Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses’ knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study

Background Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses’ knowledge, attitude, and practice (KAP) concerning PIVC fixation. Methods An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses’ KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. Results The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses’ knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). Conclusion PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses’ KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients.

Defining difficult intravenous access (DIVA): A systematic review

Background: The term “difficult intravenous access” (DIVA) is commonly used but not clearly defined. Repeated attempts at peripheral intravenous catheter (PIVC) insertion can be a traumatic experience for patients, leading to sub-optimal clinical and economic outcomes. We conducted a systematic literature review (SLR) to collate literature definitions of DIVA, with the aim of arriving at an evidence-driven definition. Methods: The SLR was designed to identify clinical, cost, and quality of life publications in patients requiring the insertion of a PIVC in any setting, including studies on US-guidance and/or guidewire, and studies with no specific intervention. The search was restricted to English language studies published between 1st January 2010 and 30th July 2020, and the Ovid platform was used to search several electronic databases, in addition to hand searching of clinical trial registries. Results: About 121 studies were included in the SLR, of which 64 reported on the objectives relevant to this manuscript. Prevalence estimates varied widely from 6% to 87.7% across 19 publications, reflecting differences in definitions used. Of 43 publications which provided a definition of DIVA, six key themes emerged. Of these, themes 1–3 (failed attempts at PIV access using traditional technique; based on physical examination findings for example no visible or palpable veins; and personal history of DIVA) were covered by all but one publication. Following a failed insertion attempt, the most common number of subsequent attempts was 3, and it was frequently reported that a more experienced clinician would attempt to gain access after multiple failed attempts. Conclusions: Considering the themes identified, an evidence-driven definition of DIVA is proposed: “when a clinician has two or more failed attempts at PIV access using traditional techniques, physical examination findings are suggestive of DIVA (e.g. no visible or palpable veins) or the patient has a stated or documented history of DIVA.”

Techniques and Technologies to Improve Peripheral Intravenous Catheter Outcomes in Pediatric Patients: Systematic Review and Meta-Analysis

OBJECTIVE: Insertion and function of pediatric peripheral intravenous catheters (PIVCs) present challenges. We systematically reviewed techniques and technologies to improve PIVC outcomes (first-time insertion success, overall insertion success, time to insertion, dwell time, failure, and complications). DATA SOURCES: Cochrane Central Register of Controlled Trials (CONTROL), Cumulative Index to Nursing and Allied Health (CINAHL), US National Library of Medicine, and Embase. STUDY SELECTION: English-language pediatric trials published post 2010 reporting PIVC outcomes. DATA EXTRACTION: Following Cochrane standards, two authors screened, extracted, and critiqued study quality (Grading of Recommendations Assessment, Development and Evaluation approach) data, random effects analysis, results expressed as risk ratios (RR), mean differences (MD) and 95% CIs. RESULTS: Twenty-one studies (3237 children; 3098 PIVCs) were included. First-time insertion success significantly increased with ultrasound guidance (compared with landmark insertion; RR, 1.60; 95% CI, 1.02-2.50). Use of ultrasound guidance (compared with landmark insertion) did not improve overall PIVC insertion success (RR, 1.10; 95% CI, 0.94-1.28). There was no evidence of an effect of near-infrared (compared with landmark) on first-time insertion success (RR, 1.21; 95% CI, 0.91-1.59) or number of attempts (MD, –0.65; 95% CI, –1.59 to 0.29); however, it significantly reduced PIVC insertion time (MD, –132.47; 95% CI, –166.68 to –98.26) and increased first-time insertion success in subgroup analysis of patients with difficult intravenous access (RR, 2.72; 95% CI, 1.02-7.24). LIMITATIONS: Few studies per intervention, small sample sizes, and inconsistent outcome measures precluded definitive conclusions. CONCLUSIONS: Ultrasound and near-infrared appear to improve pediatric PIVC insertion. High-quality studies examining the full extent of techniques and technologies are needed. Registration: CRD42020175314

