Training of Undergraduate Clinicians in Vascular Access: An Integrative Review

2012 ◽  
Vol 17 (3) ◽  
pp. 146-158 ◽  
Author(s):  
Evan Alexandrou ◽  
Lucie Ramjan ◽  
Jeff Murphy ◽  
Leanne Hunt ◽  
Vasiliki Betihavas ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Vascular Access ◽  
Search Strategy ◽  
Venous Access ◽  
Training Methods ◽  
Design Studies ◽  
Medical Practitioners ◽  
Staff Members ◽  
Methodologic Quality ◽  
Peripheral Venous Access

Abstract Introduction: Peripheral venous cannulas are predominantly inserted by nurses and medical practitioners. Placement and related care of such devices are one of the most frequently performed tasks by these staff members. Clinicians in training should be given ample opportunity to practice these skills before patient encounters begin. Aims: To identify the best available evidence on the training of undergraduate clinicians in peripheral venous access. Methods: We used an integrative literature review method that considered both experimental- and nonexperimental-design studies that addressed the issue of clinician peripheral venous access training of undergraduates. The electronic databases Medline, Embase, Ovid Nursing Database, British Nursing Index, Pre Medline, Mosby's Index, and CINAHL were searched using a predetermined search strategy. The Cochrane and Joanna Briggs databases were also searched along with the reference lists of published materials. Results: A total of 56 articles were retrieved using the defined search strategy. There were 11 experimental-design studies and 1 nonexperimental-design study selected for final review after independent assessment for methodologic quality. Retrieved articles found disparity between actual skill and student self-evaluation. Teaching methods varied with the use of traditional task trainers and high-fidelity simulation. No method was found to be superior. Conclusion: Skill acquisition in vascular access is an international issue and one that has been addressed in varying degrees. We identified heterogeneity in training methods that were tailored to institutional requirements and resources. Training in this skill is imperative to ensure competency before patient encounters.

scholarly journals Hospitalized children’s opinions about peripheral venous access process (PVAP)

2018 ◽  
Vol 15 (1) ◽  
pp. 243
Author(s):  
Nazan Çakırer Çalbayram ◽  
Sebahat Altundağ
Keyword(s):  
Vascular Access ◽  
Primary Caregivers ◽  
Research Problem ◽  
Venous Access ◽  
Structured Interview ◽  
Interview Method ◽  
Peripheral Venous Access ◽  
Qualitative Descriptive ◽  
The Universe ◽  
Process Method

Research problem/aim: This study was carried out to determine the thoughts of school-age (6-12 years old) children about peripheral venous access process. Method: The study was carried out in qualitative descriptive design using semi-structured interview method. The universe of the study was composed of children aged between 6 and 12 hospitalized in the aforementioned hospital. Findings: The children who were informed before the process said the warnings were, “take a deep breath, don’t move your hand, calm down”. The children reported that they felt “excitement, sadness, pain, and fear” while the vascular access intervention was being performed. It was observed that the children had many negative emotions and experiences about vascular access process. Conclusions: Children may need both physical and psychological support for invasive process, such as vascular access process. Nurses as primary caregivers should give this support to children.

scholarly journals Problems Associated with Vascular Access: An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 664-669 ◽  
Author(s):  
R. J. Singleton ◽  
R. K. Webb ◽  
G. L. Ludbrook ◽  
M. A. L. Fox
Keyword(s):  
Vascular Access ◽  
Vascular System ◽  
Central Venous Access ◽  
Blood Pressure Measurement ◽  
Air Embolism ◽  
Venous Access ◽  
Arterial Line ◽  
X Rays ◽  
Peripheral Venous Access ◽  
Peripheral Arterial

There were 65 incidents involving access to the vascular system amongst the first 2000 reported to the Australian Incident Monitoring Study. Thirty-three involved peripheral venous access (14 cases of extravascular extravasation, 8 of unintended arterial cannulation, 6 of disruptions to intravenous lines, and 5 of problems with infusion lines, taps, pumps and connectors). Eighteen cases involved central venous access (9 cases of arterial puncture with haematomas, 5 with morbidity and/or prolonged admission), 5 of catheter misplacement and pneumo- or hydro-thorax and 4 of problems arising from operator inexperience. Thirteen cases involved peripheral arterial acces (5 involved equipment problems (3 with possible air embolism), 3 of mistaking an arterial for a venous line (drugs were injected in 2), 3 of losing arterial lines or signals, and 2 in which the presence of an arterial line placed the patient at risk). The anaesthetist should always question the continued integrity of any vascular access system, even when it has recently been shown to be functioning, and the possibility of later “migration” and misplacement should always be borne in mind. Whenever possible, correct placement of the tip should be checked (e.g. by visual inspection of the site, use of test doses, aspiration of blood, pressure measurement, X-rays). When there is more than one line, all lines and sites of access (e.g. 3-way taps) should be clearly labelled and checked before anything is injected or infused.

Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists

2020 ◽  
pp. 112972982096622 ◽  
Author(s):  
Kirby R Qin ◽  
Mauro Pittiruti ◽  
Ramesh M Nataraja ◽  
Maurizio Pacilli
Keyword(s):  
Vascular Access ◽  
Venous Access ◽  
Common Indication ◽  
Electronic Survey ◽  
Peripheral Venous Access ◽  
General Recommendation ◽  
Peripheral Intravenous Access ◽  
Intravenous Catheters ◽  
Difficult Venous Access

Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.

