The responsibilities of an infusion therapy team may include choosing the most appropriate vascular access, performing safe insertion, maintaining the access, and even infusing medications and solutions. The objective of this study was to describe the scope of action and activities developed in the first year of operation of an infusion therapy team at a public hospital and to describe the effectiveness of the results. The team was formed by 2 infusion therapy nurses. In the first year, 1502 activities were carried out, with a predominance of peripherally inserted central catheter (PICC) insertions (896; 59.6%); consultations related to infusion therapy (185; 12.3%); and PICC clearance procedures (103; 6.8%). PICCs were inserted using tip navigation and intracavitary electrocardiogram guidance in 82.5% of cases. The PICC first-attempt insertion success was 81.7%. The cannulation with a guide was performed in 51% of the insertions, and the success of venipuncture in the first attempt while using the guide did not differ from the rate without using the guide, P = .98. The consultations were mostly related to the insertion site (33.0%) and the contraindication for PICC insertion (17.8%). The performance had positive impacts on application, dissemination of good practices, and cost reduction.
To compare the efficacy, safety, and operational efficiency of the intermittent negative-pressure guidewire technique and the stay-locking technique in restoring the function of thrombotically occluded peripherally inserted central catheters (PICCs). An in vitro thrombotically occluded PICC model was created using 110 catheters, with successful occlusion established in 90. The experimental group comprised 43 models treated with the intermittent negative-pressure guidewire technique, while the control group included 45 models treated using the stay-locking technique. Relevant procedural data were collected and analyzed statistically. The success rate was significantly higher in the experimental group (62.79%) compared with the control group (4.44%, P < .0001). There was no significant difference in the incidence of thrombus overflow at the catheter tip between groups (P = .704); however, the length of thrombus overflow was significantly greater in the control group (P = .001). Additionally, successful interventions were associated with significantly shorter operation times and significantly higher-pressure recovery rates (P < .0001 for both comparisons). In an in vitro model of thrombotically occluded PICCs, the intermittent negative-pressure guidewire technique demonstrated superior efficacy, including shorter operation time and higher success rates, compared with the stay-locking technique. The marked increase in the pressure recovery rate in successful cases indicates the technique's effectiveness in restoring catheter function.
The aim of this study was to evaluate differences in nurses' ratings of risk factors for difficult intravenous access (DIVA) between oncology infusion unit nurses who perform ≤ 10 insertions compared to > 10 insertions per week. An email requesting that recipients complete a revised version of the "Survey on Nurses" perceived DIVA factors that contained a list of 53 risk factors was sent to 152 nurses, of whom 81 responded. Nurses rated each DIVA risk factor, using a 0 (not at all predictive) to 10 (extremely predictive) scale. Of the 81 nurses who completed the survey, 55.5% and 44.5% performed ≤ 10 insertions versus > 10 insertions per week, respectively. No differences were found between the groups on age, sex, education, or years of experience in nursing or in infusion nursing. Compared to nurses who performed ≤ 10 insertions per week, those who performed > 10 rated only 1 risk factor as more predictive of DIVA (ie, the patient has a history of cirrhosis). Risk factors with the highest DIVA prediction scores were multiple intravenous attempts on the day of treatment, history of multiple venipunctures during previous visits, current or past history of intravenous drug use, and occurrence of dehydration. Findings can be used to identify high-risk patients and educate oncology nurses.
This study aimed to examine the effects of subcutaneous tissue edema at the site of peripheral intravenous catheters (PIVCs) on catheter failure. A secondary analysis was conducted based on an interventional study performed in 1 ward of the University of Tokyo Hospital. Participants included patients with PIVCs without ultrasonographic-guided insertion. Ultrasonographic images were obtained immediately after catheter placement was completed to assess for success of catheterization and subcutaneous edema. Catheter failure was defined as a PIVC with incomplete treatment. Other measured variables included nursing skill defined as number of experiences of catheterization, medications, medical history, anatomical site of catheterization, diameter of vein, and depth of the catheterization. Of the 273 PIVC cases analyzed, 19 (7.0%) had subcutaneous edema immediately after catheter placement, and 79 (28.9%) resulted in catheter failure, 15 (78.9%) of which occurred among patients with subcutaneous edema (P < .01). Subcutaneous edema immediately after catheter placement was significantly associated with catheter failure occurrence (P < .01), with an adjusted hazard ratio of 9.4 (95% confidence interval 4.62-19.44). Subcutaneous edema was identified as a predictor of catheter failure. Ultrasonographic observation of subcutaneous edema at PIVC placement may be effective in preventing catheter failure occurrence.
