ORCID Profile
0000-0002-5779-1304
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: SAGE Publications
Date: 08-07-2016
Abstract: Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey. A narrative review of studies describing the infection risks associated with PVCs. It is estimated that 30–80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment. This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies.
Publisher: Wiley
Date: 10-07-2019
DOI: 10.1111/JOCN.14979
Abstract: To explore nurses' decision-making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter-related bloodstream infection however, emerging evidence is challenging traditional hang-time durations. Nurses' perceptions and contextual factors affecting decision-making for administration set replacement have not been assessed previously. Qualitative study using focus groups with contextualism methodology and inductive analysis. During November-December 2016, eight semi-structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio-recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7-step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.
Publisher: Springer Science and Business Media LLC
Date: 26-03-2013
DOI: 10.1007/S10096-013-1854-4
Abstract: Peripheral venous catheters (PVCs) are some of the most widely used medical devices in hospitals worldwide. PVC-related infections increase morbidity and treatment costs. The inner surfaces of PVCs are rarely examined for the population structure of bacteria, as it is generally believed that bacteria at this niche are similar to those on the external surface of PVCs. We primarily test this hypothesis and also study the effect of antibiotic treatment on bacterial communities from PVC surfaces. The inner and outer surfaces of PVCs from 15 patients were examined by 454 GS FLX Titanium 16S rRNA sequencing and the culture method. None of the PVCs were colonised according to the culture method and none of the patients had a bacteraemia. From a total of 127,536 high-quality sequence reads, 14 bacterial phyla and 268 erse bacterial genera were detected. The number of operational taxonomic units for each s le was in the range of 86-157, even though 60 % of patients had received antibiotic treatment. Stenotrophomonas maltophilia was the predominant bacterial species in all the examined PVC s les. There were noticeable but not statistically significant differences between the inner and outer surfaces of PVCs in terms of the distribution of the taxonomic groups. In addition, the bacterial communities on PVCs from antibiotic-treated patients were significantly different from untreated patients. In conclusion, the surfaces of PVCs display complex bacterial communities. Although their significance has yet to be determined, these findings alter our perception of PVC-related infections.
Publisher: BMJ
Date: 09-2015
Publisher: American Society for Microbiology
Date: 13-04-2017
Abstract: Roseomonas mucosa is an opportunistic pathogen that causes infections in humans and is often associated with vascular catheter-related bacteremia. Here, we report the draft genome sequence of Roseomonas mucosa strain AU37, isolated from a peripheral intravenous catheter tip.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Wiley
Date: 03-02-2022
DOI: 10.1111/JOCN.16237
Abstract: To synthesise evidence related to medical adhesive tapes and supplementary securement products for peripheral intravenous catheters in adults, to prevent complications and device failure. Integrative review informed by Whittemore and Knafl and reported in accordance with the PRISMA 2020 statement. Data sources. The Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, EMBASE/MEDLINE and Cumulative Index to Nursing and Allied Health were searched from 2000–21 September 2020. Review Methods. Studies enrolling hospitalised participants years with peripheral intravenous catheters secured by medical adhesive tapes, or supplementary products (bandage, splint and sutureless securement device), were eligible. Quality appraisal was performed using Critical Appraisal Skills Program checklists. Nineteen studies met criteria, including 43,683 peripheral intravenous catheters. Quality appraisal identified high or unclear risk of bias in 58% of studies. Nonsterile tape was the most common intervention tested (14 studies), alone or in multiproduct combinations. Nonsterile tape directly over insertion sites was associated with increased PIVC failure and complications. Sutureless securement devices potentially reduce failure and complications. Multiproduct combinations were very common. Practice recommendations regarding other tapes and secondary securement products are challenging, due to conflicting, or lack of, evidence. Tapes and secondary securement product evidence are limited, and over half of the studies are of low methodological quality. This review found nonsterile tape was associated with increased failure and complications multiproduct dressing and securement bundles were prevalent and significant evidence gaps exist particularly regarding bandages and splints. The results provide nurses with evidence of medical adhesive tapes and supplementary product effectiveness for peripheral intravenous catheter securement, and future research directions to reduce unacceptably high failure and complication rates. Larger rigorously conducted randomised controlled trials are needed to add to current evidence.
Publisher: SAGE Publications
Date: 18-05-2019
Abstract: Central venous access devices (CVADs) are vital to enable treatment for children with cancer and other complex health conditions. However, complications effecting the CVAD wound are commonly reported. This study aimed to identify the incidence and prevalence of CVAD-associated skin complications current management, and characteristics associated with complication development, in pediatrics. A prospective observational study performed across medical, oncology, and hematology departments at a tertiary pediatric hospital in Australia, between April and July 2017. Children admitted with CVADs were assessed twice weekly for CVAD-associated skin complications and associated signs and symptoms. The data were analyzed using descriptive statistics (i.e., proportions, frequency) and time-to-event multivariable regression (i.e., hazard ratios [HRs]). Two hundred and seventy-one CVADs were reviewed over 43,787 catheter days, with over one eighth of participants (14% n = 37) having a CVAD-associated skin complication during their admission (0.95 per 1,000 catheter days, 95% confidence interval [CI 0.61, 1.17]), most commonly contact dermatitis (11% n = 29 0.72 per 1,000 catheter days 95% CI [0.50, 1.04]). Within biweekly checks the median point prevalence of complications varied between 0.4% and 11% and clinical management was wide-ranging. A primary diagnosis of oncology (HR 2.89, 95% CI [1.10, 7.62]) or medical/surgical (HR 2.55, 95% CI [1.04, 6.22]) conditions plain, nonbordered polyurethane dressings (HR 4.92, 95% CI [2.00, 12.13]) and poor dressing integrity (HR 2.64, 95% CI [1.18, 5.92]) were significantly associated with contact dermatitis. In conclusion, substantial numbers of pediatric patients experience CVAD-associated skin complications, and innovations are necessary to identify, prevent, and treat these health care–associated injuries.
