Highlights

PICCs are vital for newborns in NICUs, offering vascular access and life support.
Newborn PICC measurement may be inaccurate; alternative landmarks can enhance accuracy.
This study compared PICC traction using conventional and alternative measurement methods.
Conventional PICC measurement is correlated with the need for traction (P = 0.012).
Alternative measurement studies are needed to confirm and update neonatal care practices.

Abstract

Purpose:

To compare the conventional measurement with an alternative measurement for inserting peripherally inserted central catheters (PICCs) in neonates.

Basic Procedures:

Observational study, comparative cohort, with 24 neonates. Data analysis was performed using descriptive and inferential statistical calculations. The study was approved by the Research Ethics Committee.

Main Findings:

It was found that, in 91.7% of cases, the conventional measurement was greater than the alternative. Dislodgement occurred in 75.0% of the inserted catheters, with the length of dislodgement being between 1 cm (33.3%) and 2 cm (25.0%). Dislodgement was not associated with the weight and age of the neonate. Most catheters were silicone (54.2%), inserted in the right upper limb (62.5%), and with the catheter tip in the third intercostal space (58.3%).

Conclusions:

The alternative measurement suggests a decrease in the number of catheter dislodgements for repositioning its tip, mitigating complications arising from the use of the device. Therefore, it is recommended that the proposed alternative measure for PICC insertion in newborns be further investigated in new studies to establish robust scientific evidence aimed at modifying current practice and improving the quality of care for neonatal patients.

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Ever searched for a topic and found yourself scrolling through a sea of different review papers? Have you wondered: What’s the difference? How, for example, is a systematic review different from a narrative review? What is a scoping review? What about an umbrella review? It can be overwhelming to navigate through these types of reviews and, as librarians, we understand not only

Abstract

Introduction:

Over the past 30 years, the use of implanted vascular access devices (IVAD) for long-term administration of vesicants, parenteral nutrition, blood products, and antimicrobials has grown exponentially. IVADs are a vital part of patient care, improve quality of life, and help with body image. Despite the positive aspects of IVAD, complications can still occur, one of which is device occlusion as a result of blood reflux.

Methods:

This observational experiment was conducted in the United Kingdom and the United States. The investigators in each country tested six Huber needles and measured the fluid reflux in the IVAD catheter upon removal of each Huber. This simple experiment was done using an in vitro port with a six French catheter secured to a ruler to measure fluid reflux into the port catheter upon removal of the six available Huber needles. Six commercially available Huber needles were each tested unclamped and clamped three times upon removal; the average was then calculated.

Results:

The findings demonstrated fluid reflux volumes with the six Hubers ranging from 0.0 to 0.6 cm unclamped and 0.0 to 0.7 cm of fluid reflux with the Hubers clamped. Only one Huber had no fluid reflux during needle withdrawal from the IVAD without clamping the tubing and with the tubing clamped. Five of the Hubers had fluid reflux during removal when unclamped and clamped.

Conclusions:

This experiment confirmed and revealed the differences in fluid reflux when removing a Huber needle from a port unclamped and clamped. Highlighted was the need for further research on fluid reflux and the potential impact it has on port occlusions. This experiment demonstrated that positive pressure needle withdrawal reduced reflux, compared to positive pressure flushing. Understanding the reflux associated with each Huber needle when de-accessing a port can potentially reduce port occlusions subsequently, improving patient outcomes.

Highlights

Any component of a PIVC interacting with the skin during insertion can be contaminated.
The bacterial population on the needle is significantly reduced within the first 72 hours.
If skin bacteria were to contaminate the needle during insertion, they do not survive.

Abstract

Background:

Over-the-needle (OTN) peripheral intravenous catheters (PIVCs) are crucial in modern medicine. However, the OTN design allows for direct catheter-to-skin contact during insertion, leaving the sterile catheter at risk for bacterial contamination from the skin. A novel through-the-needle (TTN) PIVC design aims to minimize this risk by shielding the sterile catheter during insertion with the introducer needle. This needle then permanently retracts into the device housing and remains with the patient. In this study, we evaluate the survivability of bacterial contaminants on the retracted needle to address concerns about potential infection risks associated with this design.

Methods:

Fifteen TTN PIVC devices were inoculated with Staphylococcus aureus (10¹ to 10² CFU) on the outer surface of the needle. After needle retraction, devices were stored for 0, 24, 72, and 120 hours. At each time point, devices were processed, and bacterial survival was quantified using standard microbiological techniques.

Results:

The initial bacterial load (105.1 ± 51.4 CFU per device) decreased significantly over time. By 72 hours, bacterial count had reduced to 1.4 ± 2.4 CFU per device, representing a 98.7% reduction (P < 0.05). No significant change was observed between 72 and 120 hours. The most substantial decline occurred within the first 72 hours, with the difference between 0 hours and both 72 and 120 hours being statistically significant (P = 0.016 for both).

Conclusions:

The significant reduction in bacterial population on the retracted needle over time suggests a low risk of bacterial propagation within the TTN PIVC device. These findings indicate that the TTN design effectively addresses catheter contamination concerns during insertion without introducing additional infection risks due to needle retention.

Substance Use Risk Assessment: Assessing the Risk of Vascular Access Device Tampering in Patients With a History of Drug Use

Toni EastridgeMHA, BSN, RN, MEDSURG-BC,

Brandy NordBSN, RN,

Ann SteffeMSN, RN, PCCN, and

Kathleen Willegal-RussDNP, MSNEd, RN, NPD-BC, a-IPC