The objective of this study was to analyze current evidence-based pan-European standards of good clinical practice in the use of peripheral intravenous catheters (PIVCs) to determine if they meet clinicians' needs for unambiguous, standardized guidance for the prevention and management of PIVC-associated complications. Reference documents meeting agreed inclusion criteria were identified and analyzed. Documents were systematically searched for terms (selected based on expertise of the authors and supported by scientific literature) most likely to be associated with the prevention/management of complications associated with the use of PIVCs. A matrix was constructed to visualize the degree of consensus across guidelines regarding prevention and management terminology. Recommendations for optimizing clarity and standardization across Europe were proposed. Few European reference documents included PIVCs within their scope, and few were subject to a quality review. Adherence to the established GRADE framework of rating supporting evidence was missing from all reference documents. There was ambiguous terminology across documents and many instances of omission of terms rated important by the authors for the prevention and management of complications. An English-language European guideline for the prevention of complications associated with PIVCs is needed, featuring consensus terminology and a standardized, systematic, and transparent method for grading evidence.
Vascular access specialist teams (VASTs) are established worldwide to enhance the safety and efficiency of vascular access procedures. In Poland, nurse-led VASTs are a novel concept. The aim of the study was to evaluate whether implementation of a nurse-led VAST improved the efficiency and safety of vascular access devices in a large academic hospital in Poland. This retrospective analysis included long peripheral intravenous catheters inserted from 2021 to 2024 and midline catheters inserted from 2022 to 2024. Data were obtained from hospital records and the electronic medical record (EMR) after integration of VAST documentation in 2023. Outcomes included insertion time, number of attempts, dwell and withdrawal times, and reasons for removal. Over the study period, time to catheter insertion decreased (14.27 days in 2022 vs 4.34 days in 2024), the number of insertion attempts declined, dwell and withdrawal times increased, and the proportion of removals due to complications decreased from 38.37% to 22.92%. The implementation of a nurse-led VAST improved efficiency and safety of vascular access, demonstrating fewer insertion attempts, longer dwell times, and lower complication rates. These findings indicate that the VAST model can be successfully adapted in health care systems where nurse-led vascular access practice has not previously existed.
The aim of this study was to map nursing care in the treatment of lesions due to vasoactive drug extravasation. This scoping review is built according to the recommendations of the Joanna Briggs Institute and PRISMA-ScR. The review was carried out from July to August 2022, across 12 data sources. The evidence was evaluated using PAGER. Initially, 2124 studies were found. After screening and complete analysis, 12 were left, which were used for a reverse search in the literature, which resulted in 20 studies, for a total of 32 studies. The main types of care found included interruption of vasoactive drug infusion, drainage of the extravasated solution, removal of the catheter, hot or cold compresses, elevation of the limb, phentolamine, topical nitroglycerin 2%, infusion of hyaluronidase, flush-out or salt washing technique, and autolytic debridement. The interventions demonstrated repetitions in several studies, low variety in treatment, and low methodological rigor.
This study aimed to assess the knowledge of intravenous therapy among nursing students. A cross-sectional study was conducted with 170 diploma nursing students randomly selected from a private university in Malaysia between November 30 and December 30, 2023. The study found that 90% had moderate knowledge of intravenous therapy. Year 1 nursing students had the lowest knowledge level (52.9%), and medical placement students scored lower than surgical placement students (70.6%). Statistical tests revealed significant associations between knowledge level and year of nursing education (P = .021), current clinical placement (P = .046), and experience in assisting in intravenous therapy (P = .011). The majority of the nursing students were female (88.2%), with 52.4% having surgical placement postings and 78.8% having experience in assisting with intravenous therapy. Nursing education significantly impacts clinical placements (P = < .001), with year 2 nursing students in medical placements assisting more in intravenous therapy than those in years 1 and year 3. Overall, year 3 nursing students in surgical settings had more opportunities in intravenous therapy involvement than students in medical placements. In conclusion, the study highlights the need for intervention to improve nursing students' knowledge of intravenous therapy.