Publisher: Elsevier BV
Date: 10-2013
Publisher: American Academy of Pediatrics (AAP)
Date: 11-2015
Abstract: The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources. To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics. Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015. Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. Data were independently extracted and critiqued for quality by 2 authors. Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%–29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71–2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%–63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4–39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09–0.20]). The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research. CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
Publisher: Elsevier BV
Date: 08-2018
Publisher: Public Library of Science (PLoS)
Date: 05-01-2016
Publisher: Springer Science and Business Media LLC
Date: 30-10-2018
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.IJNURSTU.2016.11.007
Abstract: Peripheral venous catheterisation is the most frequent invasive procedure performed in hospitalised patients yet over 30% of peripheral venous catheters fail before treatment ends. To assess the effects of peripheral venous catheter dressings and securement devices on the incidence of peripheral venous catheter failure. We searched the Cochrane Wounds Group Register, The Cochrane Central Register of Controlled Trials, MEDLINE EMBASE and CINAHL for any randomised controlled trials comparing different dressings or securement devices used to stabilise peripheral venous catheters. The reference lists of included studies were also searched for any previously unidentified studies. We included six randomised controlled trials (1539 participants) that compared various dressings and securement devices (transparent dressings versus gauze bordered transparent dressings versus a securement device bordered transparent dressings versus tape and transparent dressing versus sticking plaster). Trial sizes ranged from 50 to 703 participants. The quality of evidence ranged from low to very low. Catheter dislodgements or accidental removals were lower with transparent dressings compared with gauze (two studies, 278 participants, risk ratio (RR) 0.40 95% confidence interval (CI) 0.17-0.92, P=0.03%). However, the relative effects of transparent dressings and gauze on phlebitis (RR 0.89 95% CI 0.47-1.68) and infiltration (RR 0.80 95% CI 0.48-1.33) are unclear. A single study identified less frequent dislodgement or accidental catheter removal with bordered transparent dressings compared to a securement device (RR 0.14, 95% CI 0.03-0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03-64.02). A comparison of a bordered transparent dressing and tape found more peripheral venous catheter failure with the bordered dressing (RR 1.84, 95% CI 1.08-3.11) but the relative effect on dislodgement was unclear. There is no strong evidence to suggest that any one dressing or securement product for preventing peripheral venous catheter failure is more effective than any other product. All of the included trials were small, had high or unclear risk of bias for one or more of the quality elements we assessed, and wide confidence intervals, indicating that further randomised controlled trials are necessary. There is a need for suitably powered, high quality trials to evaluate the newer, high use products and novel - but expensive - securement methods, such as surgical grade glue.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 13-11-2022
DOI: 10.1002/JHM.12995
Abstract: One‐third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures. We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs. A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical–surgical patients (one PIVC each) requiring intravenous therapy for h were studied. The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor‐masked. The secondary outcomes were: failure type, first‐time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health‐related quality of life, clinician, and patient satisfaction. Out of 1759 patients randomized (integrated PIVC, n = 881 nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention‐to‐treat analysis (2269 PIVC‐days integrated 2073 PIVC‐days nonintegrated). Device failure incidence was 35% (145 per 1000 device‐days) nonintegrated, and 33% (124 per 1000 device‐days) integrated PIVCs. Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69–0.96], p = .015). The per‐protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68–0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per‐patient costs were not statistically different. PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.
Publisher: Mark Allen Group
Date: 22-10-2020
DOI: 10.12968/BJON.2020.29.19.S40
Abstract: Peripheral intravenous catheters (PIVCs) are widely used, but failure is unacceptably common with up to 69% failing before treatment is complete. PIVC securement reduces failure, but the optimal way to achieve this is unclear. Tapes and supplementary securement products are widely used, however rigorous testing of these to reduce PIVC failure remains unexplored. In adult medical-surgical wards at a tertiary hospital, this pilot randomized controlled trial tests standard care (bordered polyurethane dressing plus nonsterile tape over the extension tubing) against two securement interventions (intervention one: standard care plus two sterile tape strips over the PIVC hub intervention two: intervention one plus a tubular bandage). Patients years of age requiring a PIVC for hours are eligible. Patients with laboratory-confirmed positive blood cultures within 24 hours of screening, known allergy to study products, current or high-risk of skin tear, or non-English speaking without interpreter are excluded. S le size is 35 per trial arm, and central randomization is computer-generated with allocation concealed until entry. Patients and clinical staff cannot be blinded to treatment allocation. However, infection outcomes are assessed by a blinded investigator. Primary outcome is study feasibility. Secondary outcomes (PIVC failure, dwell time, skin adverse events, PIVC colonization, and cost) are compared between groups. Feasibility outcomes are reported descriptively. Ethical approvals were received from Royal Brisbane and Women's Hospital (HREC/18/QRBW/44571) and Griffith University (2018/1000). Trial commencement was May 2019. Trial registration: ACTRN12619000026123.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2017
Publisher: BMJ
Date: 06-2017
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 11-2023
Publisher: SAGE Publications
Date: 09-11-2018
Abstract: Skin microorganisms may contribute to the development of vascular access device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is little evidence to inform choice of VAD site selection. To compare microorganisms present at different body sites used for VAD insertions and understand the effect of transparent dressings on skin microflora. The ESCAPE observational study consisted of three phases: (1) skin swabs of four sites (mid-neck, base neck, chest, upper arm) from 48 hospital patients (2) skin swabs of five body sites (mid-neck, base neck, chest, upper arm, lower arm) from 10 healthy volunteers and (3) paired skin swabs (n = 72) under and outside of transparent dressings from 36 hospital patients (16 mid/base neck, 10 chest, upper arm). Specimens were cultured for 72 h, species identified and colony-forming units (CFU) counted. Ordinal logistic regression compared CFU categories between variables of interest. The chest and upper arm were significantly associated with fewer microorganisms compared to neck or forearm (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.25–0.65, P 0.05). CFU levels under transparent dressings were not significantly different from outside (OR = 0.57, 95% CI = 0.22–1.45). Staphylococci were predominant at all sites. Other significant ( P 0.05) predictors of higher CFU count included prolonged hospitalisation and medical/surgical patient status. Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk.
