Assessment of Up-Grading Nursing Students’ Knowledge and Practice towards Short Peripheral Catheters (SPCs) Care at Al-Quds University

A short peripheral catheter is a medical device, a plastic tube inserted into a vein. A cross-sectional descriptive study was conducted to assess knowledge and practice towards short peripheral catheter care among first-year up-grading nursing students at Al-Quds University in Palestine. A convenience sample of 90 students filled questionnaires that showed they were newly- graduated with 46.1% having low experience and an inadequate knowledge level and 57.5% having a moderate practice level, with an inverse correlation between knowledge and practice. Sessions in the simulation laboratory about peripheral catheter care should be conducted to enhance quality and safety.

Effectiveness of ultrasonography for peripheral catheter insertion and catheter failure prevention in visible and palpable veins

Background: The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. Methods: Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein’s visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. Results: Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. Conclusions: Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

Comparison of 12-cm versus 6-cm long peripheral catheters in patients with difficult intravenous access (DIVA)

Background: Long peripheral catheter is 6–15 cm long vascular device. The aim of the study was to compare the frequency of complications of two types of long peripheral catheters with different length inserted in DIVA patients. Methods: Under ultrasound navigation 2.7F 6.4 cm or 4Fr 12 cm long peripheral catheter was inserted. Complications of both long peripheral catheters were prospectively observed and their relationship to the patient’s age, gender, selected vein, number of punctures and Barthel score system was evaluated. Results: Ninety-three 12 cm and fifty-five 6.4 cm long peripheral catheters were inserted. Median of dwelling time was 8 days for 6.4 cm and 9 days for 12 cm long peripheral catheter. There were 17 (26%) complications in 6.4 cm (38/1000 catheter days) and 15 (16%) in 12 cm catheter (17/1000 catheter days), p = 0.04. The complications of both peripheral catheters were not associated with the age of patients, gender, number of punctures and selected vein for insertion. Unlike 12 cm catheter, the complications of 6.4 cm long peripheral catheter were significantly associated with the result of Barthel scoring system ( p = 0.003). Conclusion: The frequency of complications was more common with 6,4 cm than with 12 cm catheter.

Safety of Early Norepinephrine Infusion Through Peripheral Vascular Access During Transport of Critically ill Children

BackgroundReversal of hypotension is a priority in the management of a collapsed child. The pediatric Surviving Sepsis Campaign advocates for the rapid use of epinephrine or norepinephrine for sepsis related myocardial or vascular dysfunction following 40-60ml/kg of fluid resuscitation. Vasoactive drugs should be started within the first hour after sepsis recognition in a patient with shock. In such a short delay, central venous access can be difficult to obtain, and infusion may be initially started through a peripheral catheter. Hereby, we reported the safety of norepinephrine infusion through a peripheral catheter in retrieved shocked patients.MethodsMulticentric retrospective analysis of medical pediatric retrieval teams experience of vasopressors infusion through a peripheral vascular access. Medical pediatric retrieval teams (SMUR) and Pediatric Intensive care units (PICU) of the Paris urban region. Children 0 to 18 years necessitating norepinephrine infusion during retrieval. Modalities of infusion (drip concentration, duration, site of infusion), incidence of complication and outcome at PICU discharge were reviewed.ResultsThirty-seven children in shock received a norepinephrine infusion for a median time of 4 hours. No local adverse event was noted. One patient had transient blanching of the skin which improved after appropriate care. The overall mortality was 10.8% with one death (2.7%) during transport and 3 (8.1%) in PICU. ConclusionsDuring transport of critically ill patients requiring vasopressor infusion by a specialized pediatric retrieval team, the use of norepinephrine on a non-central catheter was safe among all patients.

The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study

OBJECTIVES: The purpose of this study was to evaluate the feasibility of a new long peripheral catheter (LPC) program at a large academic center in an effort to reduce the use of peripherally inserted central catheters (PICCs) and their related complications. METHODS: The pilot participants were hospitalized children, age >2 years, with a need for noncentral intravenous access for 2 to 29 days, or laboratory blood draw >5 times per day. Patients expected to discharge with intravenous access were excluded. Included in the pilot program development were a literature review, 1-year baseline data analysis, and program design and implementation. A multidisciplinary committee developed and implemented the program from December 2018 to September 2019. LPCs were placed from August to September 2019. RESULTS: Regarding the baseline data, between July 2018 and June 2019, 584 PICCs were placed in 461 patients. Of these, 139 PICCs (24%) did not meet requirements necessitating central access and, potentially, could have been avoided if an LPC alternative were available at the time. For the LPC pilot program, 20 LPCs were placed in 19 patients. The median age was 11 (interquartile range of 7–15). The insertion success rate was 83%. There were no serious complications, such as venous thrombosis or catheter-related bloodstream infection. The total rate of minor complications was 35%: the rate of occlusions was 10% (n = 2), and the rate of dislodgement was 25% (n = 5). The catheter failure rate was 74 per 1000 catheter-days. The mean line duration was 6 days. CONCLUSIONS: There is a role for LPCs in hospitalized children requiring durable vascular access. Multispecialty designed pilot implementation of an LPC program was successful at an academic pediatric hospital.

Alternative vascular device for high-flow computed tomography angiography: ultrasound-guided long peripheral catheter (4 Fr × 10 cm)

Introduction: Radiological studies that require contrast media are common and useful in the emergency department. Alternatives have been proposed for the administration of contrast agent in patients with difficulty in the insertion of vascular access. Since 2017, our institution has used a 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon) for venous insertion. Its ultrasound-guided insertion is carried out by emergency physicians. So far, there are no reports in the literature about the use of this long peripheral catheter for computed tomography angiography. Objective: To describe the experience with the said device, to point out the complications associated with it, and to evaluate it as an alternative way to gain vascular access for patients with limited venous access. Methods: An observational, analytical, and retrospective study was conducted. The study included patients who received an ultrasound-guided 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon). Transparent, radiopaque, polyethylene, 18-gauge Leadercath from Vygon, sold as peripheral arterial catheter and sometimes used “off-label” as venous catheter with a flow capacity of up to 24 mL/min, was used. The flow capacity for gravity flow is 24 mL/s; with pump-driven flow, we achieved a flow infusion of 5–6 mL/s. Univariate analyses were performed. Normality was determined through the Shapiro–Wilk test. Results: In total, 172 patients met the inclusion criteria. Of them, 115 (67%) were female and the average age was 59 years. The main indication for performing the computed tomography angiography was the suspicion of pulmonary embolism (38.6%). The most frequent type of computed tomography angiography study was pulmonary tomography (88 patients, 51.5%). The contrast medium infusion rate was 6 mL/s in 51.5% (n = 88) of cases, 4.5 mL/s in 36.3%, and 5 mL/s in 12.3%. One adverse event occurred. Conclusion: An 18-gauge-long peripheral catheter (4 Fr × 10 cm, Leadercath; Vygon) following specific protocols appears to be safe for conducting high-flow computed tomography studies in patients with limited venous access.