Last month I decided I was paying too much for life insurance, so I switched carriers to a more competitive policy (please, don't turn the page yet—this story will get relevant and better).

Making that change required a mountain of paperwork, signing my name on it close to 100 times and then, finally, a Saturday morning visit from an agent representing the new insurance company. They wanted to check me out and determine if my inevitable mortality was a sooner-or-later thing.

That makes sense, however grim. Dead clients not only stop paying their premiums—they get paid! Insurance companies are basically

Abstract

Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per year resulting in failed access, interrupted treatment, and greater resource consumption with catheter replacement. The purpose of this study was to quantitatively evaluate the perceptions of frequency, impact, contributing factors, and safety issues from accidental dislodgement affecting intravenous (IV) devices as reported by healthcare clinicians.

Methodology: A cross-sectional descriptive survey was conducted via a voluntary online web-based survey of clinicians. Subjects were divided as those actively working in a clinical healthcare setting and those no longer active. Analysis of data was performed quantifying responses of clinicians on question of dislodgement.

Results: Survey results indicate clinicians routinely observe a significant percentage of accidental dislodgement, with 68% of the 1561 respondents reporting often, daily, or multiple times daily occurrence and 96.5% identifying peripheral intravenous catheters as most common device experiencing accidental dislodgement. Respondents prioritized 10 contributing factors, with confused patient (80%), patient physically removes catheter (74%), and IV catheter tape or securement loose (65%) as the top 3 causes. Over 95% of respondents consider IV dislodgement a safety risk to patients.

Conclusions: This study reports perceptions and impact of accidental dislodgement with IV devices. Inconsistencies exist with use, application, and management of catheter securement and dressings for IV catheters. Risk of additional complications and complete device failure are increased when dislodgement occurs. Given possible complications, along with necessitating replacement of the IV device in many cases, IV catheter dislodgement was considered a safety risk to patients by nearly all respondents.

Abstract

Acute care hemodialysis catheters have traditionally been validated for use through chest X-ray interpretation. This study was implemented to evaluate if hemodialysis catheters can be placed safely and accurately, utilizing an electrocardiogram plus doppler or dual vector positioning system to validate for use. Over a 24-month period hemodialysis catheters were inserted and validated by utilizing a dual vector positioning system instead of chest X-ray. During the study period, 260 hemodialysis catheters were inserted without chest X-ray and validated for use via the dual vector positioning system. An additional 74 inserted catheters required follow-up chest X-rays because of failure to obtain technological validation. During the study period, no patients had a pneumothorax or hemothorax complication subsequent to catheter placement. The use of a dual vector positioning system in this study demonstrated optimal hemodialysis catheter insertion can be done with no X-ray and no increase in mechanical complications.

Abstract

Objective: To investigate the incidence of peripherally inserted central catheter–related deep venous thrombosis (PRDVT) and their associated risk factors of PRDVT in the oncological patients who received peripherally inserted central catheters.

Methods: This is a prospective and interventional cohort study; enrolled cancer patients had ultrasound-guided peripherally inserted central catheters and followed up by an intensive ultrasound monitoring protocol for 24 weeks. Vascular color Doppler ultrasound was applicated to the prospective evaluation of thrombus every 2 weeks for each patient.

Results: Of all 406 patients (37,490 catheter days), 30.05% of patients (122/406) developed peripherally inserted central catheter–related deep vein thrombosis, with an incidence of 3.25 per 1000 catheter days. Only 1.23% (5/406) peripherally inserted central catheters were removed because of central line associated blood stream infection or accident. The incidence of asymptomatic PRDVT and symptomatic PRDVT were 26.85% (109/406) and 3.2% (13/406) respectively.

Conclusion: The incidence of PRDVT in our hospital was considerable to the published data. Catheter in right upper extremity, tip at subclavian or T 2-4, more than 1 attempt for peripherally inserted central catheter insertion, and radiotherapy were independent predictors of PRDVT in cancer patients. Proactive ultrasound monitoring protocol from insertion to follow-up visits to investigate the incidence of PRDVT in oncological patients should be a routine examination.

Background

In today's healthcare environment patients require more complex care and therapies. Patients are exhibiting a growing prevalence of chronic conditions and multiple comorbidities, adding to the complexity of routine treatments. Health conditions such as diabetes, high cholesterol, chronic kidney disease, and obesity all impact patients' vessel health and complicate intravenous access. Fundamental medical care relies on intravenous access in the hospital setting and is the route for medication administration, diagnostic treatments, and other therapies. Establishing intravenous access may not be as easy as it seems, as peripheral intravenous failure rates can vary from 18%–86%.1 Patients who fail

Insertion and Maintenance of PICC for a Pediatric Patient with Epidermolysis Bullosa

Shu-Yin WangBSN, RN, RNC-NIC,

William DuongBSN, RN, RNC-NIC,

Paula HessMLIS, AHIP,

Hyojin JenniferMin, PhD, RN, CPNP-PC, and

Rebecca BarberPhD, RN, CPN, CDCES

Editor's Message

Leave No Vein Behind

Impact and Safety Associated with Accidental Dislodgement of Vascular Access Devices: A Survey of Professions, Settings, and Devices

Abstract

Hemodialysis Catheter Insertion Without Chest X-Ray: Review of a 24-Month Study

Abstract

The Ultrasound Monitoring to the Venous Thromboembolism Associated with Peripherally Inserted Central Catheters in Chemotherapy Patients: A Prospective Cohort Study

Abstract

Primary Patency Rate of Arteriovenous Fistula Created for Hemodialysis Patients: The Indonesian Experience

Abstract

Complex Vascular Access: Mid-Thigh Femoral Peripherally Inserted Central Catheter Placement

Background

Insertion and Maintenance of PICC for a Pediatric Patient with Epidermolysis Bullosa

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Director's Message

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Director's Message