Publisher: Cambridge Media
Date: 11-11-2019
Publisher: Mark Allen Group
Date: 26-10-2017
DOI: 10.12968/BJON.2017.26.19.S4
Abstract: Despite vascular access devices (VADs) being vital for patient care, device failure rates are unacceptably high with around 25% of central venous devices, and 30–40% of peripheral venous devices, developing complications that result in VAD failure. The use of tissue adhesive is a novel method of securing VADs and is gaining popularity, however the evidence base guiding its clinical use is still emerging. This article aims to review the types and properties of tissue adhesives, provide an overview of the existing evidence base, and discuss how tissue adhesives may be used in clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2020
DOI: 10.1186/S12916-020-01728-1
Abstract: Peripheral intravenous catheters (PIVCs) are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing. The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on short PIVC maintenance had on patient outcomes. This single-centre, incomplete, stepped wedge, cluster randomised trial with an implementation period was undertaken at a quaternary hospital in Queensland, Australia. Eligible patients were from general medical and surgical wards, aged ≥ 18 years, and requiring a PIVC for 24 h. Wards were the unit of randomisation and allocation was concealed until the time of crossover to the implementation phase. Patients, clinicians, and researchers were not masked but infections were adjudicated by a physician masked to allocation. Practice during the control period was standard care (variable practice with manually prepared flushes of 0.9% sodium chloride). The intervention group received education reinforcing practice guidelines (including administration with manufacturer-prepared pre-filled flush syringes). The primary outcome was all-cause PIVC failure (as a composite of occlusion, infiltration, dislodgement, phlebitis, and primary bloodstream or local infection). Analysis was by intention-to-treat. Between July 2016 and February 2017, 619 patients from 9 clusters (wards) were enrolled (control n = 306, intervention n = 313), with 617 patients comprising the intention-to-treat population. PIVC failure was 91 (30%) in the control and 69 (22%) in the intervention group (risk difference − 8%, 95% CI − 14 to − 1, p = 0.032). Total costs were lower in the intervention group. No serious adverse events related to study intervention occurred. This study demonstrated the effectiveness of post-insertion PIVC flushing according to recommended guidelines. Evidence-based education, surveillance and products for post-insertion PIVC management are vital to improve patient outcomes. Trial submitted for registration on 25 January 2016. Approved and retrospectively registered on 4 August 2016. Ref: ACTRN12616001035415 .
Publisher: Wiley
Date: 18-10-2017
DOI: 10.12788/JHM.2867
Abstract: Almost 70% of hospitalized patients require a peripheral intravenous catheter (PIV), yet up to 69% of PIVs fail prior to completion of therapy. To identify risk factors associated with PIV failure. A single center, prospective, cohort study. Medical and surgical wards of a tertiary hospital located in Queensland, Australia. Adult patients requiring a PIV. Demographic, clinical, and potential PIV risk factors were collected. Failure occurred if the catheter had complications at removal. We recruited 1000 patients. Catheter failure occurred in 512 (32%) of 1578 PIVs. Occlusion/infiltration risk factors included intravenous (IV) flucloxacillin (hazard ratio [HR], 1.98 95% confidence interval [CI], 1.19‐3.31), 22‐gauge PIVs (HR, 1.43 95% CI, 1.02‐2.00), and female patients (HR, 1.48 95% CI, 1.10‐2.00). Phlebitis was associated with female patients (HR, 1.81 95% CI, 1.40‐2.35), bruised insertion sites (HR, 2.16 95% CI, 1.26‐3.71), IV flucloxacillin (HR, 2.01 95% CI, 1.26‐3.21), and dominant side insertion (HR, 1.39 95% CI, 1.09‐1.77). Dislodgement risks were a paramedic insertion (HR, 1.78 95% CI, 1.03‐3.06). Each increase by 1 in the average number of daily PIV accesses was associated (HR 1.11, 95% CI 1.03‐1.20)–(HR 1.14, 95% CI 1.08‐1.21) with occlusion/infiltration, phlebitis and dislodgement. Additional securement products were associated with less (HR 0.32, 95% CI 0.22‐0.46)–(HR 0.63, 95% CI 0.48‐0.82) occlusion/infiltration, phlebitis and dislodgement. Modifiable risk factors should inform education and inserter skill development to reduce the currently high rate of PIV failure.
Publisher: JMIR Publications Inc.
Date: 30-08-2023
Abstract: ntroduction: Peripheral intravenous catheters (PIVCs) are the most common vascular access device with most hospitalised patients receiving at least one during hospital admission. Traditionally, a transparent dressing alone is considered adequate to safely secure a PIVC, regardless of the potential risk of local and systemic infections. Although PIVCs have the lowest incidence of proven infection of all vascular access devices (0.1%, 0.5 per 1000 catheter-days), with nearly 2 billion purchased worldwide each year, the absolute risk of infectious complications and related costs are similar to or even greater than those for other vascular access devices. Chlorhexidine gluconate (CHG)-impregnated dressings are widely used to reduce the infectious risk of central venous and arterial catheters but their value in preventing PIVC-related infectious complications has not yet been evaluated in patients. We hypothesise an impregnated CHG transparent dressing, in comparison to standard polyurethane dressing, will be safe, effective, and cost-effective in protecting against PIVC-related infectious complications and phlebitis. Methods and analysis: The ProP Trial is a two-arm, superiority, randomised-controlled trial conducted in two centres in Australia and one centre in France. Patients (adults and children aged ≥6 years) requiring one PIVC for ≥48 hours will be eligible. Exclusion criteria include catheter placement under emergency conditions, burned, non-intact or diseased skin at catheter insertion site, known allergy to CHG or transparent dressing adhesives, and previous participation in the trial. The trial will be conducted in two phases. First, 300 participants will be enrolled as an internal pilot to test protocol feasibility without review of clinical outcomes. An independent data safety monitoring committee will assess the feasibility of pursuing the full trial, of 2624 (1312 in each study group) patients. Patients will be randomised 1:1 to 3M™ Tegaderm™ Antimicrobial IV Advanced Securement dressing or standard care group using a central, web-based randomisation service, with varied block sizes of 4 and 6 and stratification by hospital. Recruitment began on 3rd May, 2023. Other than the type of randomised dressing used to secure the PIVCs, the insertion, maintenance and removal of PIVCs will follow standard practices at the participating sites. The primary endpoint is a composite of catheter-related infectious complications (local and bloodstream infections) and phlebitis. Ethics and dissemination: Human Research Ethics Committee will be gained at participating sites. Eligible patients will receive oral and written information and will be enrolled after giving written consent. For children, parental or legal guardian consent will be required for inclusion in the study. The findings will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration: NCT05741866
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JCRC.2016.06.006
Abstract: To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU). Midtrial, due to safety, the TA+SPU intervention was replaced with a suture + TA+SPU group. A total of 221 patients were randomized with 2 postrandomization exclusions. Central venous access device failure was as follows: suture + BPU controls, 2 (4%) of 55 (0.52/1000 hours) suture + AD, 1 (2%) of 56 (0.26/1000 hours, P=.560) SSD+SPU, 4 (7%) of 55 (1.04/1000 hours, P=.417) TA+SPU, 4 (17%) of 23 (2.53/1000 hours, P=.049) and suture + TA+SPU, 0 (0%) of 30 (P=.263 intention-to-treat, log-rank tests). Central venous access device failure was predicted (P<.05) by baseline poor/fair skin integrity (hazard ratio, 9.8 95% confidence interval, 1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2 95% confidence interval, 3.0-68.4). Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Wiley
Date: 22-12-2017
DOI: 10.1111/AJO.12759
Abstract: Insertion of a 16 or 18 gauge peripheral intravenous catheter is a potentially painful intervention but one frequently experienced by pregnant women when admitted to hospital. Although the rationale for this practice is 'in case of an emergency bleed', evidence for using large-bore catheters in this population is absent. (i) To identify the proportion of 18 gauge or larger peripheral catheters inserted into maternity patients and (ii) to investigate the proportion of women who require blood products during their perinatal period. Data from a sub-set of maternity patients who were included in a study of risk factors for peripheral intravenous access failure were analysed using descriptive statistics. One hundred and fourteen catheters were inserted in 95 women. Of the 95 first-inserted catheters, 84 (88.4%) were 16 or 18 gauge and 69 (82.1%) of these were placed in the hand or wrist. Four women (4%) received blood products, all were for non-urgent transfusions. Postpartum haemorrhage requiring a blood transfusion remains a relatively rare event. Comprehensive risk assessment should be undertaken before inserting large-bore catheters in perinatal women. Small veins in the hand and wrist should not be used for large bore catheters.