This randomized controlled crossover study, conducted in a university hospital, aimed to compare the success of the first attempt at peripheral intravenous catheter (PIVC) insertion using 2 technologies of the visualization of veins in children at risk of difficult intravenous access (DIVA) guided by light-emitting diodes (LEDs) or infrared radiation (IR). The allocation of the type of technology initially used was determined by randomization. The primary outcome was successful insertion of the PIVC on first attempt. Data were analyzed using the McNemar test, paired t-test, and multiple logistic regression models. This crossover study included 143 children: 69 in Group A and 74 in Group B. The first-attempt PIVC insertion success rate with IR and LED was 65.2% and 44.9% in Group A and 55.4% and 50.0% in Group B, respectively, without statistical significance (P = .720). The results also showed that 51.5% of patients with difficult-to-see vessels (P = .022) and 49.8% with previous complications related to intravenous therapy (P = .008) had first-attempt PIVC insertion success using either transillumination device. The first-attempt PIVC insertion success was statistically similar between the groups. The device also assists in visualizing the veins in children at risk of DIVA.
This case report describes an intraoperative rupture of a peripherally inserted central catheter (PICC) that had inadvertently advanced into the azygos vein during esophagectomy for cancer after neoadjuvant therapy. The intraoperative analysis and discussion of the cause of the malpositioned PICC in this case, along with interdisciplinary collaboration, led to the successful removal of the ruptured PICC from the azygos vein. Postoperatively, the authors conducted a thorough literature review to elucidate the mechanisms underlying PICC malposition into the azygos vein. Based on this analysis, the authors have proposed a series of preventive measures and predictive management recommendations aimed at reducing the risk of both central-venous catheter malposition and device fracture. This case report may provide valuable insights for the management of similar events during surgery in the future.
The United States opioid crisis has led to significant health care challenges. Patients who inject drugs (PWID) may self-inject illicit substances into vascular access devices (SIVAD). This behavior can lead to complications, including overdose and death. Given lack of data on SIVAD, this study aims to survey hospital staff on experiences with PWID and SIVAD, assess effectiveness of current protocols, and highlight the underreporting of incidents and their impact on care. A cross-sectional survey study was conducted among hospital staff. The survey assessed experiences with SIVAD, perceptions, and suggestions for improvement. Analyses with descriptive statistics for quantitative data and thematic analysis for qualitative responses were performed. Overall, 254 surveys were obtained. Of these, 31.7% (72/227) reported confirmed SIVAD during their care, and 48.6% (110/226) believed their patient did not complete care due to the stigma of SIVAD. Furthermore, 72.3% (68/94) reported altering care plans due to concern of SIVAD. Finally, 93.8% (212/226) of respondents stated that they would use a device to mitigate SIVAD, if available. By surveying hospital staff about their experience with SIVAD, this study highlights the impact and underreporting of this issue. This study also underscores the need for enhanced patient safety in cases of SIVAD and desire for new protocols and devices to improve care quality.
Vascular access can be challenging in certain populations. Midline catheters (MLCs) are a potential solution, enabling the avoidance of central catheters, yet providing more consistent access. Although research evaluates the use of MLCs for treatment delivery, there is limited evidence regarding the use of MLCs for specimen collection. This project aimed to examine the evidence and explore a change in practice regarding the collection of specimens using MLCs. A vascular access team followed patients with MLCs used for laboratory specimen collection over 6 months. Either vascular access nurses or registered nurses drew the laboratories from the MLCs and monitored outcome data while the MLC was in use. Fifty-three patients with MLCs were ordered for laboratory draws. The average dwell time was 7.23 days, and the average number of days an MLC successfully gave blood return was 4.09. Overall, the patients avoided venipuncture over 225 days. Extremely low complication rates were documented and were comparable to previous research. Midline catheters can be used for specimen collection in difficult-to-access populations. The low complication rates and decreased patient venipunctures support consideration of this intervention. However, more work is needed to standardize best practice in this area.
The aim of the study was to evaluate the effectiveness of replacing the connector assembly in resolving occlusion of peripherally inserted central catheters (PICCs) during parenteral nutrition (PN) administration. This retrospective study reviewed data from 24 patients who received PN via 4Fr single-lumen silicone PICCs at a 2000-bed tertiary general hospital between 2018 and 2023. All patients experienced either partial or complete catheter occlusion following PN infusion. A novel procedure was adopted to replace the connector assembly, and the subsequent outcomes were observed. The success rates of connector replacement were 87.5% and 50.0% on the first and second attempts, respectively, with restored catheter function. Repeated replacement, however, markedly reduced patency (from 87.5% to 0% after the third replacement) and progressively shortened the median functional indwelling time (from 44.5 to 36.5 days), indicating diminished overall durability and therapeutic efficacy. Connector assembly replacement is an effective, immediate, and economical method to resolve PICC occlusions caused by PN. This approach may offer a practical alternative to chemical catheter clearance, particularly for 4Fr single-lumen silicone catheters.
