Journal of Infusion Nursing最新文献

Background: Peripherally inserted central catheter-related thrombosis (PICC-CRT) is a major complication in patients undergoing PICC placement. While a dedicated PICC-CRT prevention system could improve early risk assessment and targeted intervention, nurses' specific needs for such a system remain underexplored. This study aimed to explore specialist registered nurses' perspectives on a PICC-CRT prevention management system.

Methods: From April to September 2023, semi-structured interviews were conducted with 26 PICC-trained registered nurses from 10 tertiary hospitals in Beijing, China, using purposive sampling. Thematic analysis was applied to identify key themes.

Results: Three main themes emerged: (1) Core functional requirements for the nurse side: risk prediction and intelligent alerts, decision support, continuous management, systematically presented knowledge, automatic reminders, automatic statistical analysis, and auxiliary functions. (2) Key needs in promoting patient involvement in health management: personalized precision recommendations, health education, notifications and reminders, incentive functions, intelligent questions and answers and online consultation, and peer support. (3) Interface design requirements: ease of use, clear logic, visualization, and multimodality presentation.

Conclusion: This study explored hospital nurses' requirements for a functional PICC-CRT prevention management system, as well as the needs for motivating patients to participate in mobile health management. It has offered valuable insights for future system development.

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.

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.

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).

Objective: This study aimed to describe the characteristics of patients who experienced peripheral parenteral nutrition (PPN) extravasation and to analyze the clinical contexts at the time of PPN extravasation.

Methods: This descriptive study included patients who experienced PPN extravasation between 2018 and 2023 at a university hospital in Japan and was based on extravasation reports registered in the electronic medical record system by nurses.

Results: In total, 302 PPN extravasation cases were reported in 235 patients. The most common age group was the 70s (33.89%), with neoplasms as the predominant diagnosis (42.68%). Median (interquartile range) albumin and D-dimer levels were 2.9 (2.5-3.3) g/dL and 4.57 (1.69-8.96) µg/mL, respectively. The most common symptom of PPN extravasation was swelling (75.50%), followed by pain (50.00%). PPN extravasation was most frequently detected between 10:00 and 11:00 AM, and detections were made primarily through nurse observation (54.87%).

Conclusions: Aging, neoplasms (especially hematological malignancy), malnutrition, and blood coagulation abnormalities were common characteristics of patients with PPN extravasation. Nurses should be careful about PPN extravasation even at midnight or in the early hours of the morning because of the relatively poor subjective symptoms, such as pain and discomfort, caused by PPN extravasation.

Background: 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.

Objective: This project aimed to examine the evidence and explore a change in practice regarding the collection of specimens using MLCs.

Methods: 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.

Results: 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.

Conclusion: 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.

Objective: This study aimed to examine the effects of subcutaneous tissue edema at the site of peripheral intravenous catheters (PIVCs) on catheter failure.

Methods: 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.

Results: 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).

Conclusion: 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.