Publisher: BMJ
Date: 22-09-2020
DOI: 10.1136/BMJQS-2020-011274
Abstract: Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices. A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5 eg, age), device characteristics (n=5 eg, device type), insertion (n=16 eg, indication), management (n=9 eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes. We developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JHIN.2017.04.009
Abstract: A number of antimicrobial-impregnated discs to prevent central-line-associated bloodstream infection (CLABSI) are marketed but it is unclear which disc is most effective. To investigate the feasibility and safety of comparing two antimicrobial-impregnated discs to prevent CLABSI. A single-centre, parallel group, randomized controlled trial was conducted in a 929-bed tertiary referral hospital. Hospital inpatients requiring a peripherally inserted central catheter were randomized to chlorhexidine gluconate (CHG) or polyhexamethylene biguanide (PHMB) disc dressing group. Dressings were replaced every seven days, or earlier, if clinically required. Participants were followed until device removal or hospital discharge. Feasibility outcomes included: proportion of potentially eligible participants who were enrolled proportion of protocol violations and proportion of patients lost to follow-up. Clinical outcomes were: CLABSI incidence, diagnosed by a blinded infection control practitioner all-cause bloodstream infection (BSI) and product-related adverse events. Of 143 patients screened, 101 (71%) were eligible. Five (3.5%) declined participation. There was one post-randomization exclusion. Two (2%) protocol violations occurred in the CHG group. No patients were lost to follow-up. Three (3%) BSIs occurred two (2%) were confirmed CLABSIs (one in each group) and one a mucosal barrier injury-related BSI. A total of 1217 device-days were studied, resulting in 1.64 CLABSIs per 1000 catheter-days. One (1%) disc-related adverse event occurred in the CHG group. Disc dressings containing PHMB are safe to use for infection prevention at catheter insertion sites. An adequately powered trial to compare PHMB and CHG discs is feasible.
Publisher: Elsevier BV
Date: 2020
Publisher: John Wiley & Sons, Ltd
Date: 12-04-2014
Publisher: Wiley
Date: 12-06-2015
Publisher: Informa UK Limited
Date: 30-01-2020
Publisher: Wiley
Date: 12-06-2023
DOI: 10.1002/JUM.16286
Abstract: There is a lack of international consensus as to whether high‐ or low‐level disinfection (HLD or LLD) is required for ultrasound (US) transducers used during percutaneous procedures. This study compared the effectiveness of LLD to HLD on US transducers contaminated with microorganisms from skin. Two identical linear US transducers repeatedly underwent either LLD or HLD during the study. Randomization determined which of these transducers was applied to left and right forearms of each participant. Swabs taken from transducers before and after reprocessing were plated then incubated for 4–5 days, after which colony forming units (CFU) were counted and identified. The primary hypothesis was the difference in the proportion of US transducers having no CFUs remaining after LLD and HLD would be less than or equal to the noninferiority margin of −5%. Of the 654 recruited participants 73% (n = 478) had microbial growth from both transducers applied to their left and right forearms before reprocessing. These were included in the paired noninferiority statistical analysis where, after disinfection, all CFUs were eliminated in 100% (95% CI: 99.4–100.0%) of HLD transducer s les (n = 478) and 99.0% (95% CI: 97.6–99.7%) of LLD transducer s les (n = 473). The paired difference in the proportion of transducers having all CFUs eliminated between LLD and HLD was −1.0% (95% CI: −2.4 to −0.2%, P ‐value .001). Disinfection with LLD is noninferior to HLD when microorganisms from skin have contaminated the transducer. Therefore, using LLD for US transducers involved in percutaneous procedures would present no higher infection risk compared with HLD.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Mark Allen Group
Date: 26-10-2017
DOI: 10.12968/BJON.2017.26.19.S18
Abstract: Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients' experiences of PVC insertion. Some 10 participants were purposively s led for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter technique of device insertion competence of the inserter and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences siting the PVC in locations other than the antecubital fossa and hand ensuring experienced and confident inserters are available to insert PVCs.
