JAVA - Journal of the Association for Vascular Access最新文献

{"title":"A Critical Appraisal of Variability in Informed Consent for Vascular Access Procedures","authors":"J. Hotchkiss, Judy Thompson","doi":"10.2309/java-d-21-00007","DOIUrl":"https://doi.org/10.2309/java-d-21-00007","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Vascular access device insertion is one of the most performed procedures in healthcare today. With different device types available to provide infusion therapy, there are many different variables to consider, including the process of obtaining informed consent from patients. This literature review aims to discuss common themes present in current evidence-based practice and point out critical areas of variability that exist.\u0000 Methods: A literature review was conducted searching Cochrane Library, Joanna Briggs Institute for Evidence-Based Practice, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Google Scholar databases for recently published articles in the English language and those written in English. Articles were screened to include those that describe informed consent within the context of vascular access or other invasive procedures. There were 35 articles and 5 systematic reviews identified that met criteria for inclusion in this literature review.\u0000 Discussion: The topics of ethics, legal responsibility, who provided consent, and how education about procedures was performed demonstrated clear insight into how to improve the consent process. Some areas in current evidence lack clear direction and create variability in the informed consent procedure. These included who should obtain consent from the patient and which vascular access devices required a written consent. Who obtains consent was found to be more related to current legal precedence and not the clinician inserting the device like that found when a nonphysician clinician performed the procedure. Vascular access device related variability in requiring written versus verbal consent was found to be rooted in the degree of complexity of the procedure, need for specialized training, and the inherent risk to the patient.\u0000 Conclusion: These two areas of variability described in current clinical practice require more research and consensus agreement to standardize the practice of obtaining informed consent in vascular access device insertion.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48352368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter","authors":"Tara M. Daly, Constance Girgenti","doi":"10.2309/java-d-21-00008","DOIUrl":"https://doi.org/10.2309/java-d-21-00008","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access.\u0000 Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique.\u0000 Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686.\u0000 Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47558581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"President’s Message","authors":"Jocelyn Grecia Hill","doi":"10.2309/JAVA-2021-26-03-04","DOIUrl":"https://doi.org/10.2309/JAVA-2021-26-03-04","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49291482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Modified Measurement of the Peripherally Inserted Central Catheter in Newborns: A Randomized Study","authors":"Andréia Tomazoni, P. K. Rocha, S. D. Souza, Juliana Coelho Pina, C. B. Dalcin","doi":"10.2309/java-d-21-00002","DOIUrl":"https://doi.org/10.2309/java-d-21-00002","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Introduction: The measurement recommended in literature for a peripherally inserted central catheter presents considerable rates of poor positioning in the neonatal population.\u0000 Objective: To evaluate the effectiveness of the modified measurement method for a peripherally inserted central catheter in newborns, with respect to the positioning of the catheter tip.\u0000 Method: A randomized clinical trial, conducted in a Neonatal Intensive Care Unit in south Brazil. The sample comprised the number of catheter insertion procedures in newborns, being randomized in the control group by applying the traditional measure and in the experimental group by applying a modified measure. The sample included 155 procedures, with 88 procedures included in data analysis. The data collection period was from September 2018 to September 2019.\u0000 Results: The group-related variable was considered a risk factor for tip location. The control group was 28.87 times more likely to have the tip’s initial location peripheral than the experimental group, and 44.80 times more likely that the location would be intracardiac than in the experimental group.\u0000 Conclusions: The modified measurement method proved to be more effective for the central location of the tip. The need for new assessments of this method in future research studies is highlighted.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42522578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized, Controlled Clinical Study on the Use of Noninvasive (Near-Infrared Light) Technology Compared with the Conventional Technique for Peripheral Venous Access Puncture in Pediatrics","authors":"G. F. Bomfim, Ariane Ferreira Machado Avelar, Mariana Lucas da Rocha Cunha","doi":"10.2309/java-d-21-00003","DOIUrl":"https://doi.org/10.2309/java-d-21-00003","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Obtaining peripheral venous access, especially in children, is usually a challenging procedure for nursing professionals. In pediatric patients this is because of the small caliber of the vessels, deep localization in the tissue, and multiple previous attempts of venipuncture. This experiment compared the success in obtaining venous access in pediatric patients with the use of near-infrared light and with the conventional technique. Method: True experiment, developed in a large private general hospital and a public general hospital under the same management. The study included children aged 0 to 6 y (including newborns and pediatric patients up to 5 y, 11 mo and 29 d) under clinical or surgical treatment, undergoing peripheral venous puncture both for laboratory test collection and for infusion of medications and solutions. A total of 144 punctures were analyzed, 51.4% with the conventional technique and 48.6% using the device with near-infrared light.\u0000 Results: The success for the conventional technique was 89.2%, and 97.1% on the technique with near-infrared light, P = 0.098, with no evidence of significant differences.