Drug therapy and vascular devices used by patients hospitalized for COVID-19: a descriptive study / Terapia medicamentosa e dispositivos vasculares utilizados por doentes hospitalizados para a COVID-19: um estudo descritivo

To describe drug therapy and types of vascular access adopted in the treatment of patients with COVID-19 and admitted to the clinical wards of a university hospital, a referential institution for COVID-19 in Rio de Janeiro, Brazil. Descriptive, retrospective documentary study with a quantitative approach. The sample consisted of 243 electronic medical records from hospitalized patients with a laboratory-confirmed diagnosis of COVID-19, between April and June 2020. The selection of participants took place by intentional non-probabilistic sampling. Peripheral venous access was the mostly applied in 83.5% of the patients. The mostly used classes of drugs were analgesics, (81.9%), followed by antiemetics (70.4%), and antihypertensives (51.9%). For medications directed to COVID-19, azithromycin, oseltamivir, ceftriaxone, and hydroxychloroquine stands out with 67.5%, 58.8%, 50.2% and 27.2%, respectively. Regarding the treatment directed to COVID-19, the medications mostly taken were azithromycin and hydroxychloroquine, justified to a large extent by being recommended by the Ministry of Health in the treatment, according to signs and symptoms (Brazil, 2020). Patients treated with the medications described had good recovery from the clinical condition. Thus, studies based on randomized clinical trials are suggested to prove the efficacy of drug therapies, including their combination.

Intrinsic and extrinsic factors associated with phlebitis in hospitalized patients: Systematic Review [Factores intrínsecos y extrínsecos asociados a flebitis en pacientes hospitalizados: Revisión Sistemática]

Nursing care in central and peripheral venous access is part of nursing work, and the quality of care is affected by the presence of phlebitis in various hospitalization areas. Therefore, factors related to phlebitis are identified. Objective: To analyze the development of scientific evidence on intrinsic and extrinsic factors associated with phlebitis in hospitalized patients. Methodology: A literature search was carried out in databases over the last ten years. There was no language restriction, studies in English, Spanish and Portuguese published in full-text indexed journals were included. A critical analysis of each selected article was carried out, creating a matrix for ordering and categorizing. Results: From a total of 64 articles, 9 were included of which 2 were English and 7 in Portuguese, whose results were that there are intrinsic factors specific to the patient, extrinsic factors that correspond to factors that can be avoidable by the nursing professional when identified. Conclusions: Phlebitis is considered an indicator of nursing service quality. In the course of the article reviews, multiple factors related to phlebitis have been identified, with which preventive, corrective and educational measures should be taken in the areas where venous accesses are manipulated, avoiding future complications, as well as improving the quality of care reflected in the indicators of phlebitis with a zero result as a goal.

The use of peripherally inserted central catheter reduced the incidence of phlebitis in heart failure patients: A randomized trial

Background: During decompensated heart failure, the use of intravenous inotropes can be necessary. With peripheral venous access, prolonged inotrope infusion can cause phlebitis. However, traditional central venous catheters have possible complications. Peripherally inserted central catheters (PICCs) may be an alternative to traditional catheters. Aim: Our objective was to compare the incidence of phlebitis between patients with PICC and those with peripheral venous access catheter indwelling. Methods: In a randomized clinical trial, the patients were randomized to PICC and control groups, with 40 patients in each group. The inclusion criteria were hospitalized patients with advanced heart failure, ejection fraction of <0.45, and platelet count of >50,000/mm3 and current use of continuous intravenous infusion of dobutamine. The patients were randomly assigned to receive a PICC or keep their peripheral venous access. The primary end point was the occurrence of phlebitis. Results: The PICC and control groups included 40 patients each. The median age was 61.5 years; ejection fraction, 0.24; and dobutamine dose, 7.73 µg/(kg min). Phlebitis occurred in 1 patient (2.5%) in the PICC group and in 38 patients (95.0%) in the control group, with an odds ratio of 0.10% (95% confidence interval: 0.01%–1.60%, p < 0.001). Conclusion: In conclusion, in severe heart failure patients who received intravenous dobutamine, PICC use reduced the incidence of phlebitis when compared to patients with peripheral venous access. Therefore, the PICC use should considered over peripheral venous access for prolonged intravenous therapy in heart failure patients.