Emergency Vascular Access (DRAFT)

2018 ◽  
Author(s):  
Rajagopala Padmanabhan ◽  
Holt N. Murray
Keyword(s):  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Rapid Response Team ◽  
Venous Access ◽  
Critically Ill Patient ◽  
Blood Products ◽  
Life Saving ◽  
Peripheral Venous Access ◽  
Response Team

Emergency resuscitation and stabilization of the critically ill patient is a cornerstone of patient care during a rapid response team (RRT) call. The establishment of vascular access, along with airway, breathing, and circulation management is pivotal for the delivery of fluid, blood products, and life-saving medications that can directly impact the morbidity and mortality of critically ill patients. Unfortunately, peripheral venous access may be difficult, if not impossible, to get in some patients. In these, and other select situations, excess time spent attempting to insert a peripheral line can delay essential therapies. In this chapter, the indications, types, and methods of establishing vascular access will be reviewed briefly.

scholarly journals Intramuscular ketamine to facilitate pediatric central vascular access

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 259-262 ◽  
Author(s):  
T. Kent Denmark ◽  
Jenny R. Hargrove ◽  
Lance Brown
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Emergency Physicians ◽  
Central Venous ◽  
Peripheral Venous Access

ABSTRACT Objectives: Obtaining prompt vascular access in young children presenting to the emergency department (ED) is frequently both necessary and technically challenging. The objective of our study was to describe our experience using intramuscular (IM) ketamine to facilitate the placement of central venous catheters in children presenting to our ED needing vascular access in a timely fashion. Methods: We performed a retrospective medical record review of all pediatric patients <18 years of age who presented to our tertiary care pediatric ED between May 1, 1998, and August 7, 2003, and underwent the placement of a central venous catheter facilitated by the use of IM ketamine. Results: Eleven children met our inclusion criteria. Most of the children were young and medically complicated. The children ranged in age from 6 months to 8 years. The only complication identified was vomiting experienced by an 8-year-old boy. Emergency physicians successfully obtained central venous access in all subjects in the case series. Conclusions: The use of IM ketamine to facilitate the placement of central venous catheters in children who do not have peripheral venous access appears to be helpful. Emergency physicians may find it useful to be familiar with this use of IM ketamine.

Consultation with the Specialist

1994 ◽  
Vol 15 (4) ◽  
pp. 157-159
Author(s):  
James Seidel
Keyword(s):  
Critically Ill ◽  
Health Care Providers ◽  
Vascular Access ◽  
Subcutaneous Fat ◽  
Venous Access ◽  
Infants And Children ◽  
Care Providers ◽  
Injured Child ◽  
Pediatric Resuscitation ◽  
Peripheral Venous Access

Achieving vascular access in infants and children is often a challenge for emergency medical technicians, nurses, and physicians. It is a vital intervention in the critically ill or injured child and is necessary for infusing medications and fluids and obtaining blood samples for laboratory analysis. It often takes more than 10 minutes to achieve venous access during pediatric resuscitation. The presence of subcutaneous fat, the small size of peripheral vessels, vasoconstriction, and the behavior of anxious and frightened infants and children often are barriers to successful intravenous line placement. Other factors that may affect success include: 1) the skill of the person performing the procedure, 2) immobilization of the patient and/or extremity, 3) the availability of small over-the-needle catheters, 4) the availability of all materials necessary to secure the line, and 5) the site of catheter placement. Critically ill or injured pediatric patients need rapid vascular access. Health-care providers, therefore, must understand the priorities for obtaining access to a vein. Peripheral venous access is a satisfactory route for infusions, but no more than 1 to 2 minutes should be spent attempting to establish peripheral intravenous access in ill or injured patients. A reasonable approach to vascular access in these patients is as follows: 1) Attempt peripheral access for 1 to 2 minutes

Ultrasound-guided vascular access in intensive/acute cardiac care

2015 ◽  
Author(s):  
Richard Paul
Keyword(s):  
Vascular Access ◽  
Posterior Wall ◽  
Venous Access ◽  
Cardiac Care ◽  
Complication Rates ◽  
International Consensus ◽  
Arterial Access ◽  
Fluid Delivery ◽  
Peripheral Venous Access ◽  
Acute Cardiac Care

Vascular access is an essential requirement for the care of the critically ill cardiac patient, being necessary for drug and fluid delivery and monitoring of a patient’s haemodynamic response to an instigated therapy. The most common vascular access procedures conducted in the acute cardiac care unit are central venous and peripheral venous access, and arterial cannulation. Traditional landmark methods are associated with complication rates, ranging from 18 to 40%, depending on the site of access. The use of ultrasound to guide venous and arterial access has been shown to reduce the incidence of complications, such as inadvertent arterial puncture and pneumothorax formation (venous) and posterior wall puncture (arterial), to reduce the time taken and number of attempts to place a catheter, and to reduce the incidence of complete failure to insert a vascular access device. Since 2002, international consensus groups have published recommendations that two-dimensional ultrasound guidance be the preferred method for elective and emergency internal jugular catheter insertion. This chapter explores the evidence for the use of ultrasound to guide vascular access across multiple sites of insertion and describes the basic equipment and techniques necessary for successful deployment.

Ultrasound‐based criteria for adequate peripheral venous access in therapeutic apheresis procedures

2021 ◽  
Author(s):  
Eric Salazar ◽  
Faaria Gowani ◽  
Francisco Segura ◽  
Heather Passe ◽  
Lamesha Seamster ◽  
...  
Keyword(s):  
Venous Access ◽  
Peripheral Venous Access

scholarly journals Peripheral Inotropes in Critically Ill Children: Is It Safe?

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110222
Author(s):  
Ravi K. Mooli ◽  
Kalaimaran Sadasivam
Keyword(s):  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Critically Ill Children ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.

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