ORCID Profile
0000-0002-3128-2034
Current Organisations
University of Wollongong
,
Global Vascular Access, LLC
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Publisher: American Chemical Society (ACS)
Date: 27-07-2023
Publisher: SAGE Publications
Date: 06-11-2020
Abstract: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice ( ) and expert ( ) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p 0.001) and ultrasound skills ( p 0.001). The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.
Publisher: American Astronomical Society
Date: 09-2029
Abstract: The understanding of novae, the thermonuclear eruptions on the surfaces of white dwarf stars in binaries, has recently undergone a major paradigm shift. Though the bolometric luminosity of novae was long thought to arise directly from photons supplied by the thermonuclear runaway, recent gigaelectronvolt (GeV) gamma-ray observations have supported the notion that a significant portion of the luminosity could come from radiative shocks. More recently, observations of novae have lent evidence that these shocks are acceleration sites for hadrons for at least some types of novae. In this scenario, a flux of neutrinos may accompany the observed gamma rays. As the gamma rays from most novae have only been observed up to a few GeV, novae have previously not been considered as targets for neutrino telescopes, which are most sensitive at and above teraelectronvolt (TeV) energies. Here, we present the first search for neutrinos from novae with energies between a few GeV and 10 TeV using IceCube-DeepCore, a densely instrumented region of the IceCube Neutrino Observatory with a reduced energy threshold. We search both for a correlation between gamma-ray and neutrino emission as well as between optical and neutrino emission from novae. We find no evidence for neutrino emission from the novae considered in this analysis and set upper limits for all gamma-ray detected novae.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.ACCPM.2022.101096
Abstract: Radial artery catheterization is a frequently performed procedure for critically ill patients. The correct function of arterial catheters is essential to provide accurate and continuous hemodynamic monitoring, facilitating intermittent blood s ling and helping to optimize the workload for critical care nurses and physicians. However, they are not without their own problems. This narrative practice review discusses several clinical aspects that are not frequently considered but may contribute to enhanced catheter functionality, less device-related failure and more acceptable dwell times. Ultrasound has demonstrated unequivocal efficacies and safety with the procedure, improving first attempt success rates with children, the obese or patients with unstable clinical vital signs and shock. Moreover, anatomic variations of the radial artery are not rare, and ultrasound-guided catheterization reduces the incidence of insertion-related complications such as hematoma, posterior wall puncture, intimal dissection, and radial nerve injury. Ultrasound guidance offers several immediate benefits by enhancing the most appropriate insertion techniques, allows for the correct catheter to vessel ratio measurements to be performed and reduces the angle of insertion, which may affect catheter failure due to inappropriate catheter length. A deeper and more proximal cannulation site at least 4 cm from wrist joint, avoiding the area of wrist flexion, reduces mechanical complications related to patient movements and may improve catheter functionality and dwell along with a better area for stabilization and securement.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Wiley
Date: 13-05-2010
DOI: 10.1111/J.1365-2702.2009.02910.X
Abstract: Aims and objectives. The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role. Design. Modified integrative literature review. Methods. Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Medline, Embase, and the World Wide Web were undertaken using MeSH key words. Hand searching for relevant articles was also undertaken. All studies relating to the nurses role inserting central venous cannulae in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Results. Ten studies met the inclusion criteria for the review, all reported data were from the UK. There were disparate models of service delivery and study populations and the studies were predominantly non experimental in design. The results of this review need to be considered within the methodological caveats associated with this approach. The studies identified did not demonstrate differences in rates of adverse events between a specialist nurse and a medical officer. Conclusions. There were only a small number of studies found in the literature review and the limited availability of clinical outcome data precluded formal analysis from being generated. Relevance to clinical practice. Central vein cannulation is potentially an emerging practice area with important considerations for policy practice and research. Training specialist nurses to provide such a service may facilitate standardising of practice and improving surveillance of lines, and possibly improve the training and accreditation process for CVC insertions for junior medical officers. For this to occur, there is a need to undertake well‐conducted clinical studies to clearly document the value and efficacy of this advanced practice nursing role.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: SAGE Publications
Date: 02-06-2023
DOI: 10.1177/11297298231178064
Abstract: Direct puncture and cannulation of peripheral arteries is frequently performed in critical care and in emergency settings, mainly for hemodynamic monitoring and blood s ling. While there is abundant literature on peripheral arterial cannulation in children and adults, there is still scope for clinical improvements which may impact on patient safety. Although the radial artery is the most frequently utilized access site today, due to its superficial proximity, ease of access, and low risk of adverse events, other sites are sometimes chosen. The authors propose the Safe Insertion of Arterial Catheters (SIA) protocol, an ultrasound-guided insertion bundle applying a systematic approach to arterial cannulation, with a focus on improving insertion practices, reducing procedural complications, increasing the patient safety profile, and improving device performance.
