Tunnelling a midline catheter: When the traffic light shifts from yellow to green

2018 ◽  
Vol 19 (6) ◽  
pp. 667-671
Author(s):  
Adam Fabiani ◽  
Lorella Dreas ◽  
Gianfranco Sanson
Keyword(s):  
Insertion Site ◽  
Venous Catheter ◽  
Venous Access ◽  
Axillary Vein ◽  
Traffic Light ◽  
Exit Site ◽  
Peripheral Venous Catheter ◽  
Ultrasound Guide ◽  
Ultrasound Evaluation ◽  
Difficult Venous Access

Introduction: A safe, largely used practice for difficult venous access patients is positioning a catheter in deeper veins under ultrasound guide. However, the risk of complications is increased when there is a high catheter-to-vein ratio or when the insertion site is in a zone with particular anatomical/physiological characteristics. Case description: A 60-year-old woman admitted to a post-operative intensive care unit after cardiac surgery had a complicated post-operative course. After the removal of a central venous catheter, it was necessary to insert a midline catheter. A complete ultrasound evaluation showed that only the axillary vein was suitable for direct cannulation. To avoid creating an exit site in the axillary cavity, the decision was made to tunnel the catheter to locate an exit site in a safer position. A guidewire was introduced through a needle in the axillary vein. A tunnel was created using a subcutaneous injection of lidocaine. A 14 G/13.3 cm peripheral venous catheter was inserted in the subcutaneous tract. A 4 Fr/20 cm catheter was introduced through the peripheral venous catheter and moved to the axillary vein through the previously inserted sheath. No acute complications occurred. The catheter was accessed several times a day during the period following its insertion to infuse drugs and take blood samples. It was removed 50 days after its placement because it was no longer needed. No symptomatic thrombosis or infections occurred. Conclusion: The placement of the tunnelled midline catheter is shown to be a safe and effective way to ensure vascular access for almost 2 months.

Higher success rates and satisfaction in difficult venous access patients with a guide wire–associated peripheral venous catheter

2015 ◽  
Vol 33 (12) ◽  
pp. 1742-1744 ◽  
Author(s):  
Gerardo Chiricolo ◽  
Andrew Balk ◽  
Christopher Raio ◽  
Wendy Wen ◽  
Athena Mihailos ◽  
...  
Keyword(s):  
Guide Wire ◽  
Venous Catheter ◽  
Venous Access ◽  
Success Rates ◽  
Peripheral Venous Catheter ◽  
Difficult Venous Access

scholarly journals Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 611
Author(s):  
Aitana Guanche-Sicilia ◽  
María Sánchez-Gómez ◽  
María Castro-Peraza ◽  
José Rodríguez-Gómez ◽  
Juan Gómez-Salgado ◽  
...  
Keyword(s):  
Venous Catheter ◽  
Venous Access ◽  
Medication Administration ◽  
Volume Control ◽  
Nursing Interventions ◽  
Intravenous Therapy ◽  
Treatment Protocols ◽  
Peripheral Venous Catheter ◽  
Treatment And Prevention ◽  
Prevention And Treatment

The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.

scholarly journals Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Goodness Of Fit ◽  
Insertion Site ◽  
Healthcare Providers ◽  
Venous Catheter ◽  
Goodness Of Fit Test ◽  
Peripheral Venous Catheter ◽  
Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

A new device for ultrasound-guided peripheral venous access

2018 ◽  
Vol 20 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Lucio Brugioni ◽  
Marco Barchetti ◽  
Giovanni Tazzioli ◽  
Roberta Gelmini ◽  
Massimo Girardis ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Femoral Vein ◽  
Venous Catheter ◽  
Venous Access ◽  
External Jugular Vein ◽  
Axillary Vein ◽  
Rapid Infusion ◽  
Serious Adverse Events ◽  
New Device ◽  
Peripheral Venous Access

Background: In patients with difficult peripheral venous access, alternative techniques require expertise and are invasive, expensive, and prone to serious adverse events. This brought us to designing a new venous catheter (JLB® Deltamed, Inc.) for the cannulation of medium and large bore veins; it is echogenic, and available in different lengths (60 / 70 / 80 mm) and Gauges (14 / 16 / 17 / 18). Methods: We led a multi-center observational convenience sampling study to evaluate safety and effectiveness of JLB. Data was collected from June 2015 to February 2018. Inclusion criteria were age ⩾ 18, difficulty in obtaining superficial venous access in the veins of the arm, need for rapid infusion, or patient’s preference. Results: We enrolled 1000 patients, mean age 66.8 years. In total, 951 (95.1%) had the device placed in internal jugular vein, 28 in basilic or cephalic vein, 15 in femoral vein, 5 in axillary vein (infra-clavicular tract), and 1 in the external jugular vein. The procedure was performed by attending physicians or emergency medicine residents under US guidance. Mean procedure time (from disinfection to securing) was approximately 240 s. Mean attempts number was 1.21. Early complications (<24 h) occurred in four patients, consisting in two soft tissue hematoma, one phlebitis, and one atrial tachyarrhythmia. No major complications (such as pneumothorax) were reported. Mean indwelling time was 168 h (7 days); early occlusion/dislocation occurred in four cases. Conclusion: According to preliminary data, the application of JLB appears to be safe, cost-effective, and rapid to place bedside.

