Intravascular Access

2018 ◽  
pp. 269-274
Author(s):  
Jenna Fine ◽  
Ndidi Nwokorie ◽  
Lia H. Lowrie
Keyword(s):  
Cognitive Ability ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Behavioral Modification ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Intravascular Catheters ◽  
Control Pain ◽  
Central Catheters ◽  
Intravascular Access

Vascular access is necessary for routine and emergent care of patients for delivery of fluids and medications. The vascular access devices (VADs) discussed here include peripheral intravascular catheters, intraosseous needles, peripherally inserted central catheters (PICC lines), and central venous catheters. VAD insertion can be painful and frightening for children, and their inherently smaller anatomy may also make the procedure more challenging. Children often require behavioral modification as well as medications to control pain and anxiety in order to tolerate placement of VADs. The sedationist must have a good knowledge of the demands of the procedure, the patient’s level of cooperation and cognitive ability, and pharmacologic resources available to aid in the performance of the procedure.

Letters

2008 ◽  
Vol 27 (6) ◽  
pp. 427-427
Author(s):  
Lee Shirland
Keyword(s):  
Vascular Access ◽  
Great Risk ◽  
Skin Closure ◽  
System State ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Dressing Change ◽  
Central Catheters

I am writing concerning an article titled “Neonatal Peripherally Inserted Central Catheters: Recommendations for Prevention of Insertion and Postinsertion Complications,” published in Vol. 27, No. 4 (July/August 2008), pages 245– 257. Of concern are Figures 3 and 4 on page 253 titled securing the catheter with adhesive skin closure strips and looping the catheter. The instructions and pictures demonstrate how to secure the catheter using skin closure strips and show the strips placed over the catheter. This is of great concern. The manufacturer’s recommendations on BD L-Cath System state the following on page 8 line 26, “Secure the catheter and dress the site with a sterile dressing. Tapes and securing devices should never be applied directly to the non-protected catheter.” This caution is echoed in the article titled “Tiny Patients, Tiny Dressings: A Guide to Neonatal PICC Dressing Change,” published in Advances in Neonatal Care, Vol. 8, No. 3, pages 141–162. The author states the following, “Some hospitals use skin closure strips. If these are utilized, manufacturer’s recommendations should be followed, and they should never be placed directly overlying the catheter to avoid catheter breakage and embolism.” The author supports this statement with the following reference, Frey AM. PICC complications in neonates and children. Journal of Vascular Access Devices. 1999: 17–26. It is clear that skin closure strips used to secure the peripherally inserted central catheter pose great risk and must never be applied directly over the catheter. Thank you for sharing this important information with your readers.

Open- vs Closed-Tip Valved Peripherally Inserted Central Catheters and Midlines: Findings from a Vascular Access Database

2015 ◽  
Vol 20 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Pietro Antonio Zerla ◽  
Antonio Canelli ◽  
Giuseppe Caravella ◽  
Alessandra Gilardini ◽  
Giuseppe De Luca ◽  
...  
Keyword(s):  
Vascular Access ◽  
Cost Reduction ◽  
Infectious Complications ◽  
Central Venous Catheters ◽  
Blood Component ◽  
Central Venous ◽  
Vascular Access Devices ◽  
Care Workers ◽  
Thrombotic Complications ◽  
Central Catheters

Abstract Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal.

Peripherally inserted central catheter placement in a multidisciplinary intensive care unit: A preliminary study demonstrating safety and procedural time in critically ill subjects

2020 ◽  
pp. 112972982092861
Author(s):  
Ryan J Smith ◽  
Rodrigo Cartin-Ceba ◽  
Julie A Colquist ◽  
Amy M Muir ◽  
Jeanine M Moorhead ◽  
...  
Keyword(s):  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Time Required ◽  
Central Catheters

Objective: Peripherally inserted central catheters are a popular means of obtaining central venous access in critically ill patients. However, there is limited data regarding the rapidity of the peripherally inserted central catheter procedure in the presence of acute illness or obesity, both of which may impede central venous catheter placement. We aimed to determine the feasibility, safety, and duration of peripherally inserted central catheter placement in critically ill patients, including obese patients and patients in shock. Methods: This retrospective cohort study was performed using data on 55 peripherally inserted central catheters placed in a 30-bed multidisciplinary intensive care unit in Mayo Clinic Hospital, Phoenix, Arizona. Information on the time required to complete each step of the peripherally inserted central catheter procedure, associated complications, and patient characteristics was obtained from a prospectively assembled internal quality assurance database created through random convenience sampling. Results: The Median Procedure Time, beginning with the first needle puncture and ending when the procedure is complete, was 14 (interquartile range: 9–20) min. Neither critical illness nor obesity resulted in a statistically significant increase in the time required to complete the peripherally inserted central catheter procedure. Three (5.5%) minor complications were observed. Conclusion: Critical illness and obesity do not delay the acquisition of vascular access when placing a peripherally inserted central catheter. Concerns of delayed vascular access in critically ill patients should not deter a physician from selecting a peripherally inserted central catheter to provide vascular access when it would otherwise be appropriate.

Peripherally Inserted Central Catheters and Nontunneled Central Venous Catheters

2020 ◽  
pp. 669-676.e2
Author(s):  
Jennifer L. Kissane ◽  
Joseph A. Hughes ◽  
Colin P. Cantwell ◽  
Peter N. Waybill
Keyword(s):  
Central Venous Catheters ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters
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