Publisher: SAGE Publications
Date: 27-05-2022
DOI: 10.1177/11297298221099838
Abstract: Insertion of Peripherally Inserted Central Catheters (PICCs) is potentially associated with the risk of immediate/early adverse events, some of them minimal (repeated punctures) and some relevant (accidental arterial puncture or nerve-related injury). Several strategies adopted during the insertion process may minimize the risk of such events, including late complication risks such as infection, venous thrombosis, or catheter dislodgment and/or malposition. This paper describes an update version of the SIP protocol (Safe Insertion of PICCs), an insertion bundle which includes eight effective strategies that aims to minimize immediate, early, or late insertion-associated complications. These strategies include: preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol appropriate skin antiseptic technique choice of appropriate vein, adoption of the Zone Insertion Method™ clear identification of the median nerve and brachial artery ultrasound-guided puncture ultrasound-guided tip navigation intra-procedural assessment of tip location correct securement of the catheter, and appropriate protection of the exit site. This updated version of the SIP protocol includes several novelties based on the most recent evidence-based scientific literature on PICC insertion, such as the clinical relevance of the tunneling technique, the use of ultrasound for intra-procedural tip navigation and tip location, and the new technologies for the protection of the exit site (cyanoacrylate glue) and for the securement of the catheter (subcutaneous anchorage).
Publisher: Association for Vascular Access
Date: 03-2010
DOI: 10.2309/JAVA.15-1-5
Abstract: Background: Health care systems promote care models that deliver both safety and quality. Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes. Objectives: The aim of this paper is to discuss the process of establishing a nurse-led central venous catheter (CVC) insertion service in a university affiliated hospital using a process evaluation method. Method: Archival information, including reports, communications and minutes of departmental meetings were reviewed. Key stakeholders involved in establishing this nurse-led service at the time were interviewed. Results: A nurse-led CVC insertion service was first established in 1996 and has increased in service provision over 13 years. Initially there was scepticism from some medical practitioners about the feasibility of a nurse performing a traditional medical procedure. The service currently provides central venous access across the hospital including critical care areas. The service places up to 500 catheters per annum. Conclusions: Establishing a nurse-led CVC insertion service has increased organizational efficiencies and provided an infrastructure for support of best practice. The support of senior management and medical practitioners was crucial to the successful implementation of this model of care.
