scholarly journals O-OGC05 Every veneSection Counts – can we improve patient experience in high-risk upper gastointestinal surgery patients?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Richard Bentley ◽  
Edward Ireland ◽  
Nathan Griffiths ◽  
Bethan Beharall ◽  
Barry Paul ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Experience ◽  
Perioperative Complications ◽  
Intervention Group ◽  
High Risk Patient ◽  
Venous Access ◽  
Blood Sampling ◽  
Central Venous ◽  
Patient Journey ◽  
Operative Care

Abstract Background Patients with upper gastrointestinal (UGI) malignancy undergo major surgical resections resulting in significant postoperative inpatient stays. Central venous access is utilised to aid management of intraoperative physiology, immediate post-operative care and perioperative complications, which are often complex. Central venous catheters (CVC) and peripheral intravenous (IV) cannulae have a relatively short safe duration; consequently these patients undergo numerous unpleasant venous access attempts. Our aim was to optimise quality of care and patient satisfaction in this high-risk patient group, by inserting Peripherally Inserted Central Catheters (PICCs) pre-operatively to facilitate administration of intravenous (IV) medications, fluids and perioperative blood sampling. Methods We reviewed venous access management in this group from October 2019 to May 2020;recording numbers of IV cannuale, CVCs and any associated complications. From September 2020, all patients deemed high-risk, undergoing a major UGI resection were offered a PICC, inserted pre-operatively. We recorded data on use of CVCs and alternative venous access devices, peripheral venous stabs, complications and overall patient experience. Results Over the first 6 month period we sited 30 PICCs - significantly fewer patients required a perioperative CVC (9% vs 64%) in the PICC group and these lines remained in situ for much longer than CVCs (mean 17 days vs 4.7 days). The PICC group required fewer peripheral cannulae (mean 2.73 vs 5.95 per patient). One patient suffered deep vein thrombosis (DVT) but there were no other adverse consequences. Two patients (9%) were treated for fast ventricular response to Atrial Fibrillation successfully on their surgical ward, with IV Amiodarone via their PICC, negating need for critical care admission. Patients in the baseline study required peripheral stabs for blood sampling most days of their inpatient stay (median 12.5 days), whereas the majority of samples were taken from PICCs in the post-intervention group. Satisfaction scores were high in 100% of cases. Conclusions The introduction of PICCs in our high-risk UGI patients has been a huge success, positively influencing the patient journey. There are demonstrable outcome benefits with reduction in CVCs, peripheral cannulations and phlebotomy attempts. In addition, it has facilitated easier and timelier perioperative administration of IV fluids and medication, optimising patients’ experiences and care.

Long-Term Central Venous Access in Pediatric Patients at High Risk: Conventional versus Antibiotic–Impregnated Catheters

2014 ◽  
Vol 25 (3) ◽  
pp. 411-418 ◽  
Author(s):  
Kevin M. Baskin ◽  
Christopher Hunnicutt ◽  
Megan E. Beck ◽  
Elan D. Cohen ◽  
John J. Crowley ◽  
...  
Keyword(s):  
High Risk ◽  
Pediatric Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous

A step-by-step guide to placing a central venous jugular catheter

2020 ◽  
Vol 25 (7) ◽  
pp. 1-4
Author(s):  
Delphine Le Chevallier
Keyword(s):  
Veterinary Medicine ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Sampling ◽  
Seldinger Technique ◽  
Peripheral Vein ◽  
Central Venous

Placing a central venous jugular catheter is a valuable technique. The method used is the modified Seldinger technique (over the wire), which is also used to place chest drains. While intravenous catheterisation of a peripheral vein is common practice in veterinary medicine, critically ill patients may require central venous access if peripheral access is not possible. This is also useful when large volumes of fluid are required, for example for administration of irritant drugs or for parenteral nutrition, or for regular blood sampling.

scholarly journals Health professionals' lack of knowledge of central venous access devices: the impact on patients

2019 ◽  
Vol 28 (14) ◽  
pp. S4-S14
Author(s):  
Linda J Kelly ◽  
Austyn Snowden ◽  
Ruth Paterson ◽  
Karen Campbell
Keyword(s):  
Patient Experience ◽  
Online Survey ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Doctoral Study ◽  
Study Objective ◽  
Disease Experience ◽  
Venous Access Device ◽  
The Impact

Background: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. Aim: the study objective was to uncover the global, cross-disease experience of patients with CVADs. Method: an online survey was sent to an international sample of people living with CVADs. Findings: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. Conclusion: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.

scholarly journals Deep vein thrombosis risk stratification in intensive care unit patients: a pressing need

2020 ◽  
Vol 8 (2) ◽  
pp. 406
Author(s):  
Viral B. Patel ◽  
Labani M. Ghosh ◽  
Bhalendu Vaishnav
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Risk Stratification ◽  
Central Venous Access ◽  
Venous Access ◽  
P Value ◽  
Central Venous ◽  
Assessment Score ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU.  SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.

scholarly journals Virtual Reality as an Adjunct to Anesthesia in the Operating Room

