Search results for: peripherally-inserted-central-venous-catheters

Peripherally Inserted Central Venous Catheters

Author : Sergio Sandrucci
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Indications for central venous cannulation in critically ill patients have increased dramatically, but central venous access has the drawbacks of morbidity and a scarcity of experienced operators. Ultrasound-guided peripheral venous access offers a solution, in that it reduces morbidity and can be performed by a dedicated nursing team. The aim of this book is to teach the fundamentals of this emerging technique. Advice is provided on choice of materials; maneuvers for positioning of peripherally inserted central venous catheters (PICCs), techniques for evaluation of PICC tip placement; prevention, diagnosis, and management of complications; and organization of a dedicated team within a hospital or a supportive care program. Legal and economic issues are also considered. The book will be of interest to a wide range of professionals, including nutritionists, oncologists, anesthesiologists, surgeons, registered nurses, nurse practitioners, physicians, physician assistants, and radiologists.

Peripherally Inserted Central Venous Catheter an Alternative for Improving the Quality of Nursing Care

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Introduction: Evidence suggests high rates of complications related to the peripheral venous catheter (PVC). Among causes is the administration of irritant/vesicant medicine, with pH u2264 5 or u2265 9 and osmolarity u2265 900 mOsm/L(1-2) . These risk factors are indications for using peripherally inserted central venous catheters (PICC)(3-4). Therefore, their use may be an alternative for improving the outcome of nursing care. However, safely using PICC requires the acquisition of knowledge based on scientific evidence, because care differs from that usually provided to patients with PVC(4). Objective: Analyze the cumulative incidence of complications in Portuguese patients with PICC or PVC after implementing an educational intervention on care with PICC. Method: A theoretical and practical educational intervention with nurses of a service of medicine of Portugal, on care for patients in the insertion, maintenance and monitoring of the PICC. A cohort pilot study was held during 40 consecutive days, in 2016. Patients included were adults: nine patients with PICC and 36 with PVC. Descriptive statistical analysis was performed. Results: Complication in patients with PICC: obstruction (22.2%); PVC: Phlebitis (22.2%), infiltration (38.8%), obstruction (27.7%), accidental removal of the PVC (47.2%), fluid leakage on insertion (36.1%) and pain at the site of insertion (5.5%). Discussion & Conclusion: Permanent education is essential to improve nurses' knowledge of PICC care, and is a strategy to achieve higher levels of qualification and the transformation of practices (5). PICC showed a lower incidence of complications when compared to the PVC, becoming a favorable alternative to improve the quality of nursing care to patients who have a medical indication for PICC. Ensuring the criteria of selection of a venous catheter is essential in order to reduce complications, improve the results of nursing care and promote the patients' well-being (3-4).

Applying MAGIC Recommendations in the Indication of Peripherally Inserted Central Venous Catheters Retrospective Analysis on a Private Hospital in Brazil

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Background: Peripherally inserted central venous catheters (PICC) are increasingly being used to provide central venous access and PICC complications lead to increased mortality and cost. The presence and proliferation of vascular access nursing in hospital settings has been identified as a potential contributor to growing demand, and possible overuse, of PICC lines. Objectives: We aim to evaluate if PICC indication is appropriate, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), in a 300-bed Brazilian Hospital. Methods: We analyzed retrospectively the PICC inserted in intensive care units (ICU) and non-ICU setting from January to July/2017. These catheters were evaluated within each scenario through the mobile app u2013 Michigan MAGIC u2013 and each one were categorized as appropriate, neutral, inappropriate or disagreement. Results: PICC were inserted in 605 patients (49% male and 51% female), with a mean age of 73 years (03 to 113), 53% in non-ICU settings and 47% in ICU. The right arm was chosen in 69% of the cases and the most common vein punctured was basilic (66%), followed by brachial (33%) and cephalic (1%). According to proposed duration of infusion and type of infusate, 95% of all PICC inserted (575) were considered appropriate. There were 14 cases (2,3%) classified as inappropriate (peripherally compatible infusate) and 16 (2,7%) classified as disagreement (difficult venous access and frequent blood draw with duration

High Rate of Complications Associated with Peripherally Inserted Central Venous Catheters in Patients with Solid Tumours

Author : K. Cheong
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Central Venous Catheters

Author : Andy Bodenham
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This book addresses all the issues a patient may experience prior to receiving a VAD. Selection of equipment, practical aspects of technique, the pros and cons of the various veins, and modifications of technique for certain circumstances are examined. Covereage also includes the roles played by radiologists, anaesthetists, surgeons, nurses, and other team memebers. Throughout the chapters a reference is made to the IV Therapy Standards published by the Royal College of Nursing IV Therapy Forum in 2003. Each chapter is evidence based and fully referenced.

