scholarly journals 622. Evaluation of Vascular Access Device Selection in Patients Discharged on Outpatient Parenteral Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S413-S414
Author(s):  
Jessica Hu ◽  
Lauren Dutcher ◽  
Vasilios Athans ◽  
Shawn Binkley ◽  
Justin Harris ◽  
...  
Keyword(s):  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Secondary Outcome ◽  
Patient Specific ◽  
National Guidelines ◽  
Access Device ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Increased Risk ◽  
Multivariable Regression ◽  
Vascular Access Device

Abstract Background Selection of a vascular access device (VAD) is an important consideration for patients receiving outpatient parenteral antimicrobial therapy (OPAT). Midline catheters (MC) and peripherally inserted central catheters (PICC) are the most commonly placed VADs, with the former recommended by national guidelines to be used for durations no longer than two weeks. These recommendations, however, are based on limited data from heterogeneous populations. As such, we aim to further characterize VAD-associated complications specifically in patients receiving antimicrobials. Methods We conducted a retrospective cohort study that included adult patients discharged on OPAT with a newly inserted MC or PICC between January 2020 and August 2020. Patients with non-OPAT VAD indications were excluded. The primary outcome was the incidence of VAD-associated complications, which was further assessed by type and severity. The secondary outcome was time to complication. Multivariable Poisson regression was used to assess the association between VAD type and incidence of VAD-associated complications. Results A total of 190 encounters from 181 patients were included for analysis. Baseline demographics are detailed in Table 1. Despite a higher number of complications in the PICC group, rates per 1000 VAD days were not significantly different between VAD types (Table 2). Median time to first complication was 17 days in the overall cohort. Multivariable regression analysis showed those with a dermatologic history had a four-fold increased risk for VAD-associated complications (Table 3). VAD type was not independently associated with the risk of developing a complication. Conclusion Our results suggest that the development of VAD-associated complications was strongly associated with patients’ dermatologic history. To our knowledge, dermatologic history has not been previously identified as a risk factor for VAD-associated complications. Thorough assessment of patient-specific risk factors can inform optimal VAD selection for patients discharged on OPAT. Further studies are needed to assess the safety of MC for extended OPAT use. Disclosures All Authors: No reported disclosures

scholarly journals Predictors of adverse outcomes using a multidimensional nursing assessment in an Italian community hospital

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249630
Author(s):  
Beatrice Gasperini ◽  
Gilda Pelusi ◽  
Annamaria Frascati ◽  
Donatella Sarti ◽  
Franco Dolcini ◽  
...  
Keyword(s):  
Vascular Access ◽  
Community Hospital ◽  
Patient Characteristics ◽  
Nursing Assessment ◽  
Vascular Access Devices ◽  
Acute Hospitalization ◽  
Access Device ◽  
Risk Of Death ◽  
Increased Risk ◽  
Vascular Access Device

Background There is growing evidence about the role of nurses in patient outcomes in several healthcare settings. However, there is still a lack of evidence about the transitional care setting. We aimed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during community hospital stay. Methods A retrospective observational study was performed on patients consecutively admitted to a community hospital (CH) in Loreto (Ancona, Italy) between January 1st, 2018 and May 31st, 2019. The nursing assessment included sociodemographic characteristics, functional status, risk of falls (Conley Score) and pressure damage (Norton scale), nursing diagnoses, presence of pressure sores, feeding tubes, urinary catheters or vascular access devices and comorbidities. Two logistic regression models were developed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during CH stay. Results We analyzed data from 298 patients. The mean age was 83 ± 9.9 years; 60.4% (n = 180) were female. The overall mean length of stay was 42.8 ± 36 days (32 ± 32 days for patients who died and 33.9 ± 35 days for patients who had an acute hospitalization, respectively). An acute hospitalization was reported for 13.4% (n = 40) of patients and 21.8% (n = 65) died. An increased risk of death was related to female sex (OR 2.25, 95% CI 1.10–4.62), higher Conley Score (OR 1.19; 95% CI 1.03–1.37) and having a vascular access device (OR 3.64, 95% CI 1.82–7.27). A higher Norton score was associated with a decreased risk of death (OR 0.71, 95% CI 0.62–0.81). The risk for acute hospitalization was correlated with younger age (OR 0.94, 95% CI 0.91–0.97), having a vascular access device (OR 2.33, 95% CI 1.02–5.36), impaired walking (OR 2.50, 95% CI 1.03–6.06) and it is inversely correlated with a higher Conley score (OR 0.84, 95% CI 0.77–0.98). Conclusion Using a multidimensional nursing assessment enables identification of risk of nearness of end of life and acute hospitalization to target care and treatment. The present study adds further knowledge on this topic and confirms the importance of nursing assessment to evaluate the risk of patients’ adverse outcome development.

