Volume 26: Issue 1

Highlights

Reduction in exchanges.
Resulted in financial savings.
Decreased delays in treatment.

Abstract

Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure.

Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures.

Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure.

Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies.

Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution.

Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations.

Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.

Highlights

Catheter-related infection remains a major cause of morbidity among hemodialysis patients.
In addition to the use of prophylactic lock solutions, additional maneuvers, often overlooked, can help prevent this infection: positioning the cuff of the catheter close to the exit site, properly aligning the lumens, and placing a protective gauze under the catheter at exit site.

Highlights

A randomized, controlled trial with 65 participants compared the efficacy of a newly designed universal guidewire advancer (WINguide) with novel wire-in-needle (WIN) technique (WT) and a newly designed needle guide (Hybrid Guide) for use with the newly described hybrid technique (HT) versus freehand modified Seldinger technique (MST) with the HT for effectively and safely achieving vein cannulation with a peripherally inserted central line catheter (PICC) guidewire on a simulation model.
The HT for PICC line placement uses ultrasound to view a short axis puncture, rotating to long axis (LA) for guidewire placement. This provides real-time visualization of the needle tip during the entire procedure.
Of the total participants, 63.1% believe the procedure is faster with WINguide with WT and Hybrid Guide with HT (WT/HT). Inexperienced participants (82.9%) felt PICC guidewire placement is safer using WT/HT. Inexperienced participants (82.9%) prefer WT/HT over freehand MST, and 90.8% of all participants would use WT/HT again.
There were significantly fewer disappearances of LA view with devices (P = .002) and significantly fewer unique cases with disappearances of LA view (P = .002).
Using survey results, there seems to be a preference to use the WT/HT compared to MST for guidewire placement. In all metrics evaluated, the two techniques had either statistically similar results or the WT/HT had statistically significantly better results than did MST.

Abstract

Purpose/Design: This study was conducted to determine the efficacy of WINguide with the wire-in-needle (WIN) technique and the Hybrid Guide with hybrid technique (WT/HT) in effectively and safely achieving vein cannulation with a peripherally inserted central line catheter (PICC) guidewire on a simulation model.

Methods: Two videos were watched. The first illustrates freehand modified Seldinger technique (MST) for PICC guidewire placement with ultrasound using a short axis (SA) puncture, rotating to long axis (LA) for placement into a Blue Phantom© manikin. The second uses the same SA and LA method using WT/HT. Randomized selection was performed to eliminate control bias; participants were recorded for data collection. Participants completed a survey on past proficiency and experience with the study devices.

Results: Sixty-three of the 65 total participants’ hands were video recorded with the ultrasound screen during procedures and were included in data analysis. There were significantly fewer disappearances (the image of the vein on the ultrasound screen disappears) of LA view with devices (P = .002) and significantly fewer unique cases with disappearances of the LA view (P = .002). Survey results of all 65 participants are included in descriptive statistics. Of the total participants, 63.1% believe the procedure is faster with WT/HT. Of the inexperienced participants, 82.9% felt PICC guidewire placement is safer using WT/HT; 82.9% of inexperienced participants prefer WT/HT over freehand MST; and 90.8% of all participants would use WT/HT again.

Limitations: Future research should be done with larger sample size.

Conclusions: Using survey results, there seems to be a preference for using the WT/HT compared to MST for guidewire placement. In all metrics evaluated, the two techniques had either statistically similar results or the WT/HT had statistically significantly better results than MST.

The Editorial Review Board of the Journal of the Association for Vascular Access (JAVA) acknowledges all of our 2020 reviewers. Thank you for your time and expertise. Your thoughtful evaluations ensure only quality articles are published in the journal. JAVA reviewers with reviews completed in 2020 (* indicates person reviewed five or more articles):

Leigh Ann Bowe-Geddes*

Chris Cavanaugh*

Naceur Chouayet*

Lois Davis*

Mary Beth Hovda Davis*

Michelle DeVries*

Salomao Faintuch

Anne Marie J. Frey

Hudson Garrett

Gregory Gilbert

Michelle Lea Hawes

Mark Hunter

James C. Lacy

Jack LeDonne

Donna Matocha

Britt M. Meyer*

A Randomized Control Trial to Determine the Effect of Handball Exercise on Arteriovenous Fistula Maturation

Vipul Gupta,

Himansu Sekhar Mahapatra,

B. Muthukumar,

Lalit Pursnani,

Chandra Krishnan,

Anamika,

Sutanay Bhattacharya,

Preeti Chaudhary, and

Rajesh Tarachandani

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Leadership in the Time of COVID-19

CE Article: Use of an Evidence-Based Protocol for Repositioning Peripherally Inserted Central Catheters (PICCs) in Children and Adults ^CE

Highlights

Abstract

Minimum Education and Training for Pediatric and Neonatal IV Insertion for all Clinicians

Introduction/Summary

Comments on the Use of Lock Solution to Prevent Hemodialysis Catheter-Related Infection and Dysfunction

Highlights

Reply to: Comments on the Use of Lock Solution to Prevent Hemodialysis Catheter-Related Infection and Dysfunction

A WIN for Safety and Efficacy: Evaluation of Developmental WINguide and Hybrid Guide for Wire-in-Needle Peripherally Inserted Central Line Catheter (PICC) Cannulation

Highlights

Abstract

Comparison of Patency in 5- and 6-mm Hemodialysis Grafts

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Abstract

Peripherally Inserted Central Catheter (PICC) Insertion Success and Optimal Placement with New Technology: A Pre-Post Cohort Study

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Abstract

Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience

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Abstract

Recurrent Hemorrhage from Intermittent Pneumatic Compression Device Use After the Removal of a Femoral Venous Catheter—A Case Review

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Abstract

Thank You, 2020 JAVA Reviewers

A Randomized Control Trial to Determine the Effect of Handball Exercise on Arteriovenous Fistula Maturation

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

Venous Valves: What’s the Hang-Up? A Deeper Dive

A Quality Improvement PDSA to Evaluate the Effectiveness of Blood Diversion Using a Three-Way Connector During Blood Culture Collection

Midlines: Useful, Not Universal

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