Publisher: Wiley
Date: 2013
DOI: 10.1111/J.1365-2702.2012.04340.X
Abstract: To evaluate the evidence base and rationale underpinning the various infections control strategies during central venous catheter insertion and to promote discussion about the key, recurring concepts and recommendations in the literature. Logistical and organisational factors relating to central venous catheter insertion are also examined. Catheter-related bloodstream infections following the insertion of central venous catheters are associated with significant patient mortality and morbidity, prolonged hospital stays and increased economic costs. Limited published literature specifically examines microbial contamination during the peri-insertion process. An integrative literature review supervised by a health informatics librarian was undertaken. On the basis of these data, considerations for clinical practice are provided. Retrieved articles were categorised under the following themes: risk of contamination at insertion clinical and organisational impact of contamination strategies for reducing contamination controversies and challenges with decontamination strategies recommendations for practice and implications for further research and organisational practice. Specific recommendations for reducing catheter-related bloodstream infections based on recurring themes include the following: reducing microbial burden on skin prior to the central venous catheter insertion decreasing contact of gloves and insertion equipment with the patient's skin using specifically trained staff to prepare and maintain a sterile field and ensuring a sterile technique is adhered to throughout the central venous catheter insertion process. The need for organisational, procedural and clinical practices to support better healthcare outcomes is demonstrated. Highlighting the importance of executive support and regular review of policy and guidelines are necessary to improve patient outcomes. Preventing infections related to central venous catheters requires the integration of clinical, organisational and workforce factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-05-2021
DOI: 10.1097/ANC.0000000000000963
Abstract: Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant. This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments. This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type. In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.
Publisher: SAGE Publications
Date: 15-09-2021
DOI: 10.1177/11297298211044363
Abstract: Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures. The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses. The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure. A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan–Meier survival probabilities than PIVs ( p 0.001). The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.
Publisher: Elsevier BV
Date: 12-2020
Publisher: SAGE Publications
Date: 04-10-2018
Abstract: Ultrasound technology has revolutionized the practice of safer vascular access, for both venous and arterial cannulation. The ability to visualize underlying structures of the chest, neck, and upper/lower extremities provides for greater success, speed, and safety with all vascular access procedures. Ultrasound not only yields superior procedural advantages but also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of other important and best avoided anatomical structures—prior to performing any procedures. Such assessment is best performed using a systematic and standardized approach, as the Rapid Central Vein Assessment, described in this study.
Publisher: SAGE Publications
Date: 08-02-2017
DOI: 10.5301/JVA.5000748
Abstract: Malpositioned central venous access device (CVAD) tip locations can cause significant mechanical and chemical vessel-related injuries and complications if left in inappropriate positions. The aim of this study is to determine the use of a high-flow flush technique (HFFT) in successful correction of malpositioned catheters into the lower superior vena cava or cavoatrial junction and provide a cost comparison to interventional/fluoroscopic-based repositioning. This is a retrospective chart and radiographic review of all inserted CVADs found malpositioned between 1996-2014 in a multi-specialty 1000-bed tertiary trauma center in Sydney, Australia. 7450 CVADs placed by a nurse-led vascular access service were reviewed. Catheters repositioned pre-2010 were excluded owing to radiology repositioning interventions. There were 3996 peripherally inserted central catheters (PICCs) and 3454 centrally inserted central catheters (CICCs) placed. Seventy-four were malpositioned post-2010. Of these, 53 devices were repositioned using the studied technique 86% (46/53) of catheters were successfully repositioned on the first HFFT attempt. There was supportive evidence that device insertion side is important in potential catheter malposition. Clinical outcomes suggest that CICCs and PICCs may be successfully repositioned utilizing this technique, with no adverse events associated and a prospective cost saving benefit when compared to interventional-based repositioning procedures.
Publisher: Wiley
Date: 20-06-2023
DOI: 10.1111/NICC.12941
Abstract: Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood s les clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated s ling. To decrease the incidence of rejected blood s les taken for laboratory investigation as a result of clotted s le. This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112‐cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood s les included: awareness raising and safe s ling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) s le collection pathway, review of s le collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the s les were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13–1.78, p = .002), 1.46 (95% CI 1.17–1.81, p .001) and 0.49 (95% CI 0.39–0.63, p .001), respectively. The majority (87%–95%) of blood s les were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood s ling device. Heel prick s ling was the second (2%–9%) most common method. Clotted s les were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34–5.13, p .001) and 3.11 (95% CI 2.51–3.86, p .001), respectively. Our interventions over 3 years were associated with reduced rates of s le rejection due to clotting, and this led to improved patient experience through fewer repeated s lings. The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood s le rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications.
