices for a wide variety of intravenous infusions used in patients treated at our day hospital.