2019 ◽  
Author(s):  
Adeel Ahmad Faruki ◽  
Thy Nguyen ◽  
Samantha Proeschel ◽  
Nadav Levy ◽  
Jessica Yu ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Patient Experience ◽  
Standard Care ◽  
Perioperative Complications ◽  
Controlled Trial ◽  
Intervention Group ◽  
Care Practice ◽  
Current Standard ◽  
Propofol Sedation

Abstract Background Advancements in virtual reality (VR) technology have resulted in its expansion into healthcare. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience. Methods In this single-center randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments that will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if/when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the post-anesthesia care unit, overall patient satisfaction and postoperative functional outcomes. Discussion It is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result of this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple procedure types. This could lead to a change in practice, with the introduction of a non-pharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience.

scholarly journals Virtual reality as an adjunct to anesthesia in the operating room

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Adeel Faruki ◽  
Thy Nguyen ◽  
Samantha Proeschel ◽  
Nadav Levy ◽  
Jessica Yu ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Patient Experience ◽  
Standard Care ◽  
Perioperative Complications ◽  
Controlled Trial ◽  
Intervention Group ◽  
Care Practice ◽  
Postanesthesia Care Unit ◽  
Propofol Sedation

Abstract Background Advancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience. Methods In this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes. Discussion It is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience. Trial registration ClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.

scholarly journals Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Arnaud Devriendt ◽  
Emmanuel Tran-Ngoc ◽  
Philippe Gottignies ◽  
José Castro-Rodriguez ◽  
Oliver Lomas ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Central Venous Access ◽  
High Risk Patient ◽  
Venous Access ◽  
Percutaneous Closure ◽  
Closure Device ◽  
Central Venous ◽  
Jude Medical ◽  
Vertebral Arteries ◽  
The Right

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

Risk of Thrombosis with Different Approaches to Central Venous Access During Acquired Asparaginase Related Antithrombin Deficiency in Children with Leukemia.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2241-2241
Author(s):  
Susanna Ranta ◽  
Mats Heyman ◽  
Kirsi Jahnukainen ◽  
Mervi Taskinen ◽  
Ulla M. Saarinen-Pihkala ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Thrombotic Event ◽  
Intervention Group ◽  
Venous Access ◽  
Control Group ◽  
Central Venous ◽  
Children's Hospital ◽  
On Demand ◽  
Significant Difference ◽  
Children’S Hospital

Abstract Abstract 2241 Background Children with acute lymphoblastic leukemia (ALL) have several risk factors for thrombosis including asparaginase related acquired antithrombin (AT) deficiency and central venous catheters (CVCs). Both external tunneled and internal CVCs (tunneled, fully implantable devices known as ports) are used to provide reliable venous access. After introduction of a new ALL protocol with prolonged continuous asparaginase treatment aiming at approximately 30 weeks depletion of asparagine more symptomatic thromboses than expected were observed at the Children's Hospital, Helsinki University Central Hospital, Finland. To ensure asparaginase treatment and prevent thromboses an on-demand AT substitution regimen was adopted. Previous studies have described AT substitution during ALL induction; this is the first description and evaluation of on-demand AT substitution over a longer period of time in children. Aim The aim of this study is to describe the prolonged on-demand AT substitution practice in Helsinki during depletion of asparagine from the blood with PEG-ASP and to compare experiences from two Nordic pediatric oncology centers (Children's Hospital in Helsinki and the Astrid Lindgren Children's Hospital Karolinska University Hospital, in Stockholm, Sweden) with the same leukemia protocol but different approaches to central venous access. Procedure All Finnish children with ALL and external tunneled CVCs diagnosed at Children's Hospital in Helsinki between May 2008 and November 2011 (n=38) were compared with Swedish children with ALL and internal CVCs treated concurrently with the same ALL protocol (n=39). Children treated in Helsinki according to the standard or intermediate risk NOPHO-ALL 2008 protocol after initiation of the AT substitution regiment received AT concentrate when their AT level decreased below 55% (the intervention group, n=25). The thrombosis rate and laboratory parameters were compared with children treated earlier in the same unit (the control group, n=10). Results In Helsinki, 2/10 (20%) children in the control group had 3 symptomatic thromboses and 2/25 (8%) children in the intervention group with on-demand AT substitution had one symptomatic thrombotic event each. Both thromboses in the intervention group were associated with concomitant steroid treatment. In the intervention group 14/25 (56%) received AT concentrate (median number of infusions 3, range 1–17). Altogether, 4/38 Finnish patients with external CVCs and 0/39 Swedish patients with internal CVCs had thromboses (Mann Whitney U test, p=0.039) in spite of similar exposure to asparaginase and low antithrombin. A significant difference was also observed in the use of tissue plasminogen activator (tPA): 28/38 Swedish patients had received tPA at least once to restore dysfunctional CVCs (usually loss of the ability to withdraw blood) compared to 2/38 Finnish patients (Mann Whitney U test, p≤0.001). Conclusions Most children are exposed to low AT levels during ASP treatment predisposing to thrombosis especially with concomitant steroids. Larger studies are needed to evaluate the benefit of prophylactic antithrombin treatment. Internal CVCs and tPA may be beneficial in preventing symptomatic thrombosis during leukemia treatment. Disclosures: No relevant conflicts of interest to declare.

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