Journal of Infusion Nursing最新文献

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Background: Peripheral intravenous catheter (PIVC) vasopressor administration is increasingly used to expedite the treatment of septic shock when central venous access is not immediately available. This shift in practice reflects growing support from national guidelines, which permit short-term peripheral administration of vasopressors in adults. On March 9, 2023, hospitals within 1 health care system implemented guidelines for PIVC vasopressor administration in adult critical care settings, specifically emergency departments and intensive care units.

Objective: This study examined adherence to these guidelines for PIVC vasopressor use and to identify associated complications.

Methods: This retrospective descriptive study included 106 adult patients (68 emergency department and 38 intensive care unit patients) diagnosed with sepsis and receiving peripheral vasopressors.

Results: The majority of patients received norepinephrine through a short PIVC. Overall, 5 patients (4.7%) experienced complications, 4 with thrombophlebitis and 1 with an extravasation. All 5 patients received norepinephrine at the organization's policy-specified concentration via short PIVCs. However, only 1 of these patients met the system's guidelines for minimum PIVC size, quantity, and maximum infusion duration. Overall, only 58% of patients were managed in full compliance with the system's guidelines.

Conclusion: These results support the use of standardized protocols to reduce complications associated with short-term peripheral vasopressor administration.

This study aimed to evaluate the effectiveness of warm compress and cold compress in managing peripheral intravenous catheter (PIVC)-induced pain and phlebitis. A quantitative, pre-experimental 2-group pre-test post-test design was adopted, involving 60 purposively selected patients. Participants were divided into 2 groups on the basis of 2 different interventions: Group A (warm compress) and Group B (cold compress). Data were collected using a sociodemographic and clinical variables interview, Numerical Pain Rating Scale, and Visual Infusion Phlebitis (VIP) Scale. In Group A, the mean pain score decreased from 4.37 ± 1.00 to 1.97 ± 1.73, and the mean phlebitis score decreased from 3.20 ± 0.76 to 1.03 ± 0.89. In Group B, the mean pain score reduced from 4.33 ± 0.92 to 1.03, and the mean phlebitis score dropped from 3.24 ± 0.74 to 1.00 ± 0.53. The cold compress demonstrated slightly more effectiveness in relieving pain, whereas the warm compress showed marginally better outcomes in reducing phlebitis severity. No clinical variables were associated with post-test pain levels. However, a significant association was observed between the phlebitis score and type of drug administered (P = .04), suggesting that certain medications, such as antibiotics or inotropes, may influence the development or severity of phlebitis.

Objective: The aim of this study is to assess catheter-related bloodstream infections (CRBSIs) in Chinese intensive care units (ICUs), covering prevalence, risk factors, pathogen distribution, and impacts of outcome.

Methods: A cross-sectional study was conducted in ICUs across 22 tertiary hospitals (2023-2024), with CRBSI diagnoses following Chinese national guidelines. Data were analyzed using R software (version 4.4.2), employing chi-square tests, robust Poisson regression, and Bayesian logistic regression (P < .05).

Results: The prevalence of CRBSI was 1.19% (1.53/1000 catheter days, 32 patients, and 36 episodes). Risk factors included no formal education/illiteracy (OR: 1.995-9.604), circulatory diseases (OR: 1.142-5.787), complex/rare diseases (OR: 2.417-13.048), and multiple catheterizations (OR: 4.502-15.093). The subclavian vein was safest (femoral/axillary OR: 4.01-6.86). Gram-negatives predominated (47.22%). Each additional day of catheter dwell days increased CRBSI risk by 4.33% (95% CI: 3.04%-5.20%), and each additional ICU stay raised risk by 4.2% (95% CI: 2.9%-5.1%). CRBSI increased mortality (OR: 8.65), prolonged ICU stay (mean increase of 9.09 days), and additional costs (¥122 539.56 per case, approximately $17 505.65).

Conclusion: CRBSI significantly worsens outcomes and costs in Chinese ICUs. Prioritizing subclavian catheterization, infection prevention bundles, and gram-negative antimicrobial stewardship is essential. Further research is needed to validate these interventions across diverse settings.

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.