Journal of Infusion Nursing最新文献

Central vascular access devices in renal hemodialysis patients have critical utility; nevertheless, they are associated with increased relative mortality risk compared to arteriovenous fistulas and grafts. Appropriate flushing and catheter locking are key to minimizing complication and dysfunction risk. Observational pre-post quality improvement evaluation was undertaken to evaluate 4% tetrasodium ethylenediaminetetraacetic acid (T-EDTA) catheter lock solution in renal hemodialysis. Four percent T-EDTA was piloted as the standard catheter lock solution (replacing 4 mg gentamicin/5000 IU per mL heparin lock). There was a 6-month evaluation period following product change, with retrospective comparison to 6 months prior. Outcome measures included bleeding complications post-insertion, catheter dysfunction, and catheter-related bloodstream infections (CR-BSI). SQUIRE 2.0 checklist for quality improvement reporting was used. Sixty-four catheters (4908 catheter days) (post) and 43 catheters (4603 catheter days) (pre) were evaluated. Bleeding complications post-catheter insertion (6% post; 38% pre), catheter dysfunction (minimal pre and post), CR-BSI (0.6 per 1000 catheter days post; 0.4 per 1000 catheter days pre) were observed. For the vulnerable population dependent on renal replacement therapy via renal hemodialysis catheters, 4% T-EDTA shows promise as a catheter lock solution, given no notable increase in CR-BSI or dysfunction, and a major reduction in post-catheter insertion bleeding was observed.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Objective: Totally implantable venous access devices (TIVADs) are essential in pediatric oncology but pose a risk of catheter-related infections. This study assesses the impact of 70% isopropyl alcohol-impregnated disinfecting caps on microbial colonization of needleless connectors (NCs) and extension set lumens.

Design: This is a single-center, open-label, prospective study.

Participants: The study included 23 pediatric patients (50 treatment episodes) with acute lymphoblastic leukemia using TIVADs.

Methods: From April to July 2024, patients with double-lumen extension sets and needleless connectors (NCs) were included. One NC remained uncovered, while the other was capped with a 70% alcohol-impregnated disinfecting cap. Surface cultures were obtained from the uncovered NC on days 2, 3, and 4, and from the capped NC on day 4.

Results: Microbial colonization was significantly higher in uncovered NCs (63.3%) than in capped NCs (2%) (P < .001). Coagulase-negative staphylococci were the predominant isolates (88.4%). Intraluminal colonization was also higher in uncovered NCs (76% vs. 6%; P < .001).

Conclusion: Alcohol-impregnated disinfecting caps significantly reduce microbial colonization of NCs and extension set lumens in pediatric oncology patients, suggesting their effectiveness in infection prevention.

Objective: The aim of the study was to compare complication rates and laboratory outcomes between tunneled and conventional peripherally inserted central catheters (PICCs) in cancer patients using propensity score matching (PSM).

Methods: This single-center retrospective cohort study, which took place from 2021 to 2023, included 418 patients. After 1:1 PSM, 113 matched patients were analyzed in each group. Complication rates and laboratory indicators were compared. Logistic regression was used to identify risk factors for infection and catheter displacement.

Results: Compared to traditional PICCs, tunneled PICCs were associated with lower infection (6.19% vs 17.70%; P = .014), phlebitis (0% vs 27.43%; P < .001), and catheter displacement rates (33.63% vs 60.18%; P < .001). Regression analysis confirmed reduced risks of infection (OR = 3.257, 95% CI: 1.32-8.02; P = .011) and displacement (OR = 2.982, 95% CI: 1.81-4.91; P < .001). Laboratory analysis showed significantly higher white blood cell (WBC) levels, neutrophil percentages, absolute neutrophil counts, and prothrombin time in the tunneled group (P < .05). In contrast, lymphocyte percentage and monocyte percentage were lower in the tunneled group (P < .05).

Conclusions: Tunneled PICCs may provide a safer and more stable vascular access option than conventional PICCs in oncology patients. Further prospective studies are warranted.

Objective: This study aimed to explore the nursing practices related to peripherally inserted central catheters (PICCs) in the neonatal intensive care unit (NICU).

Methods: This scoping review was guided by a PCC framework (Population-Newborns, Concept-Peripherally Inserted Central Catheters, Context-NICU). The database selection included Embase, CENTRAL, PubMed, Scopus, Web of Science, CINAHL, and MEDLINE. The Covidence platform was used to facilitate the review process.

Results: Twenty-seven studies were included, which were published between 2008 and 2024 in countries around the world. The findings highlight the critical role of ultrasound in enhancing the accuracy of PICC placements and reducing associated complications. Additionally, the review identifies practices aimed at minimizing infection risks, such as standardized protocols and aseptic techniques, as well as strategies addressing pain management and hypothermia prevention during PICC insertion. Innovative approaches, including novel catheter measurement methods and insertion techniques, were also explored.

Conclusion: These topics provide a comprehensive overview of current practices and emerging advancements in PICCs, emphasizing efforts to enhance safety and outcomes for NICU patients. By identifying current practices, challenges, and knowledge gaps, this review aims to inform clinical guidelines, promote evidence-based care, and guide future research in neonatal nursing.

Objective: 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.

Methods: The review was carried out from July to August 2022, across 12 data sources. The evidence was evaluated using PAGER.

Results: 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.

Conclusion: The interventions demonstrated repetitions in several studies, low variety in treatment, and low methodological rigor.