Publisher: Frontiers Media SA
Date: 03-11-2022
Abstract: Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices ( P & 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [ P & 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50–0.54], reason/indication for intravenous therapy ( P & 0.001, HR = 0.85, 95% CI: 0.82–0.87), and the side of insertion of the device ( P & 0.001, HR = 1.25, 95% CI: 1.24–1.27) had a significant relationship with outcomes. Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2017
DOI: 10.1007/S11239-017-1569-Y
Abstract: In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow's triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.
Publisher: Association for Vascular Access
Date: 03-2011
DOI: 10.2309/JAVA.16-1-5
Abstract: Aim and objectives: The aim of this paper was to review published manuscripts on the use of midline catheters, the implications of study findings and recommendations for clinical practice in the acute care setting. Design: Modified integrative literature review Methods: Using key MeSH terms, we searched the electronic databases: CINAHL, Medline, and Embase. The Cochrane and Joanna Briggs databases, Google Search Engine and the reference lists of published materials were also searched. Studies were included if they were in the English language and reported the use of midline catheters in adult acute care populations. Manuscripts that described midlines made of aquavene were excluded Results: Two hundred and thirty two (232) papers were identified using the search strategy. From these identified papers, thirty (30) were included in the final review. Thematic analysis identified three major themes. These included: (i) advantages of using midline catheters (ii) disadvantages of using midline catheters (iii) insertion and management issues. Conclusion: Midline catheters have both positive and negative implications for clinical practice. They can be used for extended periods of intravenous therapy without requiring repeated cannulations but are not without risk. Midline catheters have been associated with mechanical and chemical phlebitis along with intravascular thrombosis. As such they are not suitable across the entire adult acute population. Midline catheters reduce the number of repeated cannulations which reduces patient discomfort, increases patient satisfaction and also contributes to organisational efficiency.
Publisher: Elsevier BV
Date: 05-2012
Publisher: SAGE Publications
Date: 29-07-2021
DOI: 10.1177/11297298211036002
Abstract: Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.
Publisher: SAGE Publications
Date: 07-2016
DOI: 10.5301/JVA.5000564
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.IJNURSTU.2011.08.011
Abstract: Nurse-led central venous catheter placement is an emerging clinical role internationally. Procedural characteristics and clinical outcomes is an important consideration in appraisal of such advanced nursing roles. To review characteristics and outcomes of three nurse-led central venous catheter insertion services based in intensive care units in New South Wales, Australia. Using data from the Central Line Associated Bacteraemia project in New South Wales intensive care units. Descriptive statistical techniques were used to ascertain comparison rates and proportions. De-identified outcome data of patients who had a central venous catheter inserted as part of their therapy by one of the four advanced practice nurses working in three separate hospitals in New South Wales. Between March 2007 and June 2009, 760 vascular access devices were placed by the three nurse-led central venous catheter placement services. Hospital A inserted 520 catheters Hospital C with 164 and Hospital B with 76. Over the study period, insertion outcomes were favourable with only 1 pneumothorax (1%), 1 arterial puncture (1%) and 1 CLAB (1%) being recorded across the three groups. The CLAB rate was lower in comparison to the aggregated CLAB data set [1.3 per 1000 catheters (95% CI=0.03-7.3) vs. 7.2 per 1000 catheters (95% CI=5.9-8.7)]. This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities.
Publisher: SAGE Publications
Date: 28-09-2021
Abstract: Peripheral arterial catheter insertion is a common procedure for critically ill patients requiring frequent blood gas s ling and continuous blood pressure monitoring. There are clear advantages of ultrasound-guided arterial cannulation, which have shown to be more effective in reducing complications, time to successful cannulation, number of attempts, and overall first-time success rates. Evidence suggests that using palpation alone has a first-time success rate of less than 70% yet is still a widely performed technique. A systematic evaluation may be required to reduce variations in arterial catheterization practices. The arterial insertion method is a systematic evaluation to aid in arterial catheter insertion with ultrasound guidance, intended to improve the procedural approach. The process of arterial insertion method ensures appropriate choice of zone selection to optimize catheter longevity and performance in patients requiring arterial access. Moving the insertion site proximally 4 cm from the red zone into the green zone may reduce mechanical complications and preserve catheter performance and dwell time. The standardization of ultrasound guidance in arterial catheterization promotes vessel health and patient safety through device and site optimization. The arterial insertion method systematic evaluation may be utilized to reduce variation in practice and promote the use of ultrasound as a standard for the insertion of radial arterial catheters.