Publisher: Cambridge University Press (CUP)
Date: 2014
DOI: 10.1086/674398
Abstract: To assess the relative importance of independent risk factors for peripheral intravenous catheter (PIVC) failure. Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal. Three acute care hospitals in Queensland, Australia. The trial included 3,283 adult medical and surgical patients (5,907 catheters) with a PIVC with greater than 4 days of expected use. Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28–1.68], 1.27 [95% CI, 1.08–1.49], and 1.25 [95% CI, 1.04–1.50], respectively) and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08–2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 [95% CI, 0.67–0.94]). Modifiable risks for accidental removal included hand or antecubital fossa insertion compared with forearm (HR, 2.45 [95% CI, 1.93–3.10] and 1.65 [95% CI, 1.23–2.22], respectively), clinical staff insertion compared with intravenous service (HR, 1.69 [95% CI, 1.30–2.20]) and smaller PIVC diameter (HR, 1.29 [95% CI, 1.02–1.61]). Female sex was a nonmodifiable factor associated with an increased risk of both phlebitis (HR, 1.64 [95% CI, 1.28–2.09]) and occlusion (HR, 1.44 [95% CI, 1.30–1.61]). PIVC survival is improved by preferential forearm insertion, selection of appropriate PIVC diameter, and insertion by intravenous teams and other specialists. The original randomized controlled trial on which this secondary analysis is based is registered with the Australian New Zealand Clinical Trials Registry ( www.anzctr.org.au ACTRN12608000445370 ).
Publisher: Elsevier BV
Date: 11-2020
Publisher: BMJ
Date: 03-02-2015
Publisher: Springer Science and Business Media LLC
Date: 10-01-2014
DOI: 10.1007/S40258-013-0077-2
Abstract: Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72-96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative. To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters. A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed. The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95% confidence interval [CI] 4.96-10.62) and a non-significant difference in the phlebitis rate of 0.41% (95% CI -1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95% CI 4.96-10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years. The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.
Publisher: Wiley
Date: 12-06-2021
DOI: 10.1111/JAN.14933
Abstract: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision‐making during insertion and perceptions of women. This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non‐participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18‐gauge catheter was considered more painful than a 16‐gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18‐gauge catheters mostly in hand or wrist (66%). Decision‐making about site, catheter gauge, dressing and attempts varied. Thirty‐four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non‐dominant arm as key reasons for the location of PIVC. Regular use of a large‐gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
Publisher: Cambridge University Press (CUP)
Date: 31-07-2019
DOI: 10.1017/ICE.2019.205
Abstract: To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally. Diagnostic-test accuracy systematic review. We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed. A systematic search identified 1,259 publications 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies. Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time. Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989 June 7, 2015). www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989
Publisher: Microbiology Society
Date: 04-2017
DOI: 10.1099/JMM.0.000463
Abstract: Dressings containing chlorhexidine gluconate (CHG) are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in staphylococci is primarily associated with the presence of qacA/B and smr genes. We used a culture-independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG dressings. Of the 78 DNA specimens analysed, 52 (67 %) possessed qacA/B and 14 (18 %) possessed smr all s les positive for smr were also positive for qacA/B. These prevalence rates were not statistically greater than those observed in a subs le of specimens taken from non-CHG treated contralateral arms and non-CHG-dressing exposed arms. A statistically greater proportion of specimens with greater than 72 h exposure to CHG dressings were qac-positive (P=0.04), suggesting that the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qac genes was not positively associated with the presence of DNA specific for Staphylococcusepidermidis and Staphylococcusaureus in these specimens. Our results show that CHG genes are highly prevalent on hospital patients' skin, even in the absence of viable bacteria.
Publisher: Wiley
Date: 16-08-2023
DOI: 10.1111/JOCN.16852
Abstract: To test the feasibility of a study protocol that compared the efficacy of neutral‐ and negative‐pressure needleless connectors (NCs). A single‐centre, parallel‐group, pilot randomised control trial. Our study compared neutral‐(intervention) and negative‐pressure (control) NCs among adult patients in an Australian hospital. The primary feasibility outcome was measured against predetermined criteria (e.g. eligibility, attrition). The primary efficacy outcome was all‐cause peripheral intravenous catheter failure, analysed as time‐to‐event data. In total, 201 (100 control 101 intervention) participants were enrolled between March 2020 and September 2020. All feasibility criteria were met except eligibility, which was lower (78%) than the 90% criterion. All‐cause peripheral intravenous catheter failure was significantly higher in the intervention group (39%) compared to control (19%). With minor modifications to participant screening for eligibility, this randomised control trial is feasible for a large multicentre randomised control trial. The neutral NC was associated with an increased risk of peripheral intravenous catheter failure. There are several NC designs available, often identified by their mechanism of pressure (positive, negative and neutral). However, NCs can contribute to peripheral intravenous catheter failure. This is the first randomised controlled trial to compare neutral and negative NC designs. Negative pressure NCs had lower PIVC failure compared to neutral NCs, however the results might not be generalisable to other brands or treatment settings. Further high‐quality research is needed to explore NC design. Study methods and results reported in adherence to the CONSORT Statement. No patient or public contribution.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 29-10-2015
DOI: 10.1007/S10096-015-2504-9
Abstract: Microorganisms play important roles in intravascular catheter (IVC)-related infections, which are the most serious complications in children with IVCs, leading to increased hospitalisation, intensive care admissions, extensive antibiotic treatment and mortality. A greater understanding of bacterial communities is needed in order to improve the management of infections. We describe here the systematic culture-independent evaluation of IVC bacteriology in IVC biofilms. Twenty-four IVC s les (six peripherally inserted central catheters, eight central venous catheters and ten arterial catheters) were collected from 24 paediatric patients aged 0 to 14 years old. Barcoded licon libraries produced from genes coding 16S rRNA and roll-plate culture methods were used to determine the microbial composition of these s les. From a total of 1,043,406 high-quality sequence reads, eight microbial phyla and 136 erse microbial genera were detected, separated into 12,224 operational taxonomic units (OTUs). Three phyla (Actinobacteria, Firmicutes and Proteobacteria) predominate the microorganism on the IVC surfaces, with Firmicutes representing nearly half of the OTUs found. Among the Firmicutes, Staphylococcus (15.0% of 16S rRNA reads), Streptococcus (9.6%) and Bacillus (6.1%) were the most common. Community composition did not appear to be affected by patients' age, gender, antibiotic treatment or IVC type. Differences in IVC microbiota were more likely associated with events arising from catheter dwell time, rather than the type of IVC used.