A Case Control Study on the Cost Difference Between Peripherally Inserted Central Catheters and Central Venous Catheters

Author : Marlene Marie Wellman Schmid
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The Assessment of the Rate of Complications of Peripherally Inserted Central and Other Long Term Central Venous Catheters

Author : Elizabeth Ann Grabsch
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A Descriptive Study of Patients with Peripherally Inserted Central Venous Catheters

Author : Judith Ann Abi-Nader
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Comparison of Peripherally Inserted Central Venous Catheter PICC Versus Central Venous Catheter CVC U2013 a Consecutive Selection Study

Author : Martin Hubrich
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Background: The safest and most cost efficient choice of central venous access is still a matter of concern in clinical care and research. A safe and long lasting central venous catheter (CVC) with a low number of side effects is preferred. Few clinical trials have been published comparing complications and patency of CVC:s and peripherally inserted catheters (PICC:s). We performed a consecutive selection study on patients referred to the Department of Surgery at Sahlgrenska University Hospital. Methods: In 2014-15, 155 patients admitted for upper gastrointestinal cancer surgery and in need of a CVC/PICC were enrolled. End-points were development of complications requiring catheter removal, catheter related infection, thrombophlebitis, pneumo- and hemothorax. Anaesthesiologists performed CVC insertions. PICC:s were inserted by a register nurse or anesthesiologist. A study protocol followed the patients where baseline-data, catheter days, patient experience and complications were registered. Results: 114 patients received a CVC and 42 a PICC. No difference between treatment groups was found regarding gender, age, BMI, associated diagnosis, antibiotic, antitrombotic or corticosteroid treatment at postop day one. However, days of treatment reached significant difference, with more days in the PICC line (21 days) vs. CVC (15 days) group, p

Central Venous Access Devices CVADs and Peripherally Inserted Central Catheters PICCs for Adult and Pediatric Patients

Author : Chuong Ho
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Central venous access devices (CVADs) or central venous catheters (CVCs) are devices that are inserted into the body through a vein to enable the administration of fluids, blood products, medication and other therapies to the bloodstream. CVADs can be inserted into the subclavian or jugular vein (implanted ports, tunneled catheters), or can be inserted into one of the peripheral veins of the upper extremities, called peripherally inserted central catheters (PICCs).1 While generally safe, CVADs can be associated with complications such as catheter occlusion or rupture, venous thrombosis, and bloodstream infection.1 A number of strategies have been used to minimize the occurrence of CVAD- and PICC-associated complications such as antimicrobial-impregnated lines for prevention of infection, or addition of a valve (valved catheters) to prevent occlusion by preventing reflux of blood into the catheter.2 Flushing the catheters with saline or heparin - an agent with anticoagulant activity - have been used to reduce clot formation and occlusion of the catheters. This Rapid Response report is an update of the previous CADTH reports which found no difference in terms of frequency of occlusion in patients who had a valved versus a non-valved PICCs, and similar patency between heparin and saline use for CVCs.3,4 This report aims to review the evidence on the clinical effectiveness of valved versus non-valved PICCs, and saline versus heparin flushing in the maintenance of CVADs patency and reduction of complications.