Publisher: SAGE Publications
Date: 16-06-2019
Abstract: The ultrasound-guided axillary vein is becoming a compulsory alternative vessel for central venous catheterization and the anatomical position offers several potential advantages over blind, subclavian vein techniques. To determine the degree of dynamic variation of the axillary vein size measured by ultrasound prior to the induction of general anesthesia and after starting controlled mechanical ventilation. Prospective, observational study. One hundred ten patients undergoing elective surgery were enrolled and classified according to sex, age, and body mass index. Two-dimensional cross-sectional vein diameter, area, and mean flow velocity were performed using ultrasound on both the left and right axillary veins of each subject before and after induction of anesthesia. There was statistically significant evidence showing that the axillary vein area increases when patients are mechanically ventilated. When considering venous flow velocity as a primary outcome, velocity decreased after patients moved from spontaneous to mechanical ventilation (coefficient = −0.267), but this relationship failed to achieve statistical significance ( t = –1.355, p = 0.179). Anatomical variations in depth and diameter as well as the collapsibility due to intrathoracic pressures changes represent common challenges that face clinicians during central venous catheterization of the axillary vein. A noteworthy increase in vessel size as patients transition from spontaneous to mechanical ventilation may theoretically improve first-pass cannulation success with practitioners skilled in both ultrasound and procedure. As a result, placing a centrally inserted central catheter after the induction of anesthesia may be beneficial.
Publisher: American Astronomical Society
Date: 05-2023
Abstract: Core-collapse supernovae are a promising potential high-energy neutrino source class. We test for correlation between seven years of IceCube neutrino data and a catalog containing more than 1000 core-collapse supernovae of types IIn and IIP and a s le of stripped-envelope supernovae. We search both for neutrino emission from in idual supernovae as well as for combined emission from the whole supernova s le, through a stacking analysis. No significant spatial or temporal correlation of neutrinos with the cataloged supernovae was found. All scenarios were tested against the background expectation and together yield an overall p -value of 93% therefore, they show consistency with the background only. The derived upper limits on the total energy emitted in neutrinos are 1.7 × 10 48 erg for stripped-envelope supernovae, 2.8 × 10 48 erg for type IIP, and 1.3 × 10 49 erg for type IIn SNe, the latter disfavoring models with optimistic assumptions for neutrino production in interacting supernovae. We conclude that stripped-envelope supernovae and supernovae of type IIn do not contribute more than 14.6% and 33.9%, respectively, to the diffuse neutrino flux in the energy range of about [ 10 3 –10 5 ] GeV, assuming that the neutrino energy spectrum follows a power-law with an index of −2.5. Under the same assumption, we can only constrain the contribution of type IIP SNe to no more than 59.9%. Thus, core-collapse supernovae of types IIn and stripped-envelope supernovae can both be ruled out as the dominant source of the diffuse neutrino flux under the given assumptions.
Publisher: Elsevier BV
Date: 02-2009
Publisher: SAGE Publications
Date: 02-06-2021
Abstract: Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.