Publisher: SAGE Publications
Date: 21-03-2018
Abstract: Many patients are discharged from hospital with a peripherally inserted central catheter in place. Monitoring the peripherally inserted central catheter insertion site for clinical and research purposes is important for identifying complications, but the extent to which patients can reliably report the condition of their catheter insertion site is uncertain. The aim of this study was to assess the inter-observer agreement between nurses and patients when assessing a peripherally inserted central catheter site. The study was based on inpatients who were enrolled in a single-centre, randomised controlled trial comparing four different dressing and securement devices for peripherally inserted central catheter sites. A seven-item peripherally inserted central catheter site assessment tool, containing questions about the condition of the dressing and the insertion site, was developed. Assessment was conducted once by the research nurse and, within a few minutes, independently by the patient. Proportions of agreement and Cohen’s kappa were calculated. In total, 73 patients agreed to participate. Overall, percentage agreement ranged from 83% to 100% (kappa = .65–.82). For important clinical signs (redness, swelling, ooze, pus and tracking), there were high levels of percentage agreement (99%–100%). The high level of agreement between nurse atient pairs make the instrument useful for assessing peripherally inserted central catheter–associated signs of localised infection, allergic or irritant dermatitis or dressing dislodgement in a community setting.
Publisher: Oxford University Press (OUP)
Date: 10-2008
Publisher: Cambridge Media
Date: 28-10-2020
DOI: 10.33235/VA.6.2.9-14
Publisher: Springer Science and Business Media LLC
Date: 26-07-2016
Publisher: BMJ
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 24-07-2020
Publisher: Mark Allen Group
Date: 27-04-2017
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH13111
Abstract: Objective To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. Methods A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Results Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8 h for 25% of the devices in situ. Conclusions The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices. What is known about the topic? Intravascular devices are associated with health care-related infections, including rare but serious bloodstream infections Measures for reducing healthcare-associated infection related to devices include surveillance with feedback. What does this paper add? This paper complements other surveillance data undertaken in similar-sized institutions with similar patients. Ongoing surveillance and education is required to maintain best clinical practice and management of devices. What are the implications for practitioners? Health care-associated infections are a serious problem and have negative outcomes for both patients and organisations. Intravascular devices may be associated with bloodstream infections, so prudent clinical care and management of devices is important. All devices should be assessed at least daily for their continued need and removed promptly if no longer required.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.IJNURSTU.2015.07.001
Abstract: Up to 85% of hospital in-patients will require some form of vascular access device to deliver essential fluids, drug therapy, nutrition and blood products, or facilitate s ling. The failure rate of these devices is unacceptably high, with 20-69% of peripheral intravenous catheters and 15-66% of central venous catheters failing due to occlusion, depending on the device, setting and population. A range of strategies have been developed to maintain device patency, including intermittent flushing. However, there is limited evidence informing flushing practice and little is known about the current flushing practices. The aim of the study was to improve our understanding of current flushing practices for vascular access devices through a survey of practice. A cross-sectional survey of nurses and midwives working in the State of Queensland, Australia was conducted using a 25-item electronic survey that was distributed via the local union membership database. A total of 1178 surveys were completed and analysed, with n=1068 reporting peripheral device flushing and n=584 reporting central device flushing. The majority of respondents were registered nurses (55%) caring for adult patients (63%). A large proportion of respondents (72% for peripheral, 742/1028 80% for central, 451/566) were aware of their facility's policy for vascular access device flushing. Most nurses reported using sodium chloride 0.9% for flushing both peripheral (96%, 987/1028) and central devices (75%, 423/566). Some concentration of heparin saline was used by 25% of those flushing central devices. A 10-mL syringe was used by most respondents for flushing however, 24% of respondents used smaller syringes in the peripheral device group. Use of prefilled syringes (either commercially prepared sterile or prefilled in the workplace) was limited to 10% and 11% respectively for each group. The frequency of flushing varied widely, with the most common response being pro re nata (23% peripheral and 21% central), or 6 hourly (23% peripheral and 22% central). Approximately half of respondents stated that there was no medical order or documentation for either peripheral or central device flushing. Flushing practices for vascular access device flushing appear to vary widely. Specific areas of practice that warrant further investigation include questions about the efficacy of heparin for central device flushing, increasing adherence to the recommended 10mL diameter syringe use, increased use of prefilled flush syringes, identifying and standardising optimal volumes and frequency of flushing, and improving documentation of flush orders and administration.
Publisher: SAGE Publications
Date: 02-04-2015
DOI: 10.5301/JVA.5000348
Abstract: To assess the effectiveness of four securement methods to prevent peripheral intravenous catheter (PIVC) failure. A single-centre, four-arm, randomised, controlled, non-blinded, superiority pilot trial was conducted in a tertiary referral hospital in Queensland (Australia), between November 2012 and January 2013. Adult patients, with a PIVC expected to remain in situ for ≥24 hours and admitted to general medical or surgical wards, were randomly allocated to standard polyurethane dressing (control, SPU), tissue adhesive (TA) with an SPU, bordered polyurethane dressing (BPU) or sutureless securement device (SSD) with an SPU, experimental groups. The primary endpoint was PIVC failure, defined as premature device removal before the end of therapy because of pain, blockage, leaking, accidental removal and local or catheter-related bloodstream infection. PIVCs were used for an average of 2.6 days across all study groups (n = 85). Catheter failure was lowest in the TA group (3/21, 14%) and highest in the control group (8/21, 38%), with BPU and SSD failure at 5/20 (25%) and 5/23 (22%), respectively. The adjusted hazard ratio of catheter failure was lowest in the TA group (0.50, 95% CI: 0.13-1.98), and then the BPU (0.52, 95% CI: 0.15-1.78) and SSD (0.61, 95% CI: 0.20-1.91) groups. No patient was suspected of a local or catheter-related bloodstream infection. Current SPU dressings alone do not prevent many cases of PIVC failure. TA appears promising as an innovative solution, but may not be suitable for all patients. A larger Australian National Health and Medical Research Council (NHMRC)-funded trial has commenced.