scholarly journals Safety of Outpatient Parenteral Antimicrobial Therapy in Nonagenarians

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Nabin K Shrestha ◽  
Caitlin Blaskewicz ◽  
Steven M Gordon ◽  
Angela Everett ◽  
Susan J Rehm
Keyword(s):  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Negative Binomial ◽  
Drug Event ◽  
Old Patients ◽  
Younger Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Risk Of Death ◽  
Increased Risk ◽  
Access Complications

Abstract Background Although widely accepted for adults, the safety of outpatient parenteral antimicrobial therapy (OPAT) in very old patients has not been examined. Methods Nonagenarians (age ≥90 years) discharged from the hospital on OPAT over a 5-year period were identified from the Cleveland Clinic OPAT Registry. Three matched controls (<90 years) were selected for each nonagenarian. Times to OPAT-related emergency department (ED) visit and OPAT-related readmission were compared across the 2 groups in multivariable subdistribution proportional hazards competing risks regression models. Incidence of adverse drug events and vascular access complications were compared using negative binomial regression. Results Of 126 nonagenarians and 378 controls, 7 were excluded for various reasons. Among the remaining 497 subjects, 306 (62%) were male, 311 (63%) were treated for cardiovascular or osteoarticular infections, and 363 (73%) were discharged to a residential health care facility. The mean (SD) ages of nonagenarians and controls were 92 (2) and 62 (16) years, respectively. Compared with matched controls, being a nonagenarian was not associated with increased risk of OPAT-related ED visit (hazard ratio [HR], 0.77; 95% CI, 0.33–1.80; P = .55), OPAT-related readmission (HR, 0.78; 95% CI, 0.28–2.16; P = .63), adverse drug event from OPAT medications (incidence rate ratio [IRR], 1.00; 95% CI, 0.43–2.17; P = .99), or vascular access complications (IRR, 0.66; 95% CI, 0.27–1.51; P = .32). Nonagenarians had a higher risk of death overall (HR, 2.64; 95% CI, 1.52–4.58; P < .001), but deaths were not from OPAT complications. Conclusions Compared with younger patients, OPAT in nonagenarians is not associated with higher risk of OPAT-related complications. OPAT can be provided as safely to nonagenarians as to younger patients.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

Developing an OPAT service that meets the ever-changing needs of patients

2021 ◽  
Vol 30 (2) ◽  
pp. S12-S14
Author(s):  
Elizabeth Wilson
Keyword(s):  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy

Elizabeth Wilson, Lead Nurse, Outpatient Parenteral Antimicrobial Therapy, Manchester University NHS Foundation Trust ( [email protected] ), BJN Awards 2020 Vascular Access Nurse of the Year runner-up

Universal adhesive vascular access securement with Grip-Lok devices

2020 ◽  
Vol 29 (8) ◽  
pp. S28-S33
Author(s):  
Andrew Barton
Keyword(s):  
Vascular Access ◽  
Best Practice ◽  
Skin Irritation ◽  
Cost Effective ◽  
Universal Adhesive ◽  
Vascular Access Devices ◽  
Access Device ◽  
Vascular Access Device ◽  
Reliable Solution ◽  
Medical Adhesive

The use of sutureless, adhesive securement devices in vascular access has become recommended as best practice, because they are a cost-effective, reliable solution. After a vascular access device has been inserted, catheter securement is one of the most important aspects of care and maintenance. The Grip-Lok® range offers secure, comfortable adhesive securement for all types of vascular access devices. The products use hypoallergenic medical adhesive, which reduces the risk of skin irritation and provides a reliable, adaptable alternative to suturing.

Reassessing standards of vascular access device care: a follow-up audit

2019 ◽  
Vol 28 (8) ◽  
pp. S4-S12
Author(s):  
Rose McGuire ◽  
Ellen Norman ◽  
Iain Hayden
Keyword(s):  
Vascular Access ◽  
Access Device ◽  
Vascular Access Device

Optimizing vascular-access device decision-making in the era of midline catheters

2019 ◽  
Vol 40 (6) ◽  
pp. 674-680 ◽  
Author(s):  
Kelly A. Cawcutt ◽  
Richard J. Hankins ◽  
Teresa A. Micheels ◽  
Mark E. Rupp
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Narrative Review ◽  
Central Venous ◽  
Access Device ◽  
Vascular Access Device ◽  
Intravenous Catheters

AbstractThis narrative review addresses vascular access device choice from peripheral intravenous catheters through central venous catheters, including the evolving use of midline catheters. The review incorporates best practices, published algorithms, and complications extending beyond CLABSI and phlebitis to assist clinicians in navigating complex vascular access decisions.

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