Long peripheral catheters in neonates: filling the gap between short peripheral catheters and epicutaneous-caval catheters?

Introduction: Non-critically ill neonates at times require venous access to provide peripherally compatible infusions for a limited period (more than 3 days). In such a situation, short peripheral cannulas are not appropriate as their average duration is about 2 days, while—on the other hand—epicutaneous-caval catheters may be too invasive. In these patients, insertion of long peripheral cannulas may be an effective option. Methods: In this observational retrospective study, we revised all “long” peripheral catheters (4 and 6 cm long) inserted by direct Seldinger technique in our neonatal intensive care unit when peripheral venous access was required for more than 3 days. Results: We inserted 52 2Fr polyurethane catheters, either 4 cm long ( n = 25) or 6 cm long ( n = 27) in 52 patients. Mean dwelling time was 4.17 days (range 1–12). Most devices were inserted in the cephalic vein ( n = 18, 35%), and the rest in the saphenous vein ( n = 11, 21%) and other superficial veins. There was no significant correlation between the duration of the device and type of infusion ( p = 0.40). The main complications were infiltration ( n = 16, 31%) and phlebitis ( n = 8, 15%). The rate of removal due to complications was significantly higher ( p < 0.01) in neonates with bodyweight <2000 g at the time of insertion. Conclusion: In our experience, 2 Fr 4–6 cm long peripheral catheters may be a valid option for neonates requiring peripherally compatible infusions for more than 3 days. The limits of this study are the necessity of training in the technique of insertion and the small size of our sample. The longest dwell was observed in neonates weighing >2000 g at the time of LPC insertion.

Central Venous Access for Peripheral Stem Cell Collection in Autologous Donors: Safety within an Outpatient Transplantation Program

Introduction One important aspect of quality assurance in transplantation relates to the maintenance of central venous access (CVA), especially in outpatient conditions in which patients have a higher degree of activity and manipulation of CVA tends to be more frequent. A comprehensive program oriented to prevent and control complications related to CVA insertion, maintenance and removal is thought to be a highly effective strategy to improve safety outcomes. Methods A retrospective study evaluating complications related to central venous access (CVA) in patients undergoing hematopoietic stem cell transplantation (HSCT) was conducted using electronic medical records (EMR) at our center. Laboratory and radiology reports were collected in order to identify complications related to CVA. Patients from May 2015 to July 2021 were included in the study. As per local protocol, insertion of Mahurkar catheter for cell collection is conducted by an experienced surgeon under general anesthesia on day -3 and after a short-stay (6 hours) in hospital patients are discharged. On day -2, cell collection is accomplished following all cautionary measures and removal of catheter is done on day -1. Maintenance and care of CVA is guided by standardized protocols related to cleaning, manipulation, blood sample collection and removal. All patients signed a consent to participate in the study and the study protocol was approved by Clínica Ruiz IRB. To be considered as statistically significant, results had to display a two-sided p value &lt;0.05. Results A total of 1088 patients recruited since May 2015 were included in the study. Main indication for auto-HSCT was multiple sclerosis with 1066 (98%), followed by chronic inflammatory demyelinating polyneuropathy with 16 (1.5%) and 5 (0.5%) patients with other autoimmune disorders. Median age of donors was 46 (40 - 54) years. Median dose of CD34 + cells x10 6/kg infused per patient was 7.0 (3.7 - 11.3) and the median of collection events per patient was 1 (1 - 2). Cell collection was accomplished via apheresis in (99.5%) of patients, of those CVA was used as collection site in 998 (92%) patients, while a change for peripheral venous access occurred in 85 (8%) patients, due to different reasons, most frequent being any type of CVA obstruction in 62 (83%) of donors. Pneumothorax occurred in 11 (1.1%) patients in whom CVA was used for collection. All cases were successful managed with pleural drainage and hospital admission longer than 24 hours was required for 3 (27%). Furthermore, catheter-related bloodstream infections were identified in 3 (0.3%) patients whom were admitted and treated with broad-spectrum antibiotics and discharged with no further events. There were no misplacement, thrombotic- nor hemorrhagic-related events in patients with CVA. A multifactorial analysis revealed that relevant factors such as, age, sex and type of disease were not correlated with any type of CVA-related complications. Conclusions We have shown that prevention and control of complications related to CVA at our campuses are highly effective. The proportion of patients experiencing a CVA-related complication was minimal in comparison with other experiences. Disclosures Gomez-Almaguer: Roche: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Bristol-Myers-Squibb: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau.