Peripherally Inserted Central Venous Catheter PICC

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Vessel Health and Preservation The Right Approach for Vascular Access

Author : Nancy L. Moureau
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This Open access book offers updated and revised information on vessel health and preservation (VHP), a model concept first published in poster form in 2008 and in JVA in 2012, which has received a great deal of attention, especially in the US, UK and Australia. The book presents a model and a new way of thinking applied to vascular access and administration of intravenous treatment, and shows how establishing and maintaining a route of access to the bloodstream is essential for patients in acute care today. Until now, little thought has been given to an intentional process to guide selection, insertion and management of vascular access devices (VADs) and by default actions are based on crisis management when a quickly selected VAD fails. The book details how VHP establishes a framework or pathway model for each step of the patient experience, intentionally guiding, improving and eliminating risk when possible. The evidence points to the fact that reducing fragmentation, establishing a pathway, and teaching the process to all stakeholders reduces complications with intravenous therapy, improves efficiency and diminishes cost. As such this book appeals to bedside nurses, physicians and other health professionals.

Vascular access in cancer patients clinical implications

Author : Knut Taxbro
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Central venous catheters (CVC) are vital for patients receiving chemotherapy not compatible with peripheral infusion. Thousands of centrally and peripherally inserted central venous catheters are inserted into patients with cancer each year. All types of intravascular catheters are associated with complications. These complications may be divided into infectious, thrombotic, mechanical and occlusive events. All of these events have the potential to harm patients and cause additional expense for the health-care system. Furthermore, the above-mentioned complications are largely avoidable through proper patient selection, insertion technique, hygiene precautions and catheter maintenance. Catheter-related infections and deep venous thrombosis are the two most common and feared CVC related complications. Infection in a catheter can cause lifethreatening bacteraemia, and thrombosis can lead to pulmonary embolisation, post-thrombotic syndrome and stenosis of the vessel affected. Many studies describing methods to minimise infectious complications associated with central venous catheters have been carried out. These methods appear to have been implemented in most modern advanced healthcare facilities resulting in a continual decrease in catheter-related infections over the last two decades. New implantation techniques, fewer infections and better catheter materials are likely to have contributed to the reduction in the incidence of catheter-related deep venous thrombosis (CR-DVT). Peripherally inserted central venous catheters (PICC) and subcutaneously implanted vascular access ports (PORT) are two very commonly used catheter devices for delivery of chemotherapy. International guidelines are unclear as to which device to choose due to the paucity of controlled trials. The aim of this thesis was to study complications related to central venous access devices used over long periods of time, usually for the delivery of chemotherapy. Vascular access in cancer patients – clinical implications We prospectively studied PORT complications (Study 1) over a six-month follow- up period. In Study 2, we assessed the number of common CVC-related micro- organisms that are transferred across PORT membrane contaminated by a controlled suspension of micro-organisms when a non-coring access needle is inserted using two different techniques. In the largest randomised controlled trial published on this topic (Study 3), we compared PICC with PORT regarding CRDVT and other catheter-related complications. The economic implications of using PICC or PORT were assessed from health-care system´s perspective (Study 4), using data on adverse events and clinical factors (implantation, treatments and dwell-time) from Study 3. Chemotherapy against various forms of cancer is very common. Implantation of PORT is one of the ten most common surgical procedures in Sweden according to the Swedish Perioperative Register. Hence, the topic in this thesis may be clinically relevant to many patients and their health care providers. We found that the incidence of catheter-related blood stream infection was very low in the cohorts studied. In general, PICCs are associated with significantly more CR-DVTs and adverse events than PORTs. The cost to the health-care system when using PICC is higher than for PORT when complications are included. Given the choice, patients about to commence chemotherapy appear to prefer PORT to PICC. PORT implantation is more painful than PICC insertion, but PICC appears to influence activities of daily life more than PORT.

Benefits of the Implementation of the Peripherally Inserted Central Venous Catheter in the Nursing Practices of a Medical Service in Portugal

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Introduction: The incorporation of a new technology for healthcare in nursing practices, such as the peripherally inserted central venous catheter (PICC), requires the acquisition of new knowledge in order to be translated to benefits. These benefits may be for the sake of the patient and the nursing team itself (1-2). In view of implementing PICC in the nursing practices of a medical service in Portugal, research was conducted with the objective of understanding the benefits of implementing PICC in the nursing practice. Method: A qualitative approach using the focal group technique. Five nurses who cared for PICC patients in a medical service in Portugal participated. The interviews of the focus groups were recorded, and transcription and thematic analysis followed. Results: Benefits for the patients: reduction in the number of venous punctures to collect blood for analysis and for the insertion of the peripheral venous catheter (PVC), avoiding pain by replacing the routinely used venous puncture by PICC, less anxiety related to venous puncture and reduction of local complications such as phlebitis and infiltration. Benefits for the nursing team: a decrease in the number of venous puncture attempts to insert the PVC, eliminating patients without venous access on which to administer intravenous treatments thereby reducing stress, reducing time of nursing care in looking for a peripheral venous access and medication administration was performed safely and quickly. Discussion & Conclusion: The selection of the venous catheter in line with scientific evidence and patient characteristics(3) and the acquisition of specific skills through continuing education are factors that favor the implementation of the PICC in nursing practices(4), translating into qualitative benefits for the patients and the nursing team alike.

