Hello, everyone! Welcome to what I believe will be a pivotal year for the Association for Vascular Access (AVA). As 2019 AVA President, I am going to take my first opportunity in the Journal of the Association for Vascular Access (JAVA) to speak from my heart.

Our organization exists to protect the patient, educate the clinician, and save the line. Given the magnitude of vascular access devices placed annually and complications that result, our mission is just beginning.

Now you may be wondering about the title of this column. You need to know some things about

Abstract

Background: Peripherally inserted central catheters (PICCs) are increasing in popularity with over 4.3 million insertions globally each year. However, there remains little quality evidence as to the safest catheter to insert with the lowest levels of postinsertion complications.

Methods: Retrospective chart audit comprising adult patients having either a silicone or polyurethane PICC inserted by specialist nurses in the Medical Imaging Department over a predetermined time frame. Data extracted from the charts included demographic data, patient status, reason for insertion, and reason for removal of a PICC.

Results: A total of 295 PICC insertions were included in the study. Of these, 141 were silicone PICCs and 154 were polyurethane PICCs. The sample comprised various patient groups including 142 inpatients, 80 outpatients, and 73 transitional. As to reasons for requiring a PICC, 102 patients were oncology patients, 164 patients required intravenous antibiotics, and 29 patients required other types of medications. Reasons for removal of catheter varied from no complication/completion of therapy (67.8%) to infection (11.2%), migration (5.8%), deceased (4.7%), occlusion (3.7%), thrombus (2.7%), breakage (2.7%), phlebitis (0.3%), and upgrade to triple lumen catheter (0.3%).

Conclusions: PICCs remain safe and reliable; the greatest predictors of postinsertion complications were number of lumens and oncology patient groups. The emerging trend of health services to transition inpatients to outpatients in the community with catheters in situ was shown to be a safe practice.

Abstract

Background: Venous thrombosis is a possible complication of vein port insertion. A randomized cohort of 211 oncology patients receiving either a power injectable or nonpower injectable implanted arm port were prospectively assessed for complication-related removal. Because the outcome of venous thrombus occurred more frequently in power injectable port recipients, this analysis further investigates thrombus characteristics by port type among patients who underwent Doppler ultrasound within 3 months of port implantation.

Methods: Patients were randomized to receive 1 of 2 totally implanted venous access devices (TIVADs), either a nonpower injectable Cook TIVAD with a 5F catheter or a power injectable AngioDynamics TIVAD with a 6.6F catheter. Patients were scheduled to have an ipsilateral arm, subclavian region, and base of neck venous Doppler ultrasound 3 months after port implantation, or sooner, if clinically indicated.

Results: By 3 months postimplantation, 140 patients had undergone ultrasound. Two ultrasounds were performed earlier than at 3 months to investigate clinically suspected venous thrombosis. Twenty-one of these 140 patients (15.0%) developed venous thrombosis, 2 symptomatic and 19 asymptomatic. Among those receiving an ultrasound, 15 cases of venous thrombosis were identified among those with the larger, power injectable, polyurethane catheter (n = 76, 19.7%) and 6 among those with the smaller, nonpower injectable, silicone catheter (n = 67, 9.0%, P = 0.08). The former also had a higher frequency of access vein occlusive thrombus.

Conclusions: Thrombosis is concerning among patients with arm TIVADs, is often unrecognized, and warrants further investigation. Access may be compromised for those with more thrombogenic ports.

Abstract

Objectives: Phlebitis caused by peripherally infused potassium chloride (KCl) is well documented in the literature. This study focuses on documenting the rate, grade, and timing of this complication, and explores the cause and effect of added lidocaine on pain and phlebitis rate.

Methods: A retrospective chart review was conducted for patients receiving KCl peripheral infusion with or without added lidocaine. Descriptive statistical analysis was performed. The prevalence of infusion phlebitis was evaluated using the appropriate χ² test, t-test/Mann-Whitney U test. A multivariate Cox proportional hazards regression model was used to assess the independent effect of age and sex on the rate of catheter-related complications. Statistical significance was considered at P < 0.05.

Results: There were 85 infusions of 10 and 20 mEq KCl, of which 67% (N = 57) had added lidocaine. Overall, phlebitis rate was 19%. There was less phlebitis with lidocaine-added infusions (13% vs 19%; P = 0.65), and infusions lasted more than those without added lidocaine. Animal and human data support the occurrence of a KCl-mediated vasoconstriction causing pain. Our data anecdotally support such observations. Besides the low pH and high osmolarity of KCl infusions, vasoconstriction seems to add insult to the patient veins. The role of lidocaine in alleviating pain and in delaying phlebitis may go beyond being a local anesthetic once its vasodilatory and anti-inflammatory effects are considered.

Conclusions: The cause of pain and phlebitis of KCl infusions may be more related to vasoconstriction than just low pH and high osmolarity. The addition of lidocaine to KCl infusions appears to be safe, and potentially delays or alleviates KCl infusion pain through its speculative vasodilatory and anti-inflammatory effects.

Automated Ultrasonographic Detection of Thrombus and Subcutaneous Edema due to Peripheral Intravenous Catheter

Toshiaki Takahashi,

Gojiro Nakagami,

Ryoko Murayama,

Mari Abe,

Masaru Matsumoto, and

Hiromi Sanada

New Partner, New Opportunities

Bacon and Eggs

Peripherally Inserted Central Catheter Postinsertion Complications: A Retrospective Study

Abstract

CE Article: Venous Doppler Ultrasound Findings 3 Months after Arm Port Implantation: Thrombosis by Port Type within a Randomized, Controlled Trial

Abstract

The Etiology of Potassium Chloride–Induced Phlebitis: How Safe and Effective Is Admixed Lidocaine?

Abstract

Comparing Incidence of Thrombosis in PICC and Midlines and Evaluating the Role of Anticoagulation, Site of Insertion, and Risk Factors

Abstract

Subclavian Vein Catheter Extravasation—Insufficient Catheter Length as a Probable Causal Factor

Abstract

What Happens When Adequate Vascular Access Cannot Be Provided for Major Surgery (Liver Transplantation)?

Abstract

Automated Ultrasonographic Detection of Thrombus and Subcutaneous Edema due to Peripheral Intravenous Catheter

Vessel Depth vs. Catheter Length: How Deep Should My Catheter Go? A Deeper Dive

A Case for an Around-the-Clock Vascular Access Team in a Rural Community Hospital

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Before You Say Yes: The Responsibilities of Volunteering in Healthcare: Editor’s Message