Peripherally inserted central catheters (PICCs) are widely used in hospital settings. To ensure optimal patient care, it is essential to assess nurses' knowledge before implementing targeted training interventions. This study aims to evaluate the knowledge of nurses working in inpatient settings regarding the indications, maintenance, complications, and removal of PICCs. A quantitative, observational, cross-sectional, analytical, and prospective study was conducted. A Knowledge Questionnaire (KQ) and an Attitudinal Survey (AS) were administered to nurses caring for adult hospitalized patients. A total of 118 nurses participated, with a median age of 33 years. Most worked in the intensive care unit or inpatient units. While all nurses received training upon hiring, then annually, only 46% reported receiving PICC-related training. The median KQ score was 9 out of 12 (75%). Knowledge was highest in the domains of complications and maintenance (>85% accuracy), followed by indications (70%) and removal (46%). While nurses demonstrated satisfactory overall knowledge, significant gaps were identified in PICC indications and removal. These findings highlight the need for targeted educational interventions to enhance competency in these areas. Improving knowledge can reduce unnecessary catheter use, promote timely removal, and prevent potential complications.
Chemotherapy preparation and administration is a complex nursing procedure. Adequate competency and positive behaviors regarding safe handling of cytotoxic drugs is very important for every nurse to ensure patient safety as well as occupational safety. This study assessed the perceived barriers and risks regarding safe handling of chemotherapeutic drugs among nursing personnel of a tertiary care hospital of Delhi, India. A descriptive cross-sectional design was conducted among 60 nursing personnel, who were working in chemotherapy wards and day care units. Self-administered structured questionnaire and rating scales were used for data collection. The sociodemographic and outcome variables were analyzed using descriptive statistics in addition to inferential statistics. The overall mean scores of practice, perceived barriers, and risks of nursing personnel toward safe handling of chemotherapy is 33.26 ± 3.18, 29.75 ± 4.66, and 11.75 ± 2.99, respectively. The most important barrier was inadequate training on chemotherapy and high workload. The highest risk perceived by the nursing personnel was an inadequate regular medical surveillance program, followed by immediate non-replacement of linens soiled with drug spills. It is recommended that chemotherapy safety protocol, safety surveillance systems, and in-service training be instituted for all nursing personnel who are working in an oncology unit.
Peripherally inserted central catheters (PICCs) are vital for long-term intravenous therapy but increase the risk of venous thromboembolism (VTE), a process commonly explained through the conceptual framework of Virchow's Triad: stasis, endothelial injury, and hypercoagulability. The catheter-to-vein ratio (CVR), a key modifiable thrombosis risk factor that primarily influences stasis, lacks a universal definition, causing variability in measurement, thresholds, and clinical use. This study compares the diameter-based approach commonly cited in the literature with the area-based approach later adapted for clinical CVR tools, emphasizing that both gain from standard geometric relationships rather than distinct mathematical formulations. Through mathematical conversion, the analysis reveals that a 45% diameter-based CVR corresponds to approximately a 20% area-based CVR, underscoring substantial discrepancies when assuming equivalence. The study endorses a 20% area-based (45% diameter-based) CVR threshold for oncology patients and a 33% area-based (57% diameter-based) threshold for noncancer patients. A harmonized CVR reference is proposed to bridge the gap between methods. To enhance consistency and patient safety, the study advocates for a standardized CVR definition, consistent vein measurement techniques, and stricter control of confounders in future research. It further recommends developing a next-generation CVR calculator integrating hemodynamic and clotting risk factors to refine VTE risk assessment.