Developing a Peripherally Inserted Central Catheter PICC Service Using Ultrasound Guidance in the Haematology Setting

Author : Danielle Kennedy
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Many patients with a haematological disease will require some type of central venous access device (CVAD) to deliver both their anti-cancer and supportive therapies. The devices used within the haematology department at the University Hospital of Wales (UHW) in Cardiff include temporary central venous catheters (CVCs), Hickman lines and less commonly peripherally inserted central catheters (PICCs). -- In many circumstances, a Hickman line would be the device of choice with PICCs often overlooked due to issues surrounding the traditional method of insertion in the antecubital fossa (ACF). However, with the technological advances in ultrasound and recommendations from the then named National Institute for Clinical Excellence (NICE) (2002), PICCs can now be inserted away from the ACF and placed into the veins of the upper arm. -- This practice has already been performed in the United States of America (USA) in excess of 20 years and over the past 5 years many PICC placers in the United Kingdom (UK) have also changed to inserting PICCs under ultrasound guidance (USG). -- The aim of this service development project was to extend the current PICC service incorporating the technological advances and changing the method of insertion to that of USG in line with the successes shown in the literature review. The methods used included a situational analysis drawing on the internal and external forces and influences using a PEST analysis and formulating a change management strategy using Lewin's (1951) force field analysis to establish what was driving or restricting the project forward. -- The project predominately involved further training and education, identification and involvement of the core stakeholders and challenging current work patterns and the poor perceptions of PICCs by the staff.

Comparison Of Central Line Associated Bloodstream Infection Rate Between Conventional Peripherally Inserted Central Venous Catheter PICC And Tunneled PICC

Author : Nor Zuliana Dzul Kifli
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Trimmed Peripherally Inserted Central Catheters for Hospitalized Neonatal Patients

Author : Deepa Jahagirdar
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Peripherally inserted central catheters (PICC) are thin tubes inserted for central venous access. They are minimally invasive and used where longer-term intravenous access is required to administer therapeutic needs such as fluids or medications. PICC use has increased in the past decade, because of the relatively low cost and ease of placement compared to other catheters. While their popularity has grown, PICCs are associated with potential complications. Venous thrombosis, infections, or extravasation into a body cavity and tamponade are known adverse effects with potentially fatal results. Further, catheter failures can include accidental removal, tip migration and fracture. Compared to adults, inserting and maintaining PICCs in small infants presents specific challenges due to smaller vessel and catheter diameters, with the potential for more safety concerns.

Saline Versus Heparin for Maintaining Patency of Central Venous Catheters

Author : Canadian Agency for Drugs and Technologies in Health
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Central venous access devices (CVAD) or central venous catheters (CVC) are devices that provide easy access to a patient's circulation and are used to administer medication, provide nutrition, obtain blood samples, and monitor hemodynamic parameters. There are several types of central venous catheters (CVCs) such as peripherally inserted central catheter (PICC), tunneled catheter and implanted ports. However, complications may arise with the use of these devices such as occlusion of the catheter and infection. For efficient use of CVCs, maintenance of catheter patency is important. Patency of the catheter depends on several factors such as the catheter material and gauge, connectors used, the infusion solutions, handling protocols, and patient characteristics. After intermittent infusion, blood reflux within the catheter lumen may increase the risk of thrombus formation. Loss of catheter functionality due to thrombus formation may require thrombolytic therapy or catheter removal and replacement. When thrombotic occlusion of CVC occurs, alteplase, a recombinant tissue plasminogen activator, is often administered to lyse the clot and restore patency. To maintain functionality and patency of the catheter flushing is important. Saline or heparin have been used as a flushing solution. It is believed that heparin may prevent blood from clotting in the device. However, heparin may be associated with adverse effects, such as risk of heparin induced thrombocytopenia. Furthermore, heparin dosing errors may lead to increased risk of bleeding. There is still debate as to which flushing solution is the best option. The purpose of this report is to provide evidence on the clinical effectiveness and safety of flushing with saline in comparison to heparin for maintaining patency of central venous catheters.