\u0000 Conclusion: The success rate for obtaining peripheral venous access in children was similar in the study groups. This study expands the knowledge about the success in the peripheral venous puncture by considering that this is not exclusively related to the use of supportive technologies.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44198488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VAS 2021 abstracts","authors":"","doi":"10.1177/11297298211018180","DOIUrl":"https://doi.org/10.1177/11297298211018180","url":null,"abstract":"","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"102 1","pages":"NP1 - NP23"},"PeriodicalIF":0.0,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85830582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Central Line-Associated Bloodstream Infection in Contaminated Central Venous Catheters: Case Studies of a Pediatric Contamination Guideline","authors":"Tracy B. Chamblee, Lindsey Patton, Virginia B. Young, Jennifer Marusich, C. Bowens, D. Miles","doi":"10.2309/JAVA-D-20-00038","DOIUrl":"https://doi.org/10.2309/JAVA-D-20-00038","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient’s body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87713346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining an Appropriate To-Keep-Vein-Open (TKVO) Infusion Rate for Peripheral Intravenous Catheter Usage","authors":"B. Doyle, L. Kelsey, P. Carr, A. Bulmer, Samantha Keogh","doi":"10.2309/java-d-21-00006","DOIUrl":"https://doi.org/10.2309/java-d-21-00006","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Background: Evidence to support an optimum continuous to-keep-vein-open (TKVO) infusion rate for peripheral intravenous catheters (PIVCs) is lacking. The aim of this study was to simulate typical TKVO rates, in combination with flushing, to better understand TKVO in relation to PIVC patency.\u0000 Methods: We simulated saline infusion through a 20-gauge PIVC in 2 forearm veins (3.3 and 2.2 mm) using computational fluid dynamics under various venous flow rates (velocities 3.7–22.1 cm/s), with a saline flush rate of 1 mL/s and TKVO infusion rates of 10, 20, and 40 mL/h. We determined TKVO efficacy using the stream of saline clearing the stasis region at the device tip and the shear stress acting on the vein.\u0000 Results: At 10 mL/h TKVO rate, blood stasis occurs around the PIVC tip as saline is pulled into the faster-moving venous blood flow, creating the blood recirculation (stasis) zone at the device tip. When TKVO increases >20 mL/h, this stasis diminishes, and the likelihood of patency increases. Shear stress on the vein is negligible during TKVO but increases 10- to 19-fold when flushing the small and large veins investigated here.\u0000 Conclusions: Low TKVO rates (10 mL/h) may not clear the PIVC tip and keep the device patent. Based on our simulations, we propose a TKVO rate of at least 20 mL/h could be used in practice; however, 30–40 mL/h appears most effective across different venous flow rates and peripheral vein sizes. However, this additional fluid load must be carefully considered based on the needs of each patient.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42324545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Introduction of an Antimicrobial Peripherally Inserted Central Catheter (PICC) in Response to High PICC Central Line-Associated Bloodstream Infection Incidence","authors":"M. DeVries, Thomas K Sleweon","doi":"10.2309/java-d-21-00004","DOIUrl":"https://doi.org/10.2309/java-d-21-00004","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards.\u0000 Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter.\u0000 Setting: A 582-bed community teaching hospital in Northwest Indiana.\u0000 Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred in patients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures.\u0000 Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P = 0.0002).\u0000 Conclusion: Combined with continued compliance with basic prevention strategies (i.e., use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45212513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patency and Efficacy of Anatomical Snuffbox Arteriovenous Fistula Compared with Wrist Fistula in Patients with End-Stage Renal Disease","authors":"I. Nazari, Hossein Tajali, S. Majidi, M. Joudi, F. Pouya, Shiva Ghaderifar, Z. Abbasi","doi":"10.2309/java-d-20-00017","DOIUrl":"https://doi.org/10.2309/java-d-20-00017","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 Introduction: Snuffbox arteriovenous fistula (AVF) is one of the most common vascular accesses for hemodialysis. Despite all the advantages, it is not usually considered the first choice of treatment. This could be primarily due to difficulty in its technical procedure and a higher probability of failure than other sites such as cubital. Therefore, the present study aimed at comparing the efficacy and patency rate between the snuffbox and the wrist AVF. Methods: Seventy-eight patients with end-stage renal disease were enrolled in this study. They were randomly assigned into the snuffbox and the wrist groups. Each participant had an appropriate vein at the time of examination and was eligible for distal AVF creation. The procedure was conducted under local anesthesia, and arteriovenous anastomosis was done in an end-to-side configuration. AVF maturation was defined by initiation of successful dialysis through the AVF 8–10 weeks postoperatively.\u0000 Results: The results showed that 61% of snuffbox AVFs and 65% of wrist AVFs became matured and were used for further dialysis. Diabetes and female sex had negative impacts on AVF patency. In addition, no significant relationship was found between the patency rate and demographic as well as clinical variables such as age, hypertension, and duration of the previous dialysis.\u0000 Conclusions: No significant differences were found in the maturation and patency rate between the wrist and the snuffbox AVFs. Therefore, the snuffbox fistula is recommended in the first step, as there would be a possibility for re-creation on the ipsilateral wrist once the AVF fails.\u0000","PeriodicalId":35321,"journal":{"name":"JAVA - Journal of the Association for Vascular Access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48536186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}