Patient-reported outcome and experience measures for peripheral venous catheters: a scoping review protocol

Purpose: The purpose of this scoping review is to conduct a systematic search and establish the current state of evidence for tools and instruments used to measure self-reported outcomes and experiences, including satisfaction scores, specifically for peripheral venous access devices (PVADs). Methods: A systematic search of the literature will be conducted using medical databases including: MEDLINE (Ovid); CINAHL (EbscoHost); PubMed (NCBI); and Scopus (Elsevier); Google (Scholar); and the Cochrane Central Register of Controlled Trials. Experimental, and observational studies, published in English, after 1990 will be eligible for inclusion if they: consist of (i) a survey, instrument or tool that is designed to (ii) collect outcome, experience and/or satisfaction data, relating to PVAD insertion, care, maintenance and/or removal, among (iii) adult and paediatric participants. Conclusions: PVAD-specific patient-reported outcome and experience measures are necessary for researchers, clinicians and policy decision makers to explore more thoroughly the quality of PVAD care provided, and further inform health economic analyses in the context of quality improvement interventions for vascular access devices. This scoping review will establish the existence—or paucity—of instruments to measure these selfreported outcomes and experiences of PVADs, in order to guide value-based healthcare delivery into the future.

Extravasation of antineoplastic agents in an Oncological Center

Introduction/Objective: This retrospective cross-sectional cohort study analyzed the extravasation index of antineoplastic therapy agents, demographic and clinical data. Methods: Seventy-six patients were evaluated in the period between 2017-2019. The project was approved by the Research Ethics Committee of a Brazilian Foundation. Results: In 72 months, 105,890 applications were administered, of which the incidence rate of extravasation of antineoplastic agents was 0.071%. Patients (N=311) selected for this study had a mean age of 55.42 years and a median age of 57. The most frequent diagnoses were breast cancer (11.66%), ovarian cancer (10%), colon cancer (8.33), rectal cancer (8.33) and uterine cancer (8.33%). The main variables that presented a significant impact with p <0.05 were ECOG Scale of Performance Status, ethnicity, age (risk ratio of 3% plus for each year of life), cancer staging, lymphadenectomy, use of venous catheter, forearm puncture, use of alkylating and alkaloids agents in peripheral venous access, and patients with tumor located in the pelvis using alkylating agents. Conclusion: The findings reinforce the need for further studies, since it was not possible to compare results with some variables that demonstrated a significant increase in the risk for the event.

Midline catheters for extracorporeal photopheresis in hematological patients

Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.

Randomized, Controlled Clinical Study on the Use of Noninvasive (Near-Infrared Light) Technology Compared with the Conventional Technique for Peripheral Venous Access Puncture in Pediatrics

Highlights Abstract Background: Obtaining peripheral venous access, especially in children, is usually a challenging procedure for nursing professionals. In pediatric patients this is because of the small caliber of the vessels, deep localization in the tissue, and multiple previous attempts of venipuncture. This experiment compared the success in obtaining venous access in pediatric patients with the use of near-infrared light and with the conventional technique. Method: True experiment, developed in a large private general hospital and a public general hospital under the same management. The study included children aged 0 to 6 y (including newborns and pediatric patients up to 5 y, 11 mo and 29 d) under clinical or surgical treatment, undergoing peripheral venous puncture both for laboratory test collection and for infusion of medications and solutions. A total of 144 punctures were analyzed, 51.4% with the conventional technique and 48.6% using the device with near-infrared light. Results: The success for the conventional technique was 89.2%, and 97.1% on the technique with near-infrared light, P = 0.098, with no evidence of significant differences. Conclusion: The success rate for obtaining peripheral venous access in children was similar in the study groups. This study expands the knowledge about the success in the peripheral venous puncture by considering that this is not exclusively related to the use of supportive technologies.