Nurse led PICC Team Outcomes and Lessons Learned in the Journey of Establishing a Centre of Excellence

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INTRODUCTIONPatients with long term therapy needed a comfortable venous access that could avoid multiple line insertions and pricks for therapeutic and diagnostic purpose that they could afford and was comfortable for use even at home or at a local setting.Thus we launched our Nurse Led PICC team in the month of January 2016. OBJECTIVE To look at outcomes of last 2 years, and understand areas of improvement.METHODThis is retrospective cohort study of 494 PICC lines inserted by Nurse led PICC team during 2016-2017 in tertiary care teaching hospital in India. Each line inserted is tracked using insertion data sheets and followed through.RESULTSOur median line days were 53 (interquartile range of 22-110) and most common indication was for Chemotherapy (68.2% ) Insertions were under USG guidance (91.9%) all in the upper arm with left basilic (63%) as common site with a first prick success of 70%. Our complication rates were 1.8 per 1000 line days , most being infectious and BSI rates were 1.46per 1000 line days. Around 77 lines were still on, by the end of Dec 2017 and we had lost follow up of 27 lines. Out of reason for removal the commonest was end of treatment (47%).DISCUSSION & CONCLUSIONWe had 26% of patients needing long term antibiotic therapy and hence the line days would be much lesser : 53 vs mean of 129 (Sulav etal 2018) and average of 171.20 (Paula etal 2016). Rate of mechanical complications were lesser (2.6% )compared to other studies, but infectious complications which were seen more in patients with more than 50% IP line days was a concern.Ongoing education for the floor nurses was intiated to ensure best practice the lines. PICC lines can be inserted and managed by trained nurses and our team has earned reputation internationally.REFRENCES1.Sapkota, S. and Naik, R. (2018) Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients. Journal of Cancer Therapy, 9, 35-41. doi: 10.4236/jct.2018.91005.2.Grau D, Clarivet B, Lotthu00e9 A, Bommart S, Parer S.(2017) Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrobial Resistance and Infection Control. 2017;6:18. doi:10.1186/s13756-016-0161-0.4.Paru00e1s-Bravo P, Paz-Zulueta M, Sarabia-Lavin R, Jose Amo-Setiu00e9n F, Herrero-Montes M,Olavarru00eda-Beivu00edde E, et al. (2016) Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study. PLoS ONE 11(9):e0162479. doi:10.1371/journal.pone.0162479.

Electrocardiograms Versus X rays for Guided Placement of Central Venous Catheter Tips

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Central venous catheters (CVCs) are often used to deliver drugs, supply nutrients, or draw blood samples in some severely ill patients. A peripherally inserted central venous catheter is a type of central venous line. During placement of the CVC, the correct position of the tip is of paramount importance and should be verified immediately after placement before infusion to avoid any catheter-related complications. Post-procedural chest x-ray is a commonly used method for verification of the CVC tip position. X-rays, however, have some limitations as they are not readily available until the end of the surgical procedure, the method is not 100% accurate and there is a risk of patients being exposed to radiation. Moreover, when a misplacement of the CVC tip is detected by chest x-ray, a further procedure is required to reposition the line, which implies more potential problems and costs. Electrocardiogram (ECG)-based positioning of the CVC tip is of growing interest, because it allows control of the catheter position during insertion procedure. Although the ECG-based method has been considered to be safe, accurate, quick and easy to perform, radiation-free, and real-time verification, its clinical effectiveness and cost-effectiveness compared with post-procedural chest x-ray method remains to be determined. The purpose of this report is to review the evidence regarding the clinical effectiveness and cost-effectiveness of electrocardiograms versus x-rays for the guided placement of central venous catheter tips.