Publisher: SAGE Publications
Date: 02-06-2022
DOI: 10.1177/11297298221101243
Abstract: Radial arterial catheters (RAC) are used extensively across critical care settings (Anesthesia, Intensive Care, Emergency Medicine) for continuous hemodynamic monitoring, allowing for immediate adjustments in vasopressor therapies and blood collection. Radial catheter failures are an ongoing significant issue for critical care clinicians with reported incidences at almost 25%. Common complications include loss of function, lack of blood return, poor quality waveforms and dislodgement, posing potential patient risks, and sudden loss of intra-arterial monitoring frequently requires prompt replacement. Contemporary research and technological improvements have highlighted several concepts to enhance the approach of RAC insertion and management while reducing immediate and late complications. The authors have prioritized the following 10 “best practice” aspects that may improve overall device function and reliability.
Publisher: SAGE Publications
Date: 09-10-2021
DOI: 10.1177/11297298211049648
Abstract: This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations. This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records. A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups—cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%. Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.
Publisher: SAGE Publications
Date: 23-09-2021
DOI: 10.1177/11297298211046756
Abstract: The objective of this study was to evaluate whether the choice of intravenous access (IVA) site affects aortic attenuation during thoracic computed tomographic angiography (T-CTA) and any associated risks with intravenous device placement. All T-CTA exams performed between 1/1/2013 and 8/14/2015 were retrospectively reviewed to identify those performed with contrast media injection via alternative (i.e. non-antecubital) IVA ( n = 1769). Using time matching, antecubital IVA exams ( n = 1769) were selected as controls. For each exam, attenuation was measured in the ascending aorta. Patient and technical data was subsequently collected from all 3538 patients included in this study. Multiple linear regression was used to determine if IVA site affected attenuation. Lastly, data related to extravasations for the entire T-CTA cohort were collected and compared. Hand/wrist, arm, and central venous access device IVA were all equivalent to antecubital IVA in terms of attenuation ( P = 0.579, P = 0.599, and P = 0.522 respectively). Forearm and intraosseous IVA had significantly higher attenuation ( P = 0.010 and P = 0.002, respectively) than antecubital IVA. Right-sided IVA was associated with a small attenuation increase of 11 Hounsfield Units ( P 0.001) compared to left-sided IVA. In terms of extravasation, antecubital IVA was equivalent to hand/wrist, forearm, and upper arm IVA ( P = 0.778, P = 0.060, and P = 0.090 respectively). Satisfactory aortic attenuation achieved with non-antecubital IVA is equivalent to attenuation achieved with antecubital IVA for T-CTA imaging. The risk of contrast media extravasation in peripheral IVA devices was relatively low, however, appropriate IVA site selection should be considered an important factor for successful administration of contrast media for future imaging studies. This prevents undue harm to patients through preventable device failures when using a peripheral IV device in areas of high flexion/range of movements undergoing pressure injection for contrast media.
Publisher: Association for Vascular Access
Date: 03-2020
Publisher: SAGE Publications
Date: 29-08-2021
DOI: 10.1177/11297298211041442
Abstract: The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.
Publisher: American Astronomical Society
Date: 04-2023
Abstract: This paper presents the results of a search for neutrinos that are spatially and temporally coincident with 22 unique, nonrepeating fast radio bursts (FRBs) and one repeating FRB (FRB 121102). FRBs are a rapidly growing class of Galactic and extragalactic astrophysical objects that are considered a potential source of high-energy neutrinos. The IceCube Neutrino Observatory’s previous FRB analyses have solely used track events. This search utilizes seven years of IceCube cascade events which are statistically independent of track events. This event selection allows probing of a longer range of extended timescales due to the low background rate. No statistically significant clustering of neutrinos was observed. Upper limits are set on the time-integrated neutrino flux emitted by FRBs for a range of extended time windows.