FAKTOR RISIKO EKSTERNAL KEJADIAN PHLEBITIS PADA PEMASANGAN KATETER INTRAVENA PERIFER: STUDI DOKUMENTASI

Intravenous insertion therapy given for a long time can cause complications such as phlebitis. Phlebitis is an inflammatory reaction in the veins along with signs of pain, redness, swelling, heat, and hardening at the puncture site and along the vein. One main factor that influence the incidence of phlebitis are external factors such as inappropriate intravenous (IV) catheters, length of catheter insertion, location of the catheter, pH and fluid osmolarity and internal factors include age, sex and comorbidities. External factors are factors that can be modified according to the authority of the nurse, so that the modification can reduce the incidence of phlebitis in the hospital. The aim of this study was to identify the external risk factors for phlebitis on peripheral intravenous catheter insertion in the inpatient room of a private Indonesian hospital. This research method was descriptive quantitative. Samples based on population, obtained from the Slovin formula were 95 medical records of inpatients with purposive sampling technique. Data collection obtained from medical record documents, included in the observation sheet. This study showed that more than half of the patients with intravenous catheters had the incidence of phlebitis (53%). Patients who experienced the incidence of phlebitis used an intravenous catheter size of 24G (88,89%), the location was in the metacarpal (56,33%), used hipotonic fluid (81,25%) and had an intravenous catheter inserted for more or equal to three days (63,41%). It is important to be able to increase the knowledge and skills of nurses, especially regarding the standard procedure for infusion and treatment as well as external factors that influence the occurrence of phlebitis. Keywords: Intravenous therap;, Phlebitis; Eksternal factors AbstrakTerapi pemasangan intravena yang diberikan dalam jangka waktu yang lama dapat menimbulkan komplikasi seperti adanya kejadian phlebitis. Phlebitis adalah reaksi peradangan pada pembuluh darah vena beserta dengan tanda-tanda nyeri, kemerahan, bengkak, panas, serta pengerasan pada daerah tusukan dan sepanjang pembuluh darah vena. Salah satu faktor utama yang memengaruhi kejadian phlebitis adalah faktor eksternal seperti ukuran kateter intravena/IV yang tidak sesuai, lama pemasangan kateter IV, lokasi pemasangan kateter IV, pH dan osmolaritas cairan. Faktor lainnya yaitu faktor internal seperti usia, jenis kelamin dan penyakit penyerta. Faktor eksternal merupakan faktor yang dapat di modifikasi sesuai kewenangan perawat, sehingga dapat menurunkan angka kejadia phlebitis di rumah sakit. Tujuan penelitian ini untuk mengidentifikasi faktor risiko eksternal kejadian phlebitis pada pemasangan kateter intravena perifer di ruang rawat inap di satu rumah sakit swasta Indonesia. Metode penelitian ini adalah deskriptif kuantitatif. Sampel berdasarkan populasi, yang didapatkan dari rumus Slovin adalah 95 rekam medis pasien rawat inap dengan teknik purposive sampling. Pengumpulan data yang didapatkan dari dokumen rekam medis di masukkan dalam lembar observasi. Penelitian ini menunjukkan bahwa lebih separuh pasien yang terpasang kateter intravena mengalami kejadian phlebitis (53%). Pasien yang mengalami kejadian phlebitis tersebut menggunakan ukuran kateter intravena 24G (88,89%), lokasi pada metacarpal (56,33%), menggunakan jenis cairan hipotonik (81,25%) serta terpasang kateter intravena lebih atau sama dengan tiga hari (63,41%). Penting untuk dapat meningkatkan pengetahuan dan keterampilan perawat khususnya tentang standar prosedur pemasangan infus dan perawatannya serta faktor eksternal yang memengaruhi terjadinya phlebitis.

Analysis of influencing factors on the duration of pediatric peripheral intravenous catheter

Background: The application of peripheral intravenous catheter has been an effective guarantee for the success of pediatric therapy. We aimed to investigate the correlative factors that impacting the duration of pediatric peripheral intravenous catheter. Methods: From January 2017 to October 2017, 370 cases of pediatric patients in the First Hospital of Hunan University of Chinese Medicine were collected as the research object. Based on the indwelling time, the collected cases were divided into two groups, namely long time group (>72 h) and short time group (<72 h). The general data and laboratory test results of two groups were collected, and the correlation factors of indwelling time were analyzed by single factor and Logistic multiple factors. Results: As the results revealed that compared with short time group, patients in long time group had statistically significant differences in puncture site, phlebitis, extravasation of blood vessels, hemoglobin, white blood cells, platelets, and 75% ethanol sterilization ( p < 0.05). Logistic multivariate analysis indicated that scalp puncture was the independent protective factors that affecting the duration of pediatric peripheral intravenous catheter. Moreover, phlebitis represented the independent risk factor that influencing the indwelling time of pediatric peripheral intravenous catheter. And the differences were statistically significant ( p < 0.05). Conclusions: Analyze factors influencing indwelling time of pediatric peripheral intravenous catheter and enhance the management of relevant factors are of great significance to prolong the indwelling time, reduce the pain of pediatric patients, and facilitate the clinical medication.