The Michigan Risk Score (MRS) was developed to predict peripherally inserted central catheter (PICC)-related thrombosis. This study aimed to externally validate the MRS in a Brazilian cohort. Adults hospitalized in 16 Brazilian hospitals who received a PICC were followed until catheter removal, death, or 30 days. The MRS assigned risk points based on 5 clinical variables: presence of another central line, white blood cell count >12 000, multi-lumen PICC, history of deep vein thrombosis (DVT), and active cancer. Mixed-effects logistic regression assessed MRS performance, including calibration and discrimination. A total of 12 725 PICCs in 11 135 patients (mean age 66.4 ± 19 years; 51% female) were included. Deep vein thrombosis occurred in 129 cases (1.0%). Only the number of PICC lumens and history of venous thromboembolism (VTE) were significantly associated with DVT risk. Compared to risk class I, the odds ratios for risk classes III and IV were 2.83 (95% CI, 1.51-5.3) and 3.01 (95% CI, 1.41-6.41), respectively. The area under the curve was 0.70 for the multivariable model and 0.67 for the MRS classification. Peripherally inserted central catheter lumens and VTE history were independently associated with DVT risk. Classes III and IV of the MRS had higher event rates than class I.
We appreciate the study performed and described by Devrim et al, who practice at Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital in Izmir, Turkey. This study aimed to compare the colonization rates of short-term PIVC tips between patients' catheters flushed with manually prepared saline syringes and single-use prefilled saline syringes. The practice of manually preparing saline syringes for use in flushing intravenous catheters is uncommon in many health care organizations. While many health care organizations have permanently exchanged manual flush syringe preparation for prefilled single-use saline syringes, we are respectful of professionals and organizations who serve in areas where practice is different. As noted, we appreciate Devrim et al's study and described findings. The conclusion of this study affirms and further substantiates the INS Infusion Therapy Standards of Practice described in Standard 38. Flushing and Locking. Practice Recommendation - A. Use single-dose systems (eg, single-dose vials and syringes or prefilled labeled syringes) for all VAD flushing and locking. Additional recommendations are listed in A.2. and A.3. Use commercially manufactured prefilled flush syringes (when available) to reduce the risk of catheter-associated bloodstream infection (CABSI) and device failure, save time for syringe preparation, and aid optimal flushing technique and objectives. 3. Do not use IV solution containers (eg, bags or bottles) as a source for obtaining flush solutions (see Standard 56, Compounding and Preparation of Parenteral Solutions and Medications).
There is an ongoing need for intravenous catheters designed to reduce the risk of thrombosis and catheter-related bloodstream infections. The aim of this study was to compare thrombus formation and microbial adhesion on catheters made from hydrophilic biomaterial (HBM), thermoplastic polyurethane (TPU), and fluorinated TPU. Using the industry-recognized in vitro blood loop and static model, thrombus and microbial adhesion were quantified in the presence of 7 clinically relevant microbes. Thrombotic and microbial adhesion to HBM catheters was significantly reduced in the presence of clinically relevant microbes. Thrombotic adhesion to HBM catheters showed a significant average reduction greater than 96.3% (2-tailed, paired; P ≤ . 03) for all microbes tested compared to TPU catheters. Compared to microbial adhesion to TPU catheters, HBM catheters averaged more than a 4-log reduction (>99.99% reduction) of microbial difference for all 7 microbes tested (2-tailed, paired; P ≤ .003 for all microbes). Reductions in thrombotic and microbial adhesions were independent of clotting factors. Although large clinical trials are needed, these in vitro results build on the growing evidence to support the use of HBM catheters to prevent common complications associated with vascular access devices.
The aim of the study was to compare catheter dislodgement rates between abdominal wall-tunneled femoral peripherally inserted central catheters (PICCs) and conventional upper arm PICCs in pediatric oncology patients. A retrospective analysis included 355 pediatric oncology patients from Shandong Cancer Hospital (March 2022 to March 2025). Patients were divided into the Tunnel group (abdominal wall-tunneled femoral PICC, n = 145) and Conventional group (upper arm PICC, n = 210). The primary outcome was unplanned catheter dislodgement (external migration >3 cm or complete dislodgement). The Kaplan-Meier method estimated cumulative dislodgement rates; Cox regression identified influencing factors. The dislodgement rate was 12.41% in the Tunnel group vs 40.95% in the Conventional group (χ2 = 33.727, P < .001). The mean indwelling time was longer in the Tunnel group (181.50 ± 54.72 days vs 114.97 ± 55.84 days; t = -11.165, P < .001). Survival curves showed higher cumulative catheter survival in the Tunnel group (log-rank P < .001). Abdominal wall-tunneled femoral PICCs significantly reduce dislodgement risk and prolong indwelling time, providing a stable central venous access for pediatric oncology patients requiring long-term therapy.