A novel technique of axillary vein puncture involving peripherally inserted central venous catheters for a small basilic vein

2018 ◽  
Vol 19 (3) ◽  
pp. 311-315 ◽  
Author(s):  
Fumito Saijo ◽  
Yoshinobu Odaka ◽  
Mitsuhisa Mutoh ◽  
Yu Katayose ◽  
Hiromi Tokumura
Keyword(s):  
Small Diameter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Axillary Vein ◽  
Basilic Vein ◽  
Central Venous ◽  
Puncture Site ◽  
Peripheral Venous Catheter ◽  
Brachial Vein ◽  
Subcutaneous Tunnel

Purpose: Peripherally inserted central venous catheters are some of the most useful devices for vascular access used globally. Peripherally inserted central venous catheters have a low rate of fatal mechanical complications when compared to non-tunnel central venous catheters. However, as peripherally inserted central venous catheter access requires a smaller vein, there is a high risk of thrombosis. The axillary vein (confluence of the basilic and brachial veins) can serve as an access for cannulation. Moreover, as this vein is larger than the basilic or brachial vein, it might be a superior option for preventing thrombosis. The risk of catheter-related bloodstream infection should be considered when the puncture site is at the axillary fossa. The aim of this study was to present our new protocol involving peripherally inserted central venous catheters (non-tunneled/tunneled) and a tunneling technique and assess its feasibility and safety for improving cannulation and preventing thrombosis and infection. Methods: The study included 20 patients. The axillary vein in the upper arm was used for peripherally inserted central venous catheters in patients with a small-diameter basilic vein (<3 mm). When the puncture site was in the axillary fossa, a subcutaneous tunnel of about 3 cm was constructed easily using a peripheral venous catheter. Results: The observed catheter duration was 645 days (median ± standard deviation, 26 ± 22.22 days). Catheterization was successful in all cases, however, two accidental dislodgements were identified. No fatal or serious complications were observed after catheterization. Conclusion: Our new protocol for axillary peripherally inserted central venous catheters/tunneled axillary peripherally inserted central venous catheters use for a small-diameter basilic vein is safe and feasible.

scholarly journals NURSING PRACTICES IN PERIPHERAL VENOUS CATHETER: PHLEBITIS AND PATIENT SAFETY

2019 ◽  
Vol 28 ◽  
Author(s):  
Anabela de Sousa Salgueiro-Oliveira ◽  
Marta Lima Basto ◽  
Luciene Muniz Braga ◽  
Cristina Arreguy-Sena ◽  
Michele Nakahara Melo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Participant Observation ◽  
Scientific Evidence ◽  
Insertion Site ◽  
Venous Catheter ◽  
Patient Characteristics ◽  
Structured Interviews ◽  
Hospital Data ◽  
Peripheral Venous Catheter ◽  
Data Content

ABSTRACT Objective: to understand the nursing practices related to peripheral venous catheter and to identify deviations related to the scientific evidence regarding the prevention of phlebitis. Method: qualitative study with data collection by means of participant observation techniques and semi-structured interviews, with 26 and 15 nurses, respectively, from a Portuguese hospital. Data content analysis was performed. Results: In the category “nursing actions”, nursing practices related to: selection of catheter insertion site and its caliber size, evaluation of insertion site for signs of inflammation, insertion site dressing, disinfection of accessories, hand hygiene and patient participation in care emerged. There were situations of deviations in these practices in relation to scientific evidence. Conclusion: Nursing practices presented deviations in relation to scientific evidence, and were influenced by the size of the institution, patient characteristics, and lack of knowledge of nurses regarding certain actions that pose a risk to patient safety. The creation of protocols and the implementation of continuous education are fundamental for the acquisition of competencies by nurses, for correcting deviations and providing a safe quality nursing care to the patient.

scholarly journals Role and Responsibility of Nurses in Central Line - Insertion and Maintenance

2021 ◽  
Vol 8 (9) ◽  
pp. 252-260
Author(s):  
R. Surendra Naik ◽  
Avadhesh Kumar Yadav ◽  
Rajendra Kumar Sahu
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Vein ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Axillary Vein ◽  
Central Venous ◽  
Central Line Insertion ◽  
Hematoma Formation ◽  
Line Insertion

Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters. Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion. Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion. Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion. Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis. Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures. Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique. Keywords: CVC, Central Line, Central venous catheter.

scholarly journals ANALYSIS OF NURSING CARE TO USERS OF PERIPHERAL VENOUS ACCESS

2018 ◽  
Vol 4 ◽  
Author(s):  
Alana Oliveira Porto ◽  
Carla Bianca De Matos Leal ◽  
Dieslley Amorim De Souza ◽  
Jéssica Lane Pereira Santos
Keyword(s):  
Nursing Care ◽  
Venous Catheter ◽  
Venous Access ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Professional Identification ◽  
Peripheral Venous Catheter ◽  
Peripheral Venous Access

Objective: To analyze the nursing care provided to users of peripheral venous catheter. Method: Descriptive, cross-sectional study, performed at a mid-sized hospital situated in the high productive backcountry of Bahia, whose participants were surgical patients using peripheral venous catheters for more than 72 hours. Results: 103 patients were included; 15.5% of the bandages were dirty and/or wet, 40.8% had no date of insertion, 58.3% had no professional identification, 34.9% showed signs of infection, 50.4% did not have records on the chart and 33% presented bacterial growth. Conclusion: Nursing care to users of peripheral venous catheters has not been adequate, resulting in preventable complications when considering scientific recommendations for care with peripheral venous access.

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