Publisher: American College of Physicians
Date: 21-11-2017
DOI: 10.7326/M17-2771
Publisher: Wiley
Date: 15-09-2013
Publisher: Wiley
Date: 23-01-2019
Publisher: SAGE Publications
Date: 30-08-2019
Abstract: Worldwide, there has been a shift in health care delivery, with an increasing emphasis on avoiding hospital admissions and providing treatment such as intravenous antibiotics for patients at home, using peripherally inserted central catheters (PICCs). However, there is inadequate data to demonstrate if rates of PICC failure are similar for hospital inpatients, currently understood to be between 7% and 36%, than those cared for at home. The objective of this study was to identify prevalence, dwell time, and complications associated with PICCs in the home setting. This single-center, retrospective cohort study of adults treated by the “Hospital in the Home” (HITH) program in Queensland, was conducted between June 1, 2017 and June 15, 2018. Clinical data were collected for patient and PICC characteristics. Variables were described as frequencies and proportions, means and standard deviations, or medians and interquartile ranges. In total, 304 patients treated by HITH during this timeframe, and 164 (54%) patients with 181 PICCs were included in this study. These patients were predominately male (n = 105, 64%), with a mean age of 54 years. The most common reason for admission was a wound infection and/or bone infection (n = 120, 33%). Most PICCs were single lumen (n = 120 67%), inserted in the basilic vein (n = 137 80%) by nurses (n = 122 67%). Peripherally inserted central catheter failure occurred in 10% (n = 19) the most common complications were dislodgement (n = 9 5%) and thrombosis (n = 4 2%). There were no confirmed catheter-related blood stream infections. Peripherally inserted central catheter failure rates are similar between hospitalized inpatients and those cared for at home.
Publisher: Wiley
Date: 05-10-2020
DOI: 10.1111/JAN.14565
Publisher: CSIRO Publishing
Date: 04-09-2019
DOI: 10.1071/AH18102
Abstract: Objective The aim of this study was to quantify the utilisation of vascular access devices in Queensland public hospitals and their associated cost. Methods Devices were broadly classified into peripheral intravenous catheters, central venous catheters and arterial lines. The number of catheters used was obtained from a central procurement department at Queensland Health and validated using Medicare Benefits Schedule (MBS) claims and/or hospital data from the Australian Institute of Health and Welfare for the same period. Resources consumed included equipment and staff time required to insert and remove catheters. Equipment costs were valued using negotiated hospital prices, and staff time was valued at the fixed industrial award wages in Australia or relevant MBS fees. Device maintenance costs (e.g. dressings) and costs of treating complications were excluded. Results Approximately 2.75 million vascular access devices were used in public hospitals in Queensland in 2016, at a total cost of A$59.14 million. This comprised a total equipment cost of around A$10.17 million and a total labour cost of A$48.85 million Conclusion Vascular access is an important component of healthcare expenditure. The present study is the first to characterise and cost vascular access devices in Queensland. Further research is needed on the costs of maintaining device function and of treating complications associated with vascular access. What is known about the topic? The cost of vascular access in Australia has previously been estimated from modelling, using various assumptions, or based on device utilisation in other countries. What does this paper add? For the first time, device utilisation for vascular access in Queensland has been quantified and costed. Results were obtained from reliable sources and validated against other databases. What are the implications for practitioners? Practitioners and managers may now provide accurate estimates about the cost of catheter failure, a potentially preventable problem that affects up to 50% of all catheters placed. Attaching costs to such failure may also stimulate research into how to reduce the problem.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2018
Publisher: Springer Science and Business Media LLC
Date: 14-09-2020
DOI: 10.1186/S13063-020-04699-Z
Abstract: To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants ( n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external cl (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group ( p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group ( p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Australia and New Zealand Clinical Trials Registry ACTRN12616001578493 . Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
Publisher: Cambridge Media
Date: 30-04-2019
DOI: 10.33235/VA.5.1.4-7
Publisher: Elsevier BV
Date: 09-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
DOI: 10.1097/NAN.0000000000000288
Abstract: This study was undertaken to calculate the incidence of 8 signs and symptoms used for the diagnosis of phlebitis with peripheral intravenous catheters, or short peripheral catheters, and the level of correlation between them. A total of 22 789 daily observations of 6 signs ( swelling, erythema, leakage, palpable venous cord, purulent discharge , and warmth ) and 2 symptoms ( pain and tenderness ) were analyzed of 5907 catheter insertion sites. Most signs and symptoms of phlebitis occurred only occasionally or rarely the incidence of tenderness was highest (5.7%). Correlations were mostly low warmth correlated strongly with tenderness, swelling , and erythema .
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJNURSTU.2018.10.006
Abstract: Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. Six hospitals (metropolitan and regional) in Queensland, Australia. The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1-50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5-306). The most common skin complications were bruising (peripheral n = 134, 3.7% central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296 2.9%), and dermatitis for central devices (n = 13 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices.
Publisher: Mark Allen Group
Date: 2015
Publisher: Wiley
Date: 27-10-2022
DOI: 10.1111/IJN.13110
Abstract: Despite pervasive need for peripheral intravenous catheters, insertion is often difficult, and approximately two thirds fail prematurely. Midline catheters are an alternative long peripheral catheter, inserted in the upper arm, ideal for patients with difficult access. The aim of this study is to test feasibility of the protocol and compare the efficacy and safety of midline catheters to peripheral intravenous catheters. A parallel‐group, pilot randomized controlled trial of adult medical/surgical hospitalized patients, from a single Australian referral hospital. Participants with difficult vascular access (≤2 palpable veins) and/or anticipated ≥5 days of peripherally compatible intravenous therapy were recruited between May 2019 and March 2020. Participants were randomized to (1) peripheral intravenous catheter or (2) midline catheter. Primary feasibility outcome measured eligibility, recruitment, protocol adherence, retention and attrition. Primary clinical outcomes measured device insertion failure and post‐insertion failure. In total, n = 143 participants (71 peripheral intravenous catheters and 72 midline catheters) were recruited n = 139 were analysed. Most feasibility criteria were met. Peripheral intravenous catheters had shorter functional dwell time, with higher incidence of post‐insertion failure compared to midline catheters. Midline catheters appear to be superior for patients with difficult vascular access or receiving prolonged intravenous therapy a large, multi‐centre trial to confirm findings is feasible.
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-042475
Abstract: Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications. A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve) (2) chlorhexidine gluconate-impregnated PICC (with external cl )) and one control group ((3) conventional polyurethane PICC (with external cl )). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure , a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication thrombotic complications infective complications adverse events (local or systemic reaction) PICC dwell time patient arent satisfaction and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI. Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published. ACTRN12619000022167.
