Volume 27: Issue 3

AVA’s scientific meeting attracts an array of clinical and non-clinical attendees and provides an opportunity for all who attend to network, share, and gain clinical knowledge and exchange practice experiences. For the first time in three years, AVA was able to host an in-person meeting which is allowing many of us to reacquaint with peers and colleagues, and network and engage with new clinicians. The hands-on workshops, educational posters, scholarly lectures, and informative symposia will offer ample learning opportunities in many different areas of vascular access. Once the 2022 AVA Scientific meeting has concluded; where do we go from here

Highlights

Peripheral intravenous cannulation is performed frequently, but not always successfully.
Ultrasound is generally accepted for safe and accurate intravenous cannulation.
Improve hand-eye coordination with a visible ultrasound image and a stabilized probe on target vein.
Head-mounted displays and ultrasound probe fixation have positive impacts on cannulation success.

Abstract

Background:

Ultrasound is an efficient and effective technique to aid intravenous cannulation, in which good hand-eye coordination is crucial. To reduce the difficulty, the ultrasound image should be projected and visible in front of the practitioner during cannulation, and the probe should be stabilized on the target vein. The current study investigates the impact of a head-mounted display and probe fixation for ultrasound-guided peripheral intravenous cannulation success and time needed to successful insertion.

Materials and Methods:

This nonclinical pilot study included 49 nurse anesthetists. They were divided into an intervention group (cannulation with a head-mounted display and probe stabilizer for ultrasound-guided peripheral intravenous cannulation, n = 24) and control group (conventional method of ultrasound-guided cannulation, n = 25). Participants performed 20 procedures each on phantoms, with focus on first attempt cannulation success and time taken to completion of successful cannulation.

Results:

In the intervention group, 98% succeeded on their very first attempt at cannulation, compared to 52% in the control group (P < 0.001). Time to successful cannulation on the first attempt was 1.13 ± 0.4 minutes in the intervention group, compared with 1.69 ± 0.8 minutes in the control group (P = 0.003). Overall, first attempt cannulation success was 92% in the intervention group and 90% for the control group (P = 0.359). Times required for successful cannulation was reduced by 0.08 minutes in the intervention group (P < 0.001).

Conclusions:

This pilot study is the first describing the use of a head-mounted display and probe fixation for ultrasound-guided peripheral intravenous cannulation, which resulted in an increased success rate and decreased time to cannulation success.

Highlights

Nurse-led research is investigating infection in repaired central venous catheters.
Eight out of 9 retrospective studies found no increased risk of infection with a repair.
Broken catheters outside the hospital setting may be at risk for bacteremia.
There are low frequencies of CLABSI or bacteremia and exposure to line repair.

Abstract

Background:

Silicone central venous catheters (CVCs) that weaken or rupture are reparable using a commercial repair kit. A literature review exploring bloodstream infections in repaired CVCs identified many findings indicating low or no increased risk of infection. This study aimed to understand pediatric patients’ risk of bloodstream infection with repaired Hickman or Broviac catheters.

Methods:

A matched retrospective case-control study examined central line–associated bloodstream infection (CLABSI) or bacteremia in two separately matched cohorts of patients with silicone-type catheters. Controls were patients with CVCs selected from 2016 to 2019 and were matched to cases based on age group (older or younger than 3 years). Conditional logistic regression models calculated odds ratios (OR), with 95% confidence intervals (CI) representing the odds of a line repair occurring 30 days before an event among cases versus controls.

Results:

In 61 CLABSI cases and 104 controls, the OR of exposure to a line repair was 0.43; 95% CI, 0.05–3.87, P = 0.45. In comparing 49 bacteremia cases to 109 controls, the OR of exposure to a line repair was 6.69; 95% CI, 0.69–8, P = 0.10.

Conclusions:

The frequency of CVC repair was relatively low. Associations between repair and infection were not detected in either cohort; however, odds of line repair exposure appeared to be higher in bacteremia cases (a trend not observed in the CLABSI cohort). More extensive studies examining the demographic and clinical characteristics of the CVC repair population will be critical for improving outcomes.

Highlights

Port insertion is a well-tolerated alternative to chest ports for long-term venous access.
Insertion into the brachial vein had the lowest incidence of complications.
Venous thrombosis was increased using the MedComp, Dignity Mini port.

Abstract

Background:

Totally implanted venous access devices, or ports, are safe and durable, allowing for long-term venous access. Port insertion in the upper extremity is associated with high rates of technical success and few complications. This retrospective review evaluates complication rates of power injectable ports in the upper arm preformed at a tertiary academic institution.

Methods:

A single center retrospective review of all patients undergoing arm port implantation between October 1, 2017, and January 30, 2019, were included. A minimum of 11 months of data was reviewed for each subject. A total of 165 subjects were initially enrolled.

Results:

The most frequent indication for port insertion was malignancy (n = 157). Port insertion technical success rate was 99.4%. There was no significant difference in port-related complications by gender, malignancy, clinical indication for placement, or arm used for implantation. Rates of infection (5.5%), mechanical malfunction (6.7%), device removal (10%) and arterial injury (0%) were similar to previously reported values. The rate of port-related venous thrombosis was 8.6%, exceeding previously reported values.

Conclusion:

Venous thrombosis was increased using this arm port. The polyurethane catheter material may play a role in this. Further work is warranted to investigate venous thrombosis for this device that incorporates information about insertion vein size and insertion vein characteristics.