Publisher: Association for Vascular Access
Date: 09-2013
DOI: 10.1016/J.JAVA.2013.06.001
Abstract: Background: Video sharing networks such as YouTube have revolutionized communication. Whilst access is freely available uploaded videos can contain non peer-reviewed information. This has consequences for the scientific and health care community, when the challenge in teaching is to present clinical procedures that follow empirical methods. Objective: To review 50 central venous catheter and peripherally inserted central catheter videos posted on YouTube. The aim was to appraise these videos using current evidenced-based guidelines. Methods: We searched YouTube using the key words central venous cannulation and peripherally inserted central catheter insertion on September 21, 2012. We consecutively reviewed 50 videos for both procedures. Results: There was poor adherence to evidence-based guidelines in the critiqued videos. There was a difference in adherence with the use of appropriate skin antisepsis in the 2 groups (18% for central venous catheters vs 52% for peripherally inserted central catheters p = 0.009). And a large proportion in both groups compromised aseptic technique (37% for central venous catheters vs 38% for peripherally inserted central catheter p = 0.940). The use of ultrasound guidance during procedures was also different between the 2 groups (33% for central venous catheters vs 85% for peripherally inserted central catheters p = 0.017). Conclusions: This critique of instructional videos related to the insertion of central venous catheters and peripherally inserted central catheters uploaded to YouTube has highlighted poor adherence to current evidence-based guidelines. This lack of adherence to empirical guidelines can pose risks to clinical learning and ultimately to patient safety.
Publisher: American Astronomical Society
Date: 03-2023
Abstract: Gamma-ray bursts (GRBs) have long been considered a possible source of high-energy neutrinos. While no correlations have yet been detected between high-energy neutrinos and GRBs, the recent observation of GRB 221009A—the brightest GRB observed by Fermi-GBM to date and the first one to be observed above an energy of 10 TeV—provides a unique opportunity to test for hadronic emission. In this paper, we leverage the wide energy range of the IceCube Neutrino Observatory to search for neutrinos from GRB 221009A. We find no significant deviation from background expectation across event s les ranging from MeV to PeV energies, placing stringent upper limits on the neutrino emission from this source.
Publisher: SAGE Publications
Date: 16-02-2023
DOI: 10.1177/11297298231154629
Abstract: Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods. A retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar. A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG). In the historical cohort, the catheter was secured using a semi-permeable transparent membrane dressing while in the CG cohort, CG was applied at the insertion site on initial insertion and after any dressing change. This was the only variable intervention between both groups. A total of 8330 peripheral catheters were inserted. All catheters were inserted and monitored by members of the NeoVAT team. 4457 (53.5%) were secured with just a semi-permeable transparent dressing and 3873 (46.5%) secured a semi-permeable transparent dressing with the addition of CG. The odds ratio for premature failure after securement with CG was 0.59 (0.54–0.65) when compared to the catheters secured with a semi-permeable transparent dressing, which was statistically significant ( p 0.001). The correlation between the occurrence of a complication and the use of CG for device securement was significant ( p 0.001). The risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study’s findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.
Publisher: Association for Vascular Access
Date: 12-2019
Publisher: Association for Vascular Access
Date: 03-2020
Publisher: American Astronomical Society
Date: 07-2023
Abstract: Beginning in 2016, the IceCube Neutrino Observatory has sent out alerts in real time containing the information of high-energy ( E ≳ 100 TeV) neutrino candidate events with moderate to high (≳30%) probability of astrophysical origin. In this work, we use a recent catalog of such alert events, which, in addition to events announced in real time, includes events that were identified retroactively and covers the time period of 2011–2020. We also search for additional, lower-energy neutrinos from the arrival directions of these IceCube alerts. We show how performing such an analysis can constrain the contribution of rare populations of cosmic neutrino sources to the diffuse astrophysical neutrino flux. After searching for neutrino emission coincident with these alert events on various timescales, we find no significant evidence of either minute-scale or day-scale transient neutrino emission or of steady neutrino emission in the direction of these alert events. This study also shows how numerous a population of neutrino sources has to be to account for the complete astrophysical neutrino flux. Assuming that sources have the same luminosity, an E −2.5 neutrino spectrum, and number densities that follow star formation rates, the population of sources has to be more numerous than 7 × 10 −9 Mpc −3 . This number changes to 3 × 10 −7 Mpc −3 if number densities instead have no cosmic evolution.
Location: Australia
Location: Netherlands
No related grants have been discovered for Timothy Spencer.