Abstract

Health care professionals have a duty to advocate for the children in their care. Children are in delicate stages of their development and cannot be expected to act like little adults. A child may find it difficult to endure a painful procedure. Sedation should be contemplated for any procedure that would impose pain or anxiety on a child. The non-anesthesiologist can safely and effectively administer sedation to a child for diagnostic and therapeutic procedures when institutional policy and procedures are followed.

Abstract

Purpose: To validate the formula-based central venous catheter (CVC) length measurement “tailored” to individual's height and access site for predicting optimum SVC tip position.

Method: A prospective study of 3 percutaneous insertion sites (PICC, SCC and JC). Formula-based “LUM'S CVC MEASUREMENT GUIDE” was used to determine the catheter length.

Results: Overall, 97% (373) of the total 382 insertions were successfully placed with CVC tip in the distal SVC (SVC between carina and atrio-cava junction) location.

Conclusion: The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition.

Abstract

PICC line insertion has been traditionally performed by non-dedicated per diem nurses who place PICC lines in their spare time, Interventional Radiology or IV Teams. A new option has developed to place PICC lines at the bedside. This option is to utilize an outside contractual agency that guarantees an insertion success of 90%–100% of PICC line placements at the bedside. Per diem nursing PICC teams often have insertion success rates of 50%–70% with 30%–50% of patients going to radiology for line placement. These per diem teams also have hidden costs associated with repeated re-training. Is it cost-effective to continuously retrain PICC line nurses who maintain an insertion success rate of 50%–70% or is an independent PICC contractor an economic substitute? Insertion proficiency is directly related to the concept practice makes perfect and the usage of modified seldinger technique and portable ultrasound. Can one train a per diem team to master the skill of utilizing high-tech tools in their spare time? Infusion Nurse Consultants began training per diem nursing PICC staff in 1998. Out of 100 nurses trained only 10 completed minimum Infusion Nursing Society Competency Guidelines. That is one out of every 10 nurses trained. As a result the organization embarked on offering independent PICC line insertions to contracted hospitals. In 2004, the service placed 900 PICC lines a month at a 98% insertion success rate at bedside. The author has discovered that the days of observing three PICC line insertions and placing three successful PICC lines does not lead to a 98% insertion success. A nurse who places PICC lines almost daily with high-tech tools masters that 90% insertion success. Hospital administrators should evaluate the cost losses and savings associated with the insertion success rate of their current PICC line inserters and consider the addition of an independent PICC contractor as an alternative option to reduce cost losses.

Abstract

Infusion Therapy and vascular access devices have had a profound impact on nursing practice over the years. The domain of nursing practice lends itself to providing an open window of opportunity for the nurse to enter different arenas of nursing practice and to develop expertise in a chosen field. That is what happened at the M.D. Anderson Cancer Center, Houston, TX, in the 1970s. This article provides an overview of the history of the Infusion Therapy Team along with current and future practice.