Publisher: Wiley
Date: 29-08-2022
Abstract: The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present study aimed to critically appraise the quality of (i) assessment instruments and (ii) clinical practice guidelines (CPGs) or escalation pathways for identifying and managing patients with DIVA. Cochrane Central Register of Controlled Trials, EBSCO MEDLINE, EMBASE (OVID) and EBSCO CINAHL databases were searched on 22 March 2021. Studies describing a DIVA assessment measure, CPG or escalation pathway for PIVC insertion in adults (≥18 years of age) were included. Data were extracted using a standardised data extraction form including study design, type of resource and reported clinical outcomes. Quality of DIVA assessment instruments were reviewed using the COnsensus-based Standards for the selection of health Measurement Instruments checklist. Methodological quality of CPGs and escalation pathways was assessed using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument. Overall, 24 DIVA resources comprising 16 DIVA assessment instruments and nine CPGs or escalation pathways (including one combined assessment instrument and escalation pathway) were identified. Instruments commonly focused on vein visibility and palpability as indicators of DIVA. CPGs and escalation pathways unanimously recommended use of vessel visualisation technology for patients with or suspected of DIVA. Methodological quality of the resources was mixed. Consensus and standardisation of resources to identify DIVA and recommendations for managing patients with DIVA is limited. Adopting consistent, evidence-based CPGs, escalation pathways or DIVA assessment instruments may significantly improve clinical outcomes.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.EJON.2013.11.010
Abstract: The use of intravascular devices is associated with a number of potential complications. Despite a number of evidence-based clinical guidelines in this area, there continues to be nursing practice discrepancies. This study aims to examine nursing practice in a cancer care setting to identify nursing practice and areas for improvement respective to best available evidence. A point prevalence survey was undertaken in a tertiary cancer care centre in Queensland, Australia. On a randomly selected day, four nurses assessed intravascular device related nursing practices and collected data using a standardized survey tool. 58 inpatients (100%) were assessed. Forty-eight (83%) had a device in situ, comprising 14 Peripheral Intravenous Catheters (29.2%), 14 Peripherally Inserted Central Catheters (29.2%), 14 Hickman catheters (29.2%) and six Port-a-Caths (12.4%). Suboptimal outcomes such as incidences of local site complications, incorrect/inadequate documentation, lack of flushing orders, and unclean/non intact dressings were observed. This study has highlighted a number of intravascular device related nursing practice discrepancies compared with current hospital policy. Education and other implementation strategies can be applied to improve nursing practice. Following education strategies, it will be valuable to repeat this survey on a regular basis to provide feedback to nursing staff and implement strategies to improve practice. More research is required to provide evidence to clinical practice with regards to intravascular device related consumables, flushing technique and protocols.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.AJIC.2019.06.002
Abstract: Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated. A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified. Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture. The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.JCLINEPI.2009.02.003
Abstract: To compare the effectiveness of the STRATIFY falls tool with nurses' clinical judgments in predicting patient falls. A prospective cohort study was conducted among the inpatients of an acute tertiary hospital. Participants were patients over 65 years of age admitted to any hospital unit. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive values (NPV) of the instrument and nurses' clinical judgments in predicting falls were calculated. Seven hundred and eighty-eight patients were screened and followed up during the study period. The fall prevalence was 9.2%. Of the 335 patients classified as being "at risk" for falling using the STRATIFY tool, 59 (17.6%) did sustain a fall (sensitivity=0.82, specificity=0.61, PPV=0.18, NPV=0.97). Nurses judged that 501 patients were at risk of falling and, of these, 60 (12.0%) fell (sensitivity=0.84, specificity=0.38, PPV=0.12, NPV=0.96). The STRATIFY tool correctly identified significantly more patients as either fallers or nonfallers than the nurses (P=0.027). Considering the poor specificity and high rates of false-positive results for both the STRATIFY tool and nurses' clinical judgments, we conclude that neither of these approaches are useful for screening of falls in acute hospital settings.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.IDH.2019.03.001
Abstract: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.IJANTIMICAG.2022.106552
Abstract: Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase the PVC failure rate, risk profiles for many are unclear. To synthesize data from prospective PVC studies conducted between 2013 and 2019 to determine associations between common antimicrobials and PVC failure. A secondary analysis was undertaken of seven randomized controlled trials and two prospective cohort studies from three quaternary hospitals (two adult and one paediatric) in Australia between 2013 and 2019. The primary outcome was PVC failure due to vessel injury (occlusion, infiltration or extravasation) or irritation (pain or phlebitis). Associations between antimicrobial use and PVC failure were explored using multi-variable Cox regression. In total, 5252 PVCs (4478 patients) were analysed vessel injury and irritations occurred in 19% and 11% of all PVCs, respectively. Vessel injury was significantly associated with cefepime hydrochloride [hazard ratio (HR) 2.50 95% confidence interval (CI) 1.44-4.34], ceftazidime pentahydrate (HR 1.91, 95% CI 1.11-3.31), flucloxacillin sodium (HR 1.84, 95% CI 1.45-2.33), lincomycin hydrochloride (HR 1.67, 95% CI 1.10-2.52) and vancomycin hydrochloride (HR 1.73, 95% CI 1.25-2.40). Irritation was significantly associated with flucloxacillin sodium (HR 2.58, 95% CI 1.96-3.40). This study identified several antimicrobials associated with increased PVC failure, including some that were already known to be associated and some that had not been identified previously. Research is needed urgently to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure.
Publisher: Wiley
Date: 17-07-2015
DOI: 10.1111/JEP.12396
Abstract: Many peripheral intravenous catheter (PIVC) infusion phlebitis scales and definitions are used internationally, although no existing scale has demonstrated comprehensive reliability and validity. We examined inter-rater agreement between registered nurses on signs, symptoms and scales commonly used in phlebitis assessment. Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling, erythema, palpable venous cord, purulent discharge and warmth) were observed daily by two raters (a research nurse and registered nurse). These data were modelled into phlebitis scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed and expected agreements, Cohen's kappa, the maximum achievable kappa, prevalence- and bias-adjusted kappa were calculated. Two hundred ten patients were recruited across three hospitals, with 247 sets of paired observations undertaken. The second rater was blinded to the first's findings. The Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations), whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis). Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than two-thirds, 66.7%) levels of inter-rater agreement. Inter-rater agreement for phlebitis assessment signs/symptoms and scales is low. This likely contributes to the high degree of variability in phlebitis rates in literature. We recommend further research into assessment of infrequent signs/symptoms and the Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid, reliable and based on their ability to predict complications need exploration.
No related